Annals of vascular surgery
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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.
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Patients at risk of mortality after amputation have not been well identified. We sought to devise a clinical index predicting 30-day mortality after amputation that would allow stratification of intensity of postoperative care. ⋯ More than one-third of deaths within 30 days of major amputation occur after discharge from acute care. A novel index to predict 30-day mortality after major amputation is described. Patients receiving a score ≥5 face a substantial risk of mortality and should be held in the hospital longer or, if discharged, receive closer postoperative follow-up.
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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
Ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis.
The aim of this study is to describe a case of ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis (SE) and present a comprehensive review of the literature. ⋯ Infrarenal abdominal mycotic aneurysm (MA) by SE was observed and showed vague, nonspecific signs and symptoms. We recommend a high index of suspicion and low threshold for use of CT imaging in any infected patient of age >60 years with fever and abdominal pain on a background of diabetes and connective tissue disease. A comprehensive review of the literature was performed due to a lack of consensus on the best surgical treatment and limited information on the path of SE-induced aortitis or MA from presentation to final outcome.
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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.