Persistent Buttock Claudication after Endovascular Abdominal Aortic Aneurysm Repair.

We describe the successful surgical treatment of a 71-year-old man affected by right buttock claudication after a right internal iliac artery (IIA) coil embolization as an adjunct to endovascular iliac artery aneurysm repair. Computed tomography angiography revealed extensive aortoiliac calcifications and thrombus in the vessel walls. Despite patency of the contralateral IIA and preservation of right distal collateral flow through ipsilateral hypogastric branches, the symptom was persistent and disabling. The high-risk patient underwent an "open" repair of the infrarenal abdominal aneurysm with removal of the entire stent-graft and concomitant revascularization of the right IIA. Post-operative recovery was uneventful, and the patient remained asymptomatic during a 30-month follow-up. This case underscores the importance of considering all potential solutions, including open surgery, to preserve pelvic inflow after aortoiliac stent grafting, particularly for high-risk patients with vulnerable plaque and higher risk of thrombus embolization.

Giant splenic artery aneurysm rupture.

Little exists on treatment for SAAs rupture which may require a fast bleeding control because of the hemodynamic instability and a large perisplenic/peritoneal hematoma. This case shows the use of endovascular clamping and midline laparotomy to perform the splenectomy because of the severe hypotension and the dimension of the lesion.

Vagus nerve stimulation for treatment of medically intractable seizures. Evaluation of long-term outcome.

UNLABELLED: Vagus nerve stimulation (VNS) constitutes an adjunctive, modern management of medically intractable seizures, especially when surgery is inadvisable. OBJECTIVE: To evaluate the long-term results as regards efficacy, safety and tolerability of VNS in epileptic subjects, with focal and/or generalised seizures, refractory to old and new AEDs, without indication for resective surgery. PATIENTS: 51 epileptic subjects (30 males, 21 females), aged 7-49 years, have been implanted so far. RESULTS: The results refer to the 47 subjects with a follow-up longer than 6 months. 22 (46.8%) of them had a greater than 50% reduction in seizure frequency, with a more than 75% reduction in 6. No significant difference was found in relation to type of seizures. The efficacy maintained steadily over time during the follow-up (mean 26.4 months). Twelve out of the 47 subjects had an improvement in alertness, attention and psychomotor activity. Complications were observed in 5 cases, leading to removal of the stimulator in 2. A moderate vocal hoarseness (40.4%), paresthesia (6.3%), pharingodinia and cough (4.3%) were the registered adverse events. CONCLUSIONS: Our results confirm that VNS is effective, safe and well tolerated and constitutes an alternative treatment for pharmacoresistant epileptic seizures.

Acute ascending thrombosis of abdominal and suprarenal aorta.

We report the diagnostic and successful therapeutic images of an acute occlusion of the abdominal and suprarenal aorta. This lesion is a rare but catastrophic pathology which can cause severe ischemic manifestations, depending on the site of obstruction, with high rate of mortality even after treatment. In the majority of cases it represents a surgical emergency. Although the mechanism of the thrombosis has not been delineated, the proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, dislodgment of a mural thrombus, or coagulation disorders. Frequent risk factors include advanced atherosclerosis combined with a low flow state because of poor cardiac performance. The management of this condition includes immediate intervention with systemic heparinization, improvement of the cardiac condition, and surgical revascularization based on the clinical and anatomical presentation. In this case the authors highlight the importance of an early detection and early intervention to enhance survival rates and reduce morbidity.

True giant posterior tibial artery aneurysm.

We report an unusual case of true atherosclerotic posterior tibial artery (PTA) aneurysm without any apparent causative history. To our knowledge, in the English Literature only seven previously cases of true PTA aneurysms are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.

True atherosclerotic pedis artery aneurysm.

We report an unusual case of a true atherosclerotic dorsalis pedis aneurysm in a relatively young (53-year-old), ex-semi-professional soccer player patient. This lesion is a rare entity and due to its location may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical treatment of the aneurysm are discussed. Pathological analysis did confirm atherosclerotic findings despite the rapid clinical onset of the lesion and the possible traumatic origin.