{"title":"Biodesign: Engineering an aortic endograft explantation tool","authors":"Solyman Hatami MD , Vamsi Maturi MD , Alwin Mathew MD , Shannon Lu MD , Paul Haddad MD , Daanish Sheikh BS , Maham Rahimi MD, PhD","doi":"10.1016/j.jvscit.2024.101599","DOIUrl":"10.1016/j.jvscit.2024.101599","url":null,"abstract":"<div><p>Endovascular aortic repair (EVAR) graft failure can be as high as 16% to 30% owing to endoleak, graft migration, or infection, often necessitating explantation, leading to potential morbidity (31%) and mortality (6.3%). Graft prongs frequently tear through the endothelium during explantation, leading to endothelial damage and subsequent fatal bleeding. The current standard of care involves different suboptimal techniques such as the syringe technique in which a cylinder is improvised by cutting a syringe in half and pushed over the graft hooks in a rotating motion, until covered for manual explantation. Because there is no commercially available product to address this shortcoming in graft explantation, we engage in the biodesign process to produce a functional explantation device. We designed and prototyped multiple potential solutions to remove EVAR endografts safely. Silicone tubing with EVAR endografts deployed in the lumen were used to simulate a grafted aorta and test each prototype. Prototypes were compared in their ability to meet design criteria including decrease in graft diameter, prevention of arterial dissection, ease of use, and decrease in procedure time. After determining the single best prototype, surgeon feedback was elicited to iteratively improve the original design. The most effective design uses a tapered lumenal geometry that decreases the EVAR graft diameter and uses stainless steel beads to prevent shear stress to the simulated aorta. A distal grip allows for easy single hand manipulation of the device, while a latching mechanism allows for smooth placement and removal over the endograft. After rigorous prototyping, our device proved feasible and effective for safe EVAR explantation, allowing this procedure to be performed safely.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001837/pdfft?md5=77afa473ed6b8aadc8b89dd4dbcfc87a&pid=1-s2.0-S2468428724001837-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of acute aortic occlusion in the setting of necrotizing pancreatitis with covered endovascular reconstruction of the aortic bifurcation","authors":"Eastan Marleau MD, Thekla Bacharach MD, Anand Dayama MD","doi":"10.1016/j.jvscit.2024.101602","DOIUrl":"10.1016/j.jvscit.2024.101602","url":null,"abstract":"<div><p>Acute aortic occlusion represents a rare, life-threatening condition associated with significant morbidity and mortality. Here, we present a case of acute aortic occlusion in the setting of necrotizing pancreatitis, successfully managed with covered endovascular reconstruction of the aortic bifurcation. Traditionally, treatment options for acute aortic occlusion have included thromboembolectomy, aortobifemoral bypass, and axillary bifemoral bypass. Our report demonstrates covered endovascular reconstruction of the aortic bifurcation as a viable in-line treatment option for acute aortic occlusion, particularly in patients with challenging concomitant abdominal pathology.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001862/pdfft?md5=f2d6d0eb36855cd291487f9bc4de17dc&pid=1-s2.0-S2468428724001862-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Baqir J. Kedwai BHSc, Matthew Byrne MD, Joshua T. Geiger MD, Sam Najjar BS, Michael C. Stoner MD, Doran S. Mix MD
{"title":"Balloon-expandable covered stenting of a large right hepatic artery aneurysm","authors":"Baqir J. Kedwai BHSc, Matthew Byrne MD, Joshua T. Geiger MD, Sam Najjar BS, Michael C. Stoner MD, Doran S. Mix MD","doi":"10.1016/j.jvscit.2024.101601","DOIUrl":"10.1016/j.jvscit.2024.101601","url":null,"abstract":"<div><div>Hepatic artery aneurysms (HAAs) are rare visceral aneurysms with a high rupture rate. We report the case of an 88-year-old man with a 4.2-cm right HAA treated with covered stenting. Balloon-expandable covered stents effectively excluded the HAA with excellent proximal and distal seals. Our case is one of a limited number of reports on successfully repairing a hepatic aneurysm with a balloon-expandable stent graft. This case demonstrates that balloon expandable covered stenting is a viable approach in patients with appropriate anatomy and may be favorable in patients precluded from open bypass.</div></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001850/pdfft?md5=511d7c1ce0edade247893313171b446a&pid=1-s2.0-S2468428724001850-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biodesign: Engineering an aortic endograft explantation tool","authors":"Grayson S. Pitcher MD","doi":"10.1016/j.jvscit.2024.101607","DOIUrl":"10.1016/j.jvscit.2024.101607","url":null,"abstract":"","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001916/pdfft?md5=d7fc25f5db3fccb77d3dfc3c669fdd58&pid=1-s2.0-S2468428724001916-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Panagrosso MD , Katarina Björse MD , Timothy Resch MD, PhD
