Case Reports in Vascular Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Perplexing Presentation of Entrapment of the Brachial Artery Mon, 22 Jun 2015 11:16:44 +0000 http://www.hindawi.com/journals/crivam/2015/236193/ A 45-year-old male being otherwise healthy presented acute onset of right upper extremity ischemia. On physical examination, axillary artery could be palpated whereas the brachial artery could not be palpated below the level of the antecubital fossa, including radial and ulnar artery pulses. Pulses were also inaudible with pocket-ultrasound below the level of the brachial artery bifurcation. The patient was initially diagnosed to have acute thromboembolic occlusion and given 5000 IU intravenous heparin. The patient was taken to the operating room. We noticed that the ischemic symptoms disappeared within a couple of minutes just before we began the operation. However, ischemic symptoms reappeared six hours later and computed tomography angiography showed lack of enhancement below the elbow crease. We were taking the patient to the operating room for the second time when the symptoms recovered in a few minutes, again. The operation was not canceled anymore. In the operation, the brachial artery was found anomalously perforating and it was entrapped by the bicipital aponeurosis. The artery was relieved by resecting the aponeurosis and there was no need for any other intervention. The patient had no more recurrence of symptoms postoperatively. Deniz Cevirme, Eray Aksoy, Taylan Adademir, and Hasan Sunar Copyright © 2015 Deniz Cevirme et al. All rights reserved. Endovascular Treatment of a Dissected Celiac Trunk Aneurysm Complicated with Consequent Pseudoaneurysm: Primary Treatment and Treatment Relapse after 5 Years Mon, 01 Jun 2015 08:06:57 +0000 http://www.hindawi.com/journals/crivam/2015/291953/ We report on an asymptomatic 56-year-old male with incidental diagnosis of celiac trunk aneurysm, diagnosed during an ultrasound scan performed to control polycystic kidney disease. The CT scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; finally we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success. Five years later he came back to our department for an aneurysm relapse in the common hepatic artery. We performed a second endovascular approach with a superselective catheterization of the pancreaticoduodenal arcade in order to exclude the lesion with Onyx and microcoils. Nowadays the patient is in good clinical conditions. Endovascular approach is a valuable method to treat visceral aneurysms; however, long-term imaging follow-up is essential to monitor the risk of relapse. Francesco Giurazza, Mattia Silvestre, Amedeo Cervo, and Franco Maglione Copyright © 2015 Francesco Giurazza et al. All rights reserved. Stent Placement for Acute Superior Mesenteric Artery Occlusion Associated with Type B Aortic Dissection Mon, 25 May 2015 13:33:04 +0000 http://www.hindawi.com/journals/crivam/2015/485141/ A 50-year-old man had a mesenteric ischemia related to superior mesenteric artery (SMA) occlusion associated with a type B aortic dissection. We decided to perform stent placement for the SMA and could avoid mesenteric ischemia. We think the stent placement in the SMA might be an option for the treatment of mesenteric ischemia caused by aortic dissection. Kazushi Suzuki, Masashi Shimohira, Takuya Hashizume, and Yuta Shibamoto Copyright © 2015 Kazushi Suzuki et al. All rights reserved. Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia Thu, 21 May 2015 11:38:41 +0000 http://www.hindawi.com/journals/crivam/2015/821094/ The exact knowledge of popliteal artery and its branches’ anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA). Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed. Georgios Karaolanis, George Galyfos, Evridiki Karanikola, Viktoria Varvara Palla, and Konstantinos Filis Copyright © 2015 Georgios Karaolanis et al. All rights reserved. Pulmonary Endarterectomy in a Patient with Immune Thrombocytopenic Purpura Thu, 21 May 2015 08:43:15 +0000 http://www.hindawi.com/journals/crivam/2015/898371/ Immune thrombocytopenic purpura (ITP) patients are at high risk for bleeding complications regarding surgeries involving cardiopulmonary bypass. We report an ITP patient with chronic thromboembolic pulmonary hypertension who underwent uncomplicated pulmonary endarterectomy with receiving postoperative intravenous immunoglobulin (IVIG) therapy. The positive outcome of this case may suggest that pulmonary endarterectomy surgery is performed safely for ITP patients. Bedrettin Yıldızeli, Mehmed Yanartaş, Sibel Keskin, Işık Atagündüz, and Ece Altınay Copyright © 2015 Bedrettin Yıldızeli et al. All rights reserved. From the Veins to the Heart: A Rare Cause of Varicose Veins Thu, 21 May 2015 07:02:36 +0000 http://www.hindawi.com/journals/crivam/2015/849408/ The presence of pulsating varicous veins is an uncommon finding, generically attributed to right heart failure. The precise causes of this phenomenon have been poorly defined in the literature. The finding of this infrequent condition is important because it may be a sign of major diseases, often not known. Here we described a 75-year-old woman presented to the Angiology Unit for the presence of bilateral pulsatile swelling in her groin and along both lower limbs. A bedside ultrasound examination showed an arterial like pulsating flow both in the superficial and in the deep veins of the lower limbs due to a severe tricuspid regurgitation not previously known. Michele Dalla Vestra, Elisabetta Grolla, Luca Bonanni, Vittorio Dorrucci, Fabio Presotto, and Fausto Rigo Copyright © 2015 Michele Dalla Vestra et al. All rights reserved. Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm Tue, 12 May 2015 13:39:04 +0000 http://www.hindawi.com/journals/crivam/2015/531017/ Inflammatory and juxtarenal Abdominal Aortic Aneurysm (j-iAAA) represents a technical challenge for open repair (OR) due to the peculiar anatomy, extensive perianeurysmal fibrosis, and dense adhesion to the surrounding tissues. A 68-year-old man with an 11 cm asymptomatic j-iAAA was successfully treated with elective EVAR and chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency and normal renal function are present at 24-month follow-up. The treatment of j-iAAA can be technically challenging. ch-EVAR is a feasible and safe bail-out method for elective j-iAAA with challenging anatomy. Francesca Fratesi, Ashok Handa, Raman Uberoi, and Ediri Sideso Copyright © 2015 Francesca Fratesi et al. All rights reserved. Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation Thu, 07 May 2015 09:17:08 +0000 http://www.hindawi.com/journals/crivam/2015/531201/ Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved. Konstantinos Lagios, Georgios Karaolanis, Theodossios Perdikides, Theodoros Bazinas, Nikolaos Kouris, Spiros Sfikas, and Odysseas Paxinos Copyright © 2015 Konstantinos Lagios et al. All rights reserved. Oxaliplatin Induced Digital Ischemia and Necrosis Mon, 04 May 2015 12:09:48 +0000 http://www.hindawi.com/journals/crivam/2015/248748/ Introduction. Digital ischemia is a rare complication of several chemotherapeutic medications. We aimed to present a patient with digital ischemia, secondary to a new generation chemotherapeutic drug, oxaliplatin. Case Report. 62-year-old woman presented to our department with severe pain, paresthesia, and distal acrocyanosis on her right hand fingertips. Her complaints started five days after the third cycle of a chemotherapy protocol consisting of 5-fluorourasil (5-FU), folinic acid, and oxaliplatin due to advanced colon carcinoma. On physical examination, hemorrhagic and partly ulcerative lesions were detected at her right hand fingertips. Radial and ulnar pulses were absent at affected side. Digital subtraction angiography revealed severe vascular resistance in the affected extremity. Iloprost trometamol treatment was started with the dosage of 1 ng/kg/min. In addition, low-molecule-weight heparin was used for preventing possible microemboli. Symptomatic relief was provided after five days, and patient was discharged on 7th day of treatment. Discussion. The pathogenesis of oxaliplatin induced vascular toxicity remains unclear. Endothelial damage, increased adherence of platelets, deposition of immune complexes as an immunologic effect of oxaliplatin, and hypercoagulable state may be the reason for arterial thrombosis, digital microemboli, possible digital ischemia, and their several consequences. Kubilay Karabacak, Murat Kadan, Erkan Kaya, Baris Durgun, Gokhan Arslan, Suat Doganci, Cengiz Bolcal, and Ufuk Demirkilic Copyright © 2015 Kubilay Karabacak et al. All rights reserved. Surgical Treatment for Profunda Femoris Artery Aneurysms: Five Case Reports Thu, 30 Apr 2015 08:42:20 +0000 http://www.hindawi.com/journals/crivam/2015/375278/ Profunda femoris artery aneurysm (PFAA) is an extremely rare entity, with most cases being asymptomatic, which makes obtaining an early diagnosis difficult. We herein report a case series of PFAA, in which more than half of the PFAAs, which presented with no clinical symptoms, were discovered incidentally. All PFAAs were treated surgically with aneurysmectomy with or without vascular reconstruction. In cases involving a patent superficial femoral artery (SFA), graft replacement of the profunda femoris artery (PFA) is not mandatory; however, preserving the blood flow of the PFA is necessary to maintain lower extremity perfusion in patients with occlusion of the SFA. Therefore, the treatment of PFAAs should include appropriate management of both the aneurysmectomy and graft replacement, if possible. Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, and Yoshinori Inoue Copyright © 2015 Kimihiro Igari et al. 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 http://www.hindawi.com/journals/crivam/2015/720684/ 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 http://www.hindawi.com/journals/crivam/2015/723182/ 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 http://www.hindawi.com/journals/crivam/2015/383104/ 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 http://www.hindawi.com/journals/crivam/2015/427040/ 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 http://www.hindawi.com/journals/crivam/2015/929127/ 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 http://www.hindawi.com/journals/crivam/2015/468561/ 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 http://www.hindawi.com/journals/crivam/2015/830219/ 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 http://www.hindawi.com/journals/crivam/2015/823063/ 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 http://www.hindawi.com/journals/crivam/2015/958464/ 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 http://www.hindawi.com/journals/crivam/2015/454713/ 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 http://www.hindawi.com/journals/crivam/2015/872817/ 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 http://www.hindawi.com/journals/crivam/2015/768935/ 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 http://www.hindawi.com/journals/crivam/2015/157623/ 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 http://www.hindawi.com/journals/crivam/2015/954217/ 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 http://www.hindawi.com/journals/crivam/2014/479656/ 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 http://www.hindawi.com/journals/crivam/2014/710742/ 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 http://www.hindawi.com/journals/crivam/2014/170198/ 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 http://www.hindawi.com/journals/crivam/2014/874528/ 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 http://www.hindawi.com/journals/crivam/2014/506067/ 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 http://www.hindawi.com/journals/crivam/2014/341748/ 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.