Case Reports in Vascular Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Primary Aneurysm of the Medial Marginal Vein of the Foot Wed, 21 Oct 2015 07:39:11 +0000 The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs. D. Casian and V. Culiuc Copyright © 2015 D. Casian and V. Culiuc. All rights reserved. Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery Mon, 19 Oct 2015 05:50:06 +0000 A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed. Yohei Kawatani, Yujiro Hayashi, Yujiro Ito, Hirotsugu Kurobe, Yoshitsugu Nakamura, Yuji Suda, and Takaki Hori Copyright © 2015 Yohei Kawatani et al. All rights reserved. Internal Jugular Vein Thrombosis following Oropharyngeal Infection Thu, 17 Sep 2015 12:29:22 +0000 Internal jugular vein thrombosis (IJVT) is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV) drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications. Asli Bostanci and Murat Turhan Copyright © 2015 Asli Bostanci and Murat Turhan. All rights reserved. Successful Treatment of Acute on Chronic Mesenteric Ischaemia by Common Iliac to Inferior Mesenteric Artery Bypass Tue, 01 Sep 2015 09:12:17 +0000 Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required. Here we present a case involving a 72-year-old woman with acute on chronic mesenteric ischaemia. She was a high risk surgical patient with severe unreconstructable stenotic disease of the SMA and celiac arteries. She was successfully treated with single vessel revascularisation of the inferior mesenteric artery (IMA) via a common iliac to IMA reversed vein bypass. At two-year follow-up, the graft remains patent and the patient continues to be symptom-free and is maintaining her weight. D. N. Coakley, F. M. Shaikh, and E. G. Kavanagh Copyright © 2015 D. N. Coakley et al. All rights reserved. Successful Use of the MYNXGRIP Closure Device during Repeated Transbrachial Percutaneous Peripheral Intervention Wed, 26 Aug 2015 09:17:34 +0000 The use of closure devices after transbrachial arterial puncture is still controversial. Here we report on a case where the MYNXGRIP (AccessClosure Inc., Santa Clara, CA, USA) could be used successfully in a patient, who underwent percutaneous peripheral arterial intervention twice via transbrachial access. Klaus Hertting and Werner Raut Copyright © 2015 Klaus Hertting and Werner Raut. All rights reserved. Successful Implantation of a Coronary Stent Graft in a Peripheral Vessel Tue, 25 Aug 2015 11:01:37 +0000 Peripheral artery disease (PAD) is a complex, often underdiagnosed illness with rising prevalence in western world countries. During the past decade there has been a rapid advance especially in the field of endovascular treatment of PAD. Here we present for the first time a case reporting on the placement of coronary stent graft in a peripheral vessel for the management of a peripheral side branch perforation. Interventional angiologists or radiologists may consider such an option for complication management after injury of smaller vessels during peripheral percutaneous interventions. Further specialization and novel options of complication management as described in our case may shift the treatment from surgical to even more endovascular treatment procedures in the future. Alexander Hess, Britta Vogel, Benedikt Kohler, Oliver J. Müller, Hugo A. Katus, and Grigorios Korosoglou Copyright © 2015 Alexander Hess et al. All rights reserved. Giant Arteriovenous Malformation of the Neck Mon, 10 Aug 2015 06:13:32 +0000 Arteriovenous malformations (AVM) have a wide range of clinical presentations. Operative bleeding is one of the most hazardous complications in the surgical management of high-flow vascular malformations. In the cervical region, the presence of vital vascular structures, such as the carotid artery and jugular vein, may increase this risk. This is a case of massive arteriovenous malformation deforming the neck and the face aspect of this aged lady and growing for several years. A giant mass of the left neck occupied the carotid region and the subclavian region. The AVM was developed between the carotid arteries, jugular veins, and vertebral and subclavian vessels, with arterial and venous flux. The patient underwent surgery twice for the cure of that AVM. The first step was the ligation of the external carotid. Seven days later, the excision of the mass was done. In postoperative period the patient presented a peripheral facial paralysis which completely decreased within 10 days. The first ligation of the external carotid reduces significantly the blood flow into the AVM. It permitted secondarily the complete ablation of the AVM without major bleeding even though multiple ligations were done. P. A. Dieng, P. S. Ba, M. Gaye, S. Diatta, M. S. Diop, E. Sene, A. G. Ciss, A. Ndiaye, and M. Ndiaye Copyright © 2015 P. A. Dieng et al. All rights reserved. Surgical Treatment of Cystic Adventitial Disease of the Popliteal Artery: Five Case Reports Mon, 03 Aug 2015 08:02:31 +0000 Cystic adventitial disease (CAD) is a rare cause of intermittent claudication and nonatherosclerotic conditions in middle-aged men without cardiovascular risk factors. The etiology of CAD is unclear; however, the direct communication between a cyst and a joint is presumed to be a cause. We herein report a case series of CAD of the popliteal artery (CADPA), in which patients were treated with surgical resection and vascular reconstruction. Although less invasive treatment modalities, including percutaneous cyst aspiration and percutaneous transluminal angioplasty, have been the subject of recent reports, these treatments have had a higher recurrence rate. Therefore, all of the CAPDA cases in the present series were treated surgically, which lead to good outcomes. Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, and Yoshinori Inoue Copyright © 2015 Kimihiro Igari et al. All rights reserved. A Perplexing Presentation of Entrapment of the Brachial Artery Mon, 22 Jun 2015 11:16:44 +0000 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 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 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 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 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 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 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 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 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 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 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.