Mycotic aneurysm : a lesser known complication of coarctation repair in a child, managed by endovascular aneurysm repair

We report a 12-year-old child diagnosed with mycotic aneurysm at the site of coarctation of aorta (CoA) repair. Surgical intervention, though very high risk, is the mainstay of management. In selected cases endovascular stenting is being reported in adults. Here we report the use of an endovascular stent in a child.peer-reviewe

Catheter fracture and cardiac migration of a totally implantable venous device

Totally implantable venous devices (TIVD) are increasingly being utilized for venous access for chemotherapy of oncological patients. These devices considerably improve the quality of life of patients requiring long-term chemotherapy. However, despite the great usefulness of TIVDs, their insertion and maintenance is not free of complications. Many early as well as late complications associated with these devices have been reported. We report an unusual, silent, but potentially hazardous complication of catheter fracture and cardiac migration in a 16-year-old girl, in whom the port had been unused for 9 months before presentation. Percutaneous retrieval was unsuccessful as the catheter end was embedded in the myocardium. The catheter was removed via a midline sternotomy without any further complications. We have also reviewed the literature about the possible mechanism of this complication and discussed methods to recognize and avoid it

Case Report - Catheter fracture and cardiac migration of a totally implantable venous device

Totally implantable venous devices (TIVD) are increasingly being utilized for venous access for chemotherapy of oncological patients. These devices considerably improve the quality of life of patients requiring long-term chemotherapy. However, despite the great usefulness of TIVDs, their insertion and maintenance is not free of complications. Many early as well as late complications associated with these devices have been reported. We report an unusual, silent, but potentially hazardous complication of catheter fracture and cardiac migration in a 16-year-old girl, in whom the port had been unused for 9 months before presentation. Percutaneous retrieval was unsuccessful as the catheter end was embedded in the myocardium. The catheter was removed via a midline sternotomy without any further complications. We have also reviewed the literature about the possible mechanism of this complication and discussed methods to recognize and avoid it

Role of hybrid operating room in surgery for the right atrial thrombus, pulmonary thrombi, and ventricular septal rupture after myocardial infarction

Free-floating right heart thrombi are uncommon and need emergency treatment in view of their tendency to dislodge and cause pulmonary embolism. We report a successful surgical management of a patient who had large mobile right atrial thrombus, bilateral pulmonary thrombi, coronary artery disease, and postmyocardial infarction ventricular septal rupture (VSR). The patient underwent coronary angiography, inferior vena cava filter placement, removal of thrombi from the right atrium and pulmonary arteries, repair of VSR, and coronary artery bypass graft surgery in a hybrid operating room

Supera Stent Implantation with Ultrasound Guidance for Complex Ostial Lesions of Superficial Femoral Artery by Retrograde Approach: The SUGAR Technique

Purpose The aim of this study was to describe a modified technique for accurate deployment of the Supera stent under ultrasound (US) guidance for complex lesions involving superficial femoral artery (SFA) ostium without jailing profunda femoral artery (PFA) by retrograde approach. Technique Retrograde pedal access was initially taken in all the cases. The stenotic or occlusive femoropopliteal lesions involving the SFA ostium were crossed retrogradely and additional contralateral common femoral artery (CFA) access was taken only if we failed to cross the lesion. In addition to fluoroscopy, extravascular US guidance was freely used whenever required throughout the procedure. After desired predilatation of the SFA lesion, US guidance (gray scale and color Doppler) was used to start deployment of the proximal few centimeters of Supera stent ensuring that the landing of first crown was exactly from the SFA ostium not extending into CFA or jailing the PFA ostium. The rest of the stent was deployed under fluoroscopic guidance. Retrograde pedal access site hemostasis was achieved by manual compression. The Supera stent implantation with Ultrasound Guidance for complex ostial lesions of superficial femoral Artery by Retrograde approach (SUGAR) technique was applied successfully in 35 patients (mean age 58.1 ± 4.4 years; 24 males) with critical limb ischemia via the distal pedal approach. No access site or remote complications were observed. Conclusion The SUGAR technique has superior advantage of utilizing a simple tool like extravascular US in addition to fluoroscopy for retrograde Supera stent deployment by allowing very precise landing at SFA ostium, bypassing the need for multiple oblique projections, unwanted radiation exposure, and extra contrast dye overload

