Femoral Aneurysm Research Articles

Multiple Arterial Aneurysms Revealing a New Case of Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) is a rare genetic disorder transmitted in an autosomal dominant mode. Its progression in young adults is marked by vascular, digestive, and obstetric complications. We report the case of a 24-year-old woman presenting with a mass in the right femoral triangle. Non-invasive imaging revealed multiple staged arterial aneurysms in the lower limbs. The diagnosis of vascular Ehlers-Danlos syndrome was established based on facial dysmorphia, acrogeria, and a history of right humeral aneurysm surgery. The patient underwent surgery for the right femoral aneurysm due to its significant size and risk of rupture, with simple monitoring for the other arterial aneurysms that were discovered incidentally. The postoperative course was uneventful with a favorable outcome.

Open Surgical Repair in a Patient With Loeys-Dietz Syndrome and Extensive Vascular Compromise: A Case Report and Literature Review.

Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders.

Rare femoral common vein aneurysm in a young patient with a clinical presentation of recurrent inguinal hernia

Rare femoral common vein aneurysm in a young patient with a clinical presentation of recurrent inguinal hernia

Reevaluation of the indications for permanent pacemaker implantation after cardioneuroablation

Abstract Background Cardioneuroablation(CNA) is promising and innovative method to cure vagally mediated bradycardia.However, according to current ESC2021 guidelines patients may have indications for permanent pacing. CNA is still referred to patients as an experimental and alternative method,not being recommended in guidelines due to too small amount of evidence.The study sought to validate criteria for permanent pacemaker(PPM) implantation,discontinuation of PPM therapy(PPMT) and risk of PPM implantation after CNA in a large population of patients qualified for electrophysiologic study(EPS),Extracardiac vagal nerve stimulation(ECVS) and CNA. Methods Data were collected from POLish prospective multicentre CardioneuroAblation registry(POLCA) with comprehensive management, interdisciplinary consultations, state-of-art autonomic tests, atropine tests, EPS as well as ECVS. Shared-decision making was used to developed patient-oriented therapy with clear declaration of fulfilling indications for PPMT according to ESC guidelines,(when applicable) and CNA only as alternative and developing technique. Results A total of 195 consecutive adult patients(mean age:55,6+/-14,3 years; min 20,0 Q1 44,96-Q2 58,4 - Q3 67,2; max 82;107(54%)females,) underwent first CNA. Out of them, 17(8,2%) had already PPM. According to current guidelines 100/178(51%) patients had de novo indications for PPM implantation prior to CNA including: SND(n=88,45%), AVB(n=21, 10%), TBS (n=26, 13%), CI-VVS(n=41; 21%),M-VVS(n=1;0,5%), CI-CCS(n=41;21%) or mixed etiologies (n=45;23%). Indications for de novo PMT were present in 32(37%) patients above age 60. During moderate-term (23,7+/-10,3 months), no patient died, and only 10 had syncope (which was diagnosed as orthostatic or vasodepressive). Despite preprocedural positive atropine test and positive ECVS, 6 out of 195 patients (had early and elective PPM implantation due to coexistence of functional and structural bradycardia(n=3) or bradycardia recurrences(n=2) or severe sinus chronotropic incompetence(n=1). There were 7(3,5%) major complications (tamponade (n=2), pericarditis(n=2), pericardial effusion(n=1), femoral aneurysm(n=1), pneumothorax(n=1) of CNA. Only 4 of patients with indications for PPM implantation before CNA still had those indications during follow-up. Out of 6 patients with late PPM implantations after CNA, 1 patient had syncope due to development of AVB. Conclusions About 51%patients referred for CNA had indications for PPM therapy. CNA in subgroup of patients with functional bradycardia is becoming alternative choice to PPMT and allowed to give up PPM implantation at least temporarily in 96%patients without prior PPMT. However some patients require PMT due to failed CNA or reinnervation,but also co-existence or development of complex structural bradyarrhythmias.

