Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.

No abstract

We report a case of traumatic right subclavian artery pseudoaneurysm, which failed initial treatment by endovascular covered stent. Subsequent catheter angiogram demonstrated filling of the pseudoaneurysm from retrograde flow of the right vertebral artery with outflow through the internal mammary artery. With access to the pseudoaneruysm obstructed, percutaneous thrombin injection was performed. The complex connections of the pseudoaneurysm to the right subclavian, vertebral, and internal mammary arteries resulted in the initial failure of the covered stent to induce thrombosis because of inflow from the right vertebral artery, a so-called "back door vessel".

A 38-year-old HIV-positive man presented to the emergency department with a complaint of flank pain. During the prior month, he had been seen at several different emergency departments with abdominal pain, fever, and chills. A computed tomography scan demonstrated a sacular aneurysm of the infrarenal aorta (A, B) with normal proximal and distal aorta. He underwent excision of the involved aorta and replacement with an aortobiiliac bypass using superficial femoral vein harvested from the left thigh (C). The defect through the wall of the aorta can been seen to either side of the bypass graft (C, arrow). Tissue cultures grew Staphylococcus aureus. The patient was discharged from the hospital on the seventh postoperative day on ambulatory intravenous vancomycin. Contrast imaging of the remainder of his vascular tree demonstrated no additional aneurysms, and cardiac ultrasound ruled out endocarditis.HIV-positive patients are at risk of developing mycotic aneurysms because of their immunocompromised state. They may also develop multiple sacular aneurysms, known as HIV-associated aneurysms, of the aorta and its branch vessels. HIV-associated aneurysms are a distinct entity characterized by an occluding vasculitis of the vasa vasorum. The arterial wall is chronically inflamed with fragmentation of the elastic fibers, and has areas of acute inflammation with transmural necrosis. 1 Because their radiographic appearance is similar, HIV-associated aneurysms may be confused with mycotic aneurysms, such as those seen in our patient. Mycotic aneurysm should be ruled out prior to attempting open or endoluminal repair with an aortic prosthesis. Strategies for dealing with a mycotic aneurysm include excision and extra-anatomic bypass 2 or in situ reconstruction with antibiotic-coated prosthetic graft, 2 allograft, or autogenous vein graft. 3,4 We chose to use the superficial femoral vein because of its proven durability and resistance to infection, both of particular importance in a young patient who is immunosuppressed.

No abstract