Branched stent grafts have been widely applied to treat complex aortic aneurysms. The technique often requires brachial or axillary approach to provide antegrade access to directional branches, which are bridged to target visceral arteries by self-expandable stent grafts. Preloaded guidewire catheterization may facilitate access into directional branches, decreasing or eliminating catheter manipulations required during this step of the procedure. We describe the use of a physician-modified branched stent graft using preloaded guidewire catheterization to treat a patient with recurrent, type III thoracoabdominal aortic aneurysm. The procedure was performed with no complications, and total operative time was 300 minutes, fluoroscopy time was 81 minutes, and iodinated contrast dose was 210 mL. Computed tomographic angiography revealed no endoleak and widely patent branches at 2 months.

Resumo A síndrome da congestão pélvica (SCP) é definida como dor pélvica crônica há mais de 6 meses associada a varizes perineais ou vulvares, resultantes do refluxo ou obstrução das veias gonadais, glúteas ou periuterinas. A SCP é responsável por 16-31% dos casos de dor pélvica crônica, sendo diagnosticada sobretudo na terceira e quarta décadas de vida. Nos últimos anos, houve um interesse maior nessa patologia por parte dos cirurgiões vasculares devido à sua associação com insuficiência venosa de membros inferiores. Apesar de prevalente, a SCP ainda é pouco diagnosticada tanto nos consultórios ginecológicos quanto nos de angiologistas. Portanto, neste artigo revisaremos a etiologia e o diagnóstico desta patologia e os resultados dos diversos tipos de tratamentos disponíveis.

Fenestrated endovascular aortic repair has been used with increasing frequency to treat complex aortic aneurysms. The Zenith fenestrated stent graft system (Cook Medical Inc, Brisbane, Queensland, Australia) was approved for commercial use in the United States in April 2012, offering a custom-made design with up to three fenestrations to treat short-neck infrarenal and juxtarenal abdominal aortic aneurysms. This report and the Video presentation (online only) summarize the preoperative planning, stent graft design, and technique of implantation of a Zenith fenestrated stent graft using a totally percutaneous approach in an 80-year-old female patient with a 6-cm juxtarenal abdominal aortic aneurysm. The patient was dismissed home the next day without complications, and a computed tomography angiography at 12 months showed no endoleak or stent graft complications.

Background Osteoarthritis (OA) is the most frequent joint disease, affecting 10% of men and 18% of women older than 60 years worldwide. Traditionally, treatment is based in pain management with joint replacement of end-stage disease. In this setting, transcatheter embolization has emerged as an alternative in reduction of pain in patients with OA. Case presentation A 77 years-old female presenting with two previous deep vein thrombosis and 10 years of hip pain. Magnetic resonance demonstrated a focal area of enhanced pericapsular signal near the superolateral margin of the acetabulum. Embolization of branches of the ascending branch of the lateral femoral circumflex artery was performed, with decrease of the pain and improvement in the image and her walking ability in a four-month follow-up. Conclusion This case report have shown that embolization of hip synovitis is feasible with early clinical success, in tune with the findings of genicular and shoulder embolization. Studies with more patients and long-term results are necessary to corroborate this finding. Level of evidence 4

Knowledge of the hepatic arterial anatomy and celiac trunk is gaining importance, since the use of minimally invasive surgeries is more frequent nowadays. This kind of procedure meant that surgeons had less room for visualization of anatomical variants and work. In addition, failure to recognize the correct anatomy of the hepatic vascularization in a transplant procedure can lead to organ failure and death. The present case aims to demonstrate an arterial hepatic celiac trunk pattern that was never described by any of the acknowledged classification systems. This pattern is challenging for the surgical management of possible upper abdominal interventions, since non-recognition may lead to iatrogenesis.

Endovascular repair of aortic aneurysms (EVAR) has gained widespread acceptance in the treatment of abdominal aortic aneurysms (AAAs). Prospective studies have shown advantages compared with open surgical repair, including decreased blood loss, operating time, hospital stay, morbidity, and mortality. Approximately 30% of patients treated by EVAR have ectatic or aneurysmal common iliac arteries not suitable for distal sealing zones. In these patients, one of the most commonly utilized options is exclusion of the internal iliac artery (IIA). Decreased pelvic perfusion carries the risk of ischemic complications, including buttock claudication, sexual dysfunction, and other devastating complications such as spinal cord injury, ischemic colitis, and gluteal muscle necrosis. This article summarizes the methods of pelvic revascularization in patients with aortoiliac aneurysms involving one or both common iliac arteries.

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Resumo Contexto A síndrome de May-Thurner (SMT) é a compressão da veia ilíaca esquerda (VIE) entre a artéria ilíaca direita e o corpo vertebral associada à hipertensão venosa crônica unilateral no membro inferior esquerdo. Porém, o achado tomográfico da compressão não necessariamente se reflete em sintomas. Objetivos Avaliar o achado de compressão da veia ilíaca esquerda em tomografias realizadas por outros motivos. Métodos Angiotomografias ou tomografias computadorizadas (TCs) com fase venosa foram analisadas. Foram coletados os dados demográficos e o motivo do exame, quando presente, e foi analisada a relação do diâmetro da veia ilíaca esquerda no ponto de maior compressão com um ponto a montante. Resultados De janeiro a julho de 2016, 590 tomografias foram analisadas, sendo 357 de mulheres e 233 de homens. A compressão da VIE ocorreu em 87 (14,74%) pacientes, dos quais 74 (85,05%) eram mulheres e 13 (14,9%) homens. O diâmetro médio do ponto de maior compressão entre os pacientes que apresentavam VIE < 5 mm foi de 4,4 mm, variando de 2,67 mm a 4,97 mm. O diâmetro no ponto de maior compressão representou até metade do diâmetro na última imagem justaposta ao corpo vertebral (índice de 0,5) em 179 (30,3%) dos pacientes. Conclusões Nosso estudo sugere que a ocorrência de compressão da VIE em TC de pacientes aleatórios, sem conhecimento de insuficiência venosa crônica ou TVP em MIE, é comum. Isso mostra que o achado tomográfico de compressão não necessariamente resulta em sintomas e não deve ser a única razão para tratar um paciente.