Treatment of femoral pseudoaneurysm after vascular procedure. In: A multidisciplinary Approach to Cardiovascular Diseases

Femoral artery pseudoaneurysms (FAP) incidence has increased, in last years, in line with the number of percutaneous interventions. FAP may complicate up to 8% of percutaneous vascular accesses after interventional procedures. FAP incidence can be even higher if are employed large-diameter sheaths, fibrinolytic therapy and anticoagulant regimens. A spontaneous sealing can occur in small diameter FAP, but an intervention is often required especially for larger diameter. Surgery has been considered the “gold standard” treatment, although its related perioperative morbidity in these high-risk patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound- guided compression (DUGC) and percutaneous thrombin injection are available with satisfactory results. Endovascolar solutions, as FAP exclusion with stent-graft deployment, have also been reported

Spontaneous symptomatic common carotid artery pseudoaneurysm: Case report and literature review

Spontaneous common carotid artery pseudoaneurysm (CCAP) is rare but potentially lethal disease. A 78-year-old man presented with pain in correspondence of right neck side and slight right eye ptosis. No previous surgery, trauma, or venous catheterizations in the neck region were reported. The computed tomographic angiography (CTA) showed a 4-cm saccular CCAP. The patient was managed emergently with surgical CCAP excision. At 6-month follow-up, the patient is neck pain-free with complete ptosis regression, and the CTA shows no pathologic findings. The literature review reported 7 cases of pseudoaneurysm of carotid district. All these cases were managed by surgical approach, and in 1 case, an endovascular embolization procedure was associated before. The CTA was used in all cases but angiography in only one. In these cases, the surgical repair with pseudoaneurysm evacuation is still the treatment of choice

Evoluzione nel trattamento endovascolare della patologia cerebrovascolare

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Nuovi approcci terapeutici e terapia rigenerativa delle ulcere vascolari

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Approccio vascolare nell’ischemia mesenterica cronica

Approccio vascolare nell’ischemia mesenterica cronic

Patologia aterosclerotica complessa degli arti inferiori: attualità nel trattamento

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Aneurismi aortici addominali, indicazioni e tecniche di trattamento

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Patient-Specific Rehearsal Feasibility Before Endovascular Repair of Ruptured Abdominal Aortic Aneurysm

To evaluate the feasibility of a patient-specific rehearsal (PsR) before emergency endovascular aneurysm repairs (eEVAR) and its influence on the operation. From February 2016 to October 2016, 10 consecutive patients (mean age 75±7.4 years; 9 men) presenting with a ruptured abdominal aortic aneurysm (rAAA) suitable for standard EVAR were enrolled in the study. A 3-dimensional (3D) model of the abdominal aorta was generated on a virtual reality simulator based on the patient's computed tomography (CT) images. Following the patient-specific simulation setup, PsR was conducted during patient admission or in parallel with the preoperative eEVAR workup. Measured outcomes were PsR feasibility only in the first 4 patients and impact on operative performance thereafter (changes in device selection, the planning process, clinical outcomes, perioperative mortality, and complication rates). Technical metrics and timing of system setup, rehearsal, interval from patient arrival to the actual procedure, and eEVAR were recorded. Mean time for 3D model creation was 21.3±7.8 minutes (range 13-37); there was a significant positive relationship between aortic neck diameter and segmentation time (p=0.003). The overall mean time for simulator setup and PsR was 54±14 minutes (range 37-80); PsR alone was completed in a mean 31±40 minutes (95% confidence interval -60 to -2.2). The actual eEVAR procedure duration was 69±16 minutes (range 45-90). No delay in the actual eEVAR procedure was registered owing to the PsR pathway. In 6 patients, preprocedure rehearsal induced changes in operative strategy, including device selection, main body introduction side, and/or deployment configuration. In 4 cases, rehearsal was performed twice to achieve optimal performance. PsR before eEVAR was feasible in all cases and caused no time delays in the actual eEVAR procedure. PsR optimized eEVAR planning by identifying optimal strategy for stent-graft component selection and deployment