1.Endovascular repair of giant traumatic pseudo-aneurysm of the common carotid artery
Law YUK ; Chan Che YIU ; Cheng W. STEPHEN
World Journal of Emergency Medicine 2015;6(3):229-232
BACKGROUND: Delayed presentation of carotid artery pseudoaneurysm following many years after self-inflicted penetrating injury of the neck is extremely rare. Open surgical carotid repair may involve sternotomy for proximal vascular control. Endovascular treatment is evolving as a less-invasive treatment option. METHODS: We report a 55-year-old man with a history of paranoid schizophrenia who presented with a progressively enlarging left sided neck mass many years after attempted suicide. CT scan confirmed a 6 cm pseudoaneurysm arising from the common carotid artery. RESULTS: Through an open retrograde puncture of the distal common carotid artery, the common carotid pseudoaneurysm was successfully repaired with a BARD fluency carotid stentgraft of 8 mm×80 mm (BARD, Tempe, AZ). The patient recovered well with no neurological deficits and was discharged on postoperative day 4. Dual antiplatelet agents of aspirin and clopidogrel were given for six months and then clopidogrel was administered lifelong. The neck mass decreased in size gradually and became non pulsatile upon follow-up. CONCLUSION: Endovascular stenting of giant carotid pseudoaneurysm is an acceptable less invasive treatment option for giant carotid pseudoaneurysm. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.
2.Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians.
Sally S J CHAN ; Yiu Che CHAN ; Stewart R WALSH ; Tze Tec CHONG ; Edward T C CHOKE ; Alok TIWARI ; Tjun Yip TANG
Annals of the Academy of Medicine, Singapore 2021;50(3):241-249
INTRODUCTION:
Endovenous cyanoacrylate glue (CAG) ablation for the treatment of chronic venous insufficiency (CVI) and varicose veins has shown non-inferior outcomes with an excellent safety profile, high patient satisfaction rate, and excellent efficacy when compared to the gold standard of endothermal ablation. A review of the current literature for CAG use in CVI showed that most studies and longer-term data are from Caucasian-based populations, which are subject to different anatomical venous variations and socio-economical contexts. This review aimed to gather the current evidence for CAG use in Asian CVI patients.
METHODS:
Asian studies for the use of CAG in CVI were included in this review. Successful ablation rates, quality of life improvement and novel complications such as glue hypersensitivity reactions are described, along with anatomical descriptions of superficial venous anatomy in study patients. Use of CAG in Singapore and Asia was addressed.
RESULTS:
CAG has been gaining traction as an option for CVI treatment in Asians. In Singapore, it has been adopted with comparable low complication rates and significant improvement of quality of life after treatment. As we increase our understanding of the variations in venous anatomy in the Asian population, new techniques such as retrograde deployment of the device and use of CAG ablation for venous leg ulcers have been developed.
CONCLUSION
Further robust evidence in terms of large randomised control trials along with cost effectiveness studies are needed to determine the true value of CAG ablation in the Asian setting.