Access for endovascular treatment of the superficial femoral artery (SFA) is usually gained through an antegrade approach from the ipsilateral common femoral artery (CFA), or by crossing over from the contralateral CFA. In this technical note, an alternative method, based on retrograde access of the ipsilateral iliac artery (IA), and conversion into an antegrade approach to the SFA, is described. Successful reverse ipsilateral catheterisation was obtained in 15/16 patients. Calcification of the CFA and IA required a crossover approach in one case. There were no complications related to the technique, except for moderate bleeding in relation to the deployment of a closure device.
Purpose The aim of this paper is to report our experience of type II endoleak treatment after endovascular aneurysm repair with intra-arterial injection of the embolizing liquid material, Onyx liquid embolic system. Methods From 2005 to 2012, we performed a retrospective review of 600 patients, who underwent endovascular repair of an abdominal aortic aneurysm. During this period, 18 patients were treated with Onyx for type II endoleaks. Principal findings The source of the endoleak was the internal iliac artery in seven cases, inferior mesenteric artery in seven cases and lumbar arteries in four cases. Immediate technical success was achieved in all patients and no endoleak from the treated vessel recurred. During a mean follow-up of 19 months, no major morbidity or mortality occurred, and one-year survival was 100%. Conclusions Treatment of type II endoleaks with Onyx is safe and effective over a significant time period.
Buttock necrosis is a rare presentation of severe pelvic ischaemia. It has been reported following open abdominal aortic repair and after internal iliac embolisation prior to endovascular treatment of aortic aneurysm. The internal iliac arteries are the major blood supply to the pelvis and buttocks. Collateral connections between the rectal and gluteal branches of the internal iliac artery and the deep femoral artery are well recognised. Iatrogenic interruption of this collateral circulation following rectal surgery resulting in limb ischaemia has been described. We present an exceptional case of buttock necrosis following infrainguinal bypass in a patient with bilateral internal iliac and left external iliac artery occlusions. The case is the first such reported to our knowledge. Mycotic aneurysms of the extracranial carotid arteries (MCAs) are extremely rare. They usually appear as an enlarging pulsatile neck mass with no specific signs and symptoms, and they can lead to severe morbidity and mortality if left untreated. We report a case of a saccular thrombosed MCA in a 68-year-old man, presented as a non-pulsatile enlarging mass. The patient did not have any clinical signs of infection, and he was treated with resection of the MCA and synthetic patch reconstruction of the carotid bifurcation. Postoperative microbial cultures revealed Streptococcus parasanguinis. We review and discuss the literature regarding the clinical presentation, diagnosis and treatment options of MCAs. We describe the presentation and management of a case of rectus sheath haematoma secondary to spontaneous rupture of a deep circumflex iliac artery aneurysm. This was successfully treated with coil embolization. Such a case has never, to our knowledge, previously been reported. We present an interesting case of a patient who underwent initial open repair of a descending thoracic aortic aneurysm in 1996, who subsequently had a pseudo-aneurysm that arose from his prosthetic graft, which was repaired with open surgery in 1998. He then developed a second pseudo-aneurysm with an aortobronchial fistula. This was successfully treated with an endovascular stent graft in 1999. The patient has survived 10 years after this procedure.
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