A Unique Case of Iatrogenic Femoral Arteriovenous Fistula associated with Deep Vein Thrombosis after Electrophysiological Procedure in a Kidney Transplanted Patient.

Iatrogenic femoral arteriovenous fistulas (AVFs) and deep venous thrombosis (DVT) can complicate femoral artery catheterization procedures. However, the co-occurrence of both is rare. We report the unique case of AVF with DVT, which occurred in the right femoral vessels of a 59-year-old man with a right iliac fossa kidney transplant, after percutaneous puncture for cardiac catheterization. Duplex ultrasound examination and computed tomography venography scan confirmed the diagnosis. Both the AVF and the DVT were managed surgically.

Immediate and Late Open Conversion after Ovation Endograft.

The risk of intraoperative open conversion during endovascular aortic repair (EVAR) still remains a main issue, albeit in a small percentage of cases. Open conversion can be extremely demanding and risky in relation to the type of the stent graft implanted and can be somehow challenging even for the most experienced vascular surgeons. We discuss a case of immediate conversion and 1 case of late conversion in patients previously treated with EVAR using the Ovation stent graft. The design of the endograft and its proximal sealing allowed the partial preservation of the graft and its use for proximal and distal anastomosis with a Dacron graft in both presented cases.

Postimplantation syndrome after endovascular aortic repair using the Anaconda™ endograft.

BACKGROUND: We report our retrospective experience on postimplantation syndrome (PIS) after the use of Anaconda™ endograft in patients undergoing elective endovascular repair of abdominal aortic aneurysms (EVAR). METHODS: Data of all patients undergoing elective EVAR between May 2000 and June 2013 using the Anaconda endograft were retrospectively reviewed and the outcomes were analyzed. Preoperative and intraoperative data, any early postoperative complications, length of in-hospital stay, incidence of PIS, and long-term complications were recorded in a database. Patients' quality of life (QOL) was also assessed at 1 month after the procedure. Statistical analysis was performed and P values ≤0.05 were considered statistically significant. Chi-squared tests, log-rank tests, Wilcoxon tests, and Kaplan-Meier survival analysis were performed as appropriate. RESULTS: Between May 2000 and June 2013, 118 patients (8 female, 6.7%) underwent elective EVAR using the Anaconda endograft. Primary success was obtained in 117 cases (99.1%). Patients were divided into 2 groups based on either the occurrence of PIS (group A: 24 patients, 20.3%) or not (group B). The length of the procedure and the in-hospital stay were longer for group A. One patient from group B died on second postoperative day from myocardial infarction (0.8%). Mean follow-up was 48.4 months (range 5-162 months). Seven endoleaks occurred in the long term regardless of the development of PIS. We did not find any correlation between the presence of PIS and the occurrence of long-term complications, but PIS was correlated to the preoperative burden of thrombus of the aneurysmal sac. On the other side, analysis of QOL surveys showed that patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS. CONCLUSIONS: In our experience, the occurrence of PIS was related to the duration of the procedure and the preoperative burden of thrombus of the aneurysmal sac. Overall, PIS was a benign complication after EVAR using the Anaconda endograft. However, it affected significantly the length of the in-hospital stay. Moreover, patients who had PIS after surgery felt significantly more limited in carrying out their daily physical activities and were more emotionally discouraged and depressed/anxious about their state of health than the group that did not have PIS.

Initial experience with the inspire MD C-Guard stent in the treatment of carotid artery disease.

One of the main issue concerning the treatment of carotid artery stenosis is about the use of stents which could offer the best navigability through the lesion and the smallest "maximum unprotected circular area", ensuring the lowest risk of neurological complication both intraprocedurally and in the long term. Recently, Inspire MD (Tel Aviv, Israel) presented the new stent Inspire MD C-Guard™, a bare-metal stent covered by a micron level mesh (MicroNet). We report our experience about the use of this novel stent in the endovascular treatment of carotid artery stenosis, with some technical considerations. Data about patients in whom the Inspire MD C-Guard was used for the treatment of carotid artery diseases were retrospectively collected and analyzed. The procedure was completed in all patients without any intraoperative complications. Postoperative course was uneventful in all cases and no complications have been recorded till now. In our limited experience, the Inspire MD C-Guard has proven to be a safe stent for the treatment of carotid artery diseases. However large studies are needed to better explain strengths and weaknesses of this device.

Endovascular treatment of iatrogenic axillary artery pseudoaneurysm under echographic control: a case report.

AIM: Brief case report of the treatment of a large axillary artery pseudoaneurysm after a pacemaker using a left brachial cutdown and a retrograde delivery of a covered stent using ultrasound and fluoroscopic guidance. The patient's renal function precluded the use of contrast materials. CASE REPORT: A 77 years old man presenting with acute renal failure and haemoglobin decrease arrived with an expanding pseudoaneurysm of the left axillary artery from a pacemaker placement. Considering the site of the lesion and patient's comorbidities, under echographic control, a Hemobahn® stent-graft was placed; fluoroscopy assisted manipulation of guidewires and sheaths into the aortic arch. The procedure was successfully ended without any complications. At 8 months the stent graft was still patent. CONCLUSION: Ultrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are easily detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach.