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A typical complication after conventional aortic prosthetic reconstruction is paraanastomotic aneurysm formation. Endovascular exclusion of paraanastomotic aneurysms has been shown to be a viable alternative to open surgical repair and to greatly reduce morbidity and mortality rates. We present a case report of asymptomatic proximal anastomotic pseudoaneurysm, measuring 4.5 cm in diameter, that was successfully treated by endovascular repair with a custom-made inverted limb infrarenal bifurcated graft., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Subclavian artery-esophageal fistula is a life-threatening entity. It usually occurs in cases of an aberrant right subclavian artery. A fistula between a non-aberrant subclavian artery and esophagus is extremely rare and difficult to diagnose. It is generally due to ingestion of a foreign body and it is often lethal. We present a case of subclavian artery-esophageal fistula complicated by mediastinitis in a 45-year-old man. The fistula, induced by ingestion of a fish bone, was successfully treated by endovascular stent grafting and left thoracotomy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Since 1963, Fogarty balloon catheter thromboembolectomy is usually adopted as the gold standard treatment for acute limb ischemia. As the success of the procedure depends on complete removal of all thromboembolic material, intraoperative arteriography can be used after arterial thromboembolectomy as a guide for extension of the procedure. It is still a matter of debate whether intraoperative angiography should be routinely performed in all cases or only in selected cases, depending on intraoperative findings, when the surgeon suspects an incomplete disobstruction. Most published evidence derives from analysis of lower-limb thromboembolectomies. The aim of our retrospective study was to elucidate the value of routine completion angiogram in acute arterial embolism of the upper limb., Methods: Clinical and demographic data of 100 patients with acute embolic upper-limb ischemia were prospectively recorded during an 18-year period in a central hospital vascular unit setting. The relevance of intraoperative angiography was retrospectively analyzed. The procedures were divided into two groups: group A, when intraoperative angiography was performed in selected cases (selective angiography); and group B, when angiography was performed as a routine procedure in all cases (routine angiography). All factors associated with reocclusion and mortality were investigated to produce meaningful information that could assist the surgeon to predict outcomes., Results: Cumulative reocclusion and mortality rates at 24 months were 14.0% and 70.0%, respectively. After upper-limb arterial embolectomy, the rate of extension of the procedure was significantly higher in group B than in group A (26.0% vs. 4.0%, P = 0.002). At 24 months after embolectomy, group B resulted in a lower incidence of reocclusion compared with group A (12.0% vs. 2.0%, P = 0.05), whereas there was no statistical difference between the two groups in terms of mortality (P > 0.05). On univariate analysis, the factor associated with increased 2-year reocclusion rate was only the avoidance of completion angiography, although it lost some of its predictive value on multivariate analysis. Factors associated with increased 2-year mortality rate on univariate analysis included age >80 years, diabetes mellitus [DM], and antiplatelet drug use. Only DM was significantly associated on multivariate analysis., Conclusion: Routine use of intraoperative angiography influences outcome after embolectomy for upper-limb acute arterial occlusion. Routine use of intraoperative angiography, compared with selective use, results in a higher rate of extension of the procedure for residual lesion and in a lower rate of reocclusion at 24 months. In prevention of reocclusion, completion angiogram has a hazard ratio of 5.44 on multivariate analysis. Postoperative late mortality is mainly affected by old age and DM., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Background: This review evaluates the results of our 18-year experience with surgical treatment of popliteal artery aneurysms (PAAs), examining the effects of the variables of clinical presentations, surgical technique, graft material, and runoff on operative results in the management of popliteal aneurysms., Methods: We reviewed 49 PAAs consecutively repaired in 35 patients. We preferentially use, if possible, the posterior approach for repair of popliteal aneurysms. We repaired aneurysms passing above the Hunter canal using a medial approach to allow for adequate exposure of the proximal neck of the aneurysm. We separately analyzed the results of patients who underwent the posterior approach (group A) and those that underwent the medial approach (group B). Primary, primary assisted, and secondary patency