Successful Wallstent exclusion of iliofemoral venous aneurysms—a new treatment paradigm

Treatment of venous aneurysms involving the iliac and femoral veins has generally been an open surgical approach, with a few case reports noting use of an endovascular approach. We report three cases: (1) a patient with an iliocaval occlusion involving an occluded TrapEase filter who presented with a large left external iliac vein aneurysm; (2) a patient with a left common femoral vein aneurysm; and (3) a patient with left profunda femoris vein aneurysms with associated pulmonary embolism. All three patients were successfully managed with the use of appropriately sized bare metal woven stents (Wallstents; Boston Scientific). Their clinical presentation, technical considerations, and outcomes are reviewed.

Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience.

Hypersplenism, portal hypertension, and ascites have been seen after liver transplants. Patients are usually treated medically with refractory patients potentially undergoing splenectomy. Splenic artery embolism (SAE) is an alternative that can be performed to limit the surgical intervention that may have the benefit of improving portal hypertension. Few studies have studied the effect on main portal vein (MPV) velocities and hepatic artery resistive indices (HARIs) which may be beneficial as markers of portal hypertension. This study aims to evaluate the efficacy and safety of interventional radiology (IR)-guided SAE for the management of portal hypertension in patients who have had liver transplants. A retrospective analysis was conducted on liver transplant patients who had undergone IR-guided SAE post-transplant at a single tertiary transplant center from 2012 to 2022. The primary outcome of intervention efficacy was quantified by peak HARIs and MPV velocities. Ultrasound with Doppler obtained before and after the intervention was reviewed for these parameters. Secondary outcomes included adverseeventsat the time of the procedure and within one year of the procedure, the need for splenectomy, and spleen size. Twenty-eight patients met the criteria for inclusion. The mean age of patients was 52.5 years (21-71 years) and the time after transplant was 149.5 days (2-1588 days). About 96.4% of SAEs were technically successful (n=27). Twenty-one patients had MPV velocities available, and 24 had peak HARIs available. In these patients, HARIs decreased by an average of 0.063 (95% CI 0.014-0.112) after SAE. MPV velocity decreased by an average of 47.2 cm/s (95% CI 27.3-67.1) after SAE. About 10.4% of patients (n=3) developed a procedure-related complication, all of which were femoral access site aneurysms. No (0) patients suffered from bleeding, infections, or abscesses after the procedure. About 10.7% of patients (n=3) required splenectomy after SAE: one splenectomy was due to technical failure and two were due to refractory symptoms. We performed one of the first analyses on MPV and RI and showed that our patients saw an improvement post-embolization with a theoretical improvement in portal hypertension. The complication rate and risk of infection seem to be acceptable risks, making SAE a feasible option for management.

Necrotizing Fasciitis Secondary to Mycotic Femoral Aneurysm: A Narrative Review of Diagnosis and Management Strategies.

This comprehensive literature review aims to investigate the pathophysiology, clinical manifestations, diagnostic tools, and treatment options for necrotizing fasciitis secondary to mycotic femoral aneurysm, a rare and potentially lethal infectious disease, particularly focusing on any changes throughout the years for an update of the current literature. The pathophysiology of necrotizing fasciitis and mycotic femoral aneurysms is a complex and multifaceted process that typically involves bacterial infections as a common precursor to the onset of these conditions. This can potentially lead to the formation of an aneurysm. As the infection progresses, it can spread from the aneurysm to surrounding soft tissues, resulting in significant tissue damage, obstructed blood circulation, and ultimately culminating in cell death and necrosis. Clinical manifestations of these conditions are diverse and encompass a range of symptoms, such as fever, localized pain, inflammation, skin changes, and other indicators. It is worth noting that skin color can influence the presentation of these conditions, and in patients with diverse skin tones, certain symptoms may be less noticeable due to a lack of visible discoloration. Imaging, laboratory findings, and clinical presentation are important components of the diagnosis of mycotic aneurysms. CT scans are a reliable tool for identifying specific features of infected femoral aneurysms, and elevated inflammatory laboratory results can also suggest a mycotic aneurysm. In the case of necrotizing fasciitis, clinicians should maintain a high level of suspicionas this condition is rare but life-threatening. Clinicians will need to view the big picture when an infection may be caused by necrotizing fasciitis, considering CT imaging, blood work, and clinical presentation of the patient without delaying surgical intervention. By incorporating the diagnostic tools and treatment options outlined in this review, healthcare professionals can improve patient outcomes and reduce the burden of this rare and potentially lethal infectious disease.

