Physician-Modified C3 Excluder Endograft as the Preferred Solution to Treat a Juxtarenal Para-Anastomotic Aneurysm.

Feasibility and early satisfactory results of physician-modified endografts have been reported. Most reports described the use of Cook Dacron aortic endografts (Cook Medical, Inc., Bloomington, IN). However, in some specific anatomic features (short aortic length, narrow aorta), the use of this device may not be appropriate.We here report a case of juxtarenal aortic aneurysm proximal to a former aortobifemoral graft in a high surgical risk patient. Due to a narrow proximal neck and a short aortic length, a physician-modified Gore C3 Excluder device (W. L. Gore & Associates, Inc., Flagstaff, AR) incorporating a fenestration for a large accessory renal artery was implanted. At 6-month follow-up, the aneurysm remains excluded and computed tomography scan demonstrates patent renal vessels.Surgeon-modified Gore C3 Excluder device implantation is feasible. Because of specific device characteristics (short main body, repositioning ability), it represents a valuable alternative in high-risk patients with juxtarenal aneurysms not amenable to other techniques.

Endovascular treatment of brachiocephalic artery war-related injury.

INTRODUCTION: Injuries to the innominate artery are rare, but potentially fatal. Early diagnosis and treatment may avoid life-threatening complications. Endovascular surgery often has lower morbidity and mortality rates than conventional surgery. CLINICAL CASE: We reported the case of a 28-year-old Yemenite soldier who presented with a shrapnel-related chest puncture wound following a shell explosion in Djibouti causing a 5 mm pseudoaneurysm of the innominate artery without associated complications. After medical repatriation to France, the pseudoaneurysm was treated by endovascular exclusion using a covered stent. DISCUSSION: Endovascular treatment of supra-aortic trunk lesions is an alternative to surgery with fewer postoperative complications, but long-term follow-up is lacking.

Surgical treatment of an aneurysm of a distal branch of the renal artery.

Aneurysms of the renal artery and its branches are rare, but are associated with significant morbimortality due to the absence of clinical symptoms and hemorrhagic risk in the event of rupture. We report the case of a patient with an aneurysm of a distal branch of the right renal artery that measured 25 mm in diameter. The diagnosis and localization were obtained using selective arteriography. Treatment consisted of resection of the aneurysmal sac associated with closure with a saphenous vein patch rather than an endovascular treatment in order to preserve the nephronic capital. Right renal parenchymatous vascularization was satisfactory on arterial echo-Doppler and angioscanner assessment at 1 year.

Usefulness of 18F-fluorodeoxyglucose positron emission tomography scan in the assessment of periprosthetic collections: report of 2 cases with opposite management.

Vascular prosthetic infection is a rare but serious complication of vascular surgery that requires rapid diagnosis and treatment. It is associated with high rates of amputation and death. The diagnosis is difficult when faced with a chronic nonspecific clinical presentation. We report 2 cases showing the diagnostic usefulness of positron emission tomography (PET). In 1 case, PET excluded with certainty the septic character of a periprosthetic collection fistulized with the skin by showing a periprosthetic fixation insufficient to diagnose an infection. In the other case, it confirmed the prosthetic infection in association with an evocative clinical picture by revealing a pathologic periprosthetic hyperfixation. PET scan therefore drew aside the diagnosis of prosthetic infection faced with a mild clinical and paraclinical presentation in the first case, and made it possible to pose it with certainty in the second case. This examination made it possible to save valuable time in 1 case and to elucidate the periprosthetic collection in the other case. Therefore, the rule of surgical explantation of any prosthesis with flow or periprosthetic collection is no more univocal.

In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

Two cases of misaligned deployment of Valiant Captivia thoracic stent graft.

Thoracic aortic stent grafts have been widely used. We report two cases of proximal misaligned deployment of the Valiant Captivia stent graft after hybrid treatment of thoracic aneurysms. This complication has, to our knowledge, never been previously reported in the literature with this stent graft. We discuss the various factors that may explain this complication. We also describe the bailout technique that was carried out.

Aortic rupture due to pneumococcal infection in aortoiliac stents.

We report a rare case of pneumococcal aortitis secondary to endovascular bare-metal stent infection. The patient was a 70-year-old man presenting with back pain 1 year after aortoiliac implantation of bare-metal kissing stents. Final diagnosis was microbial aortitis due to Streptococcus pneumoniae involving the stents that resulted in a contained aortic rupture requiring urgent surgical treatment. Emergency extra-anatomic revascularization, excision of the infected tissues, and appropriate antibiotic therapy led to a favorable outcome. A high index of suspicion is required in such a situation because the mortality rate is very high in the absence of appropriate treatment.

Treatment of a ballistic wound of the common carotid artery revealed by a spontaneous carotid-jugular fistula.

The case reported is of a 30-year-old patient with a left internal carotid-jugular fistula secondary to the explosion of an improvised explosive device during the Afghan war. Carotid resection with arterial bypass using a venous allograft and internal jugular ligation were performed by left cervicotomy associated with sternotomy at a specialized center. The management of cervical arteriovenous fistulas that occur as a result of penetrating trauma faced during the war must be considered and it should be noted that, on battlefields, treatment is not always performed in specialized units.