Case Reports in Vascular Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Dialysis Arteriovenous Fistula Causing Subclavian Steal Syndrome in the Absence of Subclavian Artery Stenosis Thu, 16 Apr 2015 12:34:44 +0000 We present a rare cause of subclavian steal syndrome secondary to a dialysis arteriovenous fistula (AVF). A 69-year-old female with end-stage renal disease presented with ataxia and recurrent fainting spells. Angiography revealed normal subclavian arteries bilaterally, a right VA origin occlusion, and an apparent left VA origin occlusion. However, carotid artery angiography demonstrated flow through the posterior communicating artery with retrograde filling of the basilar artery and left VA to its subclavian origin. Repeat left subclavian arteriography during external compression of the AVF demonstrated normal antegrade left VA flow. The AVF was subsequently ligated resulting in complete symptom resolution. Eesha Maiodna, Sudheer Ambekar, Jeremiah N. Johnson, and Mohamed Samy Elhammady Copyright © 2015 Eesha Maiodna et al. All rights reserved. Medial Clavicular Osteophyte: A Novel Cause of Paget-Schroetter Syndrome Thu, 16 Apr 2015 11:50:28 +0000 Paget-Schroetter syndrome is a form of upper limb deep venous thrombosis usually seen in younger patients in association with repetitive activities of the affected limb. When occurring in more elderly patients or in those where it is difficult to appreciate a causative mechanism, other aetiologies should be considered. We present a case in which degenerative osteoarthritis of the sternoclavicular joint with osteophyte development impinged on the subclavian vein, leading to extensive upper limb thrombosis. The difficulties in identifying and managing this unusual cause of Paget-Schroetter are presented and discussed. Keagan Werner-Gibbings and Steven Dubenec Copyright © 2015 Keagan Werner-Gibbings and Steven Dubenec. All rights reserved. Peripheral Thrombosis and Necrosis after Minimally Invasive Redo Mitral Valve Replacement due to Unknown Etiology: Difficult Diagnosis of Heparin Induced Thrombocytopenia Tue, 14 Apr 2015 06:18:41 +0000 We report on a 75-year-old male with acute onset of peripheral thrombosis causing necrosis of the fingers, elbow, and toes associated with thrombocytopenia after minimally invasive redo mitral valve replacement. Both warfarin and dalteparin were commenced on postoperative day 1 and his INR reached 2.1 on postoperative day 4. On postoperative day 5, the patient developed peripheral thrombosis which progressed to necrosis on postoperative day 6. Platelet counts decreased significantly on the same day. His clinical features were compatible with heparin induced thrombocytopenia (HIT). However, serology testing was negative and the diagnosis was never confirmed. The patient was treated for HIT and platelet count improved eventually. Although no clear consensus exists, we believe this case illustrates why therapy for HIT should be initiated when clinical features strongly suggest HIT despite a negative serology test, unless an alternate diagnosis can be found. Yoshitsugu Nakamura, Daniel T. Bainbridge, and Bob Kiaii Copyright © 2015 Yoshitsugu Nakamura et al. All rights reserved. Endovascular Treatment of Posttraumatic Pseudoaneurysm of the Common Carotid Artery Tue, 31 Mar 2015 08:57:34 +0000 Carotid artery injuries with pseudoaneurysm are uncommon but associated with central neurologic dysfunction. We present a case of posttraumatic pseudoaneurysm of the right common carotid artery treated by implantation of a covered stent. A 44-year-old woman with multiple injuries after fall from height presents a small dissection flap of the right common carotid artery (RCCA) on the initial computed tomography angiography (CTA). Fifteen days later a 10 mm pseudoaneurysm is observed on control CTA. We decided endovascular treatment. Through right femoral access with a long introducer sheath placed in the innominate artery, we implanted a covered stent Advanta V12  mm in the RCCA. The patient was discharged from the hospital with antiplatelet therapy without any neurological dysfunction and complete exclusion of the pseudoaneurysm. Use of covered stents has emerged as a safe and effective alternative to surgical repair of carotid injuries. Diego Rojas, Stefan Stefanov, Luis Riera del Moral, Jesús Álvarez, and Luis