Methods: A retrospective review was conducted from 2014 to 2018 of patients who presented to our institution with acute limb ischemia and underwent VAT. Primary outcome was safety and efficacy of VAT. Safety was measured by variables including estimated blood loss, distal embolization, need for transfusion, or other vessel pathologic occurrences. Efficacy was determined by presence of antegrade flow on angiography. Secondary outcome included need for adjunctive intervention in addition to VAT.Results: A total of 73 patients (48 male; mean age, 65.6 years) were evaluated in the study (Table I); 68 cases (93%) had an estimated blood loss of <300 mL (Table II). The five cases with estimated blood loss >300 mL (6.8%) were associated with endovascular and open adjunctive interventions (Table II). Two cases (2.7%) were complicated by distal embolization, and six (8.2%) required transfusion of blood products (Table II). Each case requiring transfusion included catheter-directed thrombolysis as part of the intervention. In terms of efficacy, 62 cases achieved antegrade flow (84.9%; Table II).Conclusions: These initial results suggest that VAT is safe and can provide a means of achieving antegrade flow in the management of acute limb ischemia. Further analysis is needed to evaluate VAT's efficacy alone vs when it is combined with other adjunctive interventions. In addition, this suggests that further studies should be performed looking specifically at endovascular management using VAT for Rutherford IIb ischemia.
The majority of abdominal aortic aneurysms have been treated by endovascular aneurysm repair in the past decade. Common perioperative complications after this procedure are mostly related to vascular access and improper stent-graft placement. We present the first case of bilateral lower extremity claudication due to severe angulation of the graft–aorta interface, which may have been prevented by a more critical consideration of the patient’s anatomy. Treatment required open explantation and repair of the abdominal aortic aneurysms which led to complete resolution of claudication. The results of this case highlight the importance of adherence to instructions for use guidelines.
Lymphocutaneous fistulas are an uncommon occurrence that can present after surgical intervention in lymphatic-rich areas. A spontaneous lymphatic leak can occur in conjunction with lymphedema or in the vicinity of venous stasis ulcers. However, spontaneous lymphocutaneous fistulas are extremely rare. Traditional treatments have included surgical ligation, negative pressure therapy, and embolization. We present the case of a lymphocutaneous fistula secondary to chronic venous stasis, which was treated via injection of autologous blood and subsequent thrombosis. In the present case report, we have demonstrated successful embolization of a lymphatic vessel via autologous blood injection, a nontraditional technique that, nonetheless, yielded positive and lasting results.
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