Pulmonary Embolism: A Frequent Occurrence in Indian Patients with Symptomatic Lower Limb Venous Thrombosis

Pulmonary embolism (PE) is the most severe complication of deep venous thrombosis (DVT). There have been very few studies to assess the prevalence of PE in Asian patients. The objective of this study was to define the prevalence of PE in patients presenting with suspected lower limb DVT. Methods: This was a prospective cohort study at Sir Ganga Ram Hospital, a large multispecialty hospital in New Delhi, India. From January 2001 to July 2004, 1,552 consecutive inpatients and outpatients who presented with clinically suspected lower limb DVT were enrolled in the study. Combined ascending radionuclide venography and lung perfusion scan was performed in all patients. Patients with evidence of pulmonary perfusion defects underwent ventilation lung scan. Results: Radionuclide venography-detectable DVT was noted in 744 patients, of whom 521 (70%) had suprapopliteal DVT. Of patients with DVT, 294 (39.5%) showed a high-probability lung scan and 135 (18.1%) had an intermediate-probability lung scan. Overall, 47% of patients with a high-probability scan had no clinical manifestations suggestive of PE. Conclusion: PE occurs frequently in Indian patients with symptomatic DVT. Increasing awareness will provide us with clearer ideas about the prevalence of venous thromboembolism in Asian countries

Ultrasound-guided fistuloplasty: A novel office-based technique for arteriovenous fistula salvage

Introduction: Alongwith the increasing awareness of fistula for dialysis, there has been an increasing utilization of endovascular interventions to create and maintain native Arterovenous fistulas. So far the widely practiced corrective endovascular options are fistulogram and plasty. However with most target segments being superficial veins of the outflow channel with juxta anastomotic lesions, ultrasound guided fistuloplasty is a promising answer to such a clinical scenario. Methods: All patients with diagnosed outflow vein obstruction with dialysis disturbance and no evidence of central vein stenosis were subjected to the procedure. Results: Satisfactory dialatation was achieved in 84% of patients at the end of one month. Only four patients required adjunctive procedure prior to dialysis. The most common procedure related side effect was hematoma- in 08 ( 19%) of patients, however they were non expanding and self resolving- limited to the area around the plasty site. Conclusion: The procedure can be accomplished in office setting avoiding the exposure of dye and radiation. It also decreases the burden on health care in operating theatres and decreases cost and time of hospitalization. However central vein stenosis and cephalic arch stenosis are definitely limitations of the procedure

Minimally invasive management of renal artery pseudoaneurysm following robotic nephron-sparing surgery: Report of two cases and review of literature

Partial nephrectomy (PN) either done open, laparoscopic, or robotic is associated with the complication of renal artery pseudoaneurysm (RAP), which is rare but can have grave prognosis. Minimally invasive intervention using endovascular techniques can safely treat this problem with minimal morbidity. We present here two cases of RAP following robotic PN. The first case was a 78-year male patient who underwent robotic PN 3 months prior for a 55 mm × 53 mm clear cell carcinoma of the left lower renal pole. On his 3-month follow-up computerized tomography (CT), he was incidentally diagnosed with a 48 mm × 40 mm × 36 mm well-defined pseudoaneurysm with supply from the lower polar accessory renal artery. The second case was a 42-year male patient who had undergone a robotic PN for a 3.5 cm renal mass. On day 24 postsurgery, he developed hematuria and evaluation with renal CT angiography showed two pseudoaneurysms of approximately 8–9 mm each; associated with a hematoma extending from the mid pole of the left kidney to the tail of the pancreas. We managed to successfully embolize the RAPs endovascularly in both the patients; case one with glue and case two with coils. Both patients were discharged on the next day with no side effects, complications, or morbidity. RAP post-PN; though rare, is a dreaded complication that one should be aware of and be able to treat it timely. Knowing how to managing these situations with minimally invasive techniques should be a part of the armamentarium of all endovascular specialists