Acute Testicular Ischaemia Following Endovascular Aneurysm Repair on the Opposite Side to Intentional Internal Iliac Artery Occlusion.

INTRODUCTION: Testicular ischaemia is a potential complication after endovascular aneurysm repair (EVAR), which has only rarely been reported in the literature. This is the report of a patient who presented with acute testicular ischaemia in the immediate post-EVAR period. REPORT: A 65 year old patient underwent EVAR for an aortic and bilateral iliac aneurysms. During the procedure, the right internal iliac artery was intentionally occluded to facilitate treatment of the common iliac aneurysm; however, the left internal iliac artery was preserved. The procedure was uneventful. On the second post-operative day the patient gradually developed symptoms of acute left testicular ischaemia. Clinical and ultrasonographic findings constituted the bases of diagnosis and the patient received conservative treatment with gradual improvement. To the authors' knowledge, this is the ninth case of testicular ischaemia after endovascular aneurysm repair reported in the literature. CONCLUSION: Testicular ischaemia, although rare, is a possible complication post-EVAR. Acute and chronic testicular damage found in association with an abdominal aortic aneurysm or its treatment has not been well studied in the literature and therefore may be under reported.

Common left carotid bifurcation at C7-Th1 level: a rare anatomical variant.

The left common carotid artery usually bifurcates to the internal and external carotids at or near the superior border of thyroid cartilage. In head and neck surgery, the common carotid arteries are important landmarks, defining the plane of dissection during radical neck surgeries. According to the literature, many variations exist regarding the carotid bifurcation. Anatomical knowledge of these variants is important for surgical approaches in the head and neck regions, to avoid devastating complications that may occur, mainly during anterior neck dissections. We report an interesting case of a 75-year-old male patient with low bifurcation of the left common carotid artery, accidentally found during a routine carotid Doppler ultrasonography. Bifurcation was located at the C7-Th1 intervertebral disc height, approximately 4 cm from the aortic arch.

Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results.

PURPOSE: The purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI). MATERIALS AND METHODS: Between January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1-72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates. RESULTS: Technical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years. CONCLUSIONS: Direct stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement. LEVEL OF EVIDENCE: Level 4, Case Series.

Noninvasive Estimation of Aneurysm Sac Pressurization Following Endovascular Aneurysm Repair Using M-Mode Ultrasonography to Evaluate Significance of Endoleaks: A Feasibility Study.

PURPOSE: To establish the feasibility of indirectly estimating aneurysm sac pressurization from recordings of aortic pulsatile wall motion (PWM) using M-mode ultrasonography before and after endovascular aneurysm repair (EVAR). METHODS: Twenty consecutive patients (mean age 72 years; 19 men) scheduled for EVAR in a single institution underwent M-mode ultrasonography 1 day before EVAR to record PWM of the abdominal aortic aneurysm wall during the cardiac cycle, along with simultaneous blood pressure measurements. The recording was repeated the first postoperative day. Pressure-strain elastic modulus (Ep) was calculated from the preoperative displacement and pressure data. This value and the postoperative PWM were used to inverse estimate pulse pressure in the abdominal aortic aneurysm sac post EVAR. Immediate pressure reduction post EVAR was compared between groups of endoleak vs no endoleak and expansion vs no expansion during 6-month follow-up. RESULTS: Intraobserver variability of the method presented a mean value of 0.04 mm with a 1.2-mm coefficient of variation (95% limits of agreement -1.16 to 1.24 mm). PWM was significantly reduced postoperatively (1.2 vs 0.3 mm, p<0.001) as was pulse pressure exerted on the aneurysm sac (67 vs 16 mm Hg, p<0.001). The pressure reduction was similar between the endoleak vs no endoleak groups (79% vs 75%, p=0.65), but it was significantly greater in the no expansion group (79.5%) vs the group with aneurysm expansion (50%, p=0.008). CONCLUSION: M-mode ultrasonography may provide a useful adjunct during EVAR surveillance to noninvasively estimate sac pressurization and identify aneurysms at risk of enlargement.

Diagnosing a popliteal venous aneurysm in a primary care setting: a case report.

INTRODUCTION: Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders. They can be symptomatic or asymptomatic, mimicking different conditions. Popliteal venous aneurysms are possible sources of embolism. CASE PRESENTATION: A 68-year-old woman presented at a rural primary health care unit in Crete, Greece, reporting local symptoms of discomfort in the right popliteal fossa with pain during palpation. Colour Doppler ultrasonography revealed local widening and saccular dilatation in the right distal popliteal vein. The diagnosis of a popliteal venous aneurysm was formulated. CONCLUSION: Popliteal venous aneurysms are rare conditions, but are potentially more common than usually thought in daily practice. Physician awareness and access to ultrasound examination may allow for early diagnosis, before the occurrence of any thromboembolic or other major complication.

Association of subclinical wall changes of carotid, femoral, and popliteal arteries with obstructive coronary artery disease in patients undergoing coronary angiography.

STUDY OBJECTIVES: To examine the association of occult atherosclerosis of carotid, femoral, and popliteal arteries with the presence and severity of obstructive coronary artery disease (CAD) in patients without a history or presence of cerebrovascular or peripheral arterial disease using ultrasound examination of peripheral arteries. PATIENTS/METHODS: One hundred eighty-four such individuals underwent routine coronary angiography. Obstructive CAD was found in 103 cases, which comprised the patient group. The remaining 81 individuals comprised the control group. All were blindly examined by duplex ultrasonography in order to assess occult atherosclerosis, as indicated by the estimation of intima-media thickness of the carotid artery (IMTC), intima-media thickness of the femoral artery (IMTF), intima-media thickness of the popliteal artery (IMTP), and ultrasonic biopsy (UB) of the carotid and femoral arteries. For the individuals with positive coronary angiography findings, the severity of CAD was estimated by the number of the diseased vessels. RESULTS: IMTC, IMTF, IMTP, and UB showed significant correlation with the presence of obstructive CAD, but only IMTC and IMTF were independent predictive factors, with specificity of 74% and 60% and sensitivity of 76% and 70%, respectively. Additionally, our analysis yielded a regression model that, for a given value of IMTC and IMTF, may estimate the probability of CAD: p (CAD) = e((- 4.765 + 3.36 IMTC + 1.91 IMTF))/1 + e((- 4.765 + 13.36 IMTC + 1.91 IMTF)). Patients with one-vessel disease had significantly lower IMTC (p < 0.001) and UB (p = 0.011) and lower IMTF (p = 0.057) than those with three-vessel disease. CONCLUSIONS: The assessment of occult atherosclerosis by duplex ultrasonography in both the carotid and the femoral arteries is significantly associated with the presence and severity of CAD.