{"title":"A type II endoleak from an accessory renal artery treated with laser assisted, transgraft coil embolization: A case report","authors":"Marco Panagrosso MD , Katarina Björse MD , Timothy Resch MD, PhD","doi":"10.1016/j.jvscit.2024.101598","DOIUrl":"10.1016/j.jvscit.2024.101598","url":null,"abstract":"<div><p>The main complications of coverage accessory renal artery (ARA) are renal infarction and potentially renal function impairment and type II endoleak if firm apposition to the aortic wall is not achieved. We describe the management of an ARA type II endoleak treated by laser-assisted, transgraft coil embolization (LATE). A 76-year-old patient underwent a computed tomography scan 4 years after endovascular aneurysm repair. The computed tomography scan showed an increase of sac diameter with type II endoleak originating from the left ARA as an effect of aortic neck dilatation. ARA embolization was performed successfully via fusion-guided laser in situ fenestration and standard coil placement.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001825/pdfft?md5=4f40740e88621550d4eb1c8eb1d16fb2&pid=1-s2.0-S2468428724001825-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianbin Zhang MD, Qiangqiang Nie MD, Bo Ma MD, Zhidong Ye MD, Xueqiang Fan MD
{"title":"Embolization and sclerotherapy for head and neck arteriovenous malformations with uncontrollable torrential bleeding","authors":"Jianbin Zhang MD, Qiangqiang Nie MD, Bo Ma MD, Zhidong Ye MD, Xueqiang Fan MD","doi":"10.1016/j.jvscit.2024.101597","DOIUrl":"10.1016/j.jvscit.2024.101597","url":null,"abstract":"<div><p>Torrential bleeding is a rare and life-threatening complication of arteriovenous malformations (AVMs). We report a case of head and neck AVMs present with uncontrollable torrential bleeding, which was treated with embolization and sclerotherapy. Then we explored the potential multidisciplinary handling of the procedure for this kind of case. A 25-year-old female patient was born with right face and head AVMs. The AVMs had grown gradually and ruptured spontaneously with uncontrollable torrential bleeding before admission. Emergent direct hemostasis, nasotracheal intubation, and staged embolization and sclerotherapy were carried out on this patient. Finally, the bleeding stopped and the wound healed successfully. Embolization and sclerotherapy are effective for head and neck AVMs with uncontrollable torrential bleeding. Multidisciplinary collaboration is needed to achieve a good outcome.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001813/pdfft?md5=86d15b80e14598f9e7a48347a2958b7b&pid=1-s2.0-S2468428724001813-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nunzio Francesco Franco BSc (Hon), MChD, MSurg , Ganes Pranavan MBBS, FRACP (Med onc) , Gert Frahm-Jensen BBiotech, MBBS, FRACS(Vasc)
{"title":"Renal cell carcinoma as a cause of aortic tumor thrombus embolization and acute limb ischemia","authors":"Nunzio Francesco Franco BSc (Hon), MChD, MSurg , Ganes Pranavan MBBS, FRACP (Med onc) , Gert Frahm-Jensen BBiotech, MBBS, FRACS(Vasc)","doi":"10.1016/j.jvscit.2024.101594","DOIUrl":"10.1016/j.jvscit.2024.101594","url":null,"abstract":"<div><p>This article presents a unique case of acute limb ischemia resulting from arterial tumor embolism secondary to renal cell carcinoma involving an aortobi-iliac bypass graft. To the best of our knowledge, this instance is the first documented in the literature of such a complication. The patient, a man in his 70s with a complex medical history, underwent bilateral femoral embolectomy and subsequent endovascular intervention for the resolution of the tumor thrombus. The rarity of this phenomenon poses challenges in formulating a standardized management strategy.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001783/pdfft?md5=6e3fd05f9b02c4c4a8c9e23373984b7d&pid=1-s2.0-S2468428724001783-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamza Hanif MD , Ross M. Clark MD, MBA, RPVI , Rick Gehlert MD , Rachel Danczyk MD , LeAnn Chavez MD, MBA, FACS, RPVI , Muhammad Ali Rana MD, FACS, FSVS
