Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica.

Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm.

Disease-specific patient-reported quality of life after fenestrated/branched endovascular aortic aneurysm repair.

Objectives: Fenestrated-branched endovascular technology (F/B-EVAR) is increasingly used to repair complex aortic aneurysms. While reintervention, morbidity and mortality after F/B-EVAR have been well-characterized, studies on patient-reported quality of life (QOL) after F/B-EVAR have been limited in their use of non-specific instruments and measures. We report on disease-specific QOL in patients that underwent F/B-EVAR using a validated QOL survey for aortic aneurysms.

Laser assisted trans-endograft coil embolization of a type II endoleak.

A type II endoleak after endovascular aneurysm repair can be challenging to stop. Numerous methods have been described, including trans-arterial, trans-lumbar, trans-caval, trans-endograft, peri-endograft, and open and laparoscopic surgical techniques. We present our experience with a laser-assisted trans-endograft approach, including technical variations of previous descriptions that might improve efficacy.

The financial burden associated with endovascular repair of thoracoabdominal and pararenal aortic aneurysms using physician-modified fenestrated-branched endografts.

Objective/background: Endovascular thoracoabdominal and pararenal aortic aneurysm repair is more complex and requires more devices than infrarenal aneurysm repair. It is unclear if current reimbursement covers the cost of delivering this more advanced form of vascular care. The objective of this study was to evaluate the economics of fenestrated-branched (FB-EVAR) physician-modified endograft (PMEG) repairs.

False Lumen Intercostal Artery Embolization to Halt Type R Entry Flow in Chronic Type B Aortic Dissection.

Background: Treatment of aneurysmal type B aortic dissection often involves thoracic endovascular aortic repair (TEVAR). However, persistent patency of the false lumen from type R entry flow is common and is associated with late complications including rupture. We describe 9 patients with aneurysmal chronic type B aortic dissections and patent false lumens and 7 despite prior thoracic endovascular aortic repair.

Use of real-world data and clinical registries to identify new uses of existing vascular endografts: combined use of GORE EXCLUDER Iliac Branch Endoprosthesis and GORE VIABAHN VBX Balloon Expandable Endoprosthesis.

Objective: To assess the feasibility of collecting, examining and reporting observational, real-world evidence regarding the novel use of the GORE EXCLUDER Iliac Branch Endoprosthesis (IBE) in conjunction with the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (IBE+VBX stent graft).

Design: Multicentre retrospective cohort study.

Setting: Four real-world data sources were used: a national quality improvement registry, a statewide clinical research network, a regional quaternary health system and two tertiary academic medical centres.

Procedure-Associated Costs and Mid-Term Outcomes of Endovascular Zone 0 and Zone 1 Aortic Arch Repair.

Background: Thoracic endovascular aortic repair (TEVAR) of proximal aortic arch pathology provides a less-invasive treatment option for high-risk patients ineligible for open arch reconstruction. However, the fiscal impact of these techniques remains unclear. Therefore, our objective was to characterize the mid-term outcomes after Zone 0 and Zone 1 TEVAR and describe the associated technical costs, revenues, and net margins at a single tertiary medical center.

Intercostal artery embolization to induce false lumen thrombosis in type B aortic dissection.

Persistent false lumen flow is common after thoracic endovascular aortic repair of type B aortic dissection and may contribute to continued aortic aneurysmal degeneration. We report an innovative technique of intercostal artery embolization within the false lumen for a patient who had incomplete false lumen thrombosis and progressive aortic enlargement after thoracic endovascular aortic repair of chronic type B aortic dissection. Technical success was facilitated by use of on-table cone beam computed tomography angiography, virtual vessel marking, and modern endovascular tools.

Balloon guidance for superior mesenteric artery scallop alignment during Cook Zenith Fenestrated AAA Endovascular Graft deployment.

To achieve seal, aortic endografts may require coverage of the aorta adjacent to or involving critical branch vessels. One technique for maintaining branch vessel patency at the leading edge of an endograft is use of a scallop. However, it may be difficult to ensure proper scallop alignment both before and after endograft deployment.

Novel use of the ENROUTE transcarotid arterial sheath for antegrade cerebral perfusion during retrograde innominate stenting.

