IntroductionNutcracker syndrome (NCS) is caused by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA) where it passes in the fork formed at the bifurcation of these arteries. NCS leads to LRV hypertension, resulting in left flank and abdominal pain, with or without haematuria and pelvic ureteral varices.ReportThe patient was a young female with diagnostic criteria of NCS, with severe clinical manifestations. The patient underwent transposition of the LRV approximately 3.0 cm below the original anatomic site and was anastomosed to the inferior vena cava (IVC) outside the meso-aortic compression zone.ConclusionAlthough NCS is not as common as other clinical scenarios, it may be encountered by physicians in a variety of disciplines, and can cause substantial morbidity and mortality rates. This report addresses the surgical approach used in a particular case, as well as the possible complications and outcomes if not treated in due time.
A 56-year-old female patient with significant carotid stenoses with circumferential plaques, causing localized vascular narrowing, was inappropriately indicated for carotid artery stenting. After placement of a distal embolic protection device in the left internal carotid artery, a stent was inserted; however, it could not be fully deployed due to the rigid, severely calcified vascular walls. The various endovascular attempts to recapture the protection device were futile and, eventually, led to fracture of the guidewire of the device and it remained entrapped together with the stent. Emergency carotid arteriotomy with extirpation of the stent and embolic protection device via carotid thromboendarterectomy was performed. In conclusion, the proper patient selection for carotid artery stenting is of utmost importance.
A 79-year-old male patient who presented with dizziness and several syncopal episodes was admitted to our clinic. Medical history of the patient revealed arterial hypertension and multifocal atherosclerosis with a history of two ischemic left middle cerebral artery strokes within the last year, without residual deficits, two coronary artery bypass grafts 22 years ago, and Stage IIB peripheral artery disease. The imaging studies revealed severe stenosis of the left internal carotid artery and high-grade ostial stenosis of the left common carotid artery. After clamping of the internal carotid artery and endarterectomy with patch angioplasty, before the patch was completely sutured, a sheath was placed through it and dilation and retrograde stenting of the proximal segment of the left common carotid artery were performed. The neurological symptoms of the patient disappeared and on postoperative computed tomography angiography, there was no residual carotid stenosis.
In this paper, problems concerning the uniaxial experimental investigation of the human abdominal aortic aneurysm (AAA) biomechanical characteristics, concomitant values of the associated Cauchy stress, failure (ultimate) stress in AAA, and the constitutive modeling of AAA are considered. The aim of this paper is to review and compare the disposable experimental data, to reveal the reasons for the high dissipation of the results between studies, and to propound some unification criteria. We examined 22 literature sources published between 1994 and 2017 and compared their results, including our own results. The experiments in the reviewed literature have been designed to obtain the stress–strain characteristics and the failure (ultimate) stress and strain of the aneurysmal tissue. A variety of forms of the strain–energy function (SEF) have been applied in the considered studies to model the biomechanical behavior of the aneurysmal wall. The specimen condition and physical parameters, the experimental protocols, the failure stress and strain, and SEFs differ between studies, contributing to the differences between the final results. We propound some criteria and suggestions for the unification of the experiments leading to the comparable results.
Bilateral aorto-profunda femoris bypass with Dacron bifurcation graft was performed by a patient with aortoiliac occlusive disease (AIOD) and horseshoe kidney (HSK) who had undergone stenting of the right common iliac artery and of the left superficial femoral artery with subsequent stent thrombosis as well as significant subrenal aortic stenosis. As endovascular treatment was not feasible and surgical treatment by means of transperitoneal incision would be associated with high risk of damage to the HSK, the operation was successfully accomplished through left pararectal retroperitoneal approach.
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