Case Reports in Vascular Medicine The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Idiopathic Giant Hepatic Artery Pseudoaneurysm Tue, 17 Oct 2017 00:00:00 +0000 Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition. Ahmed Abdelbaki, Neeraj Bhatt, Nishant Gupta, Shuo Li, Shady Abdelbaki, and Yogesh Kumar Copyright © 2017 Ahmed Abdelbaki et al. All rights reserved. Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia Tue, 17 Oct 2017 00:00:00 +0000 We herein report a serious vascular complication of diagnostic cardiac catheterization due to an embolization of an Angio-Seal closure device causing acute lower limb ischemia. The Angio-Seal was deployed via the right femoral artery following the catheterization which embolized several hours later to the right popliteal artery. Fogarty embolectomy restored perfusion to the right lower limb; however, compartment syndrome subsequently developed which required evacuation of a hematoma and repair of right popliteal artery. Glenmore Lasam, Joshua Brad Oaks, and Jeffrey Brensilver Copyright © 2017 Glenmore Lasam et al. All rights reserved. A Rare Report of Infectious Emphysematous Aortitis Secondary to Clostridium septicum without Prior Vascular Intervention Sun, 17 Sep 2017 08:15:43 +0000 The term “mycotic aneurysm” was first used by Osler in 1882 to describe a mushroom-shaped aneurysm in subacute bacterial endocarditis. Mycotic aneurysms account for only 2.6% of all aneurysms of the aorta. Rarer still are anaerobic infections secondary to organisms such as Clostridium septicum, which results in emphysematous aortitis. The vast majority of emphysematous aortic infections occur as a result of instrumentation; however, in this case we present an infection de novo. A 75-year-old male presented with a 2-week history of progressive fatigue and chest pain that then developed into constitutional symptoms. Chest radiograph demonstrated an obvious widened mediastinum. CT angiogram of his chest then confirmed this finding as well as significant periaortic gas and focal outpouching. Numerous diverticuli with inflammatory changes consistent with diverticulitis was observed on CT abdomen. Blood cultures returned positive for Clostridium septicum. Definitive treatment was discussed including debridement and graft insertion; however, patient decided on conservative management and was discharged on intravenous antibiotics. Unfortunately, as in most cases of emphysematous aortitis that do not undergo surgical management, the patient succumbed to his illness. The lesson provided will be the epidemiology of emphysematous aortitis, presentation, diagnosis, management, and prognosis through a case report. Ciel Harris, Joseph Geffen, Keyrillos Rizg, Stuart Shah, Aaron Richardson, Cherisse Baldeo, and Avinash Ramdass Copyright © 2017 Ciel Harris et al. All rights reserved. Endovascular Management of Right Subclavian Artery Pseudoaneurysm due to War Injury in Adolescent Patient Mon, 11 Sep 2017 00:00:00 +0000 Today there is a widespread use of endovascular treatment (EVT) for traumatic vascular injuries in adults, but there is lack of evidence of its use in adolescent patients with vascular injuries. With this case, we present successful EVT of 14-year-old adolescent with a right subclavian artery pseudoaneurysm (SAP) due to war injury. SAP was successfully excluded with deployment of  mm flexible, self-expanding covered nitinol stent graft (The GORE® VIABAHN® Endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ)). Patient was discharged from hospital 2 days after the procedure with dual antiplatelet therapy (clopidogrel and aspirin). 3 months after discharge control DUS showed patent stent graft without any residual lesions. As a result, EVT is an alternative approach to treatment of SAP. It is safe, effective, and less invasive therapy for SAP in adults as well as in adolescents. We aim to contribute to the literature with this first case report. Onur Saydam, Deniz Şerefli, Mehmet Atay, and Cengiz Sert Copyright © 2017 Onur Saydam et al. All rights reserved. Iatrogenic IVC Perforation after Successful Catheter-Directed Thrombolysis Tue, 29 Aug 2017 08:38:51 +0000 Central vein perforation as a rare complication of venous interventions is considered a nightmare if occurring in thoracic cage but behaves benignly in abdominal or pelvic region. This is not a rule, as we unfortunately encountered during the procedure of venous intervention in our patient. Although mechanical control of iatrogenic perforation or rupture is the first and most critical step during interventional procedures, the importance of anticoagulant and thrombolytic agents reversal should not be overlooked. Ata Firoozi, Jamal Moosavi, Omid Shafe, and Parham Sadeghipour Copyright © 2017 Ata Firoozi et al. All rights reserved. Lipolymphedema Associated with Idiopathic Cyclic Edema: A Therapeutic Approach Wed, 23 Aug 2017 00:00:00 +0000 Idiopathic