Anaphylactic Reaction during Implantation of Ovation Abdominal Stent Graft in Patients with Abdominal Aortic Aneurysm.

The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis planned to overcome the limitations of currently available stent grafts, allowing complex iliac and femoral access and providing a proximal seal in challenge infrarenal neck morphology. The proximal sealing is achieved by means of a network of inflatable rings filled with low-viscosity radiopaque polyethylene glycol-based polymer during stent-graft deployment. The leakage of polymer outside the channel to fill the rings into the vascular system may induce an hypersensitivity reaction and anaphylactic shock. We report a case of anaphylactic reaction during Ovation Abdominal Stent Graft System implantation. The endovascular procedure was successfully concluded.

Combined brachial embolectomy and stent graft endovascular exclusion in the treatment of acute arm ischemia due to subclavian artery aneurysms thrombosis or distal embolization.

AIM: Purpose of this study is to report our results after simultaneous transbrachial embolectomy and endovascular aneurysm exclusion with stentgraft in the treatment of upper limb acute ischemia due to subclavian artery aneurysm thrombosis and embolization . METHODS: From January 2010 to December 2015, seven consecutive patients (6 men; mean age 71.5, range 44-85) underwent to emergent revascularization for upper limb ischemia due to thrombosis/embolization of SAA by means of brachial embolectomy and endovascular exclusion. Demographics, clinical, surgical data, complications and survival were recorded. Univariate analysis by chi-square was carried out to evaluate the role of demographics data and risk factors variables on reconstruction patency rate. Primary, primary assisted and secondary patency and limb salvage were calculated using the Kaplan Meyer's life table method. RESULTS: Successful treatment was achieved in all cases. No postoperative death or complications occurred. Primary and assisted primary patency rates at 1 and 3 years were respectively 85.7%, 71.4% and 100%.Secondary patency and limb salvage at 1 and 3 years was 100%. A fatal ischemic stroke occurred in 1 case at 6 months (14.2%). A redo PTA was carried out at 24 months. Univariate analysis showed as demographics data and risk factor variables did not influence the primary, assisted primary, secondary patency rate and limb salvage. CONCLUSION: Endovascular repair is a less invasive alternative to open repair especially in high risk patients. long term results must still be confirmed in further studies. KEY WORDS: Arm ischemia, Endovascular treatment, Subclavian aneurysm.

Endovascular Treatment of Symptomatic Thrombus of the Descending Thoracic Aorta.

Thoracic aorta mural thrombosis (TAMT) is uncommon pathology with potentially catastrophic complications due to recurrent spontaneous distal embolization. Best treatment, medical or surgical, is still under debate especially in high-risk patients. Endovascular approach by means of thoracic endoprosthesis seems to be a feasible and minimally invasive treatment option. We report a successful treatment of symptomatic TAMT using a thoracic aortic stent graft in a high-risk patient for open repair and contraindication to systemic anticoagulation.

Endovascular central venous stenosis treatment ended with superior vena cava perforation, pericardial tamponade, and exitus.

Venous hypertension and outflow stenosis of arteriovenous hemodialysis access managed using endovascular procedures usually present a high technical success rate, with few complications. We reported a rare and fatal complication of superior vena cava perforation with pericardial tamponade 3 months after subclavian vein stenting. Interventional recanalization with stenting for the management of superior vena cava syndrome or central vein stenosis is a safe procedure with a low complication rate. Stent misplacement, reocclusion, migration, or access-related complications appear to occur most frequently.

Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience.