Femoral artery aneurysm with large hematoma from Pasteurella: case report and literature review

BackgroundPasteurella multocida is a well-known gram-negative facultative anaerobe well known for its ability to cause soft tissue infections following animal bite or scratch. Here we present a case with mycotic aneurysm of the superficial femoral artery due to P. multocida infection.Case presentationA 62 year old male patient presented with worsening right leg pain and swelling. On examination, he was found to have profound swelling and erythema of the right medial thigh and tenderness to palpation. Computerized tomography showed findings suggestive of right femoral pseudoaneurysm with a large right medial thigh hematoma. Blood cultures grew P. multocida. Patient underwent emergent open resection of the mycotic aneurysm and vascular bypass surgery. Intraoperatively, the site was noted to be grossly infected with multiple pockets of pus which were drained and pus cultures grew P. multocida. The diagnosis of P. multocida bacteremia with right femoral mycotic aneurysm and thigh abscess was made. Patient received 6 weeks of intravenous ceftriaxone and recovered.ConclusionOur case is the first report on infection of peripheral vessel with Pasteurella and highlights the importance of prompt surgical intervention and effective antibiotic treatment

Treatment of Ruptured and Nonruptured Aneurysms Using a Semisolid Iodinated Embolic Agent.

Saccular aneurysms (SAs) are focal outpouchings from the lateral wall of an artery. Depending on their morphology and location, minimally invasive treatment options include coil embolization, flow diverter stents, stent-assisted coiling, and liquid embolics. Many drawbacks are associated with these treatment options including recanalization, delayed healing, rebleeding, malpositioning of the embolic or stent, stent stenosis, and even rupture of the SA. To overcome these drawbacks, a nanoclay-based shear-thinning hydrogel (STH) isdeveloped for the endovascular treatment of SAs. Extensive in vitro testing isperformed to optimize STH performance, visualization, injectability, and endothelialization in cell culture. Femoral artery saccular aneurysm models in rats and in pigs arecreated to test stability, efficacy, immune response, endothelialization, and biocompatibility of STH in both ruptured and unruptured SA. Fluoroscopy and computed tomography imaging consistently confirmed SA occlusion without recanalization, migration, or nontarget embolization; STH isalso shown to outperform coil embolization of porcine aneurysms. In pigs with catastrophic bleeding due to SA rupture, STH isable to achieve instant hemostasis rescuing the pigs in long-term survival experiments. STH is a promising semisolid iodinated embolic agent that can change the standard of medical practice and potentially save lives.

Peripheral Vascular Bypass with Cadaveric Arterial Allograft in a Toddler with FemoralMycotic Aneurysm

<h3>Introduction & Objective</h3> Mycotic aneurysms are exceedingly rare in the pediatric population. The optimal surgical treatment for children with this disease is unclear as aneurysm resection and vascular reconstruction are uncommonly performed in young children. We present the unique case of a21-month-old child with a complex cardiac history who presented with leg ischemia and a femoral mycotic aneurysm that was successfully repaired with an external iliac to profunda femoris artery vascular bypass with cryopreserved arterial allograft and femoral vein reconstruction. <h3>Case Report</h3> Our patient presented with leg ischemia and blood cultures positive for <i>Aspergillus</i>, with CT angiography demonstrating complete occlusion of the left common femoral artery and proximal superficial femoral artery (Figure 1Figure 1Axial computed tomography shows large left common femoral artery mycotic aneurysm with dense inflammatory reaction.Figure 1). Upon operative exploration, there was an extremely dense inflammatory response with purulent material extruding from the region and bulky reactive lymphadenopathy (Figure 2AFigure 2A-B. (A) Intraoperative photograph demonstrating large mycotic aneurysm involving the femoral artery. (B) Intraoperative photograph demonstrating the completed anastomosis between the left common iliac artery and the profunda femoris artery, along with femoral vein reconstruction.Figure 2) with extension of thrombosis from the external iliac artery immediately at the inguinal ligament to the superficial femoral artery. The 2 mm profunda arterywas the remaining outflow to the lower extremity. A 6 mm cryopreserved artery allograft (CryoArtery) was used to perform the vascular bypass between the external iliac artery and the profunda femoris artery in an end-to-side fashion. The mycotic aneurysm and underlying vesselswere dissected and resected from the external iliac artery to the proximal superficial femoral artery. As the femoral vein was densely adherent to the inflammatory mass, a segment was removed and reconstructed in a similar fashion with CryoArtery. Completed anastomosis is shown in Figure 2B. At the conclusion of the procedure, the patient had biphasic doppler signal in the dorsalis pedis artery. <h3>Conclusions</h3> Successful vascular reconstruction can be performed in a young child with an Aspergillus mycotic aneurysm using cadaveric arterial allograft. For our patient, a cryopreserved artery allograft was used as the iliofemoral bypass conduit. Although an autologous conduit would have been the preferred bypass method, it was not possible in this case owing to the patients immaturevenous system and prior surgical manipulation. Not only is restoring flow to the distal extremity of the utmost importance in young pediatric patients to avoid future limb-length discrepancies, but flow must also be maintained in the bypass conduit postoperatively without conduit occlusion. Our patient received intravenous heparin in the immediate postoperative period and was bridged to prophylactic enoxaparin for three months and aspirin indefinitely. If the use of an autologous conduit is not possible, we show here that a cadaveric arterial allograft can be a suitable and durable alternative and report the successful vascular reconstruction of a 20-month-old with an Aspergillus mycotic aneurysm using cadaveric arterial allograft and no limb-length discrepancy as of thirty-six months follow-up.

MO1013RETROSPECTIVE ANALYSIS OF THROMBOTIC COMPLICATIONS IN SHIGA-TOXIN ASSOCIATED HEMOLYTIC UREMIC SYNDROME IN CHILDREN

Abstract Background and Aims Shiga-toxin associated hemolytic-uremic syndrome (STEC-HUS) is a thrombotic microangiopathy (TMA) followed by intestinal infection caused by shiga-toxin-producing E. coli. Endothelium damage of the microvasculature leads to the formation of platelet-fibrin thrombi and occlusion of small vessels. The aim of our study was a retrospective analysis of thrombotic complications in children with STEC-HUS. Method We retrospectively analyzed the case histories of patients in the dialysis department of St. Vladimir's Children's City Clinical Hospital from 2009 to 2019. The study included patients with STEC-HUS with the development of thrombotic complications. Results Among 410 patients with STEC-HUS, 16 patients with thrombotic complications were identified. Equally boys and girls, mean age 3.5 ± 2.4 g. Respiratory support was required in 6 cases. The duration of anuria was 9.9 +/- 6.2 days, in 2 cases only oliguria was noted. In all patients blood transfusion, fresh frozen plasma were needed, antibiotics were used. In all cases, continuous venovenous hemodiafiltration (CVVHDF) was performed with 2-way catheters, usually in the femoral vein. Thrombotic complications in all cases were associated with therapy. In 11 children, thrombosis was localized in the femoral, iliac veins and vena cava inferior. Clinical manifestations in the form of limb edema, cyanosis were noted in 4 patients, in other cases the diagnosis was made by ultrasound. 3 patients with thrombosis of the branches of the central retinal vein, vena cava superior, mesenteric thrombosis. 1 patient was diagnosed with dissecting femoral vein aneurysm. In 3 cases, CVVGDF had to be stopped due to catheter thrombosis. Before the current thrombosis, these children were not prescribed anicoagulants. Coagulation tests indices indicated hypercoagulability and were characterized by higher thrombin time, increased levels of D-dimer, and increased fibrinolysis time. Conclusion Large vessel thrombosis in children with STEC-HUS is a rare complication. The provoking factor for the implementation of thrombotic events in all cases was femoral vein catheterization. When managing patients with STEC-HUS monitoring of coagulation status is needed for the purpose of timely administration of anticoagulants.