Riera de Cubas Copyright © 2015 Diego Rojas et al. All rights reserved. Mediastinal B-Cell Lymphoma Presenting with Jugular-Subclavian Deep Vein Thrombosis as the First Presentation Wed, 04 Mar 2015 09:46:40 +0000 Jugular venous thrombosis infrequently could be secondary to malignancy and has seldom been reported secondary to mediastinal large B-cell lymphomas. The postulated mechanisms are mechanical compression that leads to stagnation of blood in the venous system of the neck and/or an increase in the circulating thrombogenic elements that could cause venous thromboembolism as a paraneoplastic phenomenon. We report the case of a middle aged male presenting with right sided neck pain and arm swelling secondary to ipsilateral jugular-subclavian deep vein thrombosis. Investigations revealed it to be secondary to a mediastinal mass shown on CT scan of the chest. Sherif Ali Eltawansy, Mana Rao, Sidney Ceniza, and David Sharon Copyright © 2015 Sherif Ali Eltawansy et al. All rights reserved. TAP-Stenting Technique for Bifurcation Stenosis of Celiac Artery Thu, 26 Feb 2015 06:20:44 +0000 We report a clinical course of a patient who developed severe ischemic liver injury and total occlusion of the celiac artery (CA). A 40-year-old man presented with abdominal pain. Computed tomography indicated total occlusion of the CA. Laboratory data demonstrated markedly elevated hepatic enzymes. An exploratory laparotomy was not necessitated due to absence of peritonism. The patient was successfully treated by endovascular recanalization of the CA occlusion via transcatheter balloon angioplasty and TAP-stenting (T-stenting and small protrusion) technique. Endovascular intervention in patients solely with liver failure appears practicable and early treatment is advised. Yucel Colkesen, Taner Seker, Osman Kuloglu, and Murat Çayli Copyright © 2015 Yucel Colkesen et al. All rights reserved. Upper Limb Ischemic Gangrene as a Complication of Hemodialysis Access Wed, 25 Feb 2015 07:11:02 +0000 Upper limb ischemia is a well-recognized complication of dialysis access creation but progression to gangrene is uncommon. We report a case of upper limb ischemic gangrene and discuss the lessons learned during the management of this case. Clinicians must be vigilant for this complication and they should be reminded that it requires urgent management to prevent tissue loss. Shamir O. Cawich, Emil Mohammed, Marlon Mencia, and Vijay Naraynsingh Copyright © 2015 Shamir O. Cawich et al. All rights reserved. Portal Vein Thrombosis Mon, 23 Feb 2015 12:35:36 +0000 Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community. Ronny Cohen, Thierry Mallet, Michael Gale, Remigiusz Soltys, and Pablo Loarte Copyright © 2015 Ronny Cohen et al. All rights reserved. Giant Dissecting Aortic Aneurysm in an Asymptomatic Young Male Mon, 23 Feb 2015 09:34:33 +0000 Giant aortic aneurysm is defined as aneurysm in the aorta greater than 10 cm in diameter. It is a rare finding since most patients will present with complications of dissection or rupture before the size of aneurysm reaches that magnitude. Etiological factors include atherosclerosis, Marfan’s syndrome, giant cell arteritis, tuberculosis, syphilis, HIV-associated vasculitis, hereditary hemorrhagic telangiectasia, and medial agenesis. Once diagnosed, prompt surgical intervention is the treatment of choice. Although asymptomatic unruptured giant aortic aneurysm has been reported in the literature, there has not been any case of asymptomatic giant dissecting aortic aneurysm reported in the literature thus far. We report a case of giant dissecting ascending aortic aneurysm in an asymptomatic young male who was referred to our institution for abnormal findings on physical exam. Priyank Shah, Nishant Gupta, Irvin Goldfarb, and Fayez Shamoon Copyright © 2015 Priyank Shah et al. All rights reserved. Giant Pseudoaneurysm Associated with Arteriovenous Fistula of the Brachial and Femoral Arteries following Gunshot Wounds: Report of Two Cases Tue, 03 Feb 2015 07:56:43 +0000 Posttraumatic pseudoaneurysm associated with arteriovenous fistula of the upper or lower limb is exceptional. We are reporting herein the history of two cases in civil life that have been followed and repaired in our service. Both patients were shot more than a year before being referred to our tertiary hospital for an