Carotid Near-Occlusion: Surgical or Conservative Management? Retrospective Multicenter Study.

BACKGROUND: Carotid near-occlusion (CNO) represents an anatomical-functional condition characterized by severe (more than 90%) internal carotid artery stenosis which can lead to a distal lumen diameter greater or less than 2 mm. CNO can be divided into a less severe subgroup (without lumen full collapse: diameter >2 mm) and a more severe subgroup (with lumen full collapse: diameter <2 mm). The decision for revascularization is still highly debated in Literature. The aim of the present multicenter retrospective study is to analyze the incidence of perioperative (30 days) and follow-up complications in 2 groups of patients with or without distal internal carotid lumen full collapse. METHODS: Between January 2011 and March 2023, in 5 Vascular Surgery Units, 67 patients (49 male, 73% and 18 females, 27%) with CNO underwent carotid endarterectomy: 28 (41.7%) with lumen diameter <2 mm and 39 (58.3%) with diameter >2 mm. 19 patients were symptomatic and 48 asymptomatic. The outcomes considered for comparative analysis were: perioperative neurological and cardiac complications, carotid restenosis or occlusion at follow-up. Both groups were homogeneous in terms of risk factors, morphological features and pharmacological treatments. RESULTS: In the group with lumen <2 mm, 3 perioperative major events (10.7%) occurred (1 ischemic stroke, 1 hemorrhagic stroke, 1 myocardial infarction) and 2 (7.1%) at follow-up (average 11 ± 14.5 months; 1 asymptomatic carotid occlusion, 1 hemodynamic restenosis treated with stenting). No event was recorded in the group with lumen >2 mm. CONCLUSIONS: According to our results CNO patients show different complication risk according to the presence or not of distal lumen collapse. The later seems to play a significant role in perioperative and follow-up complication rate. These results therefore support a surgical treatment only in patients with CNO without lumen full collapse.

Acute aortobiliac graft thrombosis.

INTRODUCTION AND IMPORTANCE: Acute limb ischemia after infrarenal aortic repair is a rare complication, which in mainly described to appear in a short time after surgery.The aim of this paper is to describe a case of a 66-year-old woman who presented at out attention with acute right limb ischemia, one year later an aortic repair for acute abdominal aortic aneurysm rupture. In the best of our knowledge there are no cases of sudden graft occlusion after such long time, described in literature. CASE PRESENTATION: Patient presented with sudden pain and pallor in the right lower limb and subsequently same symptoms to the left lower limb. One year before she underwent an emergency repair for abdominal aortic aneurysm rupture with an aortobiliac graft. Computed Tomography Angiography (CTA) scan showed a complete occlusion of the infrarenal aorta, including aortoiliac graft, to the common bilateral iliac arteries. On the right side was also found a complete occlusion of the popliteal artery.Emergent embolectomy of the right popliteal artery via the femoral artery was performed. CLINICAL DISCUSSION: CTA scan performed on third post-operative day showed the patency of infrarenal aorta and aortic portion of the grafts in presence of floating thrombus, right iliac branch patency and chronic occlusion of left iliac branch. A kinking of both graft iliac branches was evident after this CTA scan. CTA scan at one month demonstrated resolution of the thrombosis of the infrarenal aorta, complete patency of aortic portion of the graft and right iliac branch and chronic obstruction of the left common iliac artery. CONCLUSION: Acute limb ischemia caused by sudden graft occlusion one year later an aortic repair for acute abdominal aortic aneurysm rupture is a very rare event. Graft limbs kinking could explain acute thrombosis of the graft.

Symptomatic Pancreaticoduodenal Artery Aneurysm in a Patient with Prior Aortic Surgery and Celiac Trunk Obstruction: Case Report.

Pancreaticoduodenal artery aneurysm (PDA) is a rare visceral aneurysm and represents 1.5% of all the visceral arterial aneurysms. An 81-year-old man was admitted with acute abdominal pain. He suffered 2 previous episodes of pancreatitis and underwent abdominal aortic aneurysm repair 11 years before. The computed tomography scan revealed a 92-mm aneurysm of inferior PDA artery with prerupture signs associated with the celiac trunk obstruction. The patient underwent a selective catheterization and embolization of superior PDA artery with coils, inferior PDA artery with 12-mm Amplatzer, and aneurysm sac embolization by Onyx and coils. The postoperative course was uneventful and the patient was discharged on the fourth postoperative day. Celiac trunk stenosis could be one of the possible etiology but atherosclerosis and pancreatitis are the 2 most common risk factors. Treatment of choice is yet to be established and it has to be properly defined "case by case"; surgery, endovascular embolization, or percutaneous thrombin injection are valuable approaches.