Case Reports in Vascular Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. A Case of Femoral Arteriovenous Fistula Causing High-Output Cardiac Failure, Originally Misdiagnosed as Chronic Fatigue Syndrome Tue, 20 May 2014 12:54:11 +0000 Percutaneous arterial catheterisation is commonly undertaken for a range of diagnostic and interventional procedures. Iatrogenic femoral arteriovenous fistulas are an uncommon complication of these procedures. Most are asymptomatic and close spontaneously, but can rarely increase in size leading to the development of symptoms. We report a case of an iatrogenic femoral arteriovenous fistula, causing worsening congestive cardiac failure, in a 34-year-old marathon runner. This was originally diagnosed as chronic fatigue syndrome. Following clinical examination, duplex ultrasound, and CT angiography a significant arteriovenous fistula was confirmed. Elective open surgery was performed, leading to a dramatic and rapid improvement in symptoms. Femoral arteriovenous fistulas have the potential to cause significant haemodynamic effects and can present many years after the initial procedure. Conservative, endovascular, and open surgical management strategies are available. J. Porter, Q. Al-Jarrah, and S. Richardson Copyright © 2014 J. Porter et al. All rights reserved. Transcatheter Coil Embolization of a Coronary Artery-Left Ventricular Fistula Associated with Single Coronary Artery Anomaly Mon, 10 Mar 2014 13:21:34 +0000 Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization. Ozlem Ozcan Celebi, Alper Canbay, Erdem Diker, Barbaros Çil, Kudret Aytemir, and Ali Oto Copyright © 2014 Ozlem Ozcan Celebi et al. All rights reserved. Giant Idiopathic Pulmonary Artery Aneurysm: An Interesting Incidental Finding Sun, 09 Mar 2014 09:57:52 +0000 Idiopathic pulmonary artery aneurysm is a rare condition. This type of aneurysm can be presented with noncardiac symptoms or even asymptomatic. We report a 73-year-old man with a gigantic idiopathic pulmonary artery aneurysm which was referred to our unit for his kidney problems. During his workup we incidentally found the aneurysm by an abnormal chest-X ray and auscultation. Our further evaluations revealed a 9.8 cm aneurysm in transthoracic echocardiography. Afsoon Fazlinejad, Mohammad Vojdanparast, Reza Jafarzadeh Esfehani, Sahar Sadat Moosavi, and Parisa Jalali Copyright © 2014 Afsoon Fazlinejad et al. All rights reserved. Obstetric Considerations in a Rare Cardiovascular Catastrophe Needing Multidisciplinary Care Tue, 04 Mar 2014 14:00:27 +0000 Cardiovascular emergencies especially aortic dissections are rare in pregnancy. We report a case of Stanford Type A aortic dissection at 33 weeks of pregnancy presenting in shock. Rapid multidisciplinary approach and special obstetric considerations led to a successful outcome in this case. Neeta Singh, Debjyoti Karmakar, V. Devagorou, Rajnish Tiwari, and Sunesh Kumar Copyright © 2014 Neeta Singh et al. All rights reserved. Presence of Arteriovenous Communication between Left Testicular Vessels and Its Clinical Significance Tue, 04 Mar 2014 09:09:27 +0000 Maintenance of testicular temperature below body temperature is essential for the process of spermatogenesis. This process of thermoregulation is mainly achieved by testicular veins through pampiniform venous plexus of the testis by absorbing the heat conveyed by the testicular arteries. However, this mechanism of thermoregulation may be hampered if an abnormal communication exists between the testicular vessels. We report herewith a rare case of arteriovenous communication between testicular artery and testicular vein on left side. The calibre of the communicating vessel was almost similar to left testicular artery. Such abnormal communication may obstruct the flow of blood in the vein by causing impairment in the perfusion pressure with the eventual high risk of varicocele. Naveen Kumar, Ravindra Swamy, Jyothsna Patil, Anitha Guru, Ashwini Aithal, and Prakashchandra Shetty Copyright © 2014 Naveen Kumar et al. All rights reserved. Three Different Morphologies of Inferior Vena Cava Thrombosis: Case Reports Tue, 04 Mar 2014 07:44:37 +0000 Inferior vena cava (IVC) thrombosis is a rare but significant complication in hospitalized patients. However, relevant information regarding IVC thrombosis, especially on its morphology, remains scarce. We present three cases of IVC thrombosis, with each showing a different morphology: mural, floating, and small polyp-like thrombus. Satoshi Okayama, Yasuki Nakada, Shiro Uemura, and Yoshihiko Saito Copyright © 2014 Satoshi Okayama et al. All rights reserved. Hybrid Strategy for Residual Arch and Thoracic Aortic Dissection following Acute Type A Aortic Dissection Repair Wed, 19 Feb 2014 11:25:52 +0000 Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as a late sequelae following repair of ascending aortic dissection. Conventional treatment for the same requiring cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with high morbidity and mortality especially in the elderly cohort of patients. Herein we report a case of symptomatic progressive aneurysmal dilatation of residual arch and descending thoracic aortic dissection following repair of type A aortic dissection, successfully treated by total arch debranching and ascending aortic prosthesis to bicarotid and left subclavian bypass followed by staged retrograde aortic stent-graft deployment. This case report with relevant review of the literature highlights this clinical entity and the present evidence on its appropriate management strategies. Close surveillance is mandatory following surgical repair of type A aortic dissection and hybrid endovascular procedures seem to be the most dependable modality for salvage of patients detected to have progression of residual arch dissection. Sidharth Viswanathan, Vivek Agrawal, Shashidhar Kallappa Parameshwarappa, Ajay Savlania, Santhosh Kumar, and Unnikrishnan Madathipat Copyright © 2014 Sidharth Viswanathan et al. All rights reserved. Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris Wed, 19 Feb 2014 08:10:31 +0000 Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement. Murat Yuksel, Abdulkadir Yildiz, Mustafa Oylumlu, Nihat Polat, Halit Acet, and Necdet Ozaydogdu Copyright © 2014 Murat Yuksel et al. All rights reserved. Right Upper Lobe Partial Anomalous Pulmonary Venous Connection Sun, 16 Feb 2014 11:25:52 +0000 Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer. Christos Tourmousoglou, Christina Kalogeropoulou, Efstratios Koletsis, Nikolaos Charoulis, Christos Prokakis, Panagiotis Alexopoulos, Emmanoil Margaritis, and Dimitrios Dougenis Copyright © 2014 Christos Tourmousoglou et al. All rights reserved. A Rare Variation in the Origin and Course of the Artery of Penis Wed, 12 Feb 2014 10:04:44 +0000 Vascular variations of the penis are very rare. Awareness of its variations is of utmost importance to the urologists and radiologist dealing with the reconstruction or transplants of penis, erectile dysfunctions, and priapism. We report an extremely rare variation of the artery of the penis and discuss its clinical importance. The artery of the penis arose from a common arterial trunk from the left internal iliac artery. The common trunk also gave origin to the obturator and inferior vesical arteries. The artery of the penis coursed forward in the pelvis above the pelvic diaphragm and divided into deep and dorsal arteries of the penis just below the pubic symphysis. The internal pudendal artery was small and supplied the anal canal and musculature of the perineum. It also gave an artery to the bulb of the penis. Satheesha B. Nayak, Naveen Kumar, Jyothsna Patil, Surekha D. Shetty, Srinivasa Rao Sirasanagandla, and Swamy Ravindra Copyright © 2014 Satheesha B. Nayak et al. All rights reserved.