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The co-occurrence of abdominal aortic aneurysm (AAA) and colorectal malignancy creates a significant surgical dilemma over which entity should be addressed first. A 73-year-old male was referred to our hospital due to a painful pulsatile abdominal mass. Computed tomographic angiography revealed an infrarenal aortic aneurysm measuring 5.8 cm in diameter and incidentally, a synchronous mass lesion in the sigmoid colon. The patient underwent an emergency EVAR using a Gore Excluder endograft. Postoperative CT staging for colon cancer revealed a type 2 endoleak on the grounds of a patent wide inferior mesenteric artery. The patient underwent a standard laparoscopic left colectomy with high ligation of the inferior mesenteric artery in order to simultaneously address the ongoing type 2 endoleak. Follow-up examinations with computed tomographic angiography were performed confirming the resolution of the endoleak. Synchronous laparoscopic sigmoidectomy and high ligation of inferior mesenteric artery for type 2 endoleak treatment appears to be applicable with hopeful results. [ABSTRACT FROM AUTHOR]

Background: The purpose of the guideline was to achieve consensus in the care and treatment of patients with chronic venous disease, based on current evidence. Method: A systematic literature search was performed in PubMed, Embase, Cinahl, and the Cochrane library up until 1 February 2019. Additional relevant literature were added through checking of references. Level of evidence was graded through the GRADE scale and recommendations were concluded. Results: For the treatment of great and small saphenous vein reflux, endovenous ablation with laser or radiofrequency was recommended in preference to surgery or foam sclerotherapy. If tributaries are to be treated it should be done in the same procedure. Treatment with mecanicochemical ablation and glue can be used but we still need long term follow up results. Conclusion: For the treatment of truncal varicosities, endovenous ablation with laser or radiofrequency combined with phlebectomies is recommended before surgery or foam. [ABSTRACT FROM AUTHOR]

Background-Aim: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. Methods: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. Results: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. Conclusions: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices. [ABSTRACT FROM AUTHOR]

Digital ischemia has been rarely associated, as a paraneoplastic syndrome, with renal cancer. Since it can severely compromise the patients' quality of life, early recognition is important, in order to optimally address it with currently available treatment options, such as tyrosine inhibitors. Digital ischemia may occur in the general population and it can be the result of other non-cancerous diseases; accordingly, a thorough and aggressive work-up is mandatory, together with appropriate therapeutic steps such as tyrosine kinase inhibitors, vasodilators, and antiaggregants. Herein, we report a 78-year-old male patient with a history of clear-cell renal-cell cancer, who presented in the emergency department with critical ischemia in the upper limbs. [ABSTRACT FROM AUTHOR]

Objectives Diabetic patients who undergo lower limb arterial bypass surgery are considered to have a worse clinical outcome compared to non-diabetics. The aim of the study was to test this hypothesis after applying propensity score matching analysis. Patients and methods A total of 113 consecutive lower limb bypass procedures (55 diabetic and 58 non-diabetic) were evaluated regarding their clinical outcome. Endpoints of the study included amputation-free survival, limb salvage, patency and patients' survival up to 36 months post-procedure. After propensity score matching analysis, two new groups, diabetic and non-diabetic, of 31 limbs in each one were created, both equivalent regarding all baseline characteristics. Results Between the propensity score matching groups, the amputation-free survival was 68.8% in the non-diabetic and 37.7% in the diabetic group at 36 months ( p = 0.004). Similarly, the survival was 88.6% and 57.6%, respectively, in the two groups at the same time point ( p = 0.01). On the contrary, no difference was found in patency (58.3% vs. 56%) and in limb salvage rate (74.1% vs. 60.8%). Conclusions Lower limbs arterial bypass surgery has similar results regarding patency and limb salvage rate in diabetic and non-diabetic patients. On the contrary, mortality is worse in diabetic patients, this affecting negatively their amputation-free survival. [ABSTRACT FROM AUTHOR]

Evolving technology has the potential to alter the overall management of carotid body tumors (CBTs). We review our 35-year experience emphasizing on novel modalities available in the evaluation and treatment of CBTs. Medical records of 27 CBT patients between 1975 and 2009 were retrospectively reviewed. The study cohort has been arbitrarily divided into two groups: the early years' group A (18 patients, 1975?1998) and the later years' group B (9 patients, 1999?2009). The most common presenting symptom was a painless lateral neck mass (89%). Octreotide scintigraphy and genetic testing were routinely used for group B. In two cases, octreotide scintigraphy was coupled with intraoperative radiolocalization of the lesion. Preoperative embolization was performed in four CBTs. Among group B patients, five were pretreated via a covered stent placement in the external carotid artery (ECA). Twenty- three patients (24 CBTs) were eventually operated upon. One cardiovascular death, one permanent vocal cord paralysis and six transient cranial nerve injuries account for a 4.4% 30-day mortality and a 30.4% morbidity with no significant differences among groups. In conclusion, appropriate use of new techniques in CBT management has improved diagnostic accuracy and early detection without clearly affecting overall outcome in our study cohort. [ABSTRACT FROM AUTHOR]