Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage: Outcomes From a Prospective Single-Center Moroccan Registry.

PURPOSE: To evaluate endovascular repair of thoracoabdominal aortic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) using the Multilayer Flow Modulator (MFM) in high-surgical-risk patients with at least one covered branch vessel. METHODS: In this prospective single-center nonrandomized trial, 18 patients (mean age 61.1 years; 16 men) with TAAA (n=10, mean diameter 74.4 mm) and AAA (n=8, mean diameter 67.8 mm) were treated with the MFM between June 2009 and September 2012. The primary safety endpoints were all-cause mortality at 30 days and 12 months and neurological complications. The primary efficacy endpoint was overall procedure success, defined as patency of covered branch vessels, reductions in aneurysm diameter, and sac thrombus formation. RESULTS: The technical success rate was 100% (53 study devices implanted, mean stented length 273 mm). Through mean follow-up of 13.4 months, all 61 covered branch vessels remained patent; there were no neurologic complications, ruptures, or instances of device migration, kinking, or fracture. Three patients died, 2 of unrelated causes and one of an undetermined cause. Only one reintervention with an additional MFM implanted at 5 years was required for a type I endoleak in a young patient with natural growth. Carefully planned and executed diameter and volume measurements demonstrated aneurysm shrinkage and progressive sac thrombus formation for both patient groups. CONCLUSION: Through midterm follow-up, treatment of high-surgical-risk TAAA and AAA patients with the MFM appears to be safe and effective, maintaining branch vessel patency and reducing rupture risk through reduction of aneurysm diameter and modulation of flow dynamics. Longer term follow-up is needed.

Endovascular Treatment of 2 True Degenerative Aneurysms of Superficial Femoral Arteries.

We report the rare observation of a 58-year-old patient presenting 2 degenerative aneurysms of the superficial femoral arteries, with a rupture of the right aneurysm, treated by covered stents, with a satisfying midterm follow-up. The endovascular approach is a minimally invasive procedure which should be proposed as the first-line treatment to all the patients presenting aneurysms of the superficial femoral arteries, both asymptomatic as complicated.

Drop-Attacks Revealing a Cervical Cystic Lymphangioma.

We report the case of a 28-year-old man who presented in emergency for recurrent drop-attacks. Ultrasound imaging and angio computed tomography revealed a left cervical tumor, and the patient underwent surgery. The diagnosis of cystic lymphangioma was done on the anatomic characteristics of the surgical specimen and the results of the histological study. This is the first reported case of late diagnosis of a cervical cystic lymphangioma revealed by recurrent drops attack.

Multiple Visceral Artery Aneurysms: An Uncommon Manifestation of Antineutrophil Cytoplasmic Antibody Vasculitis.

The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis mainly affect small vessels. They are an exceptional etiology of visceral artery aneurysms, which are themselves unusual and potentially serious vascular disease. We report the case of a patient followed for vasculitis associated with ANCA with kidney disease who presented with symptomatic aneurysm of the inferior mesenteric artery and aneurysm of the superior mesenteric artery.

Late complication of a femoral monitoring catheter: a case of femoral false aneurysm treated surgically.

Femoral false aneurysms are rare. They are one of the main complications of femoral catheterization, trauma of this area, or the use of intravenous drugs. They usually occur in the days after femoral puncture, and only rarely occur years after the procedure or incident. Treatment often requires complex surgical methods. We report the management of a patient with a ruptured infected femoral false aneurysm that was diagnosed 4 years after a femoral puncture performed in intensive care unit to perform peripheral arterial catheter hemodynamic monitoring. The patient was operated with exclusion of the aneurysm and prosthetic bypass, associated with intravenous antibiotics adapted to the bacterial strain grown from the operative site, which resulted in a favorable outcome.

[Case study of ruptured gastroduodenal artery aneurysm revealed by hematemesis]. / Anévrisme rompu de l'artère gastroduodénale révélé par des hématémèses: à propos d'un cas.

Gastroduodenal artery aneurysm is a rare vascular lesion, asymptomatic in the majority of cases. However, ruptured aneurysm is associated with poor prognosis and mortality can achieve a 40% rate. We here report the case of an 83-year-old patient with abrupt onset of non-specific abdominal pain associated with hematemesis. Endoscopy showed beating formation compressing the duodenal bulb with active bleeding. Abdominal computed tomography (CT) scan was performed which objectified gastro duodenal artery aneurysms involving the artery ostium and making endovascular treatment impossible to perform. Thus, the patient underwent open surgery based on flattening associated with aneurysm exclusion and then complemented by bulb plasty. Post-operative CT scan confirmed total exclusion of the aneurysm with preservation of hepatic circulation.

Hybrid open and endovascular treatment of an aortic arch pseudoaneurysm in a patient with human immunodeficiency virus infection.

We describe an hybrid approach for aortic pseudoaneurysm with open and endovascular treatment as an alternative treatment for a high-risk patient infected with human immunodeficiency virus. A 42-year-old man, serum positive for human immunodeficiency virus, presented, with a large pseudoaneurysm of the arch aorta measuring 61 × 70 mm. An aortic arch debranching was performed, completed by thoracic endovascular aneurysm repair. A control computed tomography scan performed 3 months later showed a complete thrombosis of the pseudoaneurysm. The outcome of this treatment, particularly regarding the rate of infection, is yet to be determined, Longer follow-up is needed with a greater of patients.

Severe acute pancreatitis after surgical treatment of a ruptured abdominal aortic aneurysm.

Acute pancreatitis (AP) is a rare complication of surgery for abdominal aortic aneurysms, which is often diagnosed late. It is secondary to ischemia and to peroperative pancreatic trauma. We report a case of severe AP after surgical treatment of a ruptured abdominal aorta aneurysm and discuss its etiopathogenic mechanisms.

Acute systemic embolism due to an idiopathic floating thrombus of the thoracic aorta: success of medical management: a case report.

BACKGROUND: Idiopathic thoracic aortic mural thrombi are rare. They can be responsible for dramatic systemic embolization. Early treatment is imperative because of their high morbidity and mortality rate. CASE PRESENTATION: A 55-year-old previously healthy Moroccan male came in an array of acute right lower limbs pain and abdominal sensibility. Severe systemic embolism involving the lower extremities, spleen, kidney, and digestive tract, due to an idiopathic mural thrombus of the thoracic aorta was diagnosed. He received medical treatment leading to the complete disappearance of the thrombus and the effects caused by the latter. CONCLUSIONS: When faced unexplained peripheral embolization, research for a thrombus of the thoracic aorta should be performed. Medical treatment should be considered for its management, especially in patients with high surgical risk.