The Challenge of Managing a Primary Aortic Mural Thrombus: Outcomes and Technical Considerations.

 Embolization to multiple arterial beds associated with primary aortic mural thrombus (PAMT) could result in high morbidity and mortality. There are no recommendations to dictate the best management. This study aims to describe our experience in managing this rare disease.

Intrastent HeROgraft deployment as a catheter-sparing procedure.

Current vascular access (VA) practice adopts arteriovenous fistulas (AVF) as first option for haemodialysis, relegating arteriovenous grafts (AVG) for patients with exhausted upper limb venous patrimony. The Hemodialysis Reliable Outflow graft (HeRO) is a device assuring direct venous outflow to the right atrium, thus avoiding central venous obstructive disease. Its use together with early access grafts avoids the need for central venous catheters (CVC) bridging periods.

The Vascular Patient - Chronic Mesenteric Ischemia, AAA and Iliac Occlusion.

Peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA) and chronic mesenteric ischaemia (CMI) are vascular diseases uncommonly observed in the same patient, especially when treatment is required. This case report illustrates a patient requiring mesenteric revascularization due to CMI. A long flush occlusion of the superior mesenteric artery (SMA) precluded endovascular revascularization.

Sapheno-Cavernous Shunt: A Vascular Approach In The Treatment Of Ischemic Priapism.

Priapism is an urologic emergency defined as an erection that persists for more than 4 hours and is unrelated or lasts beyond sexual stimulation. Ischemic priapism, caused by prolonged venous occlusion within the corporal bodies, works as a compartment syndrome that requires prompt resolution in order to preserve erectile function. We present two cases of ischemic priapism refractory to conventional treatment that were treated with the help of vascular surgeons.

Asymptomatic Hypogastric Arteriovenous Fistula Detected 40 Years After Shotgun Injury.

84-year-old male, with a history of firearm incident with accidental gunshot shooting, and multiple projectile injuries, 40 years prior. No advanced medical treatment was required at the time. A CT was recently performed for unrelated reasons, and the scout view shows multiple projectiles, a total of 50, scattered in the thoracoabdominopelvic region as well as the lower limbs.

Penetrating Vascular Trauma To The Brachial Artery.

Civilian penetrating injuries to the upper extremities are becoming seldom, with few case reports presented in the recent literature. Nevertheless, the brachial artery is the most frequently injured artery, accounting for approximately 30% of all vascular injuries. The authors present two clinical cases of brachial artery penetrating trauma with a stab corrected with an interposition saphenous bypass graft.

Isolated common iliac artery aneurysm with specific anatomical considerations.

Introduction: Iliac artery aneurysms (IAA) are a rare entity with a prevalence lower than 2% in the general population involving typically the common iliac artery in 70-90%.

Case-report: This is the clinical case of an 88 years-old male patient with an isolated giant IAA, 84mm maximum diameter, diagnosed following a four-month period of lower abdominal discomfort and pelvic hyperemic mass. The IAA was successfully excluded with an endovascular approach with an aorto-uni-iliac endograft Endurant II (Medtronic Cardiovascular, Santa Rosa, CA, USA) followed by a femorofemoral right to left bypass.

ISOLATED COMMON ILIAC ARTERY ANEURYSM WITH SPECIFIC ANATOMICAL CONSIDERATIONS.

Introduction: Iliac artery aneurysms (IAA) are a rare entity with a prevalence lower than 2% in the general popula- tion involving typically the common iliac artery in 70-90%. Literature describes that bilateral common IAA may be present in approximately 50% of the affected patients.

Case-report: The authors present an 88 years old male patient with an isolated giant IAA, 84mm maximum diameter, diagnosed following a four-month period of lower abdominal discomfort and pelvic hyperemic mass.

SURGICAL TREATMENT OF A SPONTANEOUS RUPTURE OF A MYCOTIC ANEURYSM.

Saccular mycotic aorto-iliac aneurysms are rare but, when ruptured, they are an important life-threatening condition. We present the case of a 52 years-old male transferred from another hospital and admitted to the emergency room with a ruptured iliac artery aneurysm. He complained of persistent fever and abdominal discomfort that swiftly established as hemorrhagic shock.

Angiosarcoma of a Femoropopliteal Bypass Thrombosed Vein Graft.

Background: Angiosarcoma is a rare subtype of malignant vascular tumours which has been only anecdotally described in patients submitted to lower limb revascularization.

Case Presentation: This paper reports a patient previously submitted to a femoropopliteal bypass using autologous great saphenous vein (GSV). Nine years after the initial surgery, a primary angiosarcoma of the thrombosed vein graft was diagnosed, requiring surgical resection.

Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease.

Purpose: Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown.

Emergency Repair of a Ruptured Para-Renal Abdominal Aortic Aneurysm in a Patient with a Functional Renal Graft: A Case Report and Review of the Literature.

