Aorto-iliac aneurysm associated with congenital pelvic kidney: A short series of successful open repairs under hypothermic selective renal perfusion

The occurrence of congenital pelvic kidney (cPK) during aorto-iliac aneurysm repair is an extremely unusual finding. We report a series of four patients with aorto-iliac aneurysm and associated cPK who underwent aorto-iliac repair at our institution over the last 10 years. Aorto-iliac aneurysm repair under cPK selective hypothermic perfusion was successfully accomplished in all cases. All the cPK arteries were spared and were selectively reimplanted when required. No major complications or death were reported at long-term follow-up. Open surgical repair of aorto-iliac aneurysm in patients with cPK is safe and effective and, in our short series, we observed no worsening of the renal function; besides, we reported a persistent improvement of the renal function in two out of the four cases

Endovascular treatment of aortoesophageal and aortobronchial fistulae

none6Background: Even when promptly recognized and treated, aortoesophageal (AEF) and aortobronchial (ABF) fistulae are highly lethal conditions. Open surgical repair also carries a high risk of mortality and morbidity. Several alternative strategies have been recently reported in the literature including thoracic endovascular aortic repair (TEVAR). However, relatively little is known about results of TEVAR for AEF and ABF due to their rarity and the lack of large surveys. Methods: A voluntary national survey was conducted among Italian universities and hospital centers with an endovascular program. Questionnaires were distributed by e-mail to participating centers and aimed to evaluate the results of endovascular repair of established AEF or ABF. Results: Seventeen centers agreed to participate and provided data on their patients. Between 1998 and 2008, a total of 1138 patients were treated with TEVAR. In 25 patients (2.2%), the indication to treatment was an AEF and/or an ABF. In 10 of these cases (40%), an associated open surgical procedure was also performed. Thirty-day mortality rate of AEF/ABF endovascular repair was 28% (7 cases). No cases of paraplegia or stroke were observed. Mean follow-up was 22.6 months (range, 1-62). Actuarial survival at 2 years was 55%. Among the 18 initial survivors, five patients (28%) underwent reintervention due to late TEVAR failure. Conclusions: Stent grafting for AEF and ABF represents a viable option in emergent and urgent settings. However, further esophageal or bronchial repair is necessary in most cases. Despite less invasive attempts, mortality associated with these conditions remains very high. Copyright © 2010 by the Society for Vascular Surgery.Chiesa, R.; Melissano, G.; Marone, E.M.; Kahlberg, A.; Marrocco-Trischitta, M.M.; Tshomba, Y.Chiesa, R.; Melissano, G.; Marone, ENRICO MARIA; Kahlberg, A.; Marrocco Trischitta, M. M.; Tshomba, Y

Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery

none7Objective: The hybrid approach to the repair of thoracoabdominal aortic aneurysm (TAAA), consisting of visceral aortic debranching with retrograde revascularization of the splanchnic and renal arteries and aneurysm exclusion using stent grafts, has been previously described and may be considered particularly appealing in high-risk patients, especially those who have undergone prior aortic surgery. This study analyzed prospectively recorded data of a series of high-risk patients with prior aortic surgery who underwent hybrid TAAA repair at our institute and contrasted the outcomes with those of a similar group of patients who underwent conventional open TAAA repair. Methods: Between 2001 and 2006, 13 patients (12 men) with a median age of 69.6 years (range, 35 to 82 years) underwent one-stage hybrid repair of TAAA (7 type I, 2 type II, 2 type IV, and 2 aneurysms of the visceral aortic patch). These patients, the hybrid group, had a history of aortic surgery (30.7% ascending, 30.7% descending, 46.1% abdominal aortic repair, and 15.4% redo TAAA) and were at high risk for open repair. The criteria used to define these patients as high risk and to indicate the need for hybrid treatment were American Society of Anesthesiologists (ASA) class 3 or 4 associated with a preoperative forced expiratory volume in 1 second (FEV1) <50%. In all cases, we accomplished partial or total visceral aortic debranching through (1) a previous visceral artery retrograde revascularization with synthetic grafts (single bypass, customized Y or bifurcated grafts), and (2) aortic endovascular repair with one of three different commercially produced stent grafts (Cook, W.L. Gore & Assoc, and Medtronic). We analyzed the results and compared the outcomes of the hybrid group with those of a similar group of 29 patients (25 men) with a median age 65.3 years (range, 58 to 79) selected from our overall series of 246 TAAA repairs between 1988 and 2005. These 29 patients, the conventionally treated group, were selected for having had aortic surgery (22% ascending, 38% descending, 42% abdominal aortic repair, and 10.3% redo TAAA), an ASA 3 or 4, a preoperative FEV1 <50%, and a conventional open repair of TAAA (10 type I, 5 type II, 4 type III, 7 type IV, and 3 aneurysms of the visceral aortic patch). Results: In the hybrid group, 32 visceral bypasses were completed and endovascular TAAA repair was successful in all cases. No intraoperative deaths occurred. Perioperative mortality was 23%, and morbidity was 30.8% (renal failure in 2, respiratory failure in 1, and delayed transient paraplegia in 1). At a median follow-up of 14.9 months (range, 11 days to 59.4 months), all grafts were patent at postoperative computed tomography angiography and no aneurysm-related deaths, endoleak, stent graft migration, or morbidity related to visceral revascularization had occurred. No conventionally treated patients died intraoperatively. Perioperative mortality was 17.2% and morbidity was 44.8% (respiratory failure in 7, coagulopathy in 1, renal failure in 2, and paraplegia in 3). At a median follow-up of 5.4 years (range, 1.7 to 7.9 years), no significant complications related to aortic repair occurred, except for three patients (10.3%) with asymptomatic dilatation of the visceral aortic patch <5 cm undergoing radiologic surveillance. Conclusion: Hybrid TAAA repair is technically feasible in selected cases. Perioperative morbidity and mortality were considerable in our subset of high-risk patients with prior aortic surgery, but no aneurysm-related or procedure-related complications were reported at mid-term follow-up. Hybrid TAAA repair did not lead to a significant improvement in outcomes compared with open TAAA repair in a similar group of patients. Larger series are required for valid statistical comparisons and longer follow-ups are necessary to evaluate the durability of hybrid repairs. © 2007 The Society for Vascular Surgery.Chiesa, R.; Tshomba, Y.; Melissano, G.; Marone, E.M.; Bertoglio, L.; Setacci, F.; Calliari, F.Chiesa, R.; Tshomba, Y.; Melissano, G.; Marone, ENRICO MARIA; Bertoglio, L.; Setacci, F.; Calliari, F

