Endovascular approach in chronic aortoiliac disease in patient undergoing coronary artery bypass surgery.

Internal thoracic artery (ITA) is an excellent conduit for coronary artery bypass surgery (CABG). We present a patient with known preoperative aortoiliac disease with anterior collateral pathway who had an indication for elective coronary bypass. The use of ITA in these patients may cause lower limb ischemia. Detecting Winslow's anastomotic pathway before CABG is of utmost importance.

Mycotic aneurysm of the internal carotid artery.

Mycotic aneurysms of the extracranial carotid artery are rare. We describe a case of a patient with an aneurysm of extracranial internal carotid artery, presented as a swelling at the right submandibular triangle. Carotid angiography revealed a saccular aneurysm. During the operation, an abscess, due to Salmonella, was found around the aneurysm. Ten days later, after the drainage of the pus, new carotid angiography revealed thrombosis of the right internal carotid artery. Two months later, the physical condition of our patient improved.Atherosclerosis, trauma, and many microbial agents are common causes of the aneurysm. The symptoms of the aneurysm may vary according to its size and location. Pain over the aneurysm is a common symptom. Rupture of the aneurysm is the most dramatic complication. Clinical examination, color Doppler ultrasonography, angiography, and computed tomography are the most common diagnostic modalities. Differential diagnosis must be done from other expansive pathologies. Resection of the aneurysmatic sac with restoration of flow is the preferred method of treatment.

New exposure technique for management of giant internal carotid artery aneurysm.

We are presenting a case of giant internal carotid artery aneurysm (ICAA) managed by a new exposure technique. Following double mandibular osteotomy, the exposure of the entire aneurysm was achieved by mandible mobilization. The aneurysm repair was performed by resection and graft interposition. Mandible bone reconstruction was succeeded via mini plate osteosynthesis. No adverse events were noticed during the 24-month follow-up period. The surgical ICAA management is necessary to prevent severe complications. In cases of aneurysm extension to the skull base, double mandibular osteotomy is a safe technique that facilitates aneurysm exposure and control.

Traumatic pseudoaneurysm of the popliteal artery after blunt trauma: case report and a review of the literature.

Pseudoaneurysms of the popliteal artery following trauma are rare lesions. We present 3 cases of pseudoaneurysms of the popliteal artery (4, 20, and 45 years old respectively) with a delayed presentation, following blunt trauma, presenting over a 3-year period, and a short review of the relevant literature. A delayed pattern of presentation, over 2 years after blunt popliteal trauma, was observed in all patients. They presented with a painful pulsatile mass in the popliteal fossa, and their peripheral pulses were normal. Orthopedic and rheumatologic evaluation findings were negative. Diagnostic evaluation included triplex, arteriography, and computed tomography angiography. A posterior popliteal approach was used, and after aneurysmal excision, reversed great saphenous vein and lesser saphenous vein (1 patient) grafts were used. After 2 to 4 years of follow-up, all grafts remain patent and the patients have fully functional limbs. A literature search revealed 70 cases of pseudoaneurysms of the popliteal artery reported in civilian settings. These lesions should be repaired shortly because their complications (rupture, thromboembolic episodes) carry a high risk for limb dysfunction and amputation. Penetrating or blunt trauma is the main causative factor (62.5%), but iatrogenic trauma accounts for an increasing number of reports (37.5%). Strict follow-up of popliteal trauma is essential. A high level of suspicion and awareness can lead to early diagnosis and treatment of pseudoaneurysms of the popliteal artery and prevent the serious complications associated with these lesions.