Aneurysms of the iliac veins are extremely rare. We report a case of a 51-year-old male who was admitted for swelling of the lower right limb. Sonography and ascending phlebogram showed a complete occlusion of the right femoropopliteal veins, both iliacs and the inferior vena cava (IVC). A large collateral circulation throughout the paravertebral plexus and azygos system was also observed. The CT scan revealed a 5 x 9 cm thrombosed aneurysm of the right external iliac vein and a congenital hypoplasia of the infrarenal IVC. Anticoagulant treatment and compression with elastic stocking was started. The 3-month follow-up showed mild residual edema of the right lower limb. The literature on this pathology is extensively reviewed.
Purpose: To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia. Technique: Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained. If the vein remains anterior with respect to the artery, a needle is inserted across the vein, passing through the snare loop and puncturing the intra-arterial balloon. A wire is inserted and placed inside the punctured balloon. The balloon is retrieved and the wire externalized through the femoral access. A catheter is advanced antegradely over this wire from the artery into the vein. If the vein remains posterior to the artery, a needle is inserted, puncturing the balloon and thereafter the vein (crossing through the snare). A wire is inserted, captured by the snare, and externalized through the vein sheath. A catheter is finally advanced over this wire from the vein into the artery. Conclusion: This maneuver is a simple alternative to create an arteriovenous fistula during venous arterialization procedures in patients with no-option critical limb ischemia.
The antegrade femoral approach is a routinely used technique for the percutaneous treatment of the lower extremities vascular disease. However, this approach can be challenging in case of obese patients or due to special anatomy of the femoral bifurcation. We present a simple and inexpensive alternative by means of the use of a Fogarty catheter to convert a retrograde femoral access to an antegrade catheterization.
A 59-year-old female with hypertension presented with an 8-month history of headache and an asymptomatic pulsatile mass on her left lateral forehead (Panel A). There was no prior history of trauma or sepsis. Computed tomographic angiography obtained by the family physician confirmed the presence of an aneurysm of the superficial temporal artery (STA) (Panel B, arrow). Laboratory studies (leukocyte count, VDRL, C-reactive protein, immunoelectrophoresis, anti-nuclear and anti-smooth muscle antibodies) were normal. Subsequent imaging did not reveal aneurysms in other regions. Ultrasonography showed a 1.5 × 1 cm saccular aneurysm of the STA containing mural thrombus. The aneurysm was resected under local anaesthesia (operative findings, Panel C).
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