{"title":"Polyethylene debris following metal-on-metal total hip arthroplasty as a rare cause of symptomatic iliac vein compression and iliofemoral deep venous thrombosis","authors":"Hamza Hanif MD , Ross M. Clark MD, MBA, RPVI , Rick Gehlert MD , Rachel Danczyk MD , LeAnn Chavez MD, MBA, FACS, RPVI , Muhammad Ali Rana MD, FACS, FSVS","doi":"10.1016/j.jvscit.2024.101593","DOIUrl":"10.1016/j.jvscit.2024.101593","url":null,"abstract":"<div><p>Extrinsic venous compression of the pelvic vasculature is associated with deep venous thrombosis of the iliac veins. Inflammatory pseudotumors are a known rare complication of metal-on-metal and metal-on-polyethylene hip resurfacing, We report the case of a 73-year-old woman with such a pseudotumor compressing the left iliac vein with associated deep venous thrombosis extending distally into the lower leg. In this case, we demonstrate safe and effective use of endovascular techniques, including percutaneous mechanical thrombectomy and iliac vein stenting, followed by revision total hip arthroplasty and excision of the pseudotumor.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001771/pdfft?md5=6bab62e85d274a9dbfc6ee5578e98655&pid=1-s2.0-S2468428724001771-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph D. Bozzay MD , Peter J. Kneuertz MD , David S. Xu MD , Timur P. Sarac MD , John Bozinovski MD , Kristine C. Orion MD
{"title":"Staged complex reconstruction of infected thoracic aortic endograft and adjacent spinal hardware using latissimus wrapped lateral aortic graft","authors":"Joseph D. Bozzay MD , Peter J. Kneuertz MD , David S. Xu MD , Timur P. Sarac MD , John Bozinovski MD , Kristine C. Orion MD","doi":"10.1016/j.jvscit.2024.101596","DOIUrl":"10.1016/j.jvscit.2024.101596","url":null,"abstract":"<div><p>Thoracic endovascular aortic repair (TEVAR) enables rapid and effective treatment of life-threatening aortic injuries. The occurrence of long-term complications from TEVAR and their management is ill-defined in young patients. This report describes a complex case of a 38-year-old male patient who underwent staged interventions for different acute pathologies instigated by blunt thoracic spinal trauma. The patient was initially treated with a TEVAR for aortic pseudoaneurysm in the setting of infected spinal hardware, which later resulted in an aortobronchial fistula and eroded spinal hardware. This report illustrates a successful multidisciplinary approach for definitive treatment with graft explant and aortic reconstruction.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001801/pdfft?md5=6d01b942d7ffb0c21622d715dada9169&pid=1-s2.0-S2468428724001801-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jesse Y. Han BA , Herbert I. James III , Michelle Manesh MD , Alyssa J. Pyun MD , Elizabeth Miranda MD , Sukgu M. Han MD, MS
{"title":"Hybrid approach to achieve secure distal seal zones during endovascular aortic repair in a patient with Marfan syndrome","authors":"Jesse Y. Han BA , Herbert I. James III , Michelle Manesh MD , Alyssa J. Pyun MD , Elizabeth Miranda MD , Sukgu M. Han MD, MS","doi":"10.1016/j.jvscit.2024.101595","DOIUrl":"10.1016/j.jvscit.2024.101595","url":null,"abstract":"<div><p>This report details a hybrid approach for treatment of abdominal aortic aneurysm in a patient with Marfan syndrome (MFS). A 34-year-old patient with MFS and prior open thoracoabdominal aortic aneurysm repair underwent bilateral common iliac artery interposition graft repair and endovascular aortic repair. The bifurcated stent graft was implanted into the previous thoracoabdominal graft proximally and iliac interposition grafts distally. Postoperatively, the patient recovered uneventfully with sac regression to 4.5 cm through 2-year follow-up, without seal zone degeneration. This hybrid approach aimed to eliminate landing zone degeneration in patients with MFS undergoing endovascular repair.</p></div>","PeriodicalId":45071,"journal":{"name":"Journal of Vascular Surgery Cases Innovations and Techniques","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468428724001795/pdfft?md5=d01dade1b0f2e8b14f15dd643d3b9303&pid=1-s2.0-S2468428724001795-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}