Although the majority of acute arterial complications after TKA and THA are diagnosed on the day of surgery, a high clinical awareness for acute arterial injury should also be present in the postoperative period. Although not always feasible, endovascular management is now our preferred treatment for injuries associated with TKA or THA. This offers substantially shorter time to vascular restoration, with less morbidity than open repair, and equivalent satisfactory outcomes.

No abstract

This large series of DU surveillance for failing EVARs grafts suggests that graft limbs with PSVs <300 cm/s can be safely monitored. However, limbs with more elevated PSVs may benefit from prophylactic intervention or more frequent surveillance to prevent limb occlusion.

These findings suggest that follow-up DU surveillance can be postponed until 3 years after EVAR if the initial result of surveillance DU is normal (no endoleak, sac enlargement, stenosis), with minimal risk of an adverse clinical event.

Phlegmasia cerulea dolens (PCD) is a rare form of venous gangrene that arises secondary to occlusion of venous outflow from a limb. Classically described in the lower extremity, it is rare in the upper extremity. We present a case report of upper extremity PCD and a systematic review with data analysis of 37 cases of PCD published in PubMed. Our analysis showed that concurrent lower extremity PCD was a statistically significant marker for worse outcomes in this patient population.

Results: Four patients underwent transcaval embolization for an expanding aneurysm sac; 75% of the patients were male. The average age was 78.7 years. Average preintervention aneurysm sac size was 8.5 cm (6.7-10.6 cm). In two patients, previous transarterial/translumbar embolization attempts had failed. The technical success rate for transcaval embolization was 100%. The average fluoroscopy time was 34.6 minutes. The average amount of contrast material administered was 60 mL. The number of coils deployed averaged 8.75 (3-11). There were no immediate postoperative complications. Follow-up ranged from 1 to 12 months. All patients remained free of endoleaks with stable or decreasing aneurysm sac size. No patients developed any complications associated with the inferior vena cava or femoral veins. Conclusions: Transcaval access is a safe and effective alternative method for treating type II endoleaks. In addition, it can be considered a primary or secondary approach after failed intra-arterial or translumbar attempts.

These findings suggest that follow-up DU surveillance can predict failure of stent grafts placed for lower extremity occlusive disease. Focal PSVs >300 cm/s, Vr >3.0, and most importantly, uniform PSVs <50 cm/s throughout the stent graft were statistically reliable markers for predicting stent graft thrombosis.

Long-term follow-up of EVAR (mean, 7.5 years) revealed that approximately one in four patients will require intervention at some point during follow-up. First-time interventions were necessary in 22% of all patients in the first 5 years and in 6% of patients after 5 years, highlighting the need for continued graft surveillance beyond 5 years. All patients who had a first-time intervention after 5 years underwent an endoleak repair; none of these patients had a thrombosed limb or a rupture as a result of the endoleak.