Diffuse aneurysmal degeneration of the brachial artery after long-standing high-flow arteriovenous fistula closure for hemodialysis at elbow level.

While the possibility of development of a panarterial dilatation proximal to a long-standing high-flow posttraumatic arteriovenous fistula is well known, to the best of our knowledge, this event has never been described after vascular access for hemodialysis closure. We describe a man in whom a diffuse aneurysmal degeneration of the brachial artery has been highlighted 6 months after long-standing high-flow arteriovenous fistula closure. A 47-year-old man developed a painful pulsatile mass in the anterior distal third of his arm 6 months after long-standing high-flow arteriovenous fistula closure at the level of his elbow. A computed tomography scan revealed multiple "true" aneurysms of the brachial artery (BA) that appeared enlarged in toto. One of these aneurysms (near the BA bifurcation) presented with significant thrombus stratification. Surgery was recommended because of the major risk of peripheral embolization. Considering the anatomic characteristics of both the BA and aneurysm, no arterial substitution was performed and, after removal of the thrombus, the aneurysm diameter was reduced via direct arterial wall suture. The patient was discharged under oral anticoagulation. Aneurysmal degeneration of the donor artery after vascular access is relatively rare but represents a challenging problem. Operative or conservative management of these aneurysms should evaluate both the possible aneurysm-related complications and the feasibility of vascular reconstruction. In this context, the risk of additional donor artery and/or vascular reconstruction enlargement over time should also be considered.

Multiple aneurysms of the radial artery in a woman with neurofibromatosis type 1 presenting as aneurysm rupture.

A 48-year-old woman with neurofibromatosis type 1 (NF1) experienced progressive forearm swelling coupled with impending compartment syndrome. Computed tomography angiography revealed a ruptured aneurysm of the proximal radial artery, multiple fusiform radial artery aneurysms, and a high independent ulnar artery origin. Compartment syndrome required prompt hematoma evacuation. Radial artery reconstruction, technically demanding due to vessel wall fragility, was deemed unnecessary because of satisfactory blood supply to the hand. Histologic findings indicated NF1-related vascular abnormalities also in the apparently normal radial artery as well as in a forearm vein, suggesting diffused vasculopathy. This case report is the first on ruptured radial artery aneurysm in NF1-related polianeurysmatic degeneration.

Endovascular exclusion coupled with operative anterior leg compartment decompression in a case of postthromboembolectomy tibialis anterior false aneurysm.

The aim of this study was to present a case of iatrogenic thromboembolectomy-related tibialis anterior false aneurysm (FA) treated with endovascular FA exclusion and anterior leg compartment (ALC) operative decompression and to assess the current management options in posttraumatic leg vessel FAs. A 68-year-old man had a painful pulsating mass in the superior ALC 2 months after a thromboembolectomy was performed during popliteal aneurysm repair. He had been discharged under oral anticoagulation and had ALC manual massages for mild post-revascularization leg edema. Angio-CT showed tibialis anterior injury successfully treated with a covered stent graft, while a residual ALC hematoma was surgically evacuated. Endovascular treatment of tibialis anterior FAs using a covered stent graft is an excellent therapeutic option. After an endovascular procedure, caution must be taken to identify the need for early operative ALC decompression. Current leg vessel FA management should consider both the specific anatomic characteristics of the FA and the possibility of development of delayed compartment syndrome.

Temporary dense seismic network during the 2016 Central Italy seismic emergency for microzonation studies.

In August 2016, a magnitude 6.0 earthquake struck Central Italy, starting a devastating seismic sequence, aggravated by other two events of magnitude 5.9 and 6.5, respectively. After the first mainshock, four Italian institutions installed a dense temporary network of 50 seismic stations in an area of 260 km2. The network was registered in the International Federation of Digital Seismograph Networks with the code 3A and quoted with a Digital Object Identifier ( https://doi.org/10.13127/SD/ku7Xm12Yy9 ). Raw data were converted into the standard binary miniSEED format, and organized in a structured archive. Then, data quality and completeness were checked, and all the relevant information was used for creating the metadata volumes. Finally, the 99 Gb of continuous seismic data and metadata were uploaded into the INGV node of the European Integrated Data Archive repository. Their use was regulated by a Memorandum of Understanding between the institutions. After an embargo period, the data are now available for many different seismological studies.

Factors Affecting Long-Term Results of Above-Knee Femoropopliteal Bypass: A Single-Center Contemporary Study.

INTRODUCTION: The aim of this study was to assess whether individual patients' or bypass characteristics may influence long-term results of prosthetic above-knee femoropopliteal bypasses in patients with claudication in today's endovascular era. METHODS: Seventy-one consecutivee Expanded Polytetrafluoroethylene (e-PTFE) bypasses were considered. All patients presented a debilitating claudication. Patency of grafts was achieved by Kaplan-Meier method. The association between individual patients' or graft characteristics and primary patency (PP) or secondary patency (SP) was assessed via Cox regression models. RESULTS: An immediate technical success was achieved in all cases. No patient was lost during follow-up (8-90 months, median = 34 months). The median PP was 48 months. Occlusion occurred in 32 bypasses (45%). Eight (25%) of these were treated conservatively. Fifty-two bypasses (73%) were still patent at the end of follow-up, and 13 (25%) of these had been submitted to one or more surgical revisions. There were 2 graft infections. Of 17 (25%) patients with occluded graft at the end of follow-up, 2 (2.8%) had significant aggravation followed by limb loss. The PP was directly influenced by undetected minor distal anastomosis technical defects (hazard ratio [HR] = 5.89, P value = .000002), popliteal artery size (HR = 0.62, P value = 0.007), and distal anastomosis angle ≥40° (HR = 5.55, P value = .003). The SP was associated strictly to technical defects (HR = 11.08, P value = .000007). Multivariable analyses confirmed the influence of technical defects (HR = 6.42, P value = .000003) and anastomosis angle (HR = 1.05, P value = .009) on PP and that of technical defects on SP (HR = 10.84, P value = .00003). A significantly shorter SP was also observed after a previous failed endovascular treatment on the superficial femoral artery (HR = 3.73, P value = .02). CONCLUSION: An adequate arterial size, an ideal anastomotic angle, and the absence of minor, technical defects have a major role in prosthetic above-knee femoropopliteal bypass long-term outcome. A previous, failed endovascular procedure on the superficial femoral artery could markedly alter the natural history of patients with claudication because this approach seems to have a detrimental effect on long-term outcome of grafts needing surgical revisions.

Internal carotid artery dissection after inferior alveolar nerve block for third molar dental care presented as hypoglossal nerve palsy.

Cervicocephalic artery dissections occurring during dental care have exceptionally been reported. We describe a case of internal carotid artery dissection, presenting as hypoglossal nerve palsy, occurring immediately after difficult inferior alveolar nerve anesthetic block for third inferior molar dental care. Carotid dissection was successfully treated with anticoagulation therapy while hypoglossal nerve palsy recovered with carotid dissection shrinkage. The etiopathogenetic mechanisms of this singular form of internal carotid artery dissection are discussed. The possibility of internal carotid artery dissection development during oral or dental procedure, specifically in cases of possible trivial intraoperative internal carotid artery injury, severe local periodontal infection, or prolonged cervical hyperextension should be considered. Every possible prophylactic measure should be taken (eg, sedating the patient during oral or dental procedures, aggressive preoperative management of general and local periodontal chronic infections, avoiding prolonged perioperative neck hyperextention) to prevent this very rare but potentially life-threatening complication.