Paragangliomas are rare neuroendocrine tumors that frequently arise in the organ of Zuckerkandl (OZ). Surgical resection remains the cornerstone of treatment. Although vascular resection and reconstruction have been reported in a few cases, no prior reports have documented the simultaneous resection of both the aorta and inferior vena cava (IVC), along with their bifurcation. We present the case of a 50-year-old man with a large paraganglioma of the OZ, successfully managed through combined resection of the aorta, IVC, their bifurcation, and the psoas muscle. Dacron Y-grafts were used to reconstruct both the aorta and IVC. This case underscores the importance of detailed anatomical knowledge of major vessels, meticulous vascular control, and the technical intricacies of vascular reconstruction. We emphasize the significance of comprehensive perioperative management and provide a literature review on en bloc vascular resection for paraganglioma, offering insights into current surgical practices and outcomes.

The radial artery is currently the main vascular access site for cardiac catheterization. Radial artery occlusion (RAO), although a relatively silent complication, raises concerns because of its potential impact on future procedures. This pilot randomized controlled trial compared the efficacy and safety of two anticoagulation regimens—subcutaneous enoxaparin and oral rivaroxaban—in resolving symptomatic ultrasound-confirmed RAO in 40 patients (median age 55 years [interquartile range, 48-64], including 26 female patients [70.3%]) who underwent diagnostic cardiac catheterization without requiring dual antiplatelet therapy. Thirty-seven patients completed the 28-day ultrasound-based follow-up, demonstrating comparable complete or partial resolution rates between rivaroxaban (16 of 20 patients [80.0%]) and enoxaparin (14 of 17 patients [82.3%]), with an odds ratio of 0.85 (95% confidence interval: 0.16 to 4.50). No major bleeding events occurred during the 28-day follow-up period. While rivaroxaban shows potential in resolving RAO, larger studies are necessary to validate these findings and evaluate the long-term outcomes.

Peripheral artery disease (PAD) is a common vascular condition affecting over 200 million people worldwide. It is primarily characterized by stenosis or occlusion of peripheral arteries due to atherosclerosis. The infrainguinal segment is frequently involved in PAD, making revascularization decisions for infrainguinal arterial disease (IAD) complex. Multiple factors, including the patient’s condition and anatomical characteristics, must be carefully considered when determining the optimal treatment approach. Once these factors are evaluated, the first revascularization strategy is selected from among open, endovascular, or hybrid modalities, based on high-level evidence. Endovascular therapy is widely accepted as the standard treatment for simple IAD, with balloon angioplasty and stenting being the commonly used techniques.However, advancements in endovascular techniques have enabled the treatment of increasingly complex lesions. Additionally, drug-based technologies have enhanced the durability of treatment outcomes, including improvements in primary patency rates and freedom from target lesion revascularization. Similar to surgical endarterectomy, percutaneous atherectomy has been developed to remove atherosclerotic plaques and mitigate intimal calcification. The purpose of this paper is to present an algorithm for revascularization of IAD through a comprehensive review of studies comparing the outcomes of various treatment modalities.

This case report details the endovascular treatment of multiple pancreaticoduodenal artery (PDA) aneurysms associated with celiac artery stenosis in a 54-year-old male presenting with postprandial abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed critical stenosis of the celiac artery and three saccular PDA aneurysms measuring 34, 15, and 21 mm in diameter. Following unsuccessful attempts to access the celiac artery, the aneurysms were embolized in a retrograde manner from the superior mesenteric artery using detachable coils.Follow-up ultrasonography and CT 1 month later indicated reopening of the distal aneurysm, which was subsequently re-embolized. The patient was monitored for 10 months, during which the aneurysm remained occluded. This report highlights the approach and results of endovascular treatment in managing multiple PDA aneurysms in the context of untreated celiac artery stenosis, emphasizing the importance of close surveillance.

Purpose: Central venous catheter (CVC) insertion is a fundamental skill required for trainees to become proficient. Simulation-based training (SBT) has been shown to improve trainees’ CVC insertion performance effectively. However, implementing a CVC curriculum requires substantial costs and resources. Currently, there is a lack of validated CVC curricula that institutions can adopt as frameworks. This study aimed to evaluate the effectiveness of our institution’s CVC simulation curriculum in improving residents’ confidence and comfort with CVC insertion and management. Materials and Methods: First-year residents (n=118) participated in SBT between 2017 and 2023. Among them, 57 (48%) participants completed surveys before training and 6 months post-training to assess changes in comfort levels across various aspects of CVC insertion. Survey responses were analyzed to evaluate the overall changes in comfort by year and items. Results: Overall comfort increased from 42.1% before training to 81.3% after training (P<0.01), with notable improvements in nonprocedural aspects. Comfort with performing the unsupervised procedure increased by 16.7% (P<0.05) but remained low post-training (29.6%). Conclusion These findings suggest that the curriculum effectively enhances residents’ comfort, particularly in nonprocedural aspects, but only partially prepares them for unsupervised CVC insertions. This indicates a gap in procedural skill acquisition despite the overall positive trends. Implementing a similar CVC curriculum may help institutions reduce CVC insertion-associated complications.