OBJECTIVES: We prospectively evaluated safety and efficacy from our six-year results of general anesthesia (GA) using remifentanil conscious sedation in carotid endarterectomy (CEA). METHODS: From January 2005 to December 2010, 625 consecutive CEAs were performed on 545 patients (male/female 336/209, age 75 ± 7 years). After a superficial plexus block with ropavacaine, GA was induced with an intravenous infusion of propofol, using local lidocaine during tracheal intubation and a high-dose of remifentanil, in all cases reducing and then stopping the remifentanil infusion at the clamping time so that the patient would be awake and collaborating within a few minutes, as in local anesthesia. Data on postoperative morbidity and mortality, neurological complications, shunt insertions and the responses to one-day and three-month questionnaires on satisfaction were collected for all patients. RESULTS: The 30-day mortality was 0.32% (two patients). Only one major stroke (0.16%) and two minor strokes (0.32%) occurred. A shunt was deployed in 83 cases (13.3%). Eight patients (1.28%) reported cranial nerve injuries, and surgical drainage for postoperative hematoma was performed in 11 patients (1.8%). Thirty-one patients (4.6%) suffered postoperative nausea/vomiting. Almost all patients were satisfied at the 24-h (94.6%) and three-month (>98%) follow-up questionnaire. CONCLUSIONS: The six-year results for GA using remifentanil conscious sedation were very satisfactory and highlighted the advantages of both GA (hemodynamic stability and excellent control of ventilation) and local anesthesia (ease of evaluation of neurological status) in a calm and relaxed environment for both patient and surgeon.

A singular case of iatrogenic axillofemoral bypass disruption: a dramatic event treated by a lucky combined approach.

Proximal disruption of an axillofemoral bypass is a catastrophic event rarely caused by a posttraumatic anterior dislocation of the shoulder. Herein, we present a 74-year-old man with a painful dislocation of the right shoulder that was successfully reduced. Three hours later he had hemodynamic shock with an expanding and pulsating hematoma at the level of the right shoulder, pectoral and infraclavicular region. Surgical exposure of the right brachial artery was carried out, and intraoperative angiography revealed a proximal anastomotic leakage. The distal ballooning improved the hemodynamic status, and by a redo infraclavicular incision the hematoma was drained. The arterial leak was repaired by an 8 mm polytetrafluoroethylene interposed graft between the axillary artery and existing graft. The utility of a combined approach (endovascular + open surgical) is discussed.

Spontaneous rupture of the superficial femoral artery treated via an endovascular approach.

Isolated spontaneous rupture of the superficial femoral artery is very uncommon. To our knowledge, only 5 other cases have been reported in the medical literature. Herein, we report the case of an 86-year-old woman who was admitted to our hospital with a 4-day history of progressive swelling of the left thigh. The presence of a pulsating mass with paresthesia of the lower limb and anemia suggested a hematoma of the thigh. A computed tomographic scan revealed a 4-cm-diameter pseudoaneurysm of the left superficial femoral artery and a large hematoma of the medial muscle compartment. A nitinol-polytetrafluoroethylene VIABAHN self-expanding stent-graft (5-mm diameterx50-mm length) was placed beyond the arterial lesion, and a fasciotomy of the thigh was performed. On the 10th postoperative day, the patient was discharged from the hospital in good condition. In cases of spontaneous swelling of the thigh in the absence of trauma or other apparent causes, spontaneous rupture of the superficial femoral artery should be suspected. Surgical treatment is preferable in young patients. In patients who are elderly or in poor condition, endovascular therapy is preferable when there is diffuse atherosclerosis of the artery.

Lower limb ischemia after migration of a coronary artery stent into the femoral artery.

A coronary stent may be lost in the peripheral or visceral arterial system with an incidence ranging from 0.9 to 8.4%, however, a limb or organ ischemia after stent migration is very uncommon. We report the case of an 83-year-old man who underwent coronary artery stenting at our Hospital's Cardiological Department. During this difficult procedure, due to the critical stenosis of the circumflex artery, the stent was accidentally lost and found at the level of the insertion of the right common femoral on the external iliac artery. After several attempts to rescue the stent through an omolateral and contralateral femoral approach with the hook technique, the right common, superficial and profunda femoral arteries were surgically exposed. The stent was easily removed from the origin of the profunda femoral artery by a longitudinal arteriotomy. Finally, the arteriotomy was closed with a homologous saphenous vein patch. We underline the importance of an early extraction of the stent, discussing the preferable surgical approach to minimize the possible dramatic complications in the peripheral artery system.