Annals of vascular surgery
-
Exertional leg pain includes a broad range of conditions induced by different vascular, musculoskeletal, and neurological disorders. We report a case with isolated popliteal artery dissection as a cause of a transient acute lower limb ischemia. We report a patient with popliteal artery dissection which occurred during squatting exercise. ⋯ Isolated popliteal artery dissection in professional athletes is a rare entity, which can be manifested with exertional leg pain. Clinical findings can sometimes be similar to those of popliteal entrapment syndrome. Clinical suspicion and timely patient referral to a vascular specialist are crucial for optimal treatment of this limb-threatening condition.
-
Case Reports
Endovascular Repair of Ruptured Thoracoabdominal Aortic Aneurysm with an Off-the-shelf Endoprosthesis.
Thoracoabdominal aortic aneurysm type 3 (TAAA3) is a challenging disease to vascular surgeons. In these cases, the best treatment methodology is conventional surgery, which portends a mortality rate ranging from 8% to 25%. Endovascular treatment has been shown to be a good alternative, with encouraging results. In 2012, a new alternative for endovascular treatment of TAAA3 was presented: Cook T-Branch endoprosthesis (Cook Medical, Bloomington, Indiana). We present the first successful case of endovascular treatment of a ruptured TAAA3 with this stent. ⋯ Until now, the only endovascular alternative for ruptured aortic aneurysm was the parallel prosthesis technique. The development of an off-the-shelf T-Branch prosthesis (Cook Medical) has solved this problem in many cases, enabling immediate treatment of this type of aneurysm in approximately 83% of patients. The fact that the thoracic aorta would be excluded lead the patient to a high risk of spinal cord ischemia. We therefore decided to make a cerebrospinal fluid drainage. There is no consensus regarding the best devices to be used as branches. In this case, we chose to use the previously described covered stents, according to its flexibility and compatibility with the length of arteries. This is the first report of the use of a T-branch (Cook Medical) for treatment of a ruptured TAAA3. The development of an off-the-shelf endoprosthesis has many advantages: it is available for use in an emergency situation, and there is no time lapse for its preparation. The T-Branch stent graft is a valid option for the treatment of ruptured TAAA3.
-
Management of complicated indwelling inferior vena cava (IVC) filters has increased due to low retrieval rates. Filter migration and perforation are infrequent complications and require explantation of the filter. We report our recent experience with endovascular retrieval and surgical explantation of IVC filters after caval perforation. ⋯ Patients presenting with abdominal pain and history of IVC filter placement should cause concern for possible caval strut perforation. Endovascular retrieval or surgical explantation are required for removal and can be accomplished with minimal risk to the patient.
-
Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. ⋯ Patients with hypoalbuminemia have significantly increased mortality risk. Albumin level is regulated by nutritional intake and inflammation due to chronic disease, which make it a useful part of a preoperative frailty assessment. Further studies are needed to identify whether optimizing nutrition status will affect albumin levels or decrease mortality.
-
Comparative Study
Estimation of V-POSSUM and E-PASS Scores in Prediction of Acute Kidney Injury in Patients after Elective Open Abdominal Aortic Aneurysm Surgery.
V-POSSUM and E-PASS scoring systems are usually used to predict morbidity and early mortality in surgical patients. We conducted this study to assess the validity of the V-POSSUM and E-PASS scores in predicting risk of acute kidney injury (AKI) development in patients undergoing elective open abdominal aortic aneurysm (AAA) repair. ⋯ V-POSSUM and E-PASS scores have similar good properties in predicting postoperative AKI in patients undergoing elective open AAA repair.