enlarging mass which was a pseudoaneurysm associated with an arteriovenous fistula. The aneurysm was repaired and the fistula closed. Due to the absence of well-trained professionals, vascular injuries and their complications are usually discovered late in Cameroon while these pseudoaneurysms can reach very dramatic sizes. This presentation intends to raise the attention on a careful clinical exam and search of vascular lesion in the case of penetrating wound of the limb associated with profuse bleeding. Handy Eone Daniel, Ankouane Firmin, Pondy O. Angele, Minka Ngom Esthelle, Bombah Freddy, and Ngo Nonga Bernadette Copyright © 2015 Handy Eone Daniel et al. All rights reserved. Repeated Intra-Arterial Thrombectomy within 72 Hours in a Patient with a Clear Contraindication for Intravenous Thrombolysis Tue, 27 Jan 2015 10:33:48 +0000 Introduction. Treating patients with acute ischemic stroke, proximal arterial vessel occlusion, and absolute contraindication for administering intravenous recombinant tissue plasminogen activator (rtPA) poses a therapeutic challenge. Intra-arterial thrombectomy constitutes an alternative treatment option. Materials and Methods. We report a case of a 57-year-old patient with concomitant gastric adenocarcinoma, who received three intra-arterial thrombectomies in 72 hours due to repeated occlusion of the left medial cerebral artery (MCA). Findings. Intra-arterial recanalization of the left medial cerebral artery was performed three times with initially good success. However, two days later, the right medial cerebral artery became occluded. Owing to the overall poor prognosis at that time and knowing the wishes of the patient, we decided not to perform another intra-arterial recanalization procedure. Conclusion. To our knowledge, this is the first case illustrating the use of repeated intra-arterial recanalization in early reocclusion of intracranial vessels. Mona Laible, Markus Möhlenbruch, Werner Hacke, Martin Bendszus, Peter Arthur Ringleb, and Timolaos Rizos Copyright © 2015 Mona Laible et al. All rights reserved. Periodontal Disease and Late-Onset Aortic Prosthetic Vascular Graft Infection Wed, 21 Jan 2015 09:44:36 +0000 Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial reconstructive surgery. Although the relative risk is low, the clinical consequences can be catastrophic. Microbiological data on causative bacteria are limited. We present four cases of late-onset PVGI. Using a culture-independent nucleic acid amplification method for analysis of intraoperative samples, the presence of bacteria highly suggestive of an oral source was reported. Examination by an oral health specialist confirmed the presence of chronic periodontal disease. We hypothesize that chronic oral infection may be a previously unreported risk factor for the development of late-onset PVGI. Stephanie Thomas, Jonathan Ghosh, Johnathan Porter, Adele Cockcroft, and Riina Rautemaa-Richardson Copyright © 2015 Stephanie Thomas et al. All rights reserved. Unusual Response of Subclavian In-Stent Restenosis to Balloon Angioplasty in a Patient with HIV Sun, 18 Jan 2015 09:00:20 +0000 Human Immunodeficiency Virus (HIV) infection and use of protease inhibitors have been associated with accelerated atherosclerosis. Increased rates of coronary in-stent restenosis are reported in these patients. There is limited data available on peripheral vascular disease interventions on these patients. Herein we report an aggressive subclavian in-stent restenosis with an unexpected response to balloon angioplasty treatment with a large, mobile tissue flap formation and its treatment with another stent. Mohammad Atif Rana, Jagan Beedupalli, and Nuri I. Akkus Copyright © 2015 Mohammad Atif Rana et al. All rights reserved. Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair Sun, 11 Jan 2015 11:23:24 +0000 Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure. Hamilton Chen and Sharwin Tafazoli Copyright © 2015 Hamilton Chen and Sharwin Tafazoli. All rights reserved. Successful Endovascular Treatment of Iatrogenic Thyrocervical Trunk Pseudoaneurysm with Concomitant Arteriovenous Fistula Using 0.010-Inch Detachable Microcoils Wed, 24 Dec 2014 08:09:00 +0000 Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure. Kohei Hamamoto, Mitsunori Nakano, Kiyoka Omoto, Masahiko Tsubuku, Emiko Chiba, Tomohisa Okochi, Katsuhiko Matsuura, and Osamu Tanaka Copyright © 2014 Kohei Hamamoto et al. All rights reserved. Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment Wed, 03 Dec 2014 07:25:26 +0000 The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR. Umberto Marcello Bracale, Anna Maria Giribono, Gaetano Vitale, Donatella Narese, Gianpaolo Santini, and Luca del Guercio Copyright © 2014 Umberto Marcello Bracale et al. All rights reserved. Postoperative “Chimney” for Unintentional Renal Artery Occlusion after EVAR Sun, 16 Nov 2014 00:00:00 +0000 Renal artery obstruction during endovascular repair of abdominal aortic aneurysm using standard device is a rare but life-threatening complication and should be recognized and repaired rapidly in order to maintain renal function. Both conventional surgery and endovascular stenting have been reported. We report a case of late postoperative bilateral “chimney” to resolve a bilateral thrombosis of the renal artery following an uncomplicated endovascular aortic repair. Marco Franchin, Federico Fontana, Filippo Piacentino, Matteo Tozzi, and Gabriele Piffaretti Copyright © 2014 Marco Franchin et al. All rights reserved. The Infrapopliteal Arterial Occlusions Similar to Buerger Disease: Report of Two Cases Thu, 06 Nov 2014 12:13:04 +0000 We herein present two cases that required the differential diagnosis of Buerger disease. Case 1 involved a 55-year-old male with a smoking habit who was admitted with ulcers and coldness in his fingers and toes. Angiography showed blockage in both the radial and posterior tibial arteries, which led to an initial diagnosis of Buerger disease. However, a biopsy of the right posterior tibial artery showed pathological findings of fibromuscular dysplasia (FMD). Case 2 involved a 28-year-old male with intermittent claudication who was examined at another hospital. Angiography showed occlusion of both popliteal and crural arteries, and the patient was suspected to have Buerger disease. However, computed tomography disclosed an abnormal slip on both sides of the popliteal fossa, and we diagnosed him with bilateral popliteal artery entrapment syndrome (PAES). These cases illustrate that other occlusive diseases, such as FMD and PAES, may sometimes be misdiagnosed as Buerger disease. Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, Yoshinori Inoue, and Takehisa Iwai Copyright © 2014 Kimihiro Igari et al. All rights reserved. Peroneal Arteriovenous Fistula and Pseudoaneurysm: An Unusual Presentation Tue, 30 Sep 2014 11:42:12 +0000 Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome. Kevin C. Ching, Kevin M. McCluskey, and Abhay Srinivasan Copyright © 2014 Kevin C. Ching et al. All rights reserved. Successful Treatment of Iatrogenic Vertebral Pseudoaneurysm Using Pipeline Embolization Device Wed, 03 Sep 2014 11:01:06 +0000 Traumatic pseudoaneurysms are uncommon and one of the most difficult lesions to treat. Traditional treatment methods have focused on parent vessel sacrifice with or without revascularization. We report the case of a patient who underwent successful treatment of an iatrogenic extracranial vertebral artery pseudoaneurysm using the Pipeline Embolization Device. A 47-year-old man sustained an inadvertent injury to the left vertebral artery during C1-C2 fixation. Subsequent imaging revealed an iatrogenic vertebral artery pseudoaneurysm. Immediate angiogram was normal. A repeat angiogram done after 3 days of the surgery revealed a vertebral artery pseudoaneurysm. He underwent aneurysm exclusion and vascular reconstruction using the Pipeline Embolization Device. Although flow-diverting stents are currently not being used for treating traumatic pseudoaneurysms, their use may be considered in such cases if active bleeding has ceased. In our case, the patient did well and the aneurysm was excluded from circulation while reconstructing the vessel wall. Sudheer Ambekar, Mayur Sharma, Donald Smith, and Hugo Cuellar Copyright © 2014 Sudheer Ambekar et al. All rights reserved. Spontaneous Thrombosis in Giant Aneurysm of the Anterior Communicating Artery Complex in Pediatric Age: Five-Year Follow-Up Thu, 28 Aug 2014 11:33:32 +0000 Intracranial aneurysms are rare in the pediatric population, especially in infancy, representing less than 1% of all aneurysms. In this age group, they are more frequent at the carotid bifurcation