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Tangential Resection of a Popliteal Vein Aneurysm in a Patient Complaining of Localized Popliteal Pain.

Vascular Specialist International.2016;32(1):33-36. doi:10.5758/vsi.2016.32.1.33

A 48-year old man presented with left popliteal pain. A 2.2×1.6 cm sized saccular aneurysm at the level of the left popliteal fossa was diagnosed by ultrasonography. Tangential aneurysmectomy and popliteal vein repair was performed uneventfully. The patient fared well for a year without symptoms. Popliteal vein aneurysms are rare and typically found in patients with fatal thromboembolic features without warning symptoms. Fortunately, our patient had localized pain which was helpful in its early diagnosis and treatment.
Aneurysm* ; Early Diagnosis ; Humans ; Popliteal Vein* ; Ultrasonography

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A Case of Superior Mesenteric Artery Aneurysm Mimicking an Abdominal Aortic Aneurysm and Presenting as a Pulsating Abdominal Mass.

Sang Tae CHOI ; Keon Kuk KIM ; Jin Mo KANG

Vascular Specialist International.2016;32(1):29-32. doi:10.5758/vsi.2016.32.1.29

A 62-year-old male with a smoking history of 30 pack-years presented with a 1-year history of a periumbilical pulsating mass. He had been treated for hypertension for 2 years. Physical examination revealed a huge pulsating mass in the periumbilical abdomen. Femoral and popliteal arterial pulses were palpable. Computed tomography showed arterial dissection in the proximal segment of the superior mesenteric artery, a huge aneurysm (52×50 mm) with mural thrombus and two smaller aneurysms (20×20 mm) in the right ileocolic and ileal branches, along with atherosclerotic changes. Interposition using the great saphenous vein was performed after aneurysmal isolation and ligation of jejunal branches in the sac. Distal flow was reestablished by end-to-end and end-to-side anastomoses of the right ileocolic and ileal branches, respectively. No complications were observed at 1-year follow-up.
Abdomen ; Aneurysm* ; Aortic Aneurysm, Abdominal* ; Follow-Up Studies ; Humans ; Hypertension ; Ligation ; Male ; Mesenteric Artery, Superior* ; Middle Aged ; Physical Examination ; Saphenous Vein ; Smoke ; Smoking ; Thrombosis

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A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair.

Jong Beom SHIN ; Mi Hwa PARK ; Sang Ho JEONG ; Sung Woo KWON ; Sung Hee SHIN ; Seong Ill WOO ; Sang Don PARK

Vascular Specialist International.2016;32(1):26-28. doi:10.5758/vsi.2016.32.1.26

Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty.
Aged ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis ; Endovascular Procedures ; Extremities* ; Follow-Up Studies ; Humans ; Transplants* ; Ultrasonography

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Rescue Therapy of Inadvertent Coil Migration for Endovascular Treatment of Type II Endoleak.

Kanghaeng LEE ; Hyung Sub PARK ; Taeseung LEE

Vascular Specialist International.2016;32(1):22-25. doi:10.5758/vsi.2016.32.1.22

Coil migration during endovascular procedures is not an unusual complication, but there is no standard management strategy for bailout. Here, we describe a technique for removal of a migrated coil using a snare. During embolization of type II endoleak from the inferior mesenteric artery in a post-endovascular aneurysm repair patient, the coil migrated to the sigmoidal artery causing an occlusion. We used a microsnare loop and successfully retrieved the migrated coil. This is the first case in Korea that uses a loop snare for the removal of a migrated coil during visceral endovascular treatment to our knowledge. This technique of using a microsnare for removal of displaced coils can be a good resort in selected cases.
Aneurysm ; Arteries ; Colon, Sigmoid ; Embolization, Therapeutic ; Endoleak* ; Endovascular Procedures ; Health Resorts ; Humans ; Korea ; Mesenteric Artery, Inferior ; SNARE Proteins

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The Upside-Down Gore Excluder Limb and Double-Barrel Sandwich Technique for Penetrating Aortic Ulcer and Iliac Aneurysm Exclusion.

