Endovascular stent-graft repair of aortoenteric fistulae is possible, but further evaluation of this technique will determine its role in the management of this complication.
Background: Classic popliteal artery entrapment is caused by the abnormal relationship between the popliteal artery and the medial head of the gastrocnemius, resulting in repetitive arterial compression and trauma. There is, however, a distinct subset of calf claudicants who have an anatomically normal popliteal fossa but can occlude the popliteal artery by repetitive vigorous exercise which involves active plantar flexion with or without extension at the knee joint. Methods: Eight patients who led a vigorous athletic lifestyle were evaluated with duplex scan and biplane angiogram after being referred for bilateral calf claudication. They were found to have significant stenosis or occlusion of the popliteal artery with active plantar flexion. All patients had transection of the medial head of the gastrocnemius muscle with release of any vascular bands tethering the popliteal artery. Results: Seven of the eight patients had complete relief. One patient noticed return of claudication at long distances, but a postoperative angiogram was normal. In all patients postoperative duplex scan showed no stenosis or occlusion of the popliteal vessels with the foot in active plantar flexion and the knee in extension. Conclusions: Functional popliteal artery entrapment is becoming a significant cause of disabling claudication in young athletic individuals and needs to be diagnosed accurately for appropriate treatment. This condition is becoming well known with the incorporation of sports in the daily routine of most young people.
A customized endoluminal stent-graft can be used with great accuracy to exclude thoracic false aneurysms, avoiding the potential complexity and morbidity of an open thoracic approach.
Purpose:
To describe the endovascular repair of an aortoenteric fistula in a high-risk patient.
Methods and Results:
A Vanguard tube stent-graft was deployed at the upper anastomotic suture line of a secondary aortoenteric fistula, successfully sealing the communication between the aorta and the third part of the duodenum without occlusion of the renal arteries.
Conclusions:
Endovascular stent-graft repair of aortoenteric fistulae is possible, but further evaluation of this technique will determine its role in the management of this complication.
Purpose: Traumatic false aneurysms of the thoracic aorta presenting at a time remote from the original injury are a rare but complex problem. The treatment of a traumatic false aneurysm by endovascular techniques may offer many advantages over conventional open surgery. Methods and Results: Two male patients presented with traumatic false aneurysm of the thoracic aorta after being treated emergently for visceral injuries from a gunshot wound in one and an automobile accident in the other. In both cases, the aneurysm was situated so that only the T11 intercostal artery would be sacrificed by endoluminal exclusion. Commercially available endoluminal stent-grafts (Talent) were deployed successfully. Recovery in both patients was rapid and uneventful with no neurological sequelae. Spiral computed tomographic scans at 1 year indicated sustained aneurysm exclusion and satisfactory endograft position. Conclusions: A customized endoluminal stent-graft can be used with great accuracy to exclude thoracic false aneurysms, avoiding the potential complexity and morbidity of an open thoracic approach.
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