Retrograde Use of Gore Hybrid Vascular Graft for a Complex Carotid Tandem Lesion.

BACKGROUND: Successful treatment of tandem lesions of carotid arteries may represent a challenging goal for the vascular specialist. In the "endovascular era," a hybrid approach may represent a viable option. CASE REPORT: We describe the case of a 65-year-old patient with severe postcarotid endarterectomy recurrent stenosis of the internal carotid artery (ICA) associated with primitive stenosis of the proximal common carotid artery (CCA) treated with retrograde stenting and carotid bypass using the Gore Hybrid Vascular Graft (GHVG). CONCLUSIONS: We demonstrated the effectiveness of the hybrid technique using GHVG in treating carotid tandem lesions involving CCA and ICA.

Percutaneous Embolization of Delayed External Carotid Artery Pseudoaneurysm Eight Years after Partial Parathyroidectomy.

External carotid artery pseudoaneurysm (ECAP) is very rare. The usual mechanism is trauma or iatrogenic. We report a case of a patient with an asymptomatic, chronic ECAP secondary to partial parathyroidectomy. Percutaneous injection of the 2-component Fibrin Sealant (Tisseel; Baxter int, Deerfield, IL) with the 2 active ingredients (Sealer Protein Solution and Thrombin Solution) was carried out with successful occlusion of the pseudoaneurysmal sac. The 6-month follow-up computed tomographic scan confirmed the ECAP thrombosis. The ECAP endovascular approach is less invasive and reduces the complications of the open surgical intervention, especially in high-risk patients or presenting with hostile neck.

Extra-Anatomic Revascularization of Extensive Coral Reef Aorta.

BACKGROUND: Coral reef aorta (CRA) is a rare, potential lethal disease of the visceral aorta as it can cause visceral and renal infarction. Various surgical approaches have been proposed for the CRA treatment. The purpose of this article is to report different extensive extra-anatomic CRA treatment modalities tailored on the patients' clinical and anatomic presentation. METHODS: From April 2006 to October 2012, 4 symptomatic patients with extensive CRA were treated at our department. Extra-anatomic aortic revascularization with selective visceral vessels clamping was performed in all cases. RESULTS: Technical success was 100%. No perioperative death was registered. All patients remained asymptomatic during the follow-up period (62, 49, 25, and 94 months, respectively), with bypasses and target vessels patency. CONCLUSIONS: The extra-anatomic bypass with selective visceral vessels clamping reduces the aortic occlusion time and the risk of organ ischemia. All approaches available should be considered on a case-by-case basis and in high-volume centers.

Proximal Embolic Protection Devices in Complicated Carotid Artery Stenting.

The most frequent complication during carotid artery stenting (CAS) is intraoperative distal embolization. Three categories of embolic protection devices (EPDs) are routinely used through a transfemoral or transcervical approach: distal occlusion devices, distal EPDs with flow preservation using filters, and the proximal occlusive protective systems. We report the case of the internal carotid artery (ICA) plaque rupture during CAS using a proximal EPD (the Mo.Ma system; INVATEC), treated with immediate surgery. The proximal occlusive protective system permitted the common carotid artery and ICA endoclamping for the time necessary to prepare the patient for the carotid endarterectomy. The EPDs should always be chosen considering the patient's and lesion's characteristics. This knowledge allows their use even as "bridge" endovascular devices.

Bilateral true giant aneurysm of the profunda femoral artery: case report and review of the literature.

We report a rare case of a bilateral true giant aneurysm of the profunda femoral artery aneurysms (PFAAs) in a 80-year-old man with a previous history of "open" abdominal aortic surgery and small bilateral popliteal artery aneurysm. In the English Literature only seven previously cases of true bilateral PFAAs are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.