ROSES, the only RObotic System for any Endovascular Surgery, Including the Control of an Animated Catheter Characterized by the Presence of two Controlled Curvatures

The paper presents ROSES, its robotic components, the different devices, not necessarily sterile, and its disposables, suitable for any endovascular procedure, both actually performed and presently not assisted by any robotic system, and open in the future for new application yet to come, such as what will be allowed by the new animated catheter. In fact, this is due to the mechanical configuration of the robotic actuators based on a peculiar gear train which presents a big passage hole which allows both the passage of big catheters and even hemostasis valves, as well as full control of very small catheters and guide wires. The system measures forces opposed by the body showing their value both numerically and analogically without the need of any. special tool, measures length of penetration of each catheter and guide wires recording their value. Thus, it may become in future, connected to a work station that will register in real time also the fluoroscopic images, a kind of black box of endovascular surgeries, separating completely doctor and nurses from the patient, using also cameras and microphones to replace the physical contact with the patient

Extensive congenital asymptomatic renal arteriovenous malformation

Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. These lesions may present with a wide range of signs and symptoms, including hypertension and hematuria. We report a case of a 71-year-old woman with incidentally diagnosis of asymptomatic right renal AVM

Open conversion following Nellix Endovascular Aneurysm Sealing (EVAS)

The Nellix Endovascular Aneurysm Sealing (EVAS) System (Endologix, Irvine, California, USA) was presented as a novel concept in the treatment of abdominal aortic aneurysm (AAA). After numerous adverse events, the device has been voluntarily withdrawn from the market by the manufacturer. The purpose of this video is to describe the technical approach of a successful explantation of the Nellix endograft in a patient who underwent EVAS for AAA. The patient\u2019s consent for publication was obtained

Through-and-through femorofemoral wire retrograde technique for the E-nside precannulated inner branch thoracoabdominal stent graft

The E-nside multibranched stent graft (Jotec GmbH, Hechingen, Germany) is the first and only off-the-shelf thoracoabdominal prosthesis with precannulated inner branches. Usually, after the device deployment, target vessel stenting will be facilitated by antegrade inner branch cannulation to retrieve the precannulated guide. In the literature, the use of antegrade access has been associated with the potential risk of cerebral and systemic embolization. Therefore, other retrograde techniques have been described. We have reported a new retrograde approach using a precannulated through-and-through femorofemoral wire technique for target vessel catheterization

Long-term follow-up of adventitial cyst surgical excision in external iliac vein

Adventitial cystic disease of the venous system is an extremely rare condition. Forty-five cases have been described in the literature during the last 70 years, but they may not be representative of the real incidence of this pathologic process. We report a case of an adventitial cyst compressing the right external iliac vein and presenting with edema of the ipsilateral leg. Ultrasound imaging and computed tomography angiography showed the typical features of cystic disease and venous stenosis. Cyst excision was performed with a double surgical access. No perioperative complications were reported. There was no recurrence at 4-year follow-up

Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients

Imaging Modalities for the Diagnosis of Vascular Graft Infections:A Consensus Paper amongst Different Specialists

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients