Recurrent symptomatic aortic aneurysm in a young girl with tuberous sclerosis complex and review of the literature.

An abdominal aortic aneurysm is a rare occurrence in pediatric populations. When present, it is usually associated with an underlying etiology such as a connective tissue disorder, inflammatory process, or noninflammatory medial degeneration. In the present report, we describe the case of a girl with tuberous sclerosis complex who underwent successful emergency open repair of a symptomatic infrarenal abdominal aortic aneurysm and recurrent type IV thoracoabdominal aortic aneurysm.

Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation.

Objective: Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis [TBE]) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair. However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic simulations.

Insights on Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting.

Major branches of the aortic arch and visceral aorta pose a particular challenge for endovascular repair of aneurysms involving these regions. To preserve perfusion through these essential branches, fenestrated and branched endografts have been used. Current fenestrated and branched aortic endografts have evolved into modular devices in which the aortic main body provides appropriate access to the target branch vessel either through reinforced fenestrations or directional cuffs as the hinge point for bridging stent grafts (BSGs).

Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study.

Objective: Traumatic popliteal artery injuries are associated with the greatest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10% to 15%. The purpose of the present study was to examine the outcomes of patients who had undergone operative repair for traumatic popliteal arterial injuries and identify the factors independently associated with limb loss.

Methods: A multi-institutional retrospective review of all patients with traumatic popliteal artery injuries from 2007 to 2018 was performed.

Anatomic feasibility of off-the-shelf thoracic single side-branched endograft in patients with blunt traumatic thoracic aortic injury.

Objective: The advent of thoracic single side-branched endograft (TSSBE) has provided a treatment option to obviate the need for open cervical debranching of the left subclavian artery (LSA), thereby enabling total endovascular incorporation of the LSA during thoracic endovascular aortic repair (TEVAR). In a previous study of patients with type B aortic dissection who had required zone 2 TEVAR, the anatomic feasibility of this device was demonstrated to range from 28% to 35%, suggesting limited applicability of the currently available designs. The objectives of the present study were twofold: (1) to evaluate the anatomic feasibility of TSSBE in blunt traumatic thoracic aortic injury (BTAI) patients who would require LSA revascularization; and (2) to describe the anatomic characteristics of the supra-aortic arch branches that could be used to improve future device design.

Popliteal scoring assessment for vascular extremity injuries in trauma study.

Objective: Traumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. A method to evaluate the predictors of amputation is needed because previous scores could not be validated. In the present study, we aimed to provide a simplified scoring system (POPSAVEIT [popliteal scoring assessment for vascular extremity injuries in trauma]) that could be used preoperatively to risk stratify patients with traumatic popliteal vascular injuries for amputation.

Outcome comparison of thoracic endovascular aortic repair performed outside versus inside proximal landing zone length recommendation.

Objective: Success of thoracic endovascular aortic repair (TEVAR) relies heavily on the proximal landing zone (PLZ) sealing. Most instructions for use of thoracic endografts recommend a PLZ length of at least 2 cm. Because of the complex aortic anatomic features, TEVAR landing in zone 1 to zone 3 may not meet this requirement.

Fenestrated Endovascular Aneurysm Repair versus Snorkel Endovascular Aneurysm Repair: Competing yet Complementary Strategies.

Juxtarenal/pararenal aortic aneurysms and type IV thoracoabdominal aneurysms pose particular technical challenges for endovascular repair as they involve the visceral segment in addition to insufficient infrarenal neck for the use of standard endovascular aneurysm repair (EVAR) devices. To overcome these challenges, complex EVAR techniques have been developed to extend the proximal landing zone cephalad with maintaining perfusion to vital aortic branches, thereby broadening the applicability of endografting from the infrarenal to the suprarenal aorta. Complex EVAR can be divided into two broad categories: fenestrated endovascular aneurysm repair (FEVAR) and snorkel EVAR.

Delineating the durability outcome differences after saphenous ablation with laser versus radiofrequency.

Objective: The mechanism of delivering thermal energy to the vein wall differs between endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). Different mechanisms of ablation may have different effects on the durability of these procedures typically performed for saphenous vein insufficiency. Whether there is a difference in long-term durability outcomes between these two techniques remains uncertain.

The Use of the Agatston Calcium Score in Predicting Carotid Plaque Vulnerability.

Background: The use of the Agatston calcium scoring method has been described extensively in the coronary circulation, but to date, it has not been investigated in the extracranial carotid domain. We sought to evaluate this calcium scoring method in its ability to predict carotid plaque vulnerability.

Methods: We retrospectively reviewed all computed tomography angiogram studies of the carotid arteries performed between March 2012 and March 2017 at a single institution.

Malignancy Does not Affect Outcomes of Pharmacomechanical Thrombolysis in Acute Symptomatic Iliofemoral Deep Vein Thrombosis.

Background: Cancer patients demonstrate increased risk for venous thromboembolism (VTE), VTE recurrence, and anticoagulation-associated bleeding. Pharmacomechanical thrombolysis (PMT) aand thrombectomy improves venous patency, venous valve function, and quality of life in patients with acute iliofemoral deep vein thrombosis (DVT). It remains unknown whether pharmacomechanical thrombolysis can be used safely in patients with active cancer.

Ruptured Mycotic Abdominal Aortic Pseudoaneurysm in a Patient on Hemodialysis Complicated with Oxacillin-Resistant Staphylococcus aureus Bacteremia.

Despite a high incidence of Staphylococcus aureus bacteremia in hemodialysis patients, bacterial invasion with aortic wall infection resulting in a pseudoaneurysm rarely occurs. This report describes a case of mycotic pseudoaneurysm of the abdominal aorta that grew rapidly and ruptured into the distal vena cava causing persistent bacteremia in a patient undergoing hemodialysis complicated with oxacillin-resistant S. aureus bacteremia.

Avoiding the use of a femoral bridging catheter using a two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique.

Purpose: To evaluate a two-stage Hemodialysis Reliable Outflow (HeRO) implantation technique that avoids the use of a femoral bridging catheter versus the conventional one-stage technique requiring a bridging catheter in selected patients.

Methods: A retrospective review was performed on 20 end-stage renal disease patients with an internal jugular vein (IJV) catheter selected for two-stage HeRO implantation at our institution between January 2010 and March 2013. The arterial graft component (AGC) was implanted without anastomosing it to the target artery (first stage).

Two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging dialysis catheter.

Purpose: The purpose of this study is to report a novel two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique that avoids the use of a femoral bridging hemodialysis catheter in internal jugular vein (IJV) catheter-dependent patients with contralateral central venous occlusion.

Methods: The first stage is to implant the ePTFE component and consists of: 1) performing two to three incisions in the upper arm ipsilateral to the preexisting IJV catheter, 2) tunneling the expanded polytetrafluoroethylene (ePTFE) component through these incision sites, and 3) placing the ePTFE component in the subcutaneous tissue without anastomosing it to the target artery. The preexisting IJV catheter is maintained to provide continuous dialysis access.