and in the posterior circulation, with a greater number of giant aneurysms and spontaneous aneurysm thrombosis when compared with the adults. They are life-threatening, and, therefore, early investigation, characterization of the lesion, and treatment are essential. The appropriate management depends on the child’s condition, aneurysm characteristics, and the experience of a multidisciplinary team. Noninvasive and radiation-free imagiological studies play an important role in the diagnosis and follow-up of these young patients. We present the case of a 3-month-old boy with an intracranial hemorrhage secondary to the rupture of a giant aneurysm of the anterior communicating artery complex, with spontaneous thrombosis, which is a rare situation due to its location. A conservative approach was assumed and noninvasive evolutive imagiological studies revealed a reduction in the thrombosed aneurysm size and no signs of recanalization. The child recovered to his baseline neurological condition and has had no rehemorrhage until 5 years of follow-up. Vítor M. Gonçalves, N. Cristino, and M. Cunha e Sá Copyright © 2014 Vítor M. Gonçalves et al. All rights reserved. Surgical Repair of Lower Extremity Vascular Injuries in Children: Two Cases Mon, 25 Aug 2014 12:16:42 +0000 The use of percutaneous devices is commonplace for the treatment of many congenital heart defects. However, there are some situations where procedure-related complications are encountered and surgical help is required to ameliorate this issue. Vascular injury due to transcatheter intervention is a significant and challenging complication and occasionally requires surgical approach. In this case report, we aimed to present successful surgical management of vascular injuries associated with percutaneous interventions in children. Mehmet Tasar, Nur Dikmen Yaman, Cahit Saricaoglu, Zeynep Eyileten, Bulent Kaya, and Adnan Uysalel Copyright © 2014 Mehmet Tasar et al. All rights reserved. Concomitant Deep Venous Thrombosis, Femoral Artery Thrombosis, and Pulmonary Embolism after Air Travel Thu, 21 Aug 2014 13:02:37 +0000 The association between air travel and deep venous thrombosis and/or pulmonary embolism “economy-class syndrome” is well described. However, this syndrome does not describe any association between long duration travel and arterial thrombosis or coexistence of venous and arterial thrombosis. We present a case of concomitant deep venous thrombosis, acute femoral artery thrombosis, and bilateral pulmonary embolisms in a patient following commercial air travel. Echocardiogram did not reveal an intracardiac shunt that may have contributed to the acute arterial occlusion from a paradoxical embolus. To our knowledge, this is the first report in the literature that associates air traveling with both arterial and venous thrombosis. Salim Abunnaja, Marshall Clyde, Andrea Cuviello, Robert A. Brenes, and Giuseppe Tripodi Copyright © 2014 Salim Abunnaja et al. All rights reserved. Bilateral Jugular Vein and Sigmoid Sinus Thrombosis Related to an Inherited Coagulopathy: An Unusual Presentation Thu, 21 Aug 2014 08:27:02 +0000 Internal jugular vein thrombosis (IJVT) is a rare condition associated with malignancy, coagulopathy, and trauma. The optimal management of any IJVT must be individualized and depends on the condition of the patient. Case Presentation. We report the case of a 42-year-old woman with a history of a first trimester spontaneous abortion. Apart from a tension-type headache, she had no neurological symptoms. She reported an incidental diagnosis of right-sided IJVT when she was evaluated for hyperthyroidism ultrasonographically. On ultrasonography, we observed bilateral jugular vein thrombosis. The patient was started on oral warfarin. Seven months later, when she was adequately anticoagulated, she developed a second thrombosis. According to the etiological workup, she had a mutation in the homozygous methylene tetrahydrofolate reductase (MTHFR) gene and reduced protein C levels and activity. Conclusion. This report illustrates an unusual presentation of a rare condition. In this case, the etiology was associated with the coagulopathy, which occurred despite adequate anticoagulation. Özge Altıntaş, Azize Esra Gürsoy, Gözde Baran, Elnur Mehdi, and Talip Asil Copyright © 2014 Özge Altıntaş et al. All rights reserved. Giant