Ruptured abdominal aortic aneurysm treated with open surgical repair (OSR) of a patient with active COVID-19 infection: A case report.

Introduction and importance: Patients continued to present vascular emergencies during the most severe phase of the COVID-19 outbreak. An abdominal aortic aneurysm rupture was considered the most life-threatening condition. Aim: To report a case report of a patient with active COVID-19 infection presenting as a ruptured abdominal aorta aneurysm and treated with open surgical repair at the Department of Vascular Surgery, Royal Jordanian Medical Services (JRMS), Amman, Jordan. Case presentation: A 69-year-old male presented with an active COVID-19 pneumonic chest infection. Abdominal CT of angiography showed a 4.8-cm infrarenal abdominal aortic aneurysm unsuitable for endovascular aortic aneurysm repair (EVAR). After a rapid deterioration in his general condition, he underwent an exploratory laparotomy which revealed the diagnosis of an AAA rupture. We managed his condition operatively with repair using a tube Dacron graft. Clinical discussion: Ruptured AAA is considered a devastating lethal vascular emergency with high mortality and morbidity rates and needs emergency intervention n eligible patients. COVID-19 patients with AAA rupture have a significantly increased risk of intervention and require special attention regarding the type of intervention and anaesthesia. The COVID-19 pandemic has changed many guidelines in management vascular emergencies, among them AAA rupture patients. The National Societies guidelines recommended limiting interventions to emergencies only. Conclusion: The difficulties of surgical intervention, anaesthesia and the appropriate intervention selection increase the burden on the medical staff resisting the obstacles imposed on them by COVID-19 infection.

Ultrasound-guided thrombin injection versus ultrasound-guided compression therapy of iatrogenic femoral false aneurysms: Single center experience.

BACKGROUND: Iatrogenic femoral pseudoaneurysm (false aneurysm) due to arterial access following cardiovascular procedures is becoming common because of the increase in number and complexity of the procedures. Recently, percutaneous thrombin injection is becoming a popular treatment of these false aneurysms.The aim of this study was to assess the efficacy and safety of femoral pseudoaneurysm closure using ultrasound-guided thrombin injection in comparison to ultrasound-guided compression. METHODS: A retrospective analysis was undertaken of 65 patients who presented to our vascular department with iatrogenic femoral pseudoaneurysm between January 2015 and March 2019. Twenty-five patients underwent ultrasound-guided thrombin injection, and 40 were treated using ultrasound-guided compression therapy. The primary outcome measured was efficacy, while other outcomes examined were safety, procedure duration, and cost. RESULTS: A total of 65 patients (45 males, 20 female) were identified with a mean age of 62 years. Out of the 65, 40 patients (28 males, 12 female) underwent ultrasound-guided compression therapy (group A) with a mean aneurysm size of 2.9 cm, and 25 (17 male, 8 female) underwent ultrasound-guided thrombin injection (group B) with a mean pseudoaneurysm sac size of 3.7 cm. The success rate of thrombosis in group A was 70% and in group B was 92%. No significant complications were reported in both groups. CONCLUSIONS: Ultrasound-guided thrombin injection should be considered as the first line of treatment for uncomplicated femoral pseudoaneurysms because it has a higher thrombosis and lower recurrence rates, when compared with ultrasound-guided compression treatment.

Endovascular treatment of iatrogenic iliocaval fistula post lumbar disc surgery.

A 39-year-old patient presented with a history of right-side heart failure (dyspnea and orthopnea), right lower extremity deep vein thrombosis, and hepatic impairment. A physical exam showed increased jugular venous pressure, hepatomegaly, and bilateral lower limb pitting edema. A computed tomography angiograph revealed an arteriovenous communication between the right iliac artery and inferior vena cava (IVC) at the level of L4/L5. The patient was diagnosed with a large arteriovenous fistula (AVF), which developed post lumbar disc surgery. Fistulas between the common iliac arteries and IVC are very rare post lumbar disc surgery. Acquired iliocaval AVF is much more difficult to treat surgically because of the risk of massive hemorrhage. The patient underwent a successful endovascular stent graft repair. The patient's symptoms of heart failure including exertional dyspnea and orthopnea were resolved 6 months post surgery.

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet's Disease: A Case Report.

Behçet's disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient's clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Endovascular Repair of Renal Artery Aneurysm in a Transplanted Kidney.

We present a case of a 35-year-old male patient who underwent live donor kidney transplantation at our unit in 2003. While working overseas, he had deterioration in his kidney function and was treated conservatively over three years duration including acquirement of a renal biopsy. Upon presentation to our unit in June 2015, an ultrasound and computed tomography angiogram demonstrated a huge aneurysm arising from his upper renal artery. His lower renal artery was patent and normal. The aneurysm was treated by endovascular means with preservation of the kidney and improvement in his kidney function over the following 12 months. When feasible, endovascular repair of transplanted renal artery aneurysms provides a safe and less invasive modality of treatment.

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan.

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population. MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed. RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes. CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.

The role of stenting the superior vena cava syndrome in patients with malignant disease.

Superior vena cava (SVC) obstruction occurs in patients with intrathoracic malignancies. Clinical symptoms can be distressing but presentation is insidious. We investigated the outcome of endovascular management for patients with SVC syndrome. We retrospectively reviewed the case histories of 17 patients (9 men) from January 2003 to June 2009. All patients had malignant disease. There were 24 interventions (2 patients with 2 interventions and 2 patients with 3 interventions). All had SVC stenosis over 90%. All patients were treated with intrathoracic angioplasty and stenting. All procedures were technically successful, and all patients had insertion of 10 to 18 mm diameter stents with symptom resolution in 16 patients. There were 2 occlusions at 1 and 6 weeks and 2 patients with restenosis (3 and 7 months). Endovascular intervention is technically feasible for SVC occlusion, relieves symptoms, and is a useful palliation measure.