Endovascular aortic repair (EVAR) is often selected as a first optional treatment of aortoiliac aneurysm. Some cases have chronic kidney disease (CKD) as comorbidity, which is the risk for contrast induced nephropathy (CIN). Carbon dioxide angiography (CO2 angiography) is helpful to reduce the dose of iodine contrast medium and prevent CIN in EVAR for such patients. This description focuses on the view of CIN, CO2 angiography and CO2-guided EVAR in our CKD cases.
The ankle-brachial index (ABI) plays a key role in diagnosis of peripheral arterial disease (PAD) in clinical practice. Moreover, pulse wave velocity (PWV), upstroke time (UT), percent mean arterial pressure (%MAP), and toe-brachial index (TBI) are useful indices of predicting the presence of PAD even if ABI at rest is still within the normal range, thus improving patients risk stratification and helping in clinical decisions, especially in circumstances of discrepancy between symptoms and ABI at rest. The aim of this review is to investigate how to interpret the results of these indices for understanding of etiology, diagnosis, and severity in evaluation of PAD. Case 1: a discrepancy between PWV and pulse waveform in a patient with bilateral common femoral artery stenosis; Case 2: a discrepancy between ABI and TBI in a patient with bilateral diffuse stenosis of infra-popliteal artery; Case 3: a discrepancy within the normal range ABI between left and right in a patient with left superficial femoral artery occlusion; Case 4 and 5: a discrepancy between ABI and clinical symptoms in a patient with scleroderma and Buerger’s disease.
To avoid nerve injury during endothermal ablation of the small saphenous vein (SSV), the ablation should be limited to the area just before the SSV crosses through the deep fascial sheath in the popliteal fossa. Although the saphenopopliteal junction (SPJ) typically is located in the popliteal fossa at the knee crease, it sometimes terminates more proximally and/or has some anatomical abnormalities; thus, with conventional surgery, a recurrence in the untreated, proximal part of the SSV is possible due to inadequate treatment. Therefore, we developed a method of endothermal ablation of the SSV incorporating a high ligation of SPJ. This method might produce good long-term results.
Solitary Iliac Aneurysms (SIAs) are rare and difficult to find because of the asymptomatic natural history. Therefore, they have a significant risk of rupture with high mortality and morbidity. We report a case of successful surgical repair for ruptured SIA coexisting hydronephrosis. A 78-year-old male was addressed in a state of shock to our hospital for lower abdominal pain. CT scan demonstrated right giant SIA rupture into peritoneal cavity complicated by hydronephrosis. Emergent surgery was done by laparotomy in which Y-graft replacement was performed remaining the ureter untouched. Postoperative course was uneventful and hydronephrosis disappeared 6 months after the surgery.
We report the use of an ultrasound-guided thrombin injection (UGTI) for the treatment of a traumatic occipital artery pseudoaneurysm. We treated a 96-year-old woman who presented with dementia and difficulty with communication. She crumbled and hit the back of her head and was admitted to our hospital. On the fourth day after hospitalization, she was diagnosed with a traumatic occipital pseudoaneurysm based on ultrasonographic examination and computed tomographic angiography. We performed an UGTI with the injection of 100 units of thrombin into the aneurysmal sac. No complications or adverse effects were reported, and she soon showed disappearance of the aneurysm.
A 43-year-old man was admitted to our hospital because of continuous fever for several weeks. The computed tomography detected a huge thrombus semi-occluding the terminal aorta and infarctions of the kidneys, spleen and multiple cerebral micro bleedings. Echocardiography revealed vegetation on the mitral valve and severe mitral valve regurgitation. Mitral valve replacement was perfumed to prevent embolism recurrence. On the 3rd postoperative day, he underwent graft replacement of infrarenal abdominal aorta. He recovered successfully without embolism and infective recurrence.