Internal Jugular Vein Pyogenic Capillary Hemangioma: A Case Report.

Internal jugular vein hemangioma, also called pyogenic granuloma, is a rare tumor. Such a neoformation was accidentally discovered and excised in a middle-aged man. Histologic and immunohistochemical investigations were performed, and this case is compared with the poor amount of similar ones described in the literatur

Multidisciplinary Approach for a Relapsing Goiter with Severe Tracheal Stenosis: A Case Report in an Elderly Patient

SummaryTotal thyroidectomy is considered the gold standard for thyroid benign pathology treatment. Unfortunately, many partial interventions carried out in the past created many complications due to the tendency of the goiter to relapse and the formation of adherences in the anterior region of the neck. A woman 72 years of age with a relapsing goiter and severe respiratory symptomatology underwent thyroidectomy. After thyroid removal, tracheal stenosis persisted, making the positioning of a T silicon prosthesis (Montgomery’s T-tube) necessary. After 60 days, the prosthesis was replaced with a new made out of the same material but with a larger diameter and a softer consistency, which was removed after 4 months. The patient completely recovered her respiratory function and also maintained normal vocal cord activity without any kind of surgical sequelae. The full success was possible because of the involvement of different specialists

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

OBJECTIVES: Contrast enhanced ultrasound (CEUS) has been suggested as an imaging tool for detection of asymptomatic carotid atherosclerotic disease (ACAD) at high risk of cerebral embolisation. The objective of this study was to evaluate CEUS and immunohistochemical (IHC) patterns in ACAD (i.e., without any neurologic symptoms in the last 6 months) and their correlations with histology. METHODS: CEUS analysis was classified on a semiquantitative basis using a three-point classification scale. Plaque morphology was assessed using the American Heart Association (AHA) classification of atherosclerotic plaques, then accordingly assigned as non-vulnerable (AHA Type IV/V) or vulnerable (AHA Type VI). IHC analysis for intra-plaque neo-angiogenesis (IPN) was identified by CD34/VEGF immunostaining and classified on a semiquantitative basis using a four-point classification scale. Both CEUS and IHC analyses were performed and scored by single observers. RESULTS: Fifty-eight consecutive asymptomatic patients (mean age 73 years, 33 males) undergoing carotid endarterectomy were included in the final analysis. Nineteen had AHA Class IV/V plaques, and the remaining 39 had AHA Class VI plaques. There were two main findings of the study: (a) histologically proven vulnerable plaques compared with histologically proven non-vulnerable plaques had denser IPN (p = .004), but did not show more pronounced contrast enhancement; (b) the correlation between IHC analysis and CEUS analysis was significant for both vulnerable and non-vulnerable plaques (p = .04 and p = .01, respectively), but it was direct for AHA Type IV/V plaques and inverse for AHA Type VI plaques. CONCLUSIONS: The main findings of the study were that histologically proven vulnerable plaques (i.e., AHA Class VI) as compared with histologically proven non-vulnerable plaques (i.e., AHA Class IV/V) had denser neo-vascularisation, but not more pronounced contrast enhancement

Novel Technique for Intentional Occlusion of Directional Branches During Complex Endovascular Aortic Repair Using Microvascular Plugs

Purpose: To demonstrate the feasibility and outcomes of using the microvascular plug (MVP) for intentional occlusion of directional branches (DB) during complex endovascular aortic procedures. Case report: Two patients were treated with the off-the-shelf four-branched Zenith t-Branch thoracoabdominal stent-graft (Cook Medical, Bloomington, Ind). In both cases, the renal arteries (on one side in patient #1 and on both sides in patient #2, respectively) were occluded at time of index intervention. Preoperative planning included the intentional occlusion of each DB with one 7Q-MVP. Technical success was achieved in all cases and maintained at mid-term follow-up (12 months and 36 months, respectively). Conclusions: Use of the MVP appears to be feasible and effective for intentional occlusion of DB during complex endovascular aortic repair. This novel and simple technique may present some unique technical advantages, allowing precise placement of the device while avoiding extension using a bridging stent and DB cannulation with larger sheaths

Neoplastic Embolization from Cardiac Papillary Fibroelastoma with Unusual Presentation: A Case Report

Papillary fibroelastoma is the second most frequent primary tumor of the heart. We report the case of a cardiac papillary fibroelastoma, arising from the interatrial septum, symptomatic from distal embolization to lower limb arteries. Such a clinical presentation is extremely infrequent for cardiac papillary fibroelastomas. Moreover, the site of origin not from cardiac valves and the pathogenetic mechanism underlying the clinical manifestation both represent peculiar additional findings of our case

