Acute Embolic Occlusion of Renal Artery after the Bentall Procedure: the Role of Primary Renal Angioplasty.

Acute renal occlusion is an uncommon emergency problem in daily practice. The diagnosis is often missed or delayed not only because of its rarity but also nonspecific of clinical presentation. Sudden and complete termination of arterial blood supply to the kidney may lead to renal infarction and a complete loss of renal function. Although the need of early revascularization is uniformly recommended, but the methods has not been established. We presented a case of acute thromboembolic renal artery occlusion in patient who had a history of Bentall's surgery. Renal infarction and artery occlusion were clearly visualized by computed tomography angiogram (CTA). The patient was successfully treated with angioplasty and stenting of main renal artery with complete disappearance of symptoms and recovery of his renal function.

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases.

INTRODUCTION: Although Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection. MATERIALS AND METHODS: The design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub. The two wires will facilitate delivery and deployment of the stent graft. One patient with descending aortic aneurysm and another with Stanford B aortic dissection is included in this first in human study. RESULTS: The aneurysm and dissection were completely excluded immediately after the TEVAR. Six month follow up CT showed good position of the stent graft and patent LSA in both patients. In the patient with aortic dissection, expansion of the true lumen and partial thrombosis of the false lumen was seen. CONCLUSIONS: This is a report of a two wire system in 2 patients with distal aortic arch pathology demonstrating a good technical and clinical success using pre-cannulated fenestrations through a modified nose cone olive. LEVEL OF EVIDENCE: Level 4, report of two cases.

Open repair management of a patient with aortic arch saccular aneurysm, penetrating atherosclerotic ulcer, one vessel coronary artery disease and an isolated dissection of the abdominal aorta.

Isolated saccular compared to fusiform aneurysm is considered to be a rare entity with challenges of its own. A 62-year-old female was diagnosed with a case of saccular aneurysm and penetrating atherosclerotic ulcer of the aortic arch. Additionally, she also had one vessel coronary artery disease and type B abdominal aortic dissection. She was then managed with open aortic arch repair and coronary artery bypass grafting. If required, elective endovascular repair will be done for the abdominal aorta on a later date.