Endovascular treatment of stenoses in the superior vena cava syndrome caused by non-tumoral lesions

We report our experience in percutaneous treatment of non-tumoral superior vena cava syndrome (SVCS) between December 1998 and July 2001. During a period of 2.5 years, 9 patients (age range 27–84 years, mean age 50 years) were treated percutaneously for significant non-tumoral SVCS. Symptomatic SVCS were due to dialysis catheters (7), central line (1) and radiation therapy (1). In thrombotic occlusions and severe stenosis, a preliminary in situ thrombolysis was achieved before angioplasty. Patients were followed by echo-Doppler, computed tomography angiography (CTA), magnetic resonance angiography (MRA), or phlebography. Complete recanalization of the veins and immediate resolution of symptomatic SVCS were obtained in all patients, with no procedure-related complication. Thirteen stents were placed in 9 patients with a mean clinical follow-up of 9.1 months (range 2–23 months). One hundred percent patency at 6 months was obtained. Two patients recurred twice and were treated with new stent placement. At 12 months the patency was 67% and assisted patency was 100%. Stent placement in benign symptomatic SVCS is a safe and minimally invasive procedure, with no technical and clinical complications in our experience. It allowed immediate relief of symptoms, and in dialysed patients could provide continued use of hemodialysis access. Close clinical surveillance is mandatory to assess stent patency

Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review

Introduction and Importance Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. Case Presentation A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. Clinical Findings and Investigations The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. Intervention and Outcomes The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. Relevance and Impact Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients

Extra-anatomic bypasses as perfusion alternatives in the treatment of complex thoracoabdominal aortic disease

The management of thoracoabdominal aortic aneurysms (TAAA) presents significant challenges for vascular and cardiothoracic surgeons due to the risk of ischemic complications. Various strategies have been implemented over time, including open repair with or without left heart bypass (LHB), endovascular, and hybrid approaches. Here, we explore the application of temporary extra-anatomic bypasses (TEAB) as a technique for complex open TAAA repair when the traditional standard of care is not feasible (i.e. Unavailability of LHB) or indicated (i.e. contraindication for systemic heparinization for LHB). Case 1 is an undomiciled 59-year-old male with a chronic type B dissection (CTBD) and degenerative TAAA with failed attempt at endovascular repair at an outside institution. An open repair of the visceral segment was performed with TEAB due to risk of impending rupture, prior failed endovascular repair, and unavailability of cardiac surgery. Additionally, a staged TEVAR was planned for treatment of the thoracic portion of the CTBD in two weeks’ time. The patient experienced sudden chest pain 10 days following the TAAA repair, prompting urgent TEVAR. No complications were observed. Case 2 is a 65-year-old male with a type 2 TAAA who underwent an open repair with the use of TEAB. Technical success was achieved with no complications. TAAA repair poses significant challenges regardless of the approach selected. However, the use of TEAB has shown promise in ensuring adequate perfusion of vital organs during complex repair when LHB is not an option. Preoperative planning is essential to minimize ischemic time and reduce complications. Studies have shown favorable outcomes with TEAB, however, evidence relies only on small series and case reports. The use of TEAB is a valuable technique for safeguarding organ perfusion during open repair of TAAA. While further research and experience are needed, TEAB offers a promising alternative for cases where traditional approaches are not available. Continued exploration and documentation of TEAB in current literature will contribute to optimizing TAAA management strategies

Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease

This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). A retrospective review was conducted in patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length of stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, and patency were assessed. Thirty-six male patients (41 limbs), mean age 63.9 ± 6 years, were identified (TASC C = 39%, D = 61%). Indications for surgery were claudication (27%), rest pain (44%), and tissue loss (29%). A simultaneous adjunctive procedure (5 infrainguinal bypass, 3 superficial femoral artery stents) was performed in 22%. Thirty-day outcomes included 1 mortality (2.7%) and 2 reoperation (5.5%), 1 for femoral artery pseudoaneurysm and 1 for bilateral groin seroma. LOS was 4 days (interquartile range 3-6). All patients with available data experienced 30-day clinical and hemodynamic success. Mean follow-up was 23 months (range 1-79 months) with a primary patency of 85.4%. Cumulative primary assisted and secondary patency was 92.6%. The femoral patch repair was the most frequent site of reintervention (3/3). Mortality was 34% during the study period, and it was significantly higher in patients with tissue loss (57.1% vs. 14.8%, P = 0.01). The hybrid approach has low morbidity, mortality, and fast recovery. The use of covered stents/stent grafts provides good mid-term patency. Close follow-up with noninvasive imaging is paramount to avoid repair failure, in particular at the femoral patch repair site