Advancements and standardization of catheterization methods improved the treatment for high-risk patients. However, this has also resulted in the emergence of puncture site infections (PSIs) that are difficult to manage. We examined cases of PSI that subsequently required skin and subcutaneous reconstruction procedures. Patients who had previously developed infection from a hemostatic device developed re-infection from a vascular suture. A bypass procedure was planned for revascularization in order to keep the site of anastomosis away from the contaminated wound. Patients with chronic limb-threatening ischemia may require additional treatments for hematoma at the surgical site, which can also increase the risk of distant infection from foot lesions. Although catheter placement is a minimally invasive technique, PSI can lead to serious conditions. It is important for surgeons to educate interventionists about the risk of complications associated with minimally invasive techniques.
A 48-year-old man with Stanford type A acute aortic dissection underwent emergent total arch replacement with frozen elephant trunk (FET). Postoperative computed tomography showed inadvertent deployment of the FET into the false lumen. We therefore performed endovascular fenestration of the dissection flap and distal extension of the stent graft into the true lumen, which resulted in a thrombosed false lumen in the proximal descending thoracic aorta. Endovascular fenestration of the dissection flap and distal extension of the stent graft can be an effective bailout procedure for inadvertent deployment of the FET into the false lumen.
Acute type B aortic dissection is a disease with various complications during the course of treatment. We report a case of acute type B aortic dissection and an ARDS due to an acute exacerbation of interstitial pneumonia, an 80-year-old male. The chief complaint was back pain. He was transferred to our critical care center and was diagnosed with acute type B aortic dissection on contrast-enhanced CT. We started resting antihypertensive management. 3 days after admission, respiratory distress was observed, and CT was performed again due to poor oxygenation. Extensive ground glass shadows were found in both lung fields, and acute exacerbation of idiopathic interstitial pneumonia and accompanying diagnosis of ARDS BiPAP and methylprednisolone administration were started. Since then, his respiratory condition has gradually improved, and he has started to take prednisolone.
A 74 years-old man performed left prosthetic FP bypass before, presented with the recurrence of intermittent claudication of the left lower extremity. Computed tomography angiogram revealed 75–90% stenosis at the distal anastomosis site which might lead to the graft occlusion. Endovascular repair was performed. GORE VIABAHN was deployed from the prosthetic graft to the popliteal artery with the information of intravascular ultrasound. No complication was observed even after the operation, and the VIABAHNs remain patent for 23 months after the procedure.