cyclic edema is a type of generalized edema that mainly affects women. Diagnosis is made by the patient’s clinical history and an evaluation of the accumulation of weight during the day. The objective of this study is to report the clinical control of lymphedema associated with idiopathic cyclic edema using calcium dobesilate. A 55-year-old female patient reported generalized edema for years in that she woke up in the morning with her legs swollen and the edema worsened during the day. The physical examination revealed generalized edema. After four days of treatment with calcium dobesilate, the patient returned to the Clínica Godoy, Brazil, with less edema and reductions in body weight and the amount of extracellular and intracellular fluid. With further treatment, there was a total reduction of the edema. It is concluded that calcium dobesilate helps to control lymphedema secondary to idiopathic cyclic edema. Jose Maria Pereira de Godoy, Henrique Jose Pereira de Godoy, Aline Aparecida de Sene Souza, Ricardo Budtinger Filho, and Maria de Fatima Guerreiro Godoy Copyright © 2017 Jose Maria Pereira de Godoy et al. All rights reserved. A Case of Superficial Femoral Arteriovenous Fistula and Severe Venous Stasis Ulceration, Managed with an Iliac Extender Prosthesis Thu, 20 Jul 2017 00:00:00 +0000 Most femoral artery arteriovenous fistulas occur as a result of percutaneous interventions. However, arteriovenous fistulas can occur in the setting of trauma, with resultant consequences such as heart failure, steal syndrome, or venous insufficiency. Indications for endovascular repair in this setting are limited to patients who are at too high risk for anesthesia, have a hostile groin, or would not survive significant bleeding. We report the case of a traumatic femoral arteriovenous fistula, causing severe venous insufficiency and arteriomegaly, in a 58-year-old male, with history of traumatic gunshot wound complicated by popliteal DVT. Surgical options for arteriovenous fistula include open and endovascular repair but this patient’s fistula was more suitable for endovascular repair for reasons that will be discussed. Nicole Ilonzo, Selena Goss, Chun Yang, and Michael Dudkiewicz Copyright © 2017 Nicole Ilonzo et al. All rights reserved. A Rare Clinical Case: Giant Splenic Artery Aneurysm and Its Successful Endovascular Treatment Thu, 13 Jul 2017 00:00:00 +0000 Objectives. The true giant splenic artery aneurysms are extremely rare and can be fatal. Although surgical approach has been the standard of care in the past, endovascular methods gained more importance in recent years. Background. We describe a case with true giant splenic artery aneurysm, treated with endovascular approach. Methods. A 68-year-old female patient with abdominal pain admitted to our clinic had true splenic artery aneurysm (14 × 10 × 9 cm). We decided on endovascular treatment using vascular plug and the treatment was performed successfully. Conclusions. Due to high mortality and morbidity in open surgery, endovascular treatment of giant splenic artery aneurysm is a better treatment option. Alptekin Yasim, Hakan Kara, and Erdinc Eroglu Copyright © 2017 Alptekin Yasim et al. All rights reserved. Recurrent Upper Extremity Thrombosis Associated with Overactivity: A Case of Delayed Diagnosis of Paget-Schroetter Syndrome Mon, 10 Jul 2017 09:18:00 +0000 Paget-Schroetter syndrome is thrombosis of the axillary-subclavian vein that is associated with strenuous and repetitive activity of the upper extremities. Overuse of the arm coupled with external compression results in microtrauma in the intima of the subclavian vein, resulting in the activation of the coagulation cascade. Diagnosis is usually made by Doppler ultrasound and the treatment involves thrombolysis, while routine surgical decompression of the thoracic outlet is controversial. In this report, we present a case of a patient who presented with a second episode of spontaneous right upper extremity deep venous thrombosis. The first episode was inadequately treated with oral anticoagulation alone. During the second episode, Paget-Schroetter syndrome was diagnosed, after careful review of his occupational history. He subsequently underwent angioplasty and decompression of thoracic outlet with no recurrence of thrombosis in a 12-month follow-up period. Himani Sharma and Abhinav Tiwari Copyright © 2017 Himani Sharma and Abhinav Tiwari. All rights reserved. Bilateral Brachial Artery Disease Presenting with Features of Raynaud’s Phenomenon: A Case Report and Review of the Literature Mon, 10 Jul 2017 08:43:45 +0000 Objective. To present a case of bilateral brachial artery disease presenting with features of Raynaud’s phenomenon which was successfully treated with angioplasty and stenting, together with a review of the relevant literature. Case. A 71-year-old female presented with a one-year history of intermittent pallor of both hands