Management of an Iatrogenic Pseudoaneurysm of the Superior Gluteal Artery by Percutaneous Ultrasound-Guided Thrombin Injection: A Case Report

We report the unusual case of a pseudoaneurysm of the superior gluteal artery (SGA) as a complication of a bone marrow biopsy. A 75-year-old man presented with pain and swelling of the left buttock 1 month after a bone marrow biopsy of the left iliac crest. The patient was treated by percutaneous ultrasound-guided thrombin injection (UGTI). The procedure was successful without any complication and the patient was discharged at home the same day. Follow-up at 3 months after the procedure confirmed the complete thrombosis of the pseudoaneurysm sac. At the best of our knowledge, UGTI of a pseudoaneurysm of the SGA has never been reported since now in the English literature

Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances

Growth Rate of Small Abdominal Aortic Aneurysms and Genetic Polymorphisms of Matrix MetalloProteases-1, -3, and -9

Genetic variants of matrix metalloproteases (MMPs)-1, -3, and -9, together with clinical variables, might predict the growth rate (GR) of abdominal aortic aneurysm (AAA). Genotyping of MMP-1 (1,607 G\ufe/G), MMP-3 ( 1,171 6A/5A), and MMP-9 microsatellite (13\u201326 cytosine\u2013adenosine repeats around -90) from peripheral blood was performed in 137 AAA patients with two AAA diameter measurements (at least 3 months to 1 year apart). When the same technique (either ultrasound or computed tomography) was used for the two measurements, yearly GR was estimated and compared with MMP genotype and clinical features by linear and binary logistic regression. Collectively, 36 patients provided 94 observations, with a median GR of 3 mm/year (interquartile range, 0\u20135.8); GRs in carriers of MMP-1 polymorphism G/G, G/G\ufe, and G\ufe/G\ufe genotype were 0.3, 3.5, and 4.7mm/year, respectively (p \ubc 0.008). In linear logistic regression, the main determinant of GR was growth arrest (GA, i.e., GR \ubc 0, occurring in 32 observations, 34%). In turn, GA occurredmainly in G/G MMP-1 genotype (odds ratio, 3.9; 95% confidence interval, 1.6\u20139.7; p \ubc 0.002), while variables accounting for GR > 0 were MMP-1 G \ufe /G\ufe genotype, intake of any antihypertensive drug, and MMP-3 6A/6A genotype. Carriers of none, one, or two/three of these conditions accounted for a GR of 3, 4, and 9 mm/year, respectively (p \ubc 0.001). MMP-1 (1,607 G\ufe/) variant is associated to differential GR in AAA: homozygous G deletion variant shows higher GA prevalence and lower GR, while carriers of G \ufe /G\ufe MMP-1 genotype, together with intake of antihypertensive drugs, and 6A/6A in MMP-3 present cumulative GR increase

Novel application of custom-made stent-grafts with inner branches for secondary treatment after stent-graft migration of previous infrarenal endovascular aortic repair

Purpose: We present a novel application of custom-made stent grafts (CMSGs) with inner branches to incorporate target vessels (TVs) as an alternative to fenestrations or directional branches for secondary treatment after stent graft migration of previous infrarenal endovascular aortic repair (EVAR). Case report: Two consecutive patients with stent graft migration of previous EVAR were electively treated at our institution from January 1, 2018 through December 31, 2018. Stent graft migration was defined as radiologic evidence of stent graft displacement >10 mm. In both cases, a proximal type I endoleak was noted, and the residual infrarenal aorta above the previous endograft was unsuitable as the proximal landing zone for a nonfenestrated cuff. Repair was planned by means of a CMSG with 4 inner branches. The procedures were conducted in two-stage fashion to minimize the risk of spinal cord ischemia. The procedures were technically successful with a total of 8 TVs stented. Both patients did not suffer from any early (i.e., up to 30 days) major adverse events, and no access-site complications were noted. At one-year follow-up, computed tomography angiography showed regular placement of the CMSGs, widely patent TVs, absence of any type I or III endoleak, and stable sac size. No late reinterventions were recorded. Conclusions: Secondary treatment of stent graft migration after previous EVAR is safe and feasible using CSMGs with 4 inner branches. This technique is effective as showed by stable sac size and 100% freedom from TVI at mid-term imaging follow-up. Larger cohorts and longer follow-up are needed to confirm the preliminary results