Successful covered stent-graft repair in symptomatic renal artery aneurysm early after childbirth.

Renal artery aneurysm (RAA) rupture during pregnancy is a rare but life-threatening event and few cases have been reported in literature. Currently the best approach, endovascular or surgical, seems to be under discussion. A case of a 31-year-old woman with a symptomatic right RAA detected three days after childbirth is reported.

Endovascular Treatment of Symptomatic Thrombus of the Descending Thoracic Aorta.

Thoracic aorta mural thrombosis (TAMT) is uncommon pathology with potentially catastrophic complications due to recurrent spontaneous distal embolization. Best treatment, medical or surgical, is still under debate especially in high-risk patients. Endovascular approach by means of thoracic endoprosthesis seems to be a feasible and minimally invasive treatment option.

Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA.

Is the chimney graft technique a safe and feasible approach to treat urgent aneurysm and pseudoaneurysm of the abdominal aorta? An analysis of our experience and technical considerations.

The chimney graft (CG) technique, based on the deployment of a covered stent parallel to the aortic endograft, has been proposed to achieve a safe proximal fixation extending the sealing zone. We report our experience with the CG technique in an emergency setting. Between December 2010 and April 2012, 4 patients underwent the CG technique.

SIADH after carotid endarterectomy.

The syndrome of inappropriate secretion of antidiuretic hormone after carotid endarterectomy is very rare; only two cases have been reported in medical literature. We describe the case of an 82-year-old woman presenting with lethargy and drowsiness due to severe hyponatremia with urine hyperosmolarity and plasma hypo-osmolarity after carotid endarterectomy.

Endovascular central venous stenosis treatment ended with superior vena cava perforation, pericardial tamponade, and exitus.

Venous hypertension and outflow stenosis of arteriovenous hemodialysis access managed using endovascular procedures usually present a high technical success rate, with few complications. We reported a rare and fatal complication of superior vena cava perforation with pericardial tamponade 3 months after subclavian vein stenting. Interventional recanalization with stenting for the management of superior vena cava syndrome or central vein stenosis is a safe procedure with a low complication rate.

Acute lower limb ischaemia due to delayed upstream migration of an iliac stent.

We report a case of acute limb ischaemia due to unusual upstream stent migration into the aorta 2 years after successful kissing stenting. Angiography showed a misplacement of both common iliac stent into the aorta, upstream migration with a fracture on the left external iliac stent into the iliac common artery, occlusion of the left iliac and femoral artery, dilatation of aortic bifurcation and stent separation on the right side. The patient underwent a successful axillo-bifemoral bypass graft.

Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience.

Objectives: We prospectively evaluated safety and efficacy from our six-year results of general anesthesia (GA) using remifentanil conscious sedation in carotid endarterectomy (CEA).

Methods: From January 2005 to December 2010, 625 consecutive CEAs were performed on 545 patients (male/female 336/209, age 75 ± 7 years). After a superficial plexus block with ropavacaine, GA was induced with an intravenous infusion of propofol, using local lidocaine during tracheal intubation and a high-dose of remifentanil, in all cases reducing and then stopping the remifentanil infusion at the clamping time so that the patient would be awake and collaborating within a few minutes, as in local anesthesia.

Complete transposition of carotid bifurcation: can it be an additional risk factor of injury to the cranial nerves during carotid endarterectomy?

The internal carotid artery (ICA) usually, lies posterolaterally to the external carotid artery (ECA). Sometimes a complete carotid transposition can occur, with the ECA in a lateral position and the ICA on the medial side can occur. Our study evaluated the significance and impact that this anomaly may have on cranial nerve injuries.

Heparin-induced thrombocytopenia type II because of heparin-coated polytetrafluoroethylene graft used to bypass.

Heparin-induced thrombocytopenia type II is an immune-mediated syndrome that may arise in a time-dependent manner after heparin therapy. Thrombocytopenia and thrombosis in patients exposed to heparin are suggestive of this syndrome.

Management of acute lower limb ischemia associated with the Angio-Seal arterial puncture closing device.

Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. The aim of this study was to evaluate retrospectively our personal series of acute lower limb ischemia following the use of APCD. From January 2004 to June 2009 the Angio-Seal percutaneous closure devices was deployed in 198 patients.

Preoperative evaluation of retroperitoneal venous system anomalies during abdominal aortic aneurysm rupture.

The association of a retroaortic left renal vein and an abdominal aortic aneurysm (AAA) fistula is an infrequent event. We present two cases of AAA rupture into the retroaortic left renal vein. Preoperative computed tomography (CT) assessment showed retroperitoneal bleeding due to a large AAA rupture with an associated unusual retroaortic left renal vein.

A rare anomaly of the femoral vessels: complete transposition of the femoral artery and vein.

We report the case of complete transposition of the femoral artery and vein in a 47-year-old woman submitted to high ligation of the left saphenous femoral junction (SFJ) and great saphenous vein (GSV) stripping. During the dissection, we detected that the SFJ and the common, superficial and deep femoral veins were laterally placed to the femoral artery and the GSV crossed the femoral artery bifurcation. Associated variations of the GSV, femoral artery and vein is quite rare and, despite being asymptomatic can lead to technical difficulties increasing the risk of major intraoperative complications.

An isolated aneurysm of the thigh anterolateral branch of the greater saphenous vein in a young patient presenting as an inguinal hernia.

We report the first case of isolated aneurysm of the anterolateral branch of the greater saphenous vein in a 24-year-old man. The aneurysm was initially confused with an inguinal hernia. The patient referred with a respiratory distress due to a pulmonary embolism.

A singular case of iatrogenic axillofemoral bypass disruption: a dramatic event treated by a lucky combined approach.

Proximal disruption of an axillofemoral bypass is a catastrophic event rarely caused by a posttraumatic anterior dislocation of the shoulder. Herein, we present a 74-year-old man with a painful dislocation of the right shoulder that was successfully reduced. Three hours later he had hemodynamic shock with an expanding and pulsating hematoma at the level of the right shoulder, pectoral and infraclavicular region.

The management of arterial and venous injuries during saphenous vein surgery.

Objectives: Arterial injury of the lower limb is a rare but catastrophic complication of saphenous vein stripping with a high morbidity rate and severe medico-legal implications. Diagnosis is often delayed and outcome depends on the severity of injury. We report two cases of severe ischemia due to arterial lesion during varicose veins surgery.