Behçet's disease: Endovascular management of a ruptured peripheral arterial aneurysm

AbstractTraditionally, bypass grafts are at a high risk for thrombosis or anastomotic degeneration in patients with Behçet's disease. We report the successful deployment of a vein-covered stent across the neck of a ruptured peripheral arterial aneurysm, via a remote site access, with intermediate-term follow-up. Covered stents may represent an attractive alternative to open surgical bypass for the management of aneurysms in patients with Behçet's disease. (J Vasc Surg 2001;34:1127-9.)

Brachial Artery Vasculitis and Associated Stenosis Presenting as Elbow Pain in a 16-Year-Old Soccer Player: A Case Report

Chronic vascular occlusion in the upper extremity can result from repetitive trauma, atherosclerosis, proximal embolic events, hypercoagulable states, and systemic diseases such as collagen vascular disease and vasculitis. Considerable functional impairment can result from these maladies; however, sometimes the condition develops slowly with minimal effect on the patient. We describe a 16-year-old soccer player with slow-progressing elbow pain and loss of range in motion caused by brachial artery vasculitis and resultant brachial arterial stenosis. Although vascular insults and lesions rarely cause chronic vascular occlusion, physicians should consider this possibility in patients with localized pain or atrophy, especially if the condition develops slowly

A rare cause of claudication treated with IVC reconstruction: A case report

Introduction: Inferior vena cava (IVC) agenesis is one of rare entities of IVC anomalies which presents in young patients with unprovoked deep venous thrombosis (DVT) or unexplained bilateral lower venous insufficiency. We are presenting a case of IVC agenesis which was treated with IVC reconstruction. Case: We describe a case of 28 years old male with painful bilateral lower extremity varicose veins and a history of right lower extremity DVT and was on anticoagulation with warfarin. He was found to have extensive bilateral greater saphenous veins (GSVs) and right femoral vein reflux with patent bilateral deep veins. He was treated with bilateral GSV ablation and microphlebectomies. Six weeks later he presented with acute bilateral iliofemoral DVTs treated with tissue plasminogen activator thrombolysis tPA via bilateral popliteal vein access which helped relieve his leg swelling but he continued to have debilitating venous claudication. A computed tomography (CT scan) demonstrated resolution of DVT but revealed IVC agenesis. He underwent IVC reconstruction with prosthetic graft which helped complete resolution of his chronically debilitating bilateral lower extremity claudication. Conclusion: In young patients with severe manifestations of lower extremity venous hypertension i.e. edema, varicosity and DVT, central venous anomaly should be considered. Severely symptomatic cases of IVC agenesis can be treated with IVC reconstruction

Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial

Copyright 2016 American Medical Association. All rights reserved. IMPORTANCE: Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. OBJECTIVE: To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. DESIGN, SETTING, AND PARTICIPANTS: This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. MAINOUTCOMES ANDMEASURES: Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). RESULTS: A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89in the endovascular group and 4.84 in the open repair group (P =.68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group (P =.82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group,$153 533; difference, -$10 788; 95$29 796 to $5825; P =.25). Costs related to AAA, including the initial repair, constituted nearly 40$57 501; open repair group, $57 893; difference, -$393; 95% CI, -$12 071 to$7928; P =.94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA