Annals of vascular surgery
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Review Case Reports
Endovascular exclusion coupled with operative anterior leg compartment decompression in a case of postthromboembolectomy tibialis anterior false aneurysm.
The aim of this study was to present a case of iatrogenic thromboembolectomy-related tibialis anterior false aneurysm (FA) treated with endovascular FA exclusion and anterior leg compartment (ALC) operative decompression and to assess the current management options in posttraumatic leg vessel FAs. A 68-year-old man had a painful pulsating mass in the superior ALC 2 months after a thromboembolectomy was performed during popliteal aneurysm repair. He had been discharged under oral anticoagulation and had ALC manual massages for mild post-revascularization leg edema. ⋯ Endovascular treatment of tibialis anterior FAs using a covered stent graft is an excellent therapeutic option. After an endovascular procedure, caution must be taken to identify the need for early operative ALC decompression. Current leg vessel FA management should consider both the specific anatomic characteristics of the FA and the possibility of development of delayed compartment syndrome.
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Review Case Reports
Infectious aortitis with multiple mycotic aneurysms caused by Streptococcus agalactiae.
We report a case of a 66-year-old man with multiple thoracoabdominal mycotic aortic aneurysms caused by Streptococcus agalactiae (S agalactiae). The infectious aortitis (IA) was diagnosed by transesophageal echocardiography and computed tomography and confirmed by positive blood cultures. The patient was treated with antibiotics, but, after worsening of the aortitis, a successful surgical procedure was performed. A review of the literature is presented together with a series of 7 other cases of IA caused by S agalactiae.
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Review Case Reports
Infrahepatic inferior vena cava agenesis with bilateral renal vein thrombosis.
Congenital anomalies of the inferior vena cava (IVC) are rare and are estimated to be present in 0.07-8.7% of the general population. IVC agenesis (IVCA) is found in approximately 5% of cases of unprovoked lower extremity deep vein thrombosis in patients <30 years of age. ⋯ To our knowledge, this is the third reported case in the literature of IVCA-induced RVT and the first to affect the bilateral renal veins in the absence of any other thrombogenic risk factors or any lower extremity venous complications. We also present a literature review of IVCA-induced vein thrombosis and highlight the lack of literature to manage this condition.
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Frailty has been established as an important predictor of health-care outcomes. We hypothesized that the use of a modified frailty index would be a predictor of mortality and adverse occurrences in vascular surgery patients. ⋯ A simplified FI can be obtained by easily identifiable patient characteristics, allowing for accurate prediction of postoperative morbidity and mortality in the vascular surgery population.
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Despite promising results, endovascular aortic repair (EVAR) of ruptured/painful abdominal aortic aneurysms (RPAAA) continues to have limited use due to anatomic constraints linked to RPAAA morphology. Currently, EVAR for RPAAA is reserved for patients presenting with a long infrarenal aortic neck, because commercially available fenestrated stent grafts are not available in an emergency setting. Recently, the chimney technique (ChT) has been utilized to treat infrarenal abdominal aortic aneurysms (AAA) with short necks, but this technique requires specific materials. The aim of this study was to determine the rate of RPAAA eligible for EVAR since the advent of the ChT and to ascertain the standard materials needed in this context. ⋯ The ChT increases EVAR feasibility by 50% in RPAAA. Taking into consideration our results, we recommend continued availability of emergency kits, including suitable aortouni-iliac stent grafts and basic material for performing ChT to allow surgeons to provide EVAR to the greatest number of RPAAA cases.