Angiosarcoma of a Femoropopliteal Bypass Thrombosed Vein Graft.

BACKGROUND: Angiosarcoma is a rare subtype of malignant vascular tumours which has been only anecdotally described in patients submitted to lower limb revascularization. CASE PRESENTATION: This paper reports a patient previously submitted to a femoropopliteal bypass using autologous great saphenous vein (GSV). Nine years after the initial surgery, a primary angiosarcoma of the thrombosed vein graft was diagnosed, requiring en bloc surgical resection. Rampant metastatic spread was documented despite primary tumour surgical resection with a dismal outcome within months. CONCLUSIONS: Malignant transformation of autologous vein for lower limb revascularization is extremely rare and anecdotally described in the literature. It is a poorly studied complication with an aggressive behaviour. This report further reinforces the need for early recognition of this pathology.

Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease.

PURPOSE: Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown. CASE REPORT: A female kidney transplant recipient presented with allograft's renal artery thrombosis after a recent COVID-19 infection. Due to the risk of kidney failure or exclusion, catheter directed thrombolysis was performed. Residual thrombus was excluded using an endoprosthesis with an excellent result. There were no adverse events and kidney function improved. CONCLUSION: This paper reports the endovascular treatment of renal artery thrombosis in a living-donor kidney transplant recipient with severe COVID-19 disease.

Iliac side branch technique for repair of bilateral iliac artery aneurysms associated with a congenital pelvic kidney.

Pelvic kidney is a congenital anomaly with few literature reports of concomitant aortoiliac aneurysmal disease. When aneurysm repair is indicated, either open or endovascular, it poses a technical challenge, since kidney preservation is paramount. This paper reports a successful endovascular repair of bilateral common iliac artery aneurysms in a patient with a right congenital pelvic kidney, using iliac side branch technique.

Endovascular Treatment Of A Symptomatic Thoracic Aorta Thrombi.

Aortic mural thrombus is a rare condition with 0.45% incidence in the general population, being the thoracic aorta the most affected portion. In the absence of an atherosclerotic wall lesion, other specific conditions should be studied and excluded. The authors describe two clinical cases of a 64 years old male and a 48 years old female that despite a non- -atherosclerotic diseased aorta, had a thoracic mural thrombus which presented clinically with mesenteric and lower limb microembolization, respectively. Once presented with peripheral embolization, the aim should be to exclude the embolic source and prevent end organ malfunction. TEVAR has been developed as a therapeutic solution to exclude the embolic source, with a high rate of technical success and few comorbidities associated. Long term anti-coagulation is debatable but may prevent further embolization events.

Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment Results.

True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.

[Evaluation of diabetic foot amputation rate]. / Avaliação da taxa de amputações. Consulta multidisciplinar do pé diabético.

In 1987, it was created the first portuguese Diabetic Foot Clinic in Oporto, at the Hospital Geral de Santo António. The distinction between neuropathic and ischaemic foot was the key stone to reduce drastically the rate of major amputations in the first two years of activity. Since then and until 1995 the rate of major amputations had stabilised around 8%. The aim of the present study was to evaluate if there was any change in the last three years. A retrospective study was performed reviewing the clinical files of 843 new patients between 1998 and 2000. The 593 patients who presented with a foot ulcer with or without infection were selected: 60.4% with neuropathic foot and 39.6% with ischaemic one. Overall, 31 of the 593 patients with ulcer or infection were treated with major amputation (5.2%). There was a statistical difference between the major amputation outcome among the two types of foot (p < 0.001). Necrosis showed to carry a poor prognosis (30.7% in ischaemic foot vs 8,3% in neuropathic, p = 0.024). There was no further statistical significance for age, sex, type or duration of diabetes as risk factors for major amputation. This retrospective study has showed a slight reduction in the rate of major amputations since 1995. Poor prognosis was related to necrosis and ischaemic foot. Further improvement requires harder investment in patients' education, as well as in alerting the primary health care physicians, for the most unpredictable catastrophic complication of diabetes.