Spontaneous non-aneurysmal popliteal artery dissection managed without operative treatment: A case report and literature review.

OBJECTIVES: Primary arterial dissection in peripheral arteries of the extremities is exceedingly rare. Isolated dissection of peripheral arteries (femoropopliteal or popliteal) primarily has been reported in aneurysmal arteries. Spontaneous dissection limited to a non-aneurysmal popliteal artery was first described in 1999 by Rabkin et al. METHODS: We report a case of a non-aneurysmal popliteal artery dissection to emphasize its rare condition. RESULTS: A 61-year-old man consulted because of sudden onset of pain and cramps in his left leg after walking 60 metres. A high-resolution duplex ultrasonography could identify a dissection of a non-aneurysmal popliteal artery. Computed tomography angiography could confirm the diagnosis. An operative repair was scheduled 3 weeks later and the patient was put on antiplatelet medication (acetylsalicylic acid 80 mg 1x/day) in the meantime. After 3 weeks the dissection was resolved spontaneously and the patient didn't undergo surgery. Check-ups remained reassuring and we scheduled a duplex ultrasonography within one year. Antiplatelet medication was continued. CONCLUSIONS: Spontaneous dissection limited to a non-aneurysmal popliteal artery is extremely rare. Diagnosis can be made by duplex ultrasonography and/or CT angiography. Treatment options consist of conservative management or operative treatment. Operative treatments consist of an open repair with bypass or interposition graft or minimal invasive endovascular stent grafting. A standardized protocol for conservative treatment in this specific condition is not available. Annual follow-up of these patients is essential.

The CERAB technique: tips, tricks and results.

In this article we wanted to present an overview of the latest study results, in vitro and in vivo, of the Covered Endovascular Reconstruction of the Aortic Bifurcation or CERAB technique and the C-CERAB or Chimney CERAB for the endovascular treatment of either extensive occlusive aortoiliac or iuxtarenal disease with preservation of visceral arteries; in combination with tips and tricks to facilitate recanalization and revascularization. A review was performed of the literature of the last 5 years regarding the endovascular treatment of aortoiliac and iuxtarenal TASC II C& D lesions with covered balloon expandable stents. Furthermore we did a retrospective analysis of our most special techniques to achieve a successful interventional recanalization of these challenging lesions. Both the in vitro and the in vivo studies pointed out that there exists an important benefit of the CERAB configuration with excellent patency rates at one and two years in combination with very low mortality and morbidity, when compared to other techniques. Also the C-CERAB variant seems to be a feasible and safe option; 100% technical success; to deal with iuxtarenal or extensive aortic occlusive disease together with the safeguarding of visceral arteries. The CERAB and C-CERAB techniques may change the treatment algorithm of extensive aortoiliac occlusive disease in the near future and appears to be a safe and feasible alternative with promising results, together with a more anatomical and physiological reconstruction of the aortic bifurcation, being a valid alternative for surgery and/or kissing stents. A few critical issues still need to be solved, such as cost-effectiveness, patient selection, fine-tuning of the technique and defining the optimal medical support.

Chronic venous insufficiency in patients with absence of the inferior vena cava.

OBJECTIVE: Up until now, knowledge of absence of the inferior vena cava (AIVC) is limited to case reports and small case series, usually reported shortly after diagnosis. To characterize long-term evolution of outcomes of patients with AIVC, we performed a survey of current practice in Belgium, The Netherlands, and Luxembourg (Benelux). METHODS: Vascular surgeons and phlebologists in the Benelux area were asked to complete a questionnaire on medical history and treatment of each patient in follow-up at their practice with a diagnosis of AIVC. RESULTS: The Benelux survey yielded 35 patients with AIVC, with a follow-up ranging from 0 to 28 years. Their median age was 40 years (range, 14-65 years), and 26 (74%) were male. Diagnosis of AIVC was made in 26 patients at the time of presentation with deep vein thrombosis (DVT). DVT was bilateral in 15 patients and involved one or both iliac veins in 21 (81% of all AIVC patients with acute DVT). Computed tomography scanning was used to detect AIVC in 29 patients. Thrombophilia was present in 16 (46%). The CEAP C classification was C4-6 in 17 right legs (49%) and 15 left legs (43%). Unilateral or bilateral ulceration had occurred in 11 patients in the past, and three had active ulceration. Long-term conservative treatment consisted of oral anticoagulant treatment in 28 patients and compression stockings in 27. CONCLUSIONS: The results of this survey on AIVC illustrate the unfavorable long-term clinical evolution of these patients. They frequently present with advanced stages of chronic venous insufficiency at a relatively young age, with the development of unilateral or bilateral extensive DVT and subsequent moderate to severe post-thrombotic syndrome.