Ortner syndrome secondary to saccular thoracic aneurysm.

Mechanical stretching of the left laryngeal nerve secondary to an enlarged left atrium was first described by Dr Norbert Ortner in 1987. An extensive literature search revealed only 76 reported cases of Ortner syndrome, with the more recent reports describing other causes of the syndrome such as pulmonary hypertension, aortic dissection, and a thoracic aneurysm. We recently encountered this rare pathologic entity in an elderly man who had presented with severe hoarseness, presumed to be due to one of the aforementioned vascular anomalies.

Brescia-Cimino AV Fistula Complicated by Steal Syndrome.

The Brescia-Cimino AV fistula is most commonly performed and rarely associated with steal syndrome. A case is presented with details regarding its correction.

Iatrogenic Interval Gangrene of the Thigh.

Interval gangrene of the thigh is an extremely rare complication in vascular surgery. Most cases have reported interval gangrene of the calf as a consequence of a distal bypass procedure, with little documentation of interval thigh gangrene occurring after endovascular intervention. The present case suggests that in the process of placing multiple-level covered and bare metal stents in the iliac, superficial femoral, and popliteal arteries, interval gangrene of the thigh must be considered as a potential, albeit rare, complication.

Hybrid Repair of an Intrathoracic Bilobed Subclavian Artery Aneurysm.

Intrathoracic subclavian artery aneurysms are extremely rare, <1% of all aneurysms. The formation of these aneurysms is often multifactorial, with the most common contributing factor being atherosclerosis. This case report describes a right subclavian artery aneurysm that required a surgical hybrid approach.

Genesis of Crural Revascularization.

Background: The purpose of this study is to recognize those investigators responsible for initiating progress in limb salvage where runoff beyond the arterial blockage was limited to the crural vasculature and to also describe how crural bypass has evolved into the contemporary setting where endovascular options have become increasingly prominent.

Methods: An extensive literature review of articles published from 1960 to 1979 was the basis for selecting and recognizing surgeons who pioneered infrageniculate revascularization. Documentation of patency and amputation rates were tabulated for these early series of distal limb bypass.

Rapid Degradation and Subsequent Endovascular Salvage of Upper Extremity Cryogenic Allograft Bypass.

It has long been reported that cryogenic allografts have suboptimal mid- and long-term patencies and consequently are only used in the absence of autologous vein, predominantly in lower extremity limb salvage situations. As such, we felt that our recent experience with an upper extremity bypass for limb salvage using a cryogenic saphenous vein allograft, which aneurysmally degenerated after one month and required multiple endovascular rescues, serves to re-emphasize such concerns and the importance of continuous postoperative surveillance.

Dropped Bifurcation Technique for Femoral Endarterectomy.

Femoral endarterectomy is an established procedure with excellent outcomes. Variations in performing this operation generally reflect the extension of pathology into the superficial and deep femoral arteries. For these instances, we developed a technique not previously described that enables continued flow to the superficial and deep femoral arteries and facilitates patch placement.

Aberrant splenic artery complicated by aneurysm during pregnancy.

The aberrant splenic artery is an uncommon anomaly. It may become a challenging problem when it is associated with an aneurysm diagnosed during pregnancy. Our experience with a patient who underwent two interventions, each performed in the postpartum period without incident, highlights the need to employ techniques that ensure aneurysm closure and thus avoid recurrence and need for repetitive procedures.

Endovascular rescue of long-term vascular graft implants and need for continuous surveillance.

We present two cases of vascular graft degradation after long-term implantation. In both patients, endovascular techniques were employed to effect continued graft patency and function. Furthermore, these cases lend further credence to the doctrine of lifelong surveillance of all vascular interventions regardless of graft material.

True Aneurysm of the Anterior Tibial Artery.

Most anterior tibial aneurysm cases described in the literature are pseudoaneurysms resulting from trauma. Since 1967, only 8 cases published on true anterior tibial artery aneurysms were atraumatic. Recent experience with an atraumatic aneurysm of the anterior tibial artery prompted a literature review regarding their incidence, and accordingly, we feel the need exists for greater recognition and understanding of this entity.

Update on the role of the distal arteriovenous fistula as an adjunct for improving graft patency and limb salvage rates after crural revascularization.

Background: Critical ischemia of the lower limb continues to challenge the ingenuity of all interventionalists in achieving reliable, predictable, and durable patency. The objective of this study was to investigate the role of the distal arteriovenous fistula (dAVF) to enhance crural revascularization patency rates particularly when prosthetics are used.

Methods: All patients who underwent crural bypass with dAVF since 1979 were included.

Epigallocatechin-3-gallate is a potent phytochemical inhibitor of intimal hyperplasia in the wire-injured carotid artery.

Objective: Epigallocatechin-3-gallate (EGCG), a catechin gallate ester, is the major component of green tea and has been demonstrated to inhibit tumor growth as well as inhibit smooth muscle cell migration. We evaluated the effect of the phytochemicals resveratrol, allicin, sulforaphane (SFN), and EGCG on intimal hyperplasia in the carotid artery injury model.

Methods: Intimal hyperplasia was induced in carotid arteries of adult Sprague-Dawley rats with a wire injury.

Carotid axillary artery bypass: an option following failed open and percutaneous procedures.

Percutaneous transluminal angioplasty and stenting is being employed with increasing frequency for stenosis involving the brachiocephalic circulation. However, the efficacy of these procedures is limited by intimal hyperplasia and subsequent re-stenosis. Long-term results for treating lesions of the subclavian or innominate artery have shown significant re-stenotic rate.

Improved exposure for carotid endarterectomy.

Carotid endarterectomy continues to be an operation that is widely employed and associated with excellent outcomes. Challenges to attain adequate field visualization do occur. A new retracting device is described that vastly improves operative field visualization, particularly in the upper area where high lesions and limited cervical mobility can restrict or hamper technical maneuvers.

Cascade Autologous System Platelet-Rich Fibrin Matrix in the Treatment of Chronic Leg Ulcers.

Problem: Lower extremity ulcers (venous, diabetic) are often unresponsive to standard treatment. Various systemic and local cellular, vascular, and anatomical factors can result in nonhealing wounds that are refractory to normal healing processes and standard care.

Solution: Several published wound care guidelines strongly suggest that if an ulcer does not respond to standard good wound care within 4 weeks, then advanced wound therapies should be considered.