Stent-graft repair of isolated iliac aneurysms with wide or ectatic necks with use of inverted zenith device legs.

Although there is considerable experience in the management of iliac artery aneurysms (IAAs) accompanying abdominal aortic aneurysms, less is known about endovascular management of isolated IAAs. The distal landing zone can be secured if necessary by extending the graft to the external iliac artery, but the proximal landing zone remains a challenging issue, on which technical success is dependent. The present report describes a novel technique for endovascular management of isolated IAAs with wide proximal necks for which no commercially available grafts with fitting sizes exist: inversion of the iliac leg of a Zenith device.

Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report.

BACKGROUND: Management of patients with co-existent coronary and carotid disease is a controversial and challenging issue. The risk for stroke after coronary artery bypass grafting (CABG) in patients with hemodynamically significant carotid stenosis is up to 30%. In these patients a common practice is to proceed first with the restoration of cerebral perfusion and then perform the coronary revascularization. The rationale is that this strategy will reduce perioperative neurological morbidity and mortality. However, what happens when the carotid procedure is acutely complicated by cardiac instability which necessitates the interruption of the carotid procedure? CASE REPORT: We describe a case of a patient with unstable angina and high grade asymptomatic bilateral carotid stenosis who underwent emergency combined CABG and carotid endarterectomy (CEA). Due to hemodynamic instability, ST-T changes, hypotension and bradycardia, upon completion of endarterectomy we placed a carotid shunt and the patient was put on cardiopulmonary bypass through median sternotomy. After triple CABG (duration of 90 minutes) we concluded the interrupted CEA procedure with primary closure of the carotid arteriotomy with the shunt in place. The postoperative course was uneventful and the patient was discharged after a week. In extreme cases with bilateral severe carotid stenosis and coronary artery disease where the carotid procedure should be interrupted, we suggest the use of carotid shunt which can provide adequate cerebral perfusion giving time to cardiac surgeon to perform the life saving cardiac procedure first.

Clinical correlation of nitric oxide levels with acute rejection in renal transplantation.

BACKGROUND: The objective of this study was to examine whether there was an association between acute rejection (AR) and nitric oxide (NO) levels and also to evaluate the clinical impact of NO measurement as a noninvasive marker for early detection of AR. METHODS: Fifty consecutive patients aged 17-62 years old received a living-related kidney graft. Serum levels of total nitrite and nitrate (NOx) were measured 30 min after graft reperfusion (NOx 1) and on days 1 (NOx 2), 5 (NOx 3), and 10 (NOx 4) post-transplantation (Tx). If clinically indicated, graft biopsy was performed. RESULTS: Acute humoral rejection was diagnosed by biopsy on 3rd post-Tx day in one patient. His serum NOx 2 levels were remarkably higher (380%) compared with his NOx 1 measurement. At the same time, NOx 1-2 measurements in uncomplicated group showed lower levels (-12%). Additionally, during the first month post-Tx, 5 cases of acute cellular rejection (ACR) were diagnosed. The mean percent change of NOx 3-4 levels in ACR group was 180.7 versus 16.1 in uncomplicated patients (P < 0.01). In addition, >70 µmol/L change in NOx levels in consecutive samples had a sensitivity of 100% and a specificity of 97.7% in predicting AR episodes. CONCLUSION: Our study reports significant increase in serum NOx levels in episodes of AR. NOx might be an useful noninvasive marker for early diagnosis of AR.

Acute limb ischemia in a patient with cardiac amyloidosis: a case report.

INTRODUCTION: Cardiac amyloidosis is a manifestation of several systemic diseases known as amyloidoses. Arterial thromboembolic complications have not been reported to occur frequently, although the pathophysiology of cardiovascular amyloidosis would theoretically predispose to such manifestations. CASE PRESENTATION: We present the case of a 52-year-old woman, who suffered from cardiac amyloidosis and was admitted to our hospital for left acute limb ischemia. An urgent embolectomy was performed, improving her clinical condition and the pathologoanatomic examination of the embolus revealed deposition of amyloid. CONCLUSION: Peripheral arterial thromboembolic events in patients with amyloidosis are rare. An antiplatelet treatment is recommended in such patients with cardiac amyloidosis for the prevention of embolism.