precipitated with cold objects. On examination, bilateral radial pulses were reduced. Prior photos showed pallor of the distal aspect of both palms. Angiogram showed high grade stenosis of the right brachial artery and focal occlusion with likely dissection of the left brachial artery. She underwent angioplasty and stenting for both lesions. She was asymptomatic without further episodes of Raynaud’s phenomenon after five months on dual antiplatelet therapy. Upper-extremity vascular stenosis is uncommon. Structural changes in the vessel wall can cause vasospastic attacks, a mechanism described in secondary Raynaud’s phenomenon. We hypothesize that these attacks may have been precipitated by the bilateral brachial artery disease. Furthermore, resolution of the symptoms after stent further supports our theory. Conclusion. Bilateral brachial artery disease is uncommon. Physicians should consider this in patients presenting with Raynaud’s phenomenon. Brachial artery stenosis and occlusion is a treatable disease with good symptomatic outcomes after angioplasty and stenting. Karan Seegobin, Brittany Lyons, Satish Maharaj, Cherisse Baldeo, Pramod Reddy, and James Cunningham Copyright © 2017 Karan Seegobin et al. All rights reserved. A Novel Technique of Stenting of the Renal Artery In-Stent Restenosis with GuideLiner® through Radial Approach Sun, 04 Jun 2017 00:00:00 +0000 In-stent restenosis of the renal arteries is relatively common and its management is not well studied. An 83-year-old female with bilateral renal artery stenosis and balloon angioplasty and stenting bilaterally one year ago was found to have recurrent severe elevations in the blood pressure despite medical management. Renal artery duplex showed 60–99% stenosis of the right renal artery and 20–59% stenosis of the left renal artery. A subsequent angiography of the right renal artery revealed 80% in-stent restenosis at the ostium. We describe a new approach of balloon angioplasty and stenting through radial access site with the assistance of a GuideLiner in a complex in-stent restenosis of the renal artery. Maheedhar Gedela, Shenjing Li, Tomasz Stys, and Adam Stys Copyright © 2017 Maheedhar Gedela et al. All rights reserved. Internal Jugular Venous Pseudoaneurysm in a Patient with Heart Failure and Severe Tricuspid Regurgitation Wed, 31 May 2017 08:28:45 +0000 The differential diagnosis of a lateral neck mass includes a number of possible etiologies. While jugular venous aneurysms and pseudoaneurysms are rare entities, they should be considered in the differential diagnosis of a pulsatile lateral neck mass. We present a case of an idiopathic jugular venous pseudoaneurysm and its association with worsening tricuspid regurgitation in a patient with heart failure with preserved ejection fraction. Sujoy Phookan, Patrick T. Strickland, Bishoy Hanna, Gregory R. Hartlage, Ankit Parikh, and Stephen D. Clements Jr. Copyright © 2017 Sujoy Phookan et al. All rights reserved. Response to: Comment on “Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery” Tue, 30 May 2017 00:00:00 +0000 Mario Zanaty, Nohra Chalouhi, Robert M. Starke, Pascal Jabbour, Katherine O. Ryken, Ketan R. Bulsara, and David Hasan Copyright © 2017 Mario Zanaty et al. All rights reserved. AAA Rupture and Psoas Hematoma due to Type II Endoleak from Inferior Mesenteric Artery “Unusual” Collaterals Sun, 28 May 2017 10:05:44 +0000 Although endovascular aneurysm repair (EVAR) in the abdominal aorta has reduced the perioperative mortality when compared with open repair, the need for reintervention after complications such as endoleak may be presented in up to 20% of the cases. Type II endoleak from branch vessels is often benign but can potentially be associated with progressive abdominal aortic aneurysm growth and sac expansion. We present a rare case of a patient who presented with sac expansion and psoas hematoma due to Type II endoleak from “unusual” collaterals of IMA and was treated successfully with endoleak microembolization and percutaneous decompression of the hematoma. Panagiotis G. Theodoridis, Dimitrios N. Staramos, Nikolaos Ptochis, Ioannis A. Papailiou, Ilias Dodos, Nikolaos Iatrou, Anastasios G. Potouridis, and Konstantinos Dervisis Copyright © 2017 Panagiotis G. Theodoridis et al. All rights reserved. Pulmonary Embolism due to Inferior Vena Cava Compression by a Retroperitoneal Hematoma after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm Wed, 17 May 2017 00:00:00 +0000 We report a case of a patient with a residual hematoma compressing the inferior vena cava after endovascular aneurysm repair (EVAR), which led to a pulmonary embolism (PE). A 65-year-old man underwent emergent EVAR for a ruptured aortic aneurysm in the right retroperitoneal region. He developed sudden chest pain at midnight of the fifth day after EVAR, and computed tomography demonstrated a massive PE. He subsequently went into cardiopulmonary arrest. This case suggested that abdominal complications due to a residual hematoma, including deep vein thrombosis and PE, should be considered in addition to compartment syndrome. Kota Shukuzawa, Naoki Toya, Yasutake Momokawa, Soichiro Fukushima, Tadashi Akiba, and Takao Ohki Copyright © 2017 Kota Shukuzawa et al. All rights reserved. Comment on “Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery” Wed, 15 Mar 2017 09:35:52 +0000 Visish M. Srinivasan and Peter Kan Copyright © 2017 Visish M. Srinivasan and Peter Kan. All rights reserved. Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal Wed, 01 Mar 2017 09:46:57 +0000 Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors. Maheedhar Gedela, Vishesh Kumar, Kashif Abbas Shaikh, Adam Stys, and Tomasz Stys Copyright © 2017 Maheedhar Gedela et al. All rights reserved. Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA Tue, 31 Jan 2017 13:34:43 +0000 Introduction. Seal zone failure after EVAR leads to type 1 endoleaks and increases the risk of delayed aortic rupture. Type 1b endoleaks, although rare, represent a true risk to the repair. Case Presentation. We report the case of a 65-year-old female who underwent emergent endovascular repair for a ruptured infrarenal abdominal aortic aneurysm and developed bilateral type 1b endoleaks following proximal migration of both endograft limbs. The right-side failure was diagnosed within 48 hours from the initial repair and the left side at the 1-year follow-up. Both sides were successfully treated with endovascular techniques. A review of the literature with an analysis of potential risk factors is also reported. Conclusion. For patients undergoing EVAR for ruptured AAA and with noncalcified iliac arteries, more aggressive oversizing of the iliac limbs is recommended to prevents distal seal zone failures. Patrick T. Jasinski, Demetri Adrahtas, Spyridon Monastiriotis, and Apostolos K. Tassiopoulos Copyright © 2017 Patrick T. Jasinski et al. All rights reserved. Superior Mesenteric Artery Syndrome: A Case Report of Two Surgical Options, Duodenal Derotation and Duodenojejunostomy Thu, 22 Dec 2016 14:15:50 +0000 Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction and its management is usually conservative with nasojejunal feeding. The pathophysiology entails the loss of the fat pad between the superior mesenteric artery and the abdominal aorta. This reduces the angle between the two vessels to less than 20 degrees with the resultant compression of the third part of the duodenum. The surgical management is usually a laparoscopic duodenojejunostomy. The two cases in our series had two different surgical procedures with good outcomes in both patients. The surgical management of each patient should be determined on its own merits irrespective of the standard of care. Yagan Pillay Copyright © 2016 Yagan Pillay. All rights reserved. Palpable Mass on the Head after Minor Trauma Thu, 10 Nov 2016 09:07:26 +0000 Temporal artery is superficially exhibited and easily traumatized. Rarely, a minor and blunt trauma, especially in elderly who are under anticoagulants, can cause a pseudoaneurysm. Diagnosis should be based, primarily, on history and physical examination and secondarily on duplex ultrasound scanning which will lead to confirmation and preoperative planning. The therapeutical plan consists of surgical ligation and excision of the aneurysm. Surgery can be performed under local anesthesia with no postoperative major or minor complications. Endovascular approach consists of catheter embolization and remains a second option due to the risk of complications and the inconclusive results. On this review, authors present a case of an 80-year-old male with a pseudoaneurysm of superficial temporal artery. K. M. Nikolakopoulos, C. P. Papageorgopoulou, I. G. Ntouvas, S. Kakkos, and I. Tsolakis Copyright © 2016 K. M. Nikolakopoulos et al. All rights reserved. Management Strategy in Non-Limb-Threatening Acute Ischaemia of Limbs: Should We Rethink? Mon, 24 Oct 2016 07:09:45 +0000 The Society of Vascular Surgery and the International Society of Cardiovascular Surgery identify three types of acute limb ischaemia to inform prognosis and management. Type 1 limb ischaemia is non-limb-threatening and is currently managed conservatively. We describe three cases of Type 1 limb ischaemia with femoropopliteal occlusion that were managed differently. The first case was initially managed conservatively but resulted in an adverse outcome following worsening of ischaemia. Overall, the cases managed with earlier intervention had good outcomes suggesting that conservative management alone may not be sufficient despite resolution of symptoms. The trend in other vessel diseases such as NSTEMI and TIA is towards earlier intervention, for example, PCI and CEA. It is likely that acute limb ischaemia has a similar natural history to these conditions. It is time to consider earlier revascularisation in selected patients with non-limb-threatening ischaemia. Syed M. Asim Hussain and Thomas Joseph Copyright © 2016 Syed M. Asim Hussain and Thomas Joseph. All rights reserved. Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications Mon, 10 Oct 2016 09:32:52 +0000 Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications. Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent. Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation. Ahmed Amro, Alaa Gabi, Adee Elhamdani, Naveed Iqbal, and Mehiar El-Hamdani Copyright © 2016 Ahmed Amro et al. All rights reserved. Upper Extremity Deep Vein Thromboses: The Bowler and the Barista Sun, 09 Oct 2016 12:31:00 +0000 Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses. Seth Stake, Anne L. du Breuil, and Jeremy Close Copyright © 2016 Seth Stake et al. All rights reserved. A Case of Successful Coil Embolization for a Late-Onset Type Ia Endoleak after Endovascular Aneurysm Repair with the Chimney Technique Tue, 06 Sep 2016 14:02:21 +0000 Juxtarenal aortic aneurysms (JRAAs) are challenging to treat by endovascular aneurysm repair (EVAR) procedures. The chimney technique with EVAR (Ch-EVAR) is one of the feasible and less invasive treatments for JRAAs. However, the main concern of Ch-EVAR is the potential risk of “gutters,” which can lead to type Ia endoleak (EL). Most type Ia ELs after Ch-EVAR procedures occurred intraoperatively, and these ELs could be treated using an endovascular technique. However, late-onset type Ia ELs could be extremely rare, which might have a fear of conservative treatment. Type Ia ELs are associated with an increased risk of aneurysm rupture; therefore reintervention is recommended as soon as possible, and we should be aware of the occurrence of type Ia ELs after the Ch-EVAR procedure. Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, and Yoshinori Inoue Copyright © 2016 Kimihiro Igari et al. All rights reserved. Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review Sun, 31 Jul 2016 15:31:27 +0000 Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit. James O’Brien, Francesca Muscara, Aser Farghal, and Irshad Shaikh Copyright © 2016 James O’Brien et al. All rights reserved. Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize? Tue, 26 Jul 2016 10:02:41 +0000 The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome. Jose Maria Pereira de Godoy, Angela Río, Paloma Domingo Garcia, and Maria de Fatima Guerreiro Godoy Copyright © 2016 Jose Maria Pereira de Godoy et al. All rights reserved. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia Sun, 24 Apr 2016 14:28:18 +0000 The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft. Tom Eisele, Benedikt M. Muenz, and Grigorios Korosoglou Copyright © 2016 Tom Eisele et al. All rights reserved. Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery Wed, 16 Mar 2016 12:00:12 +0000 The pipeline embolization device has emerged as an important endovascular option. This is in part due to safety, efficacy, and possibly the ability to shorten the operative time considerably. With this new technology, some limitations are emerging as experience accumulates. We report three cases of posterior communicating (PCOM) artery aneurysms associated with fetal posterior cerebral artery where pipeline embolization was unsuccessful in obliterating the aneurysms. PCOM artery aneurysms associated with a fetal PCA should be managed either by microsurgical clipping or coiling when feasible. Mario Zanaty, Nohra Chalouhi, Robert M. Starke, Pascal Jabbour, Katherine O. Ryken, Ketan R. Bulsara, and David Hasan Copyright © 2016 Mario Zanaty et al. All rights reserved. The Changed Route of Anterior Tibial Artery due to Healed Fracture Thu, 25 Feb 2016 10:48:58 +0000 We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia). Kemal Gökkuş, Ergin Sagtas, Nuri Comert, Mehmet Bekir Unal, and Murat Baloglu Copyright © 2016 Kemal Gökkuş et al. All rights reserved. Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus Sun, 24 Jan 2016 08:15:31 +0000 Introduction. We are presenting a case report of an infected modular abdominal stent graft. Case Presentation. A 67-year-old male patient three years after Cook’s modular abdominal aortic aneurysm (AAA) graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG) confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined antibiotic treatment was started. The patient died five hours after the procedure. The cause of death was multiorgan failure caused by sepsis. Hemocultures and perioperative microbiological cultures showed the infection agent to be Staphylococcus aureus methicillin sensitive. Conclusion. Stent graft infection is a rare complication. Treatment is associated with high mortality and morbidity. Róbert Novotný, Petr Mitáš, Jaroslav Hlubocký, Ján Hrubý, Andrey Slautin, Rudolf Špunda, and Jaroslav Lindner Copyright © 2016 Róbert Novotný et al. All rights reserved.