Multicenter observational study of the gore excluder conformable endograft for endovascular abdominal aortic repair: Initial results

Abstract Objective Endovascular repair (EVAR) has become the standard of care for treatment of abdominal aortic aneurysms. However, a significant number of EVAR remains outside the IFU, especially in cases of severe proximal angulation (&amp;gt;60 degrees), resulting in failure. The new device GORE EXCLUDER Conformable AAA Endoprosthesis (W. L. Gore &amp; Associates, Flagstaff, Ariz) has been designed to accommodate neck angulation, due to conformability and angulation control. The aim of this multicenter study is to report the initial results of this device. Methods From March 2019 to January 2021, the data of all consecutive patients with AAA treated with the Gore Excluder Conformable endograft at 4 vascular centers were reviewed. Patients were followed using a standardized protocol, with CT-scan at 1, 6 and 12 months, and then yearly. The primary endpoint was technical success and secondary outcomes were postoperative morbidity, rate of endoleak (EL) and any aneurysm-related re-interventions during follow-up. Results Among the 32 patients included, most were men with a mean age of 77 years old (range 60-92). Half of patients were smokers and 72% had hypertension. The mean diameter of AAA was 62 mm (47-90). The mean length of aortic neck was 26 mm (10-69), the mean diameter 23 mm (16-31) and the median neck angulation was 81 degrees (range 40-110). The mean procedural duration was 102 min (54-153) with a mean time of scopy of 24 min (8-47) and a total volume of contrast of 101 ml (40-165). Thirteen iliac branch device have been used in 7 patients. The technical success was 97% with 1 type Ia EL (3%). In the post-operative period, 4 medical and 3 surgical complications were observed. Two reinterventions were needed with an iliac stenting for a stenosis and a correction of a femoral false aneurysm. During the mean follow-up of 7 months, 2 type Ia ELs were observed. One spontaneously resolved and the other one was followed. One distal limb extension was succesfully implanted at 3 months for a type Ib EL for a total rate of reintervention of 9%. No migration was observed. No death occured. Conclusion The use of the Gore Excluder Conformable endograft seems to be safe and effective in difficult anatomies and especially high angulation. It allows for precise deployment without the need for additional contrast or operation time. Longer follow-up and more patients are required to confirm these excellent initials results.

Femoral venous aneurysms are rare, yet confer significant mortality risk due to venous thromboembolism; consider in venous thromboembolism of unknown aetiology.

Femoral venous aneurysms are a rare disease entity, yet they carry the risk of significant mortality due to venous thromboembolism, as demonstrated by a case report of an otherwise fit and well 74-year-old gentleman.

