Left Renal Artery Chronic Occlusion in the Setting of Extensive Intraprosthetic Mural Thrombus in an Abdominal Aortic Endograft.

Thrombotic deposits within aortic endograft post-endovascular aortic aneurysm repair (EVAR) is a fairly well-recognized complication, yet their clinical significance remains inadequately understood. We present a rare case of extensive mural thrombus formation in an oncologic patient with a history of EVAR, emphasizing the importance of lifelong surveillance in abdominal aortic aneurysm (AAA)-EVAR patients. A 75-year-old female was admitted with refractory hypertension secondary to a medium-sized AAA, which exhibited an extensive mural thrombus, contributing to atrophic changes in the left kidney and likely chronic occlusion of the left renal artery. Factors contributing to thrombus formation generally include endograft configuration, aneurysm diameter, and patient-specific characteristics, such as a pro-thrombotic status conferred by metastatic lung cancer. This case underscores the necessity for comprehensive surveillance strategies post-EVAR. Recommendations advocate for a 30-day follow-up and lifelong annual surveillance, employing modalities such as color duplex ultrasound for detection of endoleaks and sac enlargement, with selective use of CT imaging. This case underscores the importance of continued vigilance and surveillance in patients undergoing EVAR, particularly those with complex medical histories, to mitigate potential long-term complications and optimize patient outcomes.

A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature.

Negative-pressure pulmonary edema (NPPE) is an uncommon diagnosis that requires a high clinical suspicion to recognize and manage and has high morbidity and mortality. It usually results secondary to markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway from upper airway infection, tumor, or laryngospasm. We present a case of a 27-year-old female with morbid obesity who underwent sleeve gastrectomy and developed NPPE upon emergence from anesthesia. The focus of supportive care should be on addressing the obstruction in the upper airway through either endotracheal intubation or cricothyroidotomy. Additionally, it is important to initiate lung-protective positive-pressure ventilation and promote diuresis, unless the patient is in a state of shock. The resolution of pulmonary edema is typically swift, partially due to the preservation of alveolar fluid clearance mechanisms. In the literature review, we delve into the clinical presentation, pathophysiology, and management of NPPE or post-obstructive pulmonary edema.

Fibrin Sheath Catheter-Related Endovascular Right-Sided Heart Infection in Heart Failure With Reduced Ejection Fraction: A Case Report.

Patients with end-stage renal disease (ESRD) receive dialysis through either hemodialysis (HD) or peritoneal dialysis (PD). HD has challenges associated with vascular access and catheter-associated complications. The development of a fibrin sheath is a common complication with tunneled catheters. However, infection of the fibrin sheath is not usually encountered. We discuss the case of a 60-year-old female with ESRD and heart failure with reduced ejection fraction (HFrEF) receiving HD via tunneled right internal jugular (RIJ) Permcath who was diagnosed with an infected fibrin sheath located in the cavoatrial junction via a transesophageal echocardiogram (TEE). Compared to a transthoracic echocardiogram (TTE), a transesophageal echocardiogram provides a much more accurate diagnosis of this rare condition. Treatment primarily involves administering antibiotics based on sensitivity cultures and closely monitoring for any potential complications.