Surgeon-modified fenestrated endograft for urgent an aortic arch aneurysm: case report.

We report the case of an endovascular repair of an aortic arch aneurysm by a surgeon-modified fenestrated endograft with a single fenestration in a high-risk patient unfit for open surgery. A patient of 84 years, chronic ischemic cardiopathic, suffering from prostate adenocarcinoma in chemotherapy treatment, came to our hospital for post-traumatic fracture of the right femur. During the hospitalization, the patient exhibited dysphonia and respiratory disorders for several days, therefore, the patient performed Computed Tomography Angiography (CTA) that found the presence of voluminous aneurysm of the aortic arch with a maximum diameter of about 74 mm. The patient was treated with a hybrid-staged procedure; in the first instance, with a carotid-carotid-succlavium bypass to preserve the cerebral and upper limb vascularization and then, the procedure was completed by implanting the surgeon-modified fenestrated endograft with stent delivery to the patient with a fenestration on the anonymous trunk. This surgeon-modified fenestrated endograft was created by modifying a standard endograft by a single fenestration following the three-dimensional reconstructions of the CTA images. The procedure was successfully completed and postoperative course was uneventful. Computed Tomography Angiography demonstrated the exclusion of the aneurysm, patency of the implanted endograft modules, and absence of signs of endoleaks and / or cerebral or medullary ischemic complications.

Endovascular management of symptomatic deep vein thrombosis with combined approach.

The combined used of thrombectomy with direct intravenous thrombolytic infusion provided effective treatment of DVT and uncovered an underlying left common iliac vein stenosis, which was successfully managed by angioplasty and stenting.

A cross-sectional study evaluating hospitalization rates for chronic limb-threatening ischemia during the COVID-19 outbreak in Campania, Italy.

The expansion of coronavirus disease 2019 (COVID-19) prompted measures of disease containment by the Italian government with a national lockdown on March 9, 2020. The purpose of this study is to evaluate the rate of hospitalization and mode of in-hospital treatment of patients with chronic limb-threatening ischemia (CLTI) before and during lockdown in the Campania region of Italy. The study population includes all patients with CLTI hospitalized in Campania over a 10-week period: 5 weeks before and 5 weeks during lockdown (n = 453). Patients were treated medically and/or underwent urgent revascularization and/or major amputation of the lower extremities. Mean age was 69.2 ± 10.6 years and 27.6% of the patients were women. During hospitalization, 21.9% of patients were treated medically, 78.1% underwent revascularization, and 17.4% required amputations. In the weeks during the lockdown, a reduced rate of hospitalization for CLTI was observed compared with the weeks before lockdown (25 vs 74/100,000 inhabitants/year; incidence rate ratio: 0.34, 95% CI 0.32-0.37). This effect persisted to the end of the study period. An increased amputation rate in the weeks during lockdown was observed (29.3% vs 13.4%; p < 0.001). This study reports a reduced rate of CLTI-related hospitalization and an increased in-hospital amputation rate during lockdown in Campania. Ensuring appropriate treatment for patients with CLTI should be prioritized, even during disease containment measures due to the COVID-19 pandemic or other similar conditions.

Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft.

BACKGROUND: The aim of this study is to retrospectively analyze the early and long-term outcomes of endovascular treatment of Trans-Atlantic Inter-Society Consensus II class C and D (TASC II) aortoiliac occlusive disease with an expanded polytetrafluoroethylene-covered stent graft. METHODS: Between January 2006 and November 2017, 61 patients (53 males, 8 females), with symptomatic aortoiliac stenotic and/or occlusive disease, were treated with VIABAHN (W.L. Gore and Associates, Flagstaff, Ariz) at 2 University medical centers. The morphology of the lesions was evaluated and classified by contrast-enhanced computed tomography angiography. Demographic data, operation details, and postoperative outcomes were collected. Follow-up data were analyzed by a life-table analysis (Kaplan-Meier test). RESULTS: Mean age of the patients was 64.89 ± 10.77 years (range 44-89). Thirty-seven patients (60.7%) presented with severe claudication (Rutherford 3), whereas 21 (34.4%) were in Rutherford class 4 and the remaining 3 patients (4.9%) suffered from necrotic lesions (Rutherford 5/6). Fifty-six patients were smokers (91.8%), 38 (62.3%) had hypertension, 23 (37.7%) had coronary artery disease, 30 (40.2%) had dyslipidemia, 18 (29.5%) had chronic obstructive pulmonary disease, 6 (9.5%) had renal insufficiency (serum creatinine>2.0 mg/dL) and 24 (39.3%) had diabetes. Technical success was achieved in 59/61 patients (96.7%) with 16 patients (26.2%) requiring combined percutaneous brachial access to obtain iliac recanalization. Perioperative mortality was 1.6%, whereas postoperative major complications occurred in 2 patients (3.6%). The mean number of VIABAHN placed was 1.77/patient. Mean follow-up was 31.5 months (range 1-108) and primary patency at 36 months was 94.9%. Two major amputations of the lower limbs occurred during the follow-up. CONCLUSIONS: Open surgery with the aortobifemoral bypass has been the gold standard treatment for complex aortoiliac occlusive disease although complications and mortality still remain significant issues. Our results suggest that endovascular therapy of TASC C and D iliac lesions using the VIABAHN stent graft is feasible, effective, and has good, long-term patency.

Ruptured Abdominal Aortic Aneurysm in a Patient with Congenital Fused Pelvic Kidney: A Case Report of Emergency Endovascular Treatment.

A 90-year-old male developed acute onset of abdominal and lumbar pain due to the rupture of an 11-cm abdominal aortic aneurysm. A congenital fused pelvic kidney perfused by three renal arteries arising from iliac axes was detected. In an emergent setting, an aorto-uni-iliac endograft was deployed through right femoral surgical access with occlusion of the upper right renal artery. An occluder device was placed in the common iliac artery above the renal artery through left femoral access. A femorofemoral crossover bypass completed the procedure. The patient developed acute renal failure, with no dialysis necessity. One-month computed tomography angiography showed procedure success.

Hemodialysis Arteriovenous Access Occlusion Using the Amplatzer Vascular Plug in Patients with Intractable Arm Edema.

OBJECTIVES: Vascular occlusion of hemodialysis arteriovenous access (AVA) using an Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA) is an arising and alternative practice in selected patients; however, few reported cases can be found in the literature. Herein, we report on our experience with endovascular treatment of complicated AVA. MATERIALS AND METHODS: From September 2015 to December 2016, 3 patients at our clinic underwent an occlusion of hemodialysis AVA with 2 different Amplatzer vascular plugs: 2 patients with type II and 1 patient with type IV. Of these, 1 patient was treated for an autologous radiocephalic fistula, the second patient was treated for an autologous brachiocephalic fistula located at the elbow, and the third was, instead, treated for a radiocephalic forearm fistula. The reason for closing the AVA in all patients was due to the presence of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema. RESULTS: All AVAs were treated using an AVP. No plug migration, access revascularization, persistent ischemia, nor other complications were observed. CONCLUSION: This report suggests that the use of AVP for embolization of complicated AVA is a safe and reasonable alternative to open surgery in selected patients.