Hyung Kee KIM ; Incheol SONG ; Seung HUH

Vascular Specialist International.2016;32(1):17-21. doi:10.5758/vsi.2016.32.1.17

Endovascular aneurysm repair has become the first-line treatment for abdominal aortic aneurysms and iliac artery aneurysms in recent years. However, the diameter of the infrarenal aorta is larger than that of the aortic bifurcation, especially with small aortic diameters, for which a reversed tapered device is necessary. We describe the off-label use of the upside-down Gore Excluder limb and double-barrel sandwich technique for the treatment of a penetrating abdominal aortic ulcer with a large common iliac artery aneurysm. These techniques offer an easy endovascular approach for excluding an aneurysm in selected patients. However, this technique is outside the standard instructions for use, therefore careful planning and long-term follow-up are mandatory.
Aneurysm ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis ; Extremities* ; Follow-Up Studies ; Humans ; Iliac Aneurysm* ; Iliac Artery ; Off-Label Use ; Ulcer*

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Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap.

Dong Yeon RYU ; Hyuk Jae JUNG ; Venkaesh G RAMAIAH ; Julio A RODRIGUEZ-LOPEZ ; Sang Su LEE

Vascular Specialist International.2016;32(1):11-16. doi:10.5758/vsi.2016.32.1.11

PURPOSE: The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009. RESULTS: Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period. CONCLUSION: We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.
Cardiac Catheterization ; Cardiac Catheters ; Coinfection ; Follow-Up Studies ; Groin* ; Hemorrhage ; Humans ; Ligation ; Lymph Nodes ; Lymphocele ; Male ; Mortality ; Natural History ; Penile Neoplasms ; Reoperation ; Retrospective Studies ; Sepsis ; Transplants ; Wounds and Injuries

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Role of Hyperhomocysteinemia and Methylene Tetrahydrofolate Reductase C677T Polymorphism in Idiopathic Portal Vein Thrombosis.

Habib GHAZNAVI ; Zahra SOHEILI ; Shahram SAMIEI ; Mohammad Soleiman SOLTANPOUR

Vascular Specialist International.2016;32(1):6-10. doi:10.5758/vsi.2016.32.1.6

PURPOSE: Portal vein thrombosis (PVT) is a rare and life-threatening vascular disorder characterized by obstruction or narrowing of the portal vein. Hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism has been studied in PVT patients with conflicting results. In the present study the association of hyperhomocysteinemia and MTHFR C677T polymorphism with PVT risk was investigated in Iranians. MATERIALS AND METHODS: Our study population consisted of 10 idiopathic PVT patients and 80 healthy control subjects matched for age and sex. MTHFR C677T polymorphism was genotyped by the polymerase chain reaction technique combined with restriction enzyme fragment length polymorphism (PCR-RFLP) technique and plasma total homocysteine (tHcy) levels were determined by enzyme immunoassay method. RESULTS: Mean plasma tHcy levels were significantly higher in PVT patients (20.2±6.8) than control subjects (10.9±4.7) (P=0.001). Moreover, plasma tHcy levels were significantly higher in 677T allele carriers relative to 677C allele carriers in both PVT patients (P=0.01) and control subjects (P=0.03). Neither homozygote nor heterozygote genotypes of MTHFR C677T polymorphism correlated significantly with PVT risk (P>0.05). Moreover, MTHFR C677T polymorphism didn't increase the risk of PVT under dominant (CT+TT vs. CC) or recessive (TT vs. CC+CT) genetic models analyzed (P>0.05). The difference in frequency of minor 677T allele between PVT patients and control subjects was not statistically significant (P>0.05). CONCLUSION: Based on the current study, we suggest that hyperhomocysteinemia constitutes a significant and common risk factor for PVT. Also, MTHFR C677T polymorphism is not a risk factor for PVT but is a contributing factor for elevated plasma tHcy levels.
Alleles ; Genotype ; Heterozygote ; Homocysteine ; Homozygote ; Humans ; Hyperhomocysteinemia* ; Immunoenzyme Techniques ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Models, Genetic ; Plasma ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Portal Vein* ; Risk Factors ; Venous Thrombosis*

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Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines.

