Endograft Sizing for Abdominal Aortic Aneurysms

While a tight seal and fixation of aortic stent-grafts to the vessel wall are vital for positive outcomes in treating abdominal aortic aneurysms (AAAs), optimal aortic stent-graft sizing for endovascular aneurysm repair (EVAR) remains debatable. We performed a holistic review of the data surrounding the sizing of endografts using instructions for use (IFU) guidelines, as well as experimental, computational, and clinical studies. Most clinical studies that have investigated the role of sizing and outcomes are limited by the strict selection criteria, or the inability to account for the multitude of confounders associated with sizing. Currently, oversizing of endografts between 10 and 20% remains safe and favored, but sizing outside the IFU guidelines frequently occurs. Oversizing up to 25% appears to be associated with decreased rates of proximal endoleak and aneurysm sac enlargement, while excessive oversizing (>30%) has been linked to graft infolding, collapse, and aortic dilatation. It is unclear, however, whether there is an association between oversizing associated with neck dilatation and graft migration. During sizing, surgeons should take an individual approach and consider several factors including device type, calcification and/or thrombus of apposition site, hemodynamics, and aortoiliac morphology

Lower extremity bypass with tumescent local anesthesia

Lower extremity bypass is most commonly performed for the treatment of critical limb ischemia. These patients often pose high surgical risk secondary to significant clinical comorbidities. These risks may be compounded when general anesthesia is considered. We present the case of a patient at high anesthesia risk with critical limb ischemia who was unable to receive general anesthesia or neuraxial blockade. An infrainguinal bypass was performed using tumescent anesthesia with minimal intravenous sedation. The patient was discharged 6 days later, and his postoperative course was complicated by a groin lymphocele. Tumescent local anesthesia is a possible alternative pain management strategy for patients undergoing lower extremity bypass surgery

Transradial stenting of a carotid pseudoaneurysm

Carotid pseudoaneurysms are rare and, if treated endovascularly, are usually approached via the femoral artery. We report the case of transradial stenting of an anastomotic carotid pseudoaneurysm secondary to vertebral transposition through an existing carotid-subclavian bypass. Keywords: Carotid aneurysm, Carotid pseudoaneurysm, Radial access, Stent, Endovascula