Surgical perspective in pseudoaneurysm of peripheral arteries: a better limb salvage option

Aneurysm involve all three layers of vessel wall. Psudoaneurysm also known as false aneurysm is a collection of blood that forms between the two outer layers of an artery. Femoral and popliteal artery aneurysms account for more than 90% of peripheral aneurysms, with popliteal artery aneurysms being the most common (70%). The estimated incidence of femoral and popliteal aneurysms is approximately 7/100,000 men and 1/100,000 women. Femoral aneurysms usually involve the common femoral artery but may occasionally extend or be limited to the superficial femoral artery (SFA) in the midthigh. Femoral and popliteal aneurysms are commonly associated with other aneurysms, with approximately 80% of patients having multiple aneurysms. Femoral and popliteal aneurysms show a high incidence of thromboembolic complications, which can result in limb loss. Pseudoaneurysm, if left untreated can result in deadly limb loss.

Intravenous drug abusers presenting with pseudoaneurysm and other surgical complications in Pakistan.

People who inject drugs (PWIDs) reuse injection equipment and other paraphernalia, which is a major source of transmission of human immunodeficiency (HIV) and hepatitis C virus (HCV) infections. PWIDs who use infected injections develop many surgical complications which are life- threatening. The most common complication is infected pseudoaneurysm. To assess complications requiring surgery in drug abusers, a study was conducted in the East Surgical Ward of Mayo Hospital Lahore, Pakistan from Jan 2017 to Jan 2019. A total of 48 PWIDs presented to the surgical department, out of which 39 (81%) were HIV positive, and 31 (64%) were HCV positive. Of the 52% who had pseudoaneurysm, 92% had femoral and popliteal aneurysm and 8% had brachial aneurysm. After ligation and excision of pseudoaneurysm only 8% required major amputation. Mortality rate was 0%. Ligation and excision is a safe option in pseudoaneurysm. Most common site for pseudoaneurysm was left femoral artery.

Ultrasound-guided thrombin injection versus ultrasound-guided compression therapy of iatrogenic femoral false aneurysms: Single center experience

BackgroundIatrogenic femoral pseudoaneurysm (false aneurysm) due to arterial access following cardiovascular procedures is becoming common because of the increase in number and complexity of the procedures. Recently, percutaneous thrombin injection is becoming a popular treatment of these false aneurysms.The aim of this study was to assess the efficacy and safety of femoral pseudoaneurysm closure using ultrasound-guided thrombin injection in comparison to ultrasound-guided compression. MethodsA retrospective analysis was undertaken of 65 patients who presented to our vascular department with iatrogenic femoral pseudoaneurysm between January 2015 and March 2019. Twenty-five patients underwent ultrasound-guided thrombin injection, and 40 were treated using ultrasound-guided compression therapy. The primary outcome measured was efficacy, while other outcomes examined were safety, procedure duration, and cost. ResultsA total of 65 patients (45 males, 20 female) were identified with a mean age of 62 years. Out of the 65, 40 patients (28 males, 12 female) underwent ultrasound-guided compression therapy (group A) with a mean aneurysm size of 2.9 cm, and 25 (17 male, 8 female) underwent ultrasound-guided thrombin injection (group B) with a mean pseudoaneurysm sac size of 3.7 cm. The success rate of thrombosis in group A was 70% and in group B was 92%. No significant complications were reported in both groups. ConclusionsUltrasound-guided thrombin injection should be considered as the first line of treatment for uncomplicated femoral pseudoaneurysms because it has a higher thrombosis and lower recurrence rates, when compared with ultrasound-guided compression treatment.

Use of Omniflow® II in Infected Vascular Grafts with Femoral Anastomotic Dehiscence