George GALYFOS ; Konstantinos FILIS ; Fragiska SIGALA ; Argiri SIANOU

Vascular Specialist International.2016;32(1):1-5. doi:10.5758/vsi.2016.32.1.1

According to literature data, there are no distinct guidelines regarding the proper diagnostic and therapeutic management of traumatic carotid artery dissection (TCAD). Although most of cases evaluated in research studies refer to spontaneous carotid artery dissection, traumatic cases demand special considerations as far as diagnosis and treatment are concerned. Although both types of dissection share some common characteristics, a patient with TCAD usually presents with several concomitant injuries as well as a higher bleeding risk, thus complicating decision making in such patients. Therefore, aim of this review is to present available data regarding epidemiology, clinical presentation, diagnostics and treatment strategy in cases with TCAD in order to produce useful conclusions for everyday clinical practice.
Carotid Arteries* ; Decision Making ; Diagnosis ; Epidemiology ; Hemorrhage ; Humans ; Wounds, Nonpenetrating

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Combination of Surgical Thrombectomy and Direct Thrombolysis in Acute Abdomen with Portal and Superior Mesenteric Vein Thrombosis.

Hyuk Jae JUNG ; Sang Su LEE

Vascular Specialist International.2014;30(4):155-158. doi:10.5758/vsi.2014.30.4.155

Portal vein (PV) thrombosis (PVT) is a rare condition with development of thrombosis in the PV and its branches. Further extension to the splenic and superior mesenteric vein (SMV) causes intestinal infarction, with a reported mortality of up to 50%. A variety of treatments for PVT exist including anticoagulation, thrombolysis, surgical thrombectomy, insertion of shunts, bypass surgery, and liver transplantation. We experienced a case of successfully treated by surgical thrombectomy with direct thrombolysis into the thrombosed-PV and SMV. A 31-year-old male presented worsening abdominal pain for one week. Preoperative contrast enhanced computed tomography scan revealed complete PVT extending to splenic vein and SMV. The PV was accessed surgically and opened by thrombectomy; visual inspection confirmed proximal and distal flow. Urokinase was administered directly into the inferior mesenteric vein with successful decrease in thrombus burden. The complete angiography showed complete dissolution of thrombosis in PV and SMV.
Abdomen, Acute* ; Abdominal Pain ; Adult ; Angiography ; Humans ; Infarction ; Liver Transplantation ; Male ; Mesenteric Veins* ; Mortality ; Portal Vein ; Splenic Vein ; Thrombectomy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis

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Hybrid Repair of Suprarenal Abdominal Aortic Aneurysm: Antegrade Debranching with Endovascular Aneurysm Repair.

Min Hyun KIM ; Hong Kyung SHIN ; Jae Young PARK ; Taeseung LEE

Vascular Specialist International.2014;30(4):151-154. doi:10.5758/vsi.2014.30.4.151

We report a hybrid repair approach to the treatment of abdominal aortic aneurysm in patients with complex anatomies when typical endovascular aneurysm repair is limited due to juxtarenal involvement. A 63-year-old man presented with a 3-day history of fever and abdominal pain. He was diagnosed with acute cholecystitis along with incidental findings of two separate aneurysms of the abdominal aorta: a 3.7 cm saccular aneurysm at the suprarenal level, and a 6.6 cm fusiform aneurysm above the iliac bifurcation. He was treated with a hybrid technique involving an open approach for antegrade debranching of the superior mesenteric artery, and renal arteries and endovascular stent placement for treatment of an abdominal aortic aneurysm. The procedure was successfully completed with no adverse events as of the most recent 6-month outpatient follow-up.
Abdominal Pain ; Aneurysm* ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal* ; Cholecystitis, Acute ; Fever ; Follow-Up Studies ; Humans ; Incidental Findings ; Mesenteric Artery, Superior ; Middle Aged ; Outpatients ; Renal Artery ; Stents

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