Endovascular treatment of iatrogenic arteriovenous fistula of the iliac vessel.

BACKGROUND: Iatrogenic vascular injuries, due to the particular nature of such pathology, are associated with high morbidity and mortality in the postoperative period. OBJECTIVES: The objective of this study was to present a case of non-classic approach to the therapy of iatrogenic arteriovenous fistula. MATERIAL AND METHODS: We present a case of a 17-year old female patient admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Lódz, Poland) due to an iatrogenic injury to the common iliac vein and artery, following neurosurgical intervention on the spine. Two weeks prior to admission, the patient underwent surgery in the Neurosurgery Clinic for herniated nucleus pulposus and lumbar spine scoliosis. The imaging diagnostic revealed the presence of a pseudoaneurysm of the right common iliac artery and arteriovenous fistula between the right common iliac vessels. The patient was qualified for endovascular treatment. Two self-expanding covered stents were successfully deployed. The clinical and radiological outcome of the procedure was good. The postoperative period was uneventful. The patient was discharged home on the 3rd postoperative day. RESULTS: The control examinations (directly after the procedure and 6, 12, 24 and 32 months thereafter) revealed full patency of the iliac vessels, as well as no recurrence of arteriovenous fistula, nor a pseudoaneurysm of the right common iliac artery. No symptoms of either chronic limb ischaemia or venous insufficiency were observed. CONCLUSIONS: Iatrogenic vessel injury, being a complication of neurosurgical and orthopedic surgeries, may be overlooked and remain undetected both in intraand postoperative period. Modern imaging techniques allow for an adequate diagnosis of the injury and planning the treatment of arteriovenous fistula. The endovascular procedures are the method of choice in patients with arteriovenous fistulas of iliac vessels, alternative to open surgery.

Endovascular management of aortic dissections involving the common carotid and subclavian arteries.

Aortic dissection is a life-threatening condition, in which rupture of the internal wall of the aorta is observed. The aim of the study was to present the techniques used in patients with type A Stanford aortic dissection treatment by means of carotid-carotid by-pass surgery and implantation of the aortic stent-graft with intentional occlusion of the left common carotid and subclavian arteries. Surgical methods were presented on the basis of three patients treated at the Department of Vascular, General and Oncological Surgery, Memorial Copernicus Hospital in Lódz. Different carotid- carotid bypass grafting techniques were also described. Our own clinical observations demonstrated that patients with retro-pharyngeal carotid-carotid bypass did not report dysphagia, and retropharyngeal grafting seems to be the optimal method considering patients in whom stent-grafts cause left carotid artery occlusion.