Acute dissection of thoracic aorta carries a risk of renal ischemia followed by the development of a kidney failure. The optimal surgical and nonsurgical management of these patients, timing of intervention, and the factors predicting renal recovery are not well delineated and remain controversial. We present a case of acute type B thoracic aortic dissection with left kidney ischemia. Evaluation of renal function was performed by the means of internationally accepted Risk, Injury, Failure, Loss of kidney function, End stage kidney disease and Acute Kidney Injury Network classifications for acute kidney injury, renal duplex sonography, and intravascular ultrasound that demonstrated left renal artery dissection with a flap completely compressing the true lumen. The patient underwent thoracic endovascular aortic repair and left renal artery stent and recovered well. Six months later, at the follow-up visit, retrograde type A aortic dissection was found, which was successfully repaired. Reversal of renal ischemia after aortic dissection depends on the precise assessment of renal function and prompt intervention.
chimney for right renal artery (RRA); one patient with fenestration to RRA and chimney to LRA; and one patient with fenestration to LSA. Total procedure mean time was 190 minutes. Mean time of ischemia was 33 minutes for SMA, 81 minutes for LRA, 87 minutes for RRA, and 20 minutes for LSA.Results: Technical success was achieved in all cases. On intraoperative angiography, all fenestrations remained sealed, and there were no remarked complications related to laser fenestration including persistent type I endoleak, visceral ischemia, or decrease in renal function during a mean follow-up.Conclusions: FIL&FIS seems to be effective, reproducible, and relatively inexpensive as well as a rapid option with no need for customized endografts that safely allows revascularization of visceral and renal arteries during treatment of type IA endoleak.
In this real-world registry, EVAR was more often offered in cases with suitable anatomy, in particular with adequate and safe proximal sealing zone. Under these conditions, EVAR can be safely offered to young and low-risk patients, providing excellent early outcomes and low 6-year mortality, aorta-related mortality, and reintervention rates.
Background: Pediatric bone tumors often involve major blood vessels, but the role of vascular surgeons in their management is not defined in the existing medical literature. The aim of this study was to review the outcomes of a multidisciplinary approach to the resection of pediatric osteosarcomas and osteochondromas over a 14-year period.Methods: A retrospective review was conducted of all pediatric bone tumor resections performed with the assistance of vascular surgery at our institution between January 2006 and January 2021. Inclusion criteria for the study included the presence of a vascular surgeon at the operative resection and radiographic evidence of major blood vessel involvement.Results: A total of 105 cases were identified, which included 54 benign tumors (47 osteochondromas, 7 inclusion bone cysts) and 51 malignant tumors (all osteosarcomas). Average age was 11.3 years (range, 4-24 years) and 60% were female (63/105). Average operative blood loss was 226 mL (range, 50-550 mL) in the malignant group and 74 (range, 50-283 mL) in the benign group (P < .01). Blood vessel reconstruction was performed in 9.8% (5/51) of the malignant cases and 1.9% (1/54) of the benign cases (P < .01). A tibial artery was ligated without reconstruction in 7.8% (4/51) of the malignant cases. Despite this vessel-sparing approach, microscopic margins were clear in all cases. Limb salvage was 100% in both groups throughout the 63-month average follow-up period. Local recurrence occurred in one patient in the malignant group at 61 months, which was treated with a second resection.Conclusions: The ideal management of pediatric bone tumors with major blood vessel involvement remains poorly defined. Our results demonstrate that even in the setting of radiographic evidence of vessel involvement, a multidisciplinary team of vascular and orthopedic surgeons can use a vessel-sparing approach with minimal blood loss, excellent limb salvage, and minimal local recurrence.
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