Popliteal Artery Aneurysm: Case Report and Review of the Literature Thu, 21 Aug 2014 00:00:00 +0000 Popliteal artery aneurysms (PAAs) are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm, inflammatory arteritis, or popliteal entrapment are responsible. The authors report the first ever case of a male diagnosed with chronic renal failure with giant popliteal artery aneurysm. We have successfully resected the aneurysm and revascularized with synthetic graft. Christos Verikokos, Georgios Karaolanis, Mikes Doulaptsis, Georgios Kouvelos, Aikaterini Kotzadimitriou, Viktoria-Varvara Palla, and Christos Klonaris Copyright © 2014 Christos Verikokos et al. All rights reserved. Concomitant Transarterial and Transvenous Embolization of a Pelvic Arteriovenous Malformation Using a New Liquid Embolic Agent, Squid-12 and Detachable Coils Thu, 07 Aug 2014 09:01:30 +0000 We describe a complex congenital pelvic AVM with multiple feeding arteries arising from the side branches of the right internal iliac artery and a single draining vein in a male patient. Concomitant transarterial and transvenous embolization with a new liquid embolic agent Squid-12 and metallic coils enabled a complete embolization at a single session. Squid-12 is composed of ethylene vinyl alcohol copolymers and its lower viscosity makes it a promising agent for the treatment of AVMs. The patient showed prompt resolution of the symptoms and complete devascularization of the AVM lesion was persisted on the 1-month control angiography. The patient was asymptomatic on the 6th month follow-up. Aysun Erbahceci Salik, Filiz Islim, Ahmet Akgul, and Barbaros Erhan Cil Copyright © 2014 Aysun Erbahceci Salik et al. All rights reserved. Bridging Endovascular Therapy and Subsequent Surgical Repair for the Treatment of Infected Aneurysms after Percutaneous Cardiac Intervention Mon, 14 Jul 2014 12:04:06 +0000 Bridging endovascular therapy, accompanied by a second stage open surgical repair was used to treat a rare case of infected aneurysms alongside external iliac artery after a percutaneous cardiac intervention. Because these aneurysms require early treatment, we suggest this approach, in order to avoid immediate, major surgery in a recently symptomatic cardiac and bacteremic patient receiving dual antiplatelet therapy. The approach seems to be safe and durable. John C. Papakostas, Evgenia Pappa, George N. Kouvelos, Nektario Papa, and Miltiadis I. Matsagkas Copyright © 2014 John C. Papakostas et al. All rights reserved. Forearm Compartment Syndrome Caused by Reperfusion Injury Thu, 10 Jul 2014 07:50:39 +0000 Compartment syndrome is commonly seen following lower extremity ischemia. However, upper extremities’ compartment syndrome, especially after any vascular surgical procedures, is infrequent. Herein we report a case of an acute forearm compartment syndrome that was developed after delayed brachial artery embolectomy. Ufuk Sayar, Tanıl Özer, and İlker Mataracı Copyright © 2014 Ufuk Sayar et al. All rights reserved. Unique Nutcracker Phenomenon Involving the Right Renal Artery and Portal Venous System Tue, 01 Jul 2014 08:14:59 +0000 The nutcracker phenomenon is usually caused by compression of the left renal vein by the superior mesenteric artery anteriorly and the aorta posteriorly, although variations of this anatomy have previously been reported. We observed a nutcracker phenomenon in a 42-year-old female who underwent portal venous phase computed tomography of the body for oncologic workup. She had no documented proteinuria or hematuria. Multiplanar reconstructions demonstrated an enhancing left renal vein draining into the left ovarian vein without draining into the inferior vena cava due to external compression immediately before the renocaval junction. The left renal vein was compressed between the right renal artery and the portal vein. This type of nutcracker has not been previously reported in the literature and represents a new variation. Maximilian Stephens, Sarah Kate Ryan, and Roger Livsey Copyright © 2014 Maximilian Stephens et al. All rights reserved. Surgical Management of Ascending Aortic Aneurysm and Its Complications Thu, 26 Jun 2014 00:00:00 +0000 Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt. Sisira Sran, Manpreet Sran, Nicole Ferguson, and Amgad N. Makaryus Copyright © 2014 Sisira Sran et al. All rights reserved.