Indroduction: Rupture of and abdominal aortic aneurysm (AAA) in a kidney transplant patient is a rare and rarely reported event. Emergent treatment can be challenging and should achieve effective aortic repair while minimizing ischemic damage to the renal graft during aortic cross-clamping. Several renal protective measures have been proposed such as permanent or temporary shunts, renal cold perfusion and general hypothermia.

Iliac side branch technique for repair of bilateral iliac artery aneurysms associated with a congenital pelvic kidney.

Pelvic kidney is a congenital anomaly with few literature reports of concomitant aortoiliac aneurysmal disease. When aneurysm repair is indicated, either open or endovascular, it poses a technical challenge, since kidney preservation is paramount. This paper reports a successful endovascular repair of bilateral common iliac artery aneurysms in a patient with a right congenital pelvic kidney, using iliac side branch technique.

Endovascular Treatment Of A Symptomatic Thoracic Aorta Thrombi.

Aortic mural thrombus is a rare condition with 0.45% incidence in the general population, being the thoracic aorta the most affected portion. In the absence of an atherosclerotic wall lesion, other specific conditions should be studied and excluded.

Hemodialysis Acess - A Creative Attitude is Necessary.

Creating and maintaining a functional vascular access (VA) is a critical factor in the survival of a dialysis patient. It implies a creative attitude either to maintain its functionality or to build a new one wherever possible, being it autologous or synthetic. We describe the VA history of a 59 years-old male patient, with extreme obesity, which started in 2012 with failed attempts of VA construction in both forearms until a functional brachiocephalic arteriovenous fistula (AVF) in the right upper limb was achieved.

[Hilar Renal Artery Aneurysm - Ex-vivo Reconstruction and Autotransplantation].

Renal artery aneurysm (RAA) is a rare entity with an estimated prevalence of 0.09%. The majority present asymptomatically and the diagnosis is made incidentally during an imaging test.

Surgical Thrombectomy, Fibrinolysis, Angioplasty and Stenting: A Combined Approach for Treatment of a May-Thurner Syndrome Presenting as Phlegmasia Cerulea Dolens.

Introduction: Phlegmasia cerulea dolens (PCD) is a rare complication of deep venous thrombosis (DVT). Massive ileo-femoral DVT is usually the cause and prompt treatment is mandatory as it represents a medical emergency. Reported amputation rates range from 12% to 25% and mortality ranges from 25% to 40%.

Hilar Renal Artery Aneurysm - Ex-vivo Reconstruction and Autotransplantation.

Introduction: Renal artery aneurysm (RAA) is a rare clinical entity with an estimated prevalence of 0.15% to 0.1%in the general population.

Creative Vascular Access Construction in Same Patient.

Introduction: Creating and maintaining a functional vascular access(VA) is a critical factor in the survival of a dialysis patient. However, it will not function forever, implying a creative attitude from the vascular surgeon either to maintain its functionality or built a new one wherever possible, being it autologous or synthetic.

Methods: Describe the VA history of a 59years-old male with morbid obesity and end-stage chronic kidney disease.

Renal Autotransplantation - The Solution for Different Pathologies.

Introduction: Renal autotransplantation (RA) is a safe and effective procedure to reconstruct the urinary tract which first successful surgery was performed by Hardy in 1963. The main indications reported for performing RA generally includes renovascular disease, ureteral pathologies and neoplastic disease. RA may be also useful as the last recourse in preventing kidney loss in highly selected patients, especially when conventional methods have failed.

Carotid Stenosis in Cardiac Surgery Patients.

Introduction: Ischemic stroke is a potential perioperative complication after an open heart surgery (OHS). Whether a carotid stenosis or occlusion is associated with an increased risk of perioperative stroke in patients or just a risk factor has been a concern of intense debate in the literature.

Methods: We retrospectively analyzed patients submitted to OHS between January and December2016 with known asymptomatic carotid disease.

Giant Ruptured Common Iliac Artery Infected Aneurysm.

Introduction: Saccular mycotic aorto-iliac aneurysms are extremely rare and when presented with ruptured, they are an important life- threatening condition.

Methods: We present a 52 years old male transferred from another Hospital and admitted to the emergency room with a ruptured iliac artery aneurysm.

Results: He complained of persistent fever and abdominal discomfort that swiftly established as hemorrhagic shock.

Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment Results.

True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis.

[Acute mesenteric ischemia: the importance of early diagnosis and aggressive revascularization].

Aim: Despite the advances in diagnostic and therapeutic approaches, acute mesenteric ischemia (AMI) remains associated with a dismal prognosis. The goal of this study was to review and report our department's experience in the surgical treatment of AMI and to identify predictive factors of postoperative morbidity and mortality.

Materials And Methods: We performed a retrospective analysis of the patients that underwent surgical revascularization after embolic or thrombotic AMI, between January 2008 and December 2015.