Annals of vascular surgery
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We present the case of a 63-year-old woman who was admitted to the intensive care unit for altered mental status and hypotension 3 weeks after creation of an arteriovenous fistula (AVF). She was found to have high-output heart failure and evidence of acute hepatic failure. High-output heart failure is a known complication of AVF creation, but hepatic failure after AVF has not been previously described. We present such a case.
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Most recent Chest 2008 guidelines counsel at least 3 months of anticoagulation for acute upper-extremity deep venous thrombosis (UEDVT). These guidelines are inconsistently followed, perhaps owing to relatively limited information regarding clinical outcomes among patients with UEDVT. Our institution maintains an UEDVT registry of consecutively encountered patients with sonographically confirmed UEDVT. We analyzed patient characteristics, treatment, and outcomes among these patients. ⋯ Anticoagulation therapy is inconsistently used to treat UEDVT and most often used for patients with multiple vein segments involved and with sonographically acute UEDVT components. However, regardless of the decision to anticoagulate, the incidence of PE attributable to UEDVT is small (2%), regardless of treatment with anticoagulation. Given the observed mortality associated with anticoagulation in this fragile patient cohort, the risk-benefit analysis for anticoagulation does not favor routine anticoagulation among these patients.
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Aortoenteric fistulas are a rare but potentially lethal condition. Here we present an unusual case of a fistula between the excluded portion of an infrarenal aneurysm repaired by stent-grafting and the duodenum. The fistula was supplied by a type II endoleak. The patient was successfully treated by extra-anatomic bypass grafting and removal of the aneurysm sac and the stent-graft.
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Perforation of inferior vena cava (IVC) by filter struts ranges from 9% to 24%, and clinical sequelae and complications are unpredictable. The aim of this article was to report an unusual case of late complication of IVC filter that caused an IVC wall perforation and penetration of the filter's hooks in the aorta, which was treated by endovascular procedure. Molding strut tip by balloon angioplasty, its accommodation with a bare stent, and its coverage and protection with an endoprosthesis is probably the first technique reported so far in this situation.
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Any obstacle in the contralateral artery has long been considered a high risk for carotid surgery. Here, we report the results of a monocentric, continuous, consecutive, prospective series and present a review of the literature. ⋯ In this series, and in a large review of literature, occlusion of the contralateral internal carotid artery increased the incidence of intolerance to clamping and thus the use of shunts but did not worsen postoperative morbidity and mortality. The presence of a stenosed contralateral carotid was not predictive of postoperative events. In our experience, the status of the contralateral carotid artery cannot be considered a high risk for carotid surgery.