Vascular
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Case Reports
Endovascular exclusion of a large spontaneous aortocaval fistula in a patient with a ruptured aortic aneurysm.
A primary aortocaval fistula (ACF) is present in less than 1% of all abdominal aortic aneurysms (AAA). The case of a 62-year-old patient with a ruptured AAA and ACF was reported. A stent-graft was implanted into the abdominal aorta. ⋯ The follow-up computed tomographic scan three months later did not reveal any evidence of endoleaks or that the fistula was still present. Hemodynamic changes with regard to transient acute liver impairment were discovered (renal and liver parameters were presented). Endovascular exclusion appears to be an effective option in the treatment of an aortocaval fistula in comparison to conventional open repair.
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The purpose of this study was to review the shift in the trend of management and mid-term outcomes of all patients who sustain thoracic aortic injury. A Retrospective analysis was performed of all patients sustaining blunt thoracic aortic trauma admitted to our unit. Forty-seven patients were presented with injury to the thoracic aorta following blunt chest injury. ⋯ The mean oversizing was 24.4 ± 5.4% (17-32%). At our institution, there has been a paradigm shift in the emergent repair of blunt thoracic aortic injury from open surgery to endovascular repair. Oversizing of the stent-graft did not translate to a poorer outcome.
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This investigation evaluated the results of single-stage thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR) for multilevel aortic disease in a series of nine patients. The lesions repaired included thoracic and abdominal aortic aneurysms (n= 7) and subacute type B dissections with abdominal aortic aneurysms (n=2). ⋯ The median follow-up period for these patients was 18.9 months (range 1.7-31.4 months) and none of the patients exhibited any signs of type I endoleaks or aneurysmal diameter enlargements more than 5 mm. In conclusion, single-stage TEVAR and EVAR procedures for multilevel aortic disease were found to be safe and feasible modalities for high-risk patients.
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Implantable venous access ports are essential for patients requiring chronic venous access. Ultrasound guided catheter placement has been recognized as a valuable adjunct for reducing complications during placement of access ports in the radiology and critical care medicine literature. We reviewed the medical records of patients undergoing insertion of implantable venous access ports from June 2006 through June 2009. ⋯ Carotid puncture was documented in 4 (0.8%)cases. Routine use of ultrasound guidance during placement of implantable venous access ports has eliminated the complications of pneumothorax and hemothorax during placement of internal jugular venous access ports on our vascular surgery service. Elimination of these complications and decreased use of chest x-rays should also provide increased cost savings for this procedure.