Vascular graft infection with anastomotic dehiscence requires immediate surgical intervention to preserve life and limb. We present our experience of using the Omniflow® II biosynthetic vascular prosthesis (LeMaitre Vascular) in the emergency repair of vascular graft dehiscence at the femoral anastomosis. A retrospective review of consecutive patients presenting with femoral anastomotic dehiscence in a single centre was conducted. All patients were revascularized using an in situ Omniflow II graft. Patient demographics, affected graft type, microbiology, and antibiotic regimes were documented. Primary outcome measures were limb salvage, patency rates, and mortality. Five patients presented with acute femoral false aneurysm and four of five with significant hemorrhage. Infected grafts included one aortobifemoral, two femoral crossover, one axillobifemoral, and one infrainguinal reversed vein graft. All were revascularized with an in situ Omniflow II graft following the excision of the infected graft material. The median followup was 50months. Limb salvage was achieved in 8 of 9 threatened limbs, and none required further intervention for re-infection. One graft occluded at 5 months. Two of five patients died during followup (one at 12 months, one at 50 months). Omniflow II provides a useful "off-the-shelf" conduit for the urgent revascularization of infected femoral dehiscence.

CAR 13. The “Sleeve-Shaping” Technique in the Treatment of Complex Peripheral Artery Aneurysms: Report of Two Cases

Peripheral artery aneurysms (PAAs) include popliteal, femoral, carotid, subclavian, upper limb, and visceral aneurysms, the incidence of which is much lower than that of abdominal aortic aneurysms. The treatment approach most recommended for PAAs is complete resection of the aneurysm sac followed by arterial reconstruction or endovascular repair with a stent graft. Here, we present a new technique, “sleeve shaping,” in the surgical treatment of two complex cases of extracranial carotid and subclavian artery aneurysms. Patients receiving surgery for PAAs using the sleeve-shaping technique in 2018 were included. Clinical characteristics, surgical procedure, and follow-up were analyzed. A 49-year-old and an 81-year-old man underwent surgery by the sleeve-shaping technique. Postoperative courses were unremarkable, and the patients are currently recovering well. In some conditions, the sleeve-shaping technique may be a good alternative for complex PAAs.

Lateral circumflex femoral artery false aneurysm as a complication of intertrochanteric hip fracture with displaced lesser trochanter

We present a patient who suffered an unstable intertrochanteric hip fracture and underwent osteosynthesis with a trochanteric nail. During the postoperative period, he presented a pseudoaneurysm of the lateral circumflex branch of the deep femoral artery secondary to a displaced fracture of the lesser trochanter. With the suspected diagnosis due to indirect clinical and radiological signs and confirmation by Doppler ultrasound and computed tomography angiography, a transverse arterial embolization with resolution of the symptoms was carried out. The pseudoaneurysm of the deep femoral artery or its branches is a very rare complication after intertrochanteric hip fractures, which must be taken into account in the late appearance of edema and hematoma in the thigh and evidence of medial and superior displacement of the lesser trochanter. The diagnosis is confirmed by CT angiography and the treatment by percutaneous arterial embolization has good results without the need of excising the lesser trochanter.

Negative-Pressure Wound Therapy for Managing Complicated Wounds at Extracorporeal Membrane Oxygenation Sites.

To evaluate the effectiveness of negative-pressure wound therapy (NPWT) for management of wound complications at extracorporeal membrane oxygenation (ECMO) removal sites. The authors retrospectively reviewed patients who underwent NPWT at ECMO removal sites followed by the development of wound complications including skin necrosis, lymphorrhea, and femoral vessel exposure. A nonadhesive bacteria-binding mesh was used as a wound contact layer of NPWT application. Patient characteristics and clinical outcomes were evaluated. Nine patients underwent NPWT for complicated wounds at ECMO sites. The mean age of patients was 49.2 years (range, 14-64 years). All patients exhibited wound complications with lymphorrhea and skin necrosis. Seven of nine patients had wound cultures that were positive for microorganisms, but culture conversion to negative was achieved after NPWT application for a mean period of 21.2 days (range, 12-30 days). Lymphorrhea was successfully managed, and formation of fresh granulation tissue was observed in all patients. Wound healing either by primary closure, skin graft, or secondary healing was achieved without recurrence of wound complications. There were no cases of femoral vessel injury or aneurysm during NPWT application. Negative-pressure wound therapy appears to be a safe and effective treatment option in the management of complicated wounds at ECMO sites.