Annals of vascular surgery
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Recently, there has been a shift toward elective endovascular repair of visceral artery aneurysms (VAAs). Transcatheter embolization (TE) and covered stenting (CS) represent the 2 most used endovascular techniques; however, TE carries the potential risk of end-organ ischemia, while CS is challenging when the parent arteries are tortuous. Flow diverter devices (FDDs) developed for cerebral aneurysms maintain distal flow and are characterized by high navigability in tortuous arteries. This report describes our initial experience in using FDD developed for cerebral aneurysms to treat extracranial VAAs/pseudoaneurysm (VAP). ⋯ When high tortuosity and small caliber of the parent arteries prevent CS and the necessity to maintain vessel patency contraindicates TE, FDD could represent an option for the treatment of VAP; however, high costs and the off-label use in extracranial vessels demand an accurate selection of the patients suitable for the VAP treatment with FDD.
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Review Case Reports
Ruptured Iliac Pseudoaneurysm after Intravesical Bacillus Calmette-Guérin: Urgent Endovascular Treatment. Case Report and Literature Review.
Ruptured mycotic aneurysms are an extremely rare complication of intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. Several cases involving various arterial sites, mostly in the thoracic or abdominal aorta, have been described in the literature. BCG immunotherapy rarely causes false aneurysms and open surgical repair using an in situ prosthetic graft is most commonly performed. Further to this, targeted antituberculous treatment is required for at least one year following surgery. ⋯ Endovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was hemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every 3 months and a computed tomography scan yearly is mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988.
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Comparative Study
Limited Clinical Relevance of Vertebral Artery Injury in Blunt Trauma.
Blunt cerebrovascular injury (BCVI), although rare, is more common than previously thought and carries a substantial stroke and mortality risk. The purpose of our study was to evaluate the differences between blunt carotid artery (CA) and vertebral artery (VA) injuries, assess the stroke and death rates related to these injuries, and identify the relationship of Injury Severity Score (ISS) with stroke and mortality in BCVI. ⋯ In this comparison of CA and VA injuries in BCVI, VA injuries were more common and more frequently found with cervical spine fractures than CA injuries. However, VA injuries had a lower incidence of CVA and mortality. A high ISS was associated with stroke and mortality while carotid injury and lowest GCS were independently associated with increased mortality.
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Comparative Study
One-Year Outcomes after Ruptured Abdominal Aortic Aneurysms Repair: Is Endovascular Aortic Repair the Best Choice? A Single-Center Experience.
Treatment of ruptured abdominal aortic aneurysms (rAAAs) is still burdened by high morbidity and mortality. Although endovascular aortic repair (EVAR) offers encouraging results in elective setting, its role as first-line strategy to treat rAAA is still debated. Our aim was to compare early and late outcomes in patients undergoing open surgical repair (OSR) versus EVAR for rAAAs. ⋯ EVAR does not independently reduce 1-year mortality in comparison with OSR in Hd stable patients. Urgent EVAR for rAAAs in unstable patients can be limited by logistical problems. It follows that patients selected for OSR have a more complex aortic anatomy and worse Hd status than those submitted to rEVAR. rEVAR burdened by a higher incidence of procedure-related complications than OSR. Reconfiguration of acute aortic services and establishment of standardized institutional protocols might be advisable for improvements in the management of ruptured AAA. A careful evaluation of whether the benefits of an endovascular strategy translate into long term benefit is needed before definitive conclusions can be drawn about the advantages of EVAR as first-line strategy for ruptured aneurysms.
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Injury to the lumbar artery during percutaneous endoscopic lumbar discectomy (PELD) is a very severe complication and only rarely reported. We present a 64-year-old patient with an injury to the right third lumbar artery during PELD which was successfully treated with intraoperative angiography and coil embolization. To our knowledge, this is the first report of the use of intraoperative angiography and coil embolization to treat a lumbar artery that had been lacerated during PELD.