Aorto-innominate artery bypass for migrated stent.

We report a case of a 64-year-old female who first presented with a transient ischemic attack in 2007 due to an innominate artery stenosis, which indicated an endovascular stent placement. In 2008, she presented with recurrence of symptoms and was diagnosed with in-stent restenosis alongside an unusual occurrence of retrograde migration into the ascending aortic arch. We performed an aorto-innominate bypass through a median sternotomy. The patient was discharged without any complications thereafter, and the graft has shown excellent patency. As of 2019, the patient remains well.

Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy.

Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.

Giant aneurysms associated with aortic coarctation: management challenges and options.

The management of giant aneurysms associated with aortic coarctation is challenging. The location, the size of the aneurysm, whether it has ruptured, previous coarctation repair, the presence of stenosis, and the ascending and distal aortic pathology will all influence the treatment approach. With more patients surviving to adulthood after early coarctation repair, a better understanding of the anatomy, pathophysiology, and radiological findings of coarctation-related aneurysms is imperative to providing sound care. We present here our experience with a series of giant aneurysms of the aorta, all with a background of underlying aortic coarctation. We highlight the decision-making process and review current management trends.

The radiological investigation and treatment of the critically ischemic limb--a review.

The contribution of radiological investigation and treatment in the management of the critically ischemic lower limb is reviewed. The methods of classifying and assessing the cause, level, and severity of the arterial disease causing the ischemia are discussed with comparison of the relative merits of the various invasive and noninvasive techniques of investigation. The development of the methods of interventional radiological management is described with an indication of the relative success of the different techniques. Newer interventional developments, including intravascular brachytherapy and gene therapy are discussed.