Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.

Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up.

Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?

OBJECTIVES: This study was conducted to investigate the progression of lower extremity ischemia following kidney transplantation to iliac artery in patients with peripheral arterial disease. METHODS: A retrospective chart review of all renal transplant patients completed at a university teaching medical center from January 2006 to December of 2011 was performed. A total of 219 patients underwent successful kidney transplantation to the common, external, or internal iliac artery. Pre- and post-transplantation ischemic changes in the ipsilateral lower extremity were reviewed and analyzed. RESULTS: Thirty-eight of the 219 patients had ipsilateral peripheral arterial disease and seven of them were symptomatic. Six of the seven symptomatic patients remained stable and one patient's rest pain improved, postoperatively. Eight patients developed new symptoms of ischemia 12 months later, including four with claudication, two with ischemic ulcers, and two with gangrene toes. The ulcers were healed following superficial femoral artery stenting and wound care. Toe amputation was performed in two patients with gangrene. No major amputation was required up to 48 months of follow-up. CONCLUSIONS: Transplanted kidney to iliac artery does not significantly deteriorate ischemia in adults with ipsilateral lower extremity peripheral arterial disease. Late developed ischemic complications may be due to the progression of underlying arterial disease.

Physician modification of Gore C3 excluder endograft for treatment of abdominal aortic aneurysms anatomically unsuitable for conventional endovascular repair.

Until recently, the Cook Zenith aortic endograft (Cook Medical Inc, Bloomington, Ind) was the only device used for physician-modified fenestration because its constraining wire allowed physicians to reconstrain the device after modifications. Although the Cook Zenith fenestrated endograft has been approved by the Food and Drug Administration, it is currently not available in the majority of the hospitals and is not applicable to the patients who need urgent or emergent aneurysm repair. With the redesign of the Gore C3 delivery system, the Gore Excluder aortic stent graft (W. L. Gore & Associates, Inc, Flagstaff, Ariz) can now also be reconstrained, which makes it suitable for physician-modified fenestration. We describe the technique for modification and implantation of the Gore Excluder aortic stent graft in a patient requiring 2-vessel bilateral renal artery fenestration. This application provides an additional option for treatment of patients with abdominal aortic aneurysms who are anatomically unsuitable for conventional endovascular aneurysm repair and are at high risk for open repair.

Percutaneous In situ Left Subclavian Artery Fenestration Using Reentry Catheter during Endovascular Thoracic Aortic Aneurysm Repair.

Left subclavian artery (LSA) revascularization is recommended during elective thoracic endovascular aortic aneurysm repair (TEVAR) when coverage is required for adequate proximal seal. Reported method for LSA revascularization includes open bypass, covered stent placement using chimney technique, and in situ laser fenestration. We reported a novel technique using percutaneous Outback reentry device for LSA revascularization in a 68-year-old male patient who underwent TEVAR for a 9-cm thoracic aortic aneurysm. This technique can be used as an alternative method for LSA in situ fenestration, and laser equipment is not required.

Endovascular repair of symptomatic carotid artery aneurysm with covered stent: A case report and literature review.

OBJECTIVES: Extracranial carotid artery true aneurysm is extremely uncommon, and definite treatment has traditionally involved open surgical repair. Although successful management of the internal carotid artery aneurysms using endovascular stenting and embolization has recently been reported, only a limited number of cases have been reported. METHODS: We present a case of symptomatic carotid true aneurysm repaired with covered stent and coil embolization of the external carotid artery. We also review the English literature and discuss the epidemiology, causes, diagnosis, and management options of internal carotid artery aneurysms. RESULTS: The patient did not have any complications, and was discharged home on the postoperative day 1 in stable condition. CONCLUSION: Our report suggests that endovascular procedure is feasible in the treatment of extracranial carotid artery aneurysms.

Symptomatic popliteal vein aneurysm.

Popliteal vein aneurysms (PVAs) can have serious consequences, including pulmonary embolism and death. We report a case of PVA in a previously healthy 58-year-old female with a history of pain in her right popliteal fossa for the past 3 years. Patient had no history of trauma or claudication of the right leg. Following a preoperative venogram to confirm the diagnosis, the PVA was dissected circumferentially through a posterior incision. The aneurysm was resected and repaired with lateral venorrhaphy. Patient had an uneventful recovery. Due to the possibility of severe consequences, if left untreated, early surgical repair is highly recommended whether the patient has symptoms or not.