Int J Surg Case Rep
Department of Vascular Surgery, Singapore General Hospital, Singapore.
Published: October 2024
Introduction And Importance: Coral-reef type aortic occlusions are uncommon conditions that can result in intermittent claudication. Many claudicants also have concomitant neurogenic aetiologies and revascularization alone may not be beneficial. These cases can prove to be a diagnostic challenge.
Case Presentation: We present a case of worsening bilateral calf claudication in a patient with previously asymptomatic coral-reef type aorta, anxiety, and spinal stenosis presents. Investigations were unable to differentiate between a neurogenic and vascular cause. The patient opted for aortic stenting before spinal surgery, after extensive discussion. Initial attempts at crossing the occluded segments were unsuccessful and the patient was offered the option to either resume conservative therapy, perform an open axillo-bifemoral bypass or repeat aortic stenting. After discussion, a repeat aortic stenting was performed. This time, the stenting attempt was successful, with completion angiogram showing brisk antegrade flow and strong distal pulses returned. Post-surgery, the patient's symptoms improved vastly.
Clinical Discussion: Differentiation of vascular claudication from neurogenic claudication is diagnostically challenging. Decision to treat the aorta or the spinal issue first depend on the patient's constellation of symptoms.
Conclusion: Endovascular aortic stenting is well accepted with good results and lower morbidity than open surgery. A repeat attempt is always a possible option.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11400984 | PMC |
http://dx.doi.org/10.1016/j.ijscr.2024.110097 | DOI Listing |
Ann Thorac Surg Short Rep
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Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
Hybrid arch repair (HAR) combines surgical reconstruction of the ascending aorta and arch debranching with stent graft deployment into the descending thoracic aorta in an effort to reduce the morbidity associated with conventional open total arch replacement. We describe a case of delayed presentation for 2 thoracic aortic wall injuries caused by stent graft migration after type II HAR. This report highlights an important late complication of HAR and the need for careful device selection.
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December 2024
Children's Heart Institute, Children's Memorial Hermann Hospital, Houston, Texas.
A patient with known pulmonary atresia and intact ventricular septum and ductal stent presented with low cardiac output and arrythmia. Intraoperatively, the patient was found to have an anomalous left coronary artery arising from the pulmonary artery. After reimplantation of the left coronary artery to the aortic root and placement of a central shunt, the patient progressed well and was discharged home.
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December 2024
Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
Coronary vasospasm involves constriction of the coronary arteries and has been described after manipulation of the coronary arteries (ie, after stenting or bypass grafting). This report details the case of a 57-year-old man who presented with an endoleak after thoracic endovascular aortic repair. He underwent a frozen elephant trunk procedure and postoperatively had diffuse coronary vasospasm, demonstrated on pre- and post-vasospasm cardiac catheterization.
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December 2024
Division of Cardiac Surgery, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
Background: DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
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Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
We report on a successful thoracic endovascular aortic repair for perigraft seroma (PGS) after ascending aorta replacement (AAR). An 82-year-old man underwent AAR. Two years after the operation, computed tomography showed a 75-mm PGS around the ascending aorta.
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