Background
Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events.
Case presentation
This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options.
Conclusion
Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options.
Background: Mycotic aneurysms are rare vascular lesions, occurring in 0.6-2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Only a few reported cases have been successfully treated with endovascular repair. Case presentation: This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting. Conclusion: Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting.
¼ 263,991; 58% of total volume) compared to inpatient (N ¼ 183,386; 40%). Radiologists performed the majority of these procedures (N ¼ 164,580; 36% of the total volume), followed by cardiologists (N ¼ 138,949; 31%) and vascular surgeons (N ¼ 75,431; 17%). However, radiologists saw the greatest decline in procedure volumes (25,907 to 13,108; -49%), compared with cardiologists (20,514 to 12,629; -35%) and vascular surgeons (9684 to 7921; -18%). Conclusions: The volume of percutaneous extremity venography procedures performed in the Medicare population declined from 2010 to 2018, most likely related to more stringent patient selection. Radiologists performed the majority of procedures but were closely followed by cardiologists.
Purpose: Tapered (4 -7 mm) hemodialysis grafts are used to prevent access-related steal syndrome. During treatment of dysfunction or thrombosis, detapering the inflow segment of such grafts by angioplasty may improve flow, albeit with a theoretical risk of development of steal. We report the immediate flow response and incidence of steal syndrome following detapering of dialysis grafts. Materials: Retrospective review of a prospectively collected quality assurance database of all hemodialysis access interventions performed between 2005 and 2017 was carried out. The inclusion criteria were detapering coupled with intravascular direct flow measurement (Transonic). Those undergoing detapering without flow measurement were excluded (n¼65). Fourteen patients (mean age: 59.7 years) with 15 dialysis grafts met inclusion criteria. A paired samples t-test was used to compare preand post-detaper flows. Distal ischemic symptoms collected by chart review included pain, pallor, diminished pulse, and ischemic skin changes. Results: Mean duration of follow-up was 28.1 months. Mean balloon taper size was 6.1 mm. Pre-and post-detaper flows (mean±SD) were 565.7±323.8 and 924.3±363.7 mL/min, respectively (p<0.0001). The mean ratio of post-to pre-detaper flows was 1.6 (range 1.1 -10.2). Although 5/65 excluded patients exhibited symptomatic steal post-detaper, no patients meeting the above criteria developed steal syndrome postdetaper. Conclusions: Detapering dialysis grafts resulted in nearly a twofold improvement in access flow, a key predictor of access function. Although a small subset of patients may develop steal postdetaper, detapering was not associated with development of steal syndrome using the defined criteria within this retrospective study.
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