An infected aortic aneurysm (IAA) is a rare but potentially life-threatening pathology characterized by rapid growth and a substantial risk of rupture compared to non-infected aneurysms. Reports on the endovscular treatment of infected paravisceral aneurysms are limited in the literature. This article describes our experience with endovascular repair of IAAs involving the visceral arteries and includes a literature review. We present two cases of symptomatic IAAs located at the celiac trunk ostium in high-risk surgical patients. Both cases were successfully treated with the parallel stent grafting (PG) technique in combination with prolonged antibiotic therapy. A bibliographic review of the endovascular treatment of IAAs was also conducted. Complex endovascular repair of paravisceral IAAs using a combination of a thoracic aortic stent graft and PG, together with prolonged antibiotic therapy, appears to be a reasonable treatment option with promising short- and medium-term results.

Paragangliomas are rare neuroendocrine tumors that frequently arise in the organ of Zuckerkandl (OZ). Surgical resection remains the cornerstone of treatment. Although vascular resection and reconstruction have been reported in a few cases, no prior reports have documented the simultaneous resection of both the aorta and inferior vena cava (IVC), along with their bifurcation. We present the case of a 50-year-old man with a large paraganglioma of the OZ, successfully managed through combined resection of the aorta, IVC, their bifurcation, and the psoas muscle. Dacron Y-grafts were used to reconstruct both the aorta and IVC. This case underscores the importance of detailed anatomical knowledge of major vessels, meticulous vascular control, and the technical intricacies of vascular reconstruction. We emphasize the significance of comprehensive perioperative management and provide a literature review on en bloc vascular resection for paraganglioma, offering insights into current surgical practices and outcomes.

The radial artery is currently the main vascular access site for cardiac catheterization. Radial artery occlusion (RAO), although a relatively silent complication, raises concerns because of its potential impact on future procedures. This pilot randomized controlled trial compared the efficacy and safety of two anticoagulation regimens—subcutaneous enoxaparin and oral rivaroxaban—in resolving symptomatic ultrasound-confirmed RAO in 40 patients (median age 55 years [interquartile range, 48-64], including 26 female patients [70.3%]) who underwent diagnostic cardiac catheterization without requiring dual antiplatelet therapy. Thirty-seven patients completed the 28-day ultrasound-based follow-up, demonstrating comparable complete or partial resolution rates between rivaroxaban (16 of 20 patients [80.0%]) and enoxaparin (14 of 17 patients [82.3%]), with an odds ratio of 0.85 (95% confidence interval: 0.16 to 4.50). No major bleeding events occurred during the 28-day follow-up period. While rivaroxaban shows potential in resolving RAO, larger studies are necessary to validate these findings and evaluate the long-term outcomes.

Peripheral artery disease (PAD) is a common vascular condition affecting over 200 million people worldwide. It is primarily characterized by stenosis or occlusion of peripheral arteries due to atherosclerosis. The infrainguinal segment is frequently involved in PAD, making revascularization decisions for infrainguinal arterial disease (IAD) complex. Multiple factors, including the patient’s condition and anatomical characteristics, must be carefully considered when determining the optimal treatment approach. Once these factors are evaluated, the first revascularization strategy is selected from among open, endovascular, or hybrid modalities, based on high-level evidence. Endovascular therapy is widely accepted as the standard treatment for simple IAD, with balloon angioplasty and stenting being the commonly used techniques.However, advancements in endovascular techniques have enabled the treatment of increasingly complex lesions. Additionally, drug-based technologies have enhanced the durability of treatment outcomes, including improvements in primary patency rates and freedom from target lesion revascularization. Similar to surgical endarterectomy, percutaneous atherectomy has been developed to remove atherosclerotic plaques and mitigate intimal calcification. The purpose of this paper is to present an algorithm for revascularization of IAD through a comprehensive review of studies comparing the outcomes of various treatment modalities.

This case report details the endovascular treatment of multiple pancreaticoduodenal artery (PDA) aneurysms associated with celiac artery stenosis in a 54-year-old male presenting with postprandial abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed critical stenosis of the celiac artery and three saccular PDA aneurysms measuring 34, 15, and 21 mm in diameter. Following unsuccessful attempts to access the celiac artery, the aneurysms were embolized in a retrograde manner from the superior mesenteric artery using detachable coils.Follow-up ultrasonography and CT 1 month later indicated reopening of the distal aneurysm, which was subsequently re-embolized. The patient was monitored for 10 months, during which the aneurysm remained occluded. This report highlights the approach and results of endovascular treatment in managing multiple PDA aneurysms in the context of untreated celiac artery stenosis, emphasizing the importance of close surveillance.