Femoral-carotid bypass has been described to preserve antegrade cerebral perfusion during aortic arch and great vessel interventions. We describe a novel use of the ENROUTE transcarotid arterial sheath (Silk Road Medical, Sunnyvale, Calif) as the outflow component of a femoral-carotid shunt for maintenance of antegrade cerebral perfusion during a retrograde innominate stenting procedure. We discuss the unique advantages of this sheath for use in this application.

Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair.

May-Thurner syndrome is characterized by unilateral lower extremity venous hypertension and stasis due to compression of an iliac vein between an iliac artery and the lumbar spine. In almost all cases, the left common iliac vein is compressed by the right common iliac artery; however, other patterns have been described. Rarely, May-Thurner syndrome may be created iatrogenically as a result of iliac artery stenting.

Surgical Needs of Internally Displaced Persons in Kerenik, West Darfur, Sudan.

Background: The burden of surgical disease in refugee and internally displaced person (IDP) populations has not been well defined. Populations fleeing conflict are mobile, limiting the effectiveness of traditional sampling methods. We employed novel sampling and survey techniques to conduct a population-based surgical needs assessment amongst IDPs in Kerenik, West Darfur, Sudan, over 4 weeks in 2008.

A Cadaver-Based Course for Humanitarian Surgery Improves Manual Skill in Powerless External Fixation.

Background: General surgery residents interested in humanitarian careers may benefit from supplemental training beyond modern residency. The Colorado Humanitarian Surgical Skills Workshop is a 2-d cadaver-based course for senior surgical residents, teaching low-resource skills across multiple specialties, including orthopedics. We assessed the course's ability to transmit manual competence in a critical humanitarian surgical skill, powerless lower extremity external fixation.

Fenestrated aortic endograft branching with Gore VBX poses failure risk from delayed-onset branch kinking.

The Gore VBX stent graft (Gore Medical, Flagstaff, Ariz) provides a new option for branching of fenestrated aortic endografts. However, its modular stent structure has raised concerns about potential kinking at the interspace between stent rings if lateralizing force exists between the fenestration and target vessel orifice. We present a case of near-occlusion of a VBX celiac branch due to narrowing of this interspace identified at postoperative month 3.

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass.

Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved.

Multiple Strokes Associated With Elongation of the Hyoid Bone.

Hyoid bone elongation is an uncommon cause of stroke. Here, we report a case of hyoid bone elongation causing localized trauma to the internal carotid artery, resulting in multiple strokes. A 32-year-old woman presented with unilateral weakness and history of a recent stroke.

The Colorado Humanitarian Surgical Skills Workshop: A Cadaver-Based Workshop to Prepare Residents for Surgery in Austere Settings.

Objective: Interest in humanitarian surgery is high among surgical and obstetric residents. The Colorado Humanitarian Surgical Skills Workshop is an annual 2-day course exposing senior residents to surgical techniques essential in low- and middle-income countries but not traditionally taught in US residencies. We evaluated the course's ability to foster resident comfort, knowledge, and competence in these skills.

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs.

Background: Effective humanitarian surgeons require skills in general surgery, OB/GYN, orthopedics, and urology. With increasing specialization, it is unclear whether US general surgery residents are receiving exposure to these disparate fields. We sought to assess the preparedness of graduating American surgical residents for humanitarian deployment.

Choosing Surgery for Neurogenic TOS: The Roles of Physical Exam, Physical Therapy, and Imaging.

Neurogenic thoracic outlet syndrome (nTOS) is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. While it is the most common subtype of TOS, nTOS can be difficult to diagnose. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal.

Using satellite imagery and GPS technology to create random sampling frames in high risk environments.

Introduction: Health surveys are important tools for assessing needs and informing policy decisions. However, obtaining representative samples is challenging in environments without traditional infrastructure or census data. We describe a method using satellite imagery, geographic information systems and GPS technology to obtain an accurate sample of such a population.

Case report: treatment of severe subcutaneous emphysema with a negative pressure wound therapy dressing.

Objective: This article describes a patient who developed severe subcutaneous emphysema and a persistent air leak after several attempts at needle thoracostomy for what was thought to be a tension pneumothorax. Subcutaneous emphysema was effectively treated with a topical negative pressure wound therapy dressing applied to a typical subfacial "blowhole" incision. This article aims to describe and contextualize the use of negative pressure wound therapy within the existing treatment options for subcutaneous emphysema.