Superficial femoral artery pseudoaneurysm caused by a solitary femoral shaft osteochondroma in a young adult.

We discuss the presentation, diagnosis, and surgical management of a young man presenting with a symptomatic superficial femoral artery pseudoaneurysm caused by a solitary femoral shaft osteochondroma. We review the existing literature regarding the incidence and management of this problem.

Initial management of noncirrhotic splanchnic vein thrombosis: when is anticoagulation enough?

BACKGROUND: The optimal initial treatment of splanchnic vein thrombosis is uncertain. Anticoagulant therapy has been shown to be associated with vessel recanalization and decreased recurrence. Furthermore, information regarding potential predictors of chronic complications is not well understood. METHODS: A retrospective cohort study involving consecutive patients diagnosed with first-episode noncirrhotic splanchnic vein thrombosis referred to the thrombosis clinic of the authors' institution between 2008 and 2011 was conducted. Demographic and clinical information was collected. The response to initial anticoagulant therapy was evaluated by determining radiographic recanalization of vessels and clinical resolution (defined as the absence of ongoing splanchnic vein thrombosis symptoms or complications requiring treatment beyond anticoagulant therapy). RESULTS: Twenty-two patients were included. Anticoagulant therapy alone resulted in vessel recanalization in 41% of patients and 68% achieved clinical resolution. Two patients experienced bleeding events. Factors associated with a lack of clinical resolution included signs of portal hypertension/liver failure on presentation, complete vessel occlusion at diagnosis, presence of a myeloproliferative disorder or JAK2V617F tyrosine kinase mutation and the absence of a local/transient predisposing factor. CONCLUSIONS: Anticoagulant therapy appeared to be an effective initial treatment in patients with splanchnic vein thrombosis. Clinical factors may help to identify patients who are at risk for developing complications thus requiring closer monitoring. These findings were limited by the small sample size and need to be explored in larger prospective studies.

Patterns of visceral and renal artery involvement in type B aortic dissections.

OBJECTIVE: The main objective of this study was to describe the visceral and renal vessel involvement and the outcomes in thoracic dissections. METHODS: Computed tomography scans of 39 patients were reviewed (30 type B, 9 type A). Visceral and renal arteries were recorded as perfused by the true lumen (TL) or false lumen (FL). Radiologic follow-up was 3.3 years (range 0-10). RESULTS: A total of 156 vessels were analyzed, and 49 (31%) were supplied by the FL. The most common patterns were FL supply of a renal artery (RA) with the visceral arteries and contralateral RA from the TL. In the follow-up, branch vessel compromise occurred in 12 vessels and was more likely to occur when supplied by the FL (P = .01). About 75% of the patients with at least 2 vessels supplied by the FL demonstrated aortic dilatation. CONCLUSIONS: Branch vessel occlusion is more likely in the vessels supplied by the FL. Aortic dilatation occurred more frequently when 2 or more vessels were supplied by the FL.