Annals of vascular surgery
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Review Case Reports
Retrograde type A dissection after endovascular repair of a "zone 0" nondissecting aortic arch aneurysm.
Retrograde type A dissection (RTAD) is not so uncommon after thoracic endovascular aortic repair of type B dissections, especially in the presence of connective tissue disorders. Risk of RTAD after thoracic endovascular aortic repair of nondissecting aneurysms has still to be clarified, mainly if proximal arch involvement requires hybrid repair with ascending aortic side clamping, supra-aortic trunks proximal re-routing and endograft landing in ascending aorta. We report a mid-term RTAD after hybrid repair of a proximal arch nondissecting aneurysm without connective tissue disorders. The technique for ascending aortic replacement without arch endograft removal and literature review about this poorly known complication are presented.
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Endoluminal laser ablation has emerged as a new method for treating greater saphenous vein insufficiency. However, the procedure is not completely painless and requires applying tumescent anesthesia. The aim of this study was to evaluate the safety and efficacy of ultrasound-guided femoral nerve block in patients subjected to endoluminal laser ablation of the greater saphenous vein. ⋯ In conclusion, ultrasound-guided femoral nerve block was shown to be a safe and effective option to decrease intraoperative discomforts associated with tumescent anesthesia and endoluminal laser ablation of the greater saphenous vein.
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Despite the publication of recent guidelines for management of the left subclavian artery (LSA) during endovascular stenting procedures of the thoracic aorta, specific management for those presenting with dissection remains unclear. This systematic review attempts to address this issue. ⋯ In patients undergoing endovascular stenting for thoracic aortic dissection, in cases where LSA coverage is necessary, revascularization should be considered before the procedure to avoid complications such as left arm ischemia, stroke, and endoleak, and where feasible, an appropriate preoperative assessment should be carried out.
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We report a case of successful stent-graft endovascular treatment of a huge traumatic carotid-jugular fistula with a pseudoaneurysm that had resulted from a bullet injury. A 77-year-old man with a pulsatile neck mass came to our hospital complaining of dyspnea and chest pain at rest; about 58 years ago, a gunshot accident had inflicted a penetrating bullet wound on the right side of his neck. Computerized tomography angiogram had demonstrated a huge vascular mass protruding into the right anterior neck with a pseudoaneurysm. ⋯ Fortunately, a stent-graft was delivered successfully across the carotid-jugular fistula and immediate follow-up angiogram demonstrated a small filling defect at the base of stent-graft representing thrombus. The follow-up computerized tomography angiograms obtained 2 weeks and 4 months later further demonstrated a patent stent-graft, no evidence of thrombus progression, and no abnormal shunt flow. The patient did not experience any neurologic complications nor did he show any evidence of pulmonary embolism for 8 months.
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We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm. ⋯ After fenestration, the patient developed severe metabolic complications (i.e., myonephropathic-metabolic syndrome) and died a day later of cardiac arrest resulting from hyperkalemia. Abdominal aortic replacement with true-lumen reconstruction in patients with abdominal aortic rupture in type B acute aortic dissection could also lead to acute aortic occlusion due to re-dissection or true-lumen compromise accompanying retrograde propagation of false-lumen thrombosis. This lethal sequela after true-lumen reconstruction might be prevented by an adjuvant procedure such as concomitant fenestration.