A Bail Out Solution for an Urgent Situation: Endovascular Exclusion and Embolization of an Infected Femoral Pseudoaneurysm.

PURPOSE: The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. CASE: We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. CONCLUSIONS: In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities.

Usefulness of the Clavien-Dindo Classification to Rate Complications after Carotid Endarterectomy and Its Implications in Patient Prognosis.

BACKGROUND: Our primary objective was to test if the Clavien-Dindo classification (C-D-C) is also applicable for the assessment of carotid surgery and how well it correlates with patient prognosis in the mid-term follow-up. METHODS: From January 2011 to March 2014, a total of 248 consecutive open surgical carotid revascularization procedures were performed at one academic institution. All patients, symptomatic and asymptomatic, had a high-grade (>70%) stenosis and were operated on under general anesthesia. Physicians graded all complications that were identified in the first 30 days after surgery according to C-D-C. Complications were considered "minor" if they were of C-D-C grades I or II. Complications were considered "major" if they were of C-D-C grades III (those requiring surgical, endoscopic, or radiological intervention) or IV (those that are life-threatening). RESULTS: In the analysis of the overall survival, we have found the following differences: (1) survival at 12 months (no complication [NC]: 96.3%, minor complications [Cmin]: 94.3%, major complications [Cmaj]: 85.7%), (2) at 24 months (NC: 93.1%, Cmin: 92.8%, Cmaj: 64.3%), and (3) at 36 months (NC: 87.7%, Cmin: 81.7%, Cmaj: 64.3%). These differences were significant (P = 0.014). When analyzing the stroke-free survival after surgery, the survival rates were as follows: (1) at 12 months (NC: 94.2%, Cmin: 91.3%, Cmaj: 84.6%), (2) at 24 months (NC: 87.7%, Cmin: 82.3%, Cmaj: 61.5%), and (3) at 36 months (NC: 81.13%, Cmin: 76.5%, Cmaj: 61.5%). The significance of the difference is P = 0.016. In the analysis of cardiovascular event-free survival, taking into account not only stroke and myocardial infarction but also major amputation, the survival analysis shows the following results: (1) at 12 months (NC: 90.3%, Cmin: 76.1%, Cmaj: 60%), (2) at 24 months (NC: 81.1%, Cmin: 61.1%, Cmaj: 50%), and (3) at 36 months (NC: 73%, Cmin: 56.8%, Cmaj: 0%). These data also show a difference between the groups (P < 0.001). CONCLUSSIONS: The C-D-C is applicable for patients who underwent a carotid endarterectomy, and the classification seems to make a good correlation of the grade of the complication and the prognosis during follow-up. More studies are needed with larger numbers of patients and longer follow-up times to clarify the use of the C-D-C after vascular surgery and identify high-risk patients. It can also be helpful to homogenize reports and make them comparable.

Endovascular treatment of a symptomatic vertebral artery pseudoaneurysm.

A 35-year-old patient was brought to the emergency department referring dysarthria, left ear tinnitus for 5 min, and short-lasting blindness, with headache in the 45 min before the clinical presentation. In the magnetic resonance imaging, an acute-subacute lesion in the cerebellum right-anterior lobe (in the territory of the cerebellum anterior artery) and a dilatation near the ostium of the right vertebral artery were seen. For a better assessment, an Angio-CT was done, showing a 9-mm saccular pseudoaneurysm of the right vertebral artery close to the origin of the vessel, without being able to determine if it had been caused because of a dissection. The rest of the study (cerebral vessels and supra-aortic vessels) showed no disorders. He was operated under local anesthesia and sedation a week after the onset of the symptoms. Through a 0.014 wire, a Biotronik PK Papyrus balloon-expandable covered cobalt-chromium stent was deployed covering the hole in the artery. Antiplatelet drugs were prescribed, and the patient was discharged 24 hr after surgery. He has remained symptom free since then.

Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy.

Aortic sarcoma is a rare entity. In most cases, the diagnosis is established late, owing to the course of the disease, with a median survival time of only a few months. We report the case of a 58-year-old patient with ischemic lesions in the lower limb. The lesions after several investigations were diagnosed by imaging studies (eg, magnetic resonance angiography, contrast-enhanced computed tomography [CT], CT angiography, or positron emission tomography-CT with fluorine-18 fluorodeoxyglucose) as possible primary angiosarcoma of the aorta. It was decided to perform endovascular aortic repair and endovascular biopsy of the lesion. This was chosen as a "palliative" treatment to avoid embolic events, given the presence of metastases, instead of open surgery, which would otherwise have been the treatment of choice. Subsequently, histologic examination confirmed aortic intimal angiosarcoma, and adjuvant chemotherapy was initiated. In the present report, we discuss the clinical presentation, diagnosis, and classification of primary aortic sarcomas. We also critically review the diagnostic and therapeutic management of these patients in previous series of studies to improve their treatment in subsequent cases.