Hybrid approach to intrapancreatic inferior pancreaticoduodenal aneurysm repair.

Pancreaticoduodenal artery aneurysms (PDAAs) are an extremely rare visceral artery aneurysm subtype, usually managed by endovascular techniques. We report the case of a 57-year-old man with an intrapancreatic, inferior PDAA abutting the superior mesenteric artery (SMA). This location, in relation to the SMA, risks SMA thrombosis using an endovascular-only approach.

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.

Acute aortoiliac and infrainguinal arterial thrombotic events in four patients diagnosed with the novel coronavirus 2019.

The novel coronavirus disease 2019 (COVID-19) pandemic is seriously challenging the healthcare system globally. Endothelial damage and increased coagulation activity have been reported in some patients with COVID-19, resulting in a variety of thrombotic events. We report the cases of four patients with various severities of COVID-19 who had presented with acute arterial thrombosis.

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.

Case report: Hybrid endovascular and open surgical approach to a chronic, traumatic arteriovenous fistula.

• Chronic traumatic AVF leads to significant morbidity when allowed to progress. • Traumatic AVF may be approached with endovascaular, open, and hybrid techniques. • We describe a traumatic AVF which was left to progress for over 30 years.

Endovascular stent graft repair of thoracic aortic mural thrombus in a patient with polycythemia vera: a word of caution.

Thoracic aortic mural thrombus (TAMT) is a rare pathology and potential source of cerebral, visceral, and peripheral emboli. We present a 62-year-old male in a hypercoagulable state due to primary polycythemia vera (PV) developed TAMT and catastrophic thromboembolisms despite aggressive medical and surgical management. The outcomes and adverse events of endovascular exclusion of TAMT in the presence of PV are unknown.

Early recognition of acute thoracic aortic dissection and aneurysm.

Background: Thoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary.

Bilateral giant extracranial carotid artery aneurysms.

Extracranial carotid artery aneurysms (ECAAs) are rare and extremely challenging disease entities. Untreated ECAAs can lead to serious neurologic sequelae, primarily from thromboembolism. Because of the high incidence of major neurologic complications, surgical intervention is warranted in most cases.

A novel method for the treatment of dysphagia lusoria due to aberrant right subclavian artery.

Dysphagia lusoria occurs secondary to an aberrant right subclavian artery coursing posterior to the oesophagus. Open ligation and transposition to the right carotid artery via a right supraclavicular approach has been described as a minimally invasive method. However, approaching the origin of the aberrant right subclavian artery through this incision can be extremely challenging.

Endovascular repair of thoracic aortic aneurysms.

A thoracic aortic aneurysm is a potentially life-threatening condition that involves a structural weakness of the aortic wall, which can lead to aneurysm, rupture, or dissection. Optimal treatment strategies for lesions of the thoracic aorta are still controversial. Open surgery is complex and is associated with significant morbidity and mortality.

Pseudoaneurysm of the subclavian-vertebral artery junction--case report and review of the literature.

Pseudoaneurysm of the subclavian-vertebral artery junction (SVJ) is a rare complication of internal jugular vein catheter placement. Because of its retroclavicular location, arterial injury at the SVJ poses a significant therapeutic challenge. A case report and review of the literature are presented.

Cholinergic antiinflammatory pathway inhibition of tumor necrosis factor during ischemia reperfusion.

Objective: Ischemia-reperfusion injury is a pathologic event characterized by tissue damage. It is mediated by tumor necrosis factor (TNF) and other cytokines that activate complement and proteases and stimulate fibrinolysis, degranulation of white blood cells, and free radical production. We recently reported that vagus nerve stimulation (VNS) suppresses endotoxin-induced cytokine synthesis through alpha bungarotoxin-sensitive cholinergic receptors.

Globin attenuates the innate immune response to endotoxin.

Hemoglobin is an endotoxin (lipopolysaccharide; LPS)-binding protein that synergistically increases the release of proinflammatory cytokines from the innate immune system in response to LPS. It has been suggested that this activity of hemoglobin facilitates the recognition of Gram-negative bacteria in a wound, thereby maximizing immune efficiency. This synergy may be important to the pathogenesis of a broad spectrum of clinical conditions because elevated hemoglobin levels frequently are observed in patients after the transfusion of red cells, trauma, cardiopulmonary bypass surgery, hemolysis, in addition to other disorders.