Hooperwalsh6890
c anatomy. More studies are needed to ascertain whether lower tensions can be applied; these results may help provide a platform for other such studies depending on configuration, aortic geometry, and device or wire/tension characteristics.
Alarming outcomes have been reported following infected endovascular aortic aneurysm repair (EVAR) device explantation. Infected fenestrated EVAR (FEVAR) exposes patients to even worse procedural risks.
A 67 year old man with a prior history of FEVAR presented with impaired general condition, abdominal and back pain, and increased C reactive protein. Computed tomography angiography revealed a collection around the aortic graft bifurcation and
F-fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed increased FDG uptake at this level, confirmed by labelled white blood cells, all favouring graft infection. A thoracophrenolumbotomy was performed and revealed an aorto-enteric fistula which was treated by small bowel resection. The left renal artery was transected at the distal end of the bridging stent and a thoracorenal bypass was performed. The thoracic aorta was cross clamped above the coeliac trunk for complete graft excision. Meanwhile, the right kidney was perfused with 4°C Ringer lactate referred to dedicated vascular centres with expertise in surgical repair, anaesthetics, and post-operative intensive care.
Total explantation of stent grafts with tissue debridement and post-operative antibiotic therapy is the gold standard when dealing with infected EVAR. As with type IV thoraco-abdominal aneurysm open repair, FEVAR device explantation requires additional protective measures to prevent visceral ischaemia and renal impairment. click here In agreement with the European Society for Vascular Surgery guidelines, such patients should be referred to dedicated vascular centres with expertise in surgical repair, anaesthetics, and post-operative intensive care.
True non-traumatic radial artery aneurysms (RAAs) are extremely rare, and few cases have been described. The majority of RAAs are post-traumatic or iatrogenic pseudo-aneurysms following arterial cannulation. However, RAAs due to other causes have also been described. Here a rare case of true idiopathic distal RAA, which was managed by surgical resection and repair with interposition vein graft, is described.
A 62 year old female with a known medical history of hypertension and hyperlipidaemia presented with left wrist swelling of one year duration, associated with a pulsatile lump that was increasing in size. Duplex ultrasound and computed tomography angiography revealed a distal RAA. She underwent open surgical resection and repair with interposition vein graft using the distal left cephalic vein. Histopathology of the specimen revealed an aneurysm with atherosclerosis. She recovered well post-operatively with no complications.
True idiopathic RAAs are rare. Surgical treatment is almost always recommended in view of the risk of complications. A case of true idiopathic distal RAA is presented here, which was managed successfully by surgical resection and repair with interposition vein graft.
True idiopathic RAAs are rare. Surgical treatment is almost always recommended in view of the risk of complications. A case of true idiopathic distal RAA is presented here, which was managed successfully by surgical resection and repair with interposition vein graft.
Current vascular grafts all have limitations. This study examined peritoneum as a potential graft material and the
transfer of peritoneum into a functional artery like conduit after end to end anastomosis into the common carotid artery of sheep. The aim was to investigate whether implantation of a peritoneal tube into the arterial tree results in a structure with function, histological findings, and gene expression like an artery, and whether such arterialisation occurs through a conversion of the phenotype of peritoneal cells or from host cell migration into the implant.
Peritoneum with adherent rectus aponeurosis from sheep was used to form tubular vascular grafts that were implanted into the common carotid artery of six sheep, then removed after five months. Two sheep received allogenic peritoneal grafts and four sheep received autologous peritoneal grafts.
One sheep died shortly after implantation, so five of the six sheep were followed. Five months after implantation, four of the five remaining ically and functionally resembled a normal artery, with a functional genetic expression that resembled that of an artery. Single nucleotide polymorphism analysis indicated that this conversion occurs through host cell migration into the graft.
Fenestrated branched endovascular aortic repair with custom manufactured devices (CMDs) has been applied to treat post-dissection thoraco-abdominal aortic aneurysms (TAAA), but the long waiting period for device manufacture limits its application in symptomatic or contained ruptured aneurysms.
A 59 year old female presented with a 7 cm chronic post-dissection extent II TAAA. The patient underwent first stage total arch repair with the elephant trunk technique. At the time of the initial placement of the thoracic stent graft a fenestration was created in the septum to perfuse the right renal artery, which originated from the false lumen. A second stage procedure was planned with a CMD, but the patient presented with severe chest pain and lower extremity weakness, which was attributed to compression of the true lumen below the renal arteries due to increased flow into a pressurised false lumen. The patient underwent successful repair using a physician modified endograft (PMEG) with four fenestrations and pributed to pressurisation of the false lumen. PMEGs remain a valuable option for TAAA repair, including chronic post-dissection aneurysms. Their application is particularly useful in symptomatic patients who are not candidates for an off the shelf endograft and cannot wait for a device to be manufactured.
The adjunctive use of Heli-FX EndoAnchors (EAs) in endovascular aneurysm repair has been proposed for the treatment or prevention of type Ia endoleaks. The aim of this study was to evaluate the impact of the penetration of EAs on endograft textile structure from two aortic endografts that had been explanted for persistent type Ia endoleak despite the implantation of EAs.
An Aorfix aortic endograft was implanted in an 85 year old man. Six months later, six EAs were implanted for Ia endoleak. The endograft was explanted as an emergency seven months later for aneurysm rupture. An Endurant II aortic endograft was implanted in an 80 year old man. Seven EAs were implanted 24 months later for type Ia endoleak. A proximal cuff extension with bilateral renal and superior mesenteric artery chimneys was performed 18 months later to treat a persistent type Ia endoleak. Endograft explantation was performed six months later owing to persistent type Ia endoleak and aneurysm sac enlargement. Explant analysis in both cases was performed at GEPROVAS.