were established using life-tables analysis., Results: In our experience, the posterior approach was used in 38 repairs (77.6%), followed by graft interposition (group A). PAAs were asymptomatic in 29 (59.2%) of 49 cases. Among 20 symptomatic PAAs, nine (18.4%) caused intermittent claudication, one (2.0%) caused rest pain and trophic wound, and the remaining 10 limbs (20.4%) presented with acute ischemia and limb threat. A total of 11 popliteal aneurysms (22.4%) required repair with a medial approach (group B) because the extension of the aneurysm was proximal to the adductor hiatus. The primary patency rates at 6 and 8 years were 94.3 and 83.8%, respectively, for group A and 100% (p = .43) and 19.1% (p = .001) for group B, the respective assisted primary patency rates were 97.3 and 86.3%, in group A and 100% (p = .43) and 19.1% (p = .001) for group B. The secondary patency rates at 6 months and 8 years were 97.3 and 97.3%, respectively, in group A and 90.9% (p = .34) and 77.9% (p = .05) in group B. Amputation occurred in two (4.1%) of 49 limbs and 30-day postoperative mortality was 2.0% (1/49 patients). There was no statistical difference in amputation rate in symptomatic and asymptomatic limbs, and in group A and B., Conclusion: We believe that the posterior approach is the gold standard surgical therapy to treat PPAs not extending above the Hunter canal. In our experience, the posterior approach was possible in 77.6% of cases. It has excellent patency and prevents further aneurysm expansion by completely interrupting the collateral circulation to the aneurysm sac. In contrast, the posterior approach had a slightly higher tibial nerve injury (p = .43), especially during the learning curve. The preoperative symptoms and the use of venous material for reconstruction affect significantly long-term patency., (Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Background: The success of thromboembolectomy for acute lower limb ischemia depends on the complete removal of all thromboembolic material accessible to the Fogarty catheter. Intraoperative arteriography can be used during arterial thromboembolectomy as a guide for extension of procedure to ensure complete clearance of the arterial tree and distal patency. However, it is still matter of debate if intraoperative angiography should be routinely performed in all cases or only in selected cases, depending on intraoperative findings, when the surgeon suspects an incomplete desobstruction., Methods: Details of 380 thromboembolectomies in 361 patients with acute lower limb ischemia due to native vessel occlusion were prospectively recorded over a 12-year period in a central hospital vascular unit setting. The relevance of intraoperative angiography was retrospectively analyzed. The procedures were divided into two groups: group A, when intraoperative angiography was performed in selected cases (selective angiography), and group B, when angiography was performed as a routine procedure in all cases (routine angiography). Thrombectomy and embolectomy cases were separately analyzed., Results: "On-table" angiography was used in 57 (26.4%) of 216 cases in group A and in all 164 cases (100%) of group B. Included in this study were 225 embolectomies and 155 thrombectomies of native vessels. After thrombectomy, the adoption of routine intraoperative angiography (group B) resulted in a statistically significant higher intraoperative reintervention rate than did selective intraoperative angiography (group A) (53.4% vs. 29.9%; p < 0.05). Also, after embolectomy extension of procedure, the rate was higher in group B than in group A (17% vs. 9.2%), but it did not reach statistical significance (p > 0.05). Considering the overall casuistic, at 24 months after thromboembolectomy, group B resulted in a lower incidence of reocclusion in comparison with group A (p < 0.05), whereas there was no statistical difference between the two groups in terms of amputation (p > 0.05) or of mortality (p > 0.05). Considering separately patients treated by embolectomy and by thrombectomy, reocclusion rate at 24 months was lower in group B than in group A, after thrombectomy and after embolectomy, with a statistical significance (p < 0.05). Amputation rate at 24 months was similar in group A and group B after embolectomy (10.7% vs. 8.9%; p > 0.05). After thrombectomy, there was in group B a slight advantage in comparison with group A, although not reaching statistical significance (31.3% vs. 46.2%; p > 0.05). There was no difference in mortality rate according to treatment group., Conclusion: Routine use of intraoperative angiography influences outcome after thromboembolectomy for lower limb acute arterial occlusion. Routine use of intraoperative angiography, compared with selective use, results in higher rate of extension of the procedure for residual lesion and in a lower reocclusion rate at 24 months., (Copyright (c) 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)