Two-Stage Open Ascending Aorta Replacement Followed by Total Aortic Arch Repair Using a Double-Fenestrated Physician-Modified Endograft for Patients with an Aortic Arch Aneurysm and an Aneurysmal Ascending Aorta.

This report summarizes our initial experience with QuikClot Interventional Hemostatic Bandage (QCI) under thrombocyte aggregation inhibition following interventional procedures using 8-French catheters or larger, and investigates the feasibility, efficacy, and safety of procedures conducted on 27 patients. We performed a retrospective analysis of patients who underwent QCI application after interventional procedures using 8F catheters or larger between February 16, 2021 and January 20, 2025, at a tertiary referral center. Of the 27 patients included, 20 were males. The mean age was 69 ± 10.2 years, and the mean body mass index was 24.6 kg/m2 (±4.1 kg/m2). Of the 27, 15 procedures performed were peripheral interventions for peripheral arterial disease. The most common access sheath size was 8F (23/27), and the maximum size was 14F. The technical success rate of the QCI application was 100%. In all patients, a false aneurysm in need of revision could be excluded via sonography. QCI-associated complication rate was 3.7%. One surgical revision was performed within the first 30 days. One case of mortality (1/27) was unlikely to be associated with the vascular closure device. The present study demonstrated that using QCI for access-site closure is easy and effective in combination with manual compression and a pressure bandage, even in cases of large-bore arteriotomies (≥8F) and under thrombocyte aggregation inhibition.

Young children often present with sharp foreign body (FB) ingestion. While the risk of complications is low when the FB is urgently removed, perforation of the gastrointestinal tract may lead to further interventions and treatments. A boy between 12 and 24 months old presented to the emergency department with a safety pin lodged within his mid-oesophagus. Nine days following removal, he had developed a right common carotid pseudoaneurysm (PSA) and right frontal brain abscess due to unrecognised oesophageal perforation by the FB. He underwent a burr hole craniotomy for the brain abscess and right common carotid artery repair for the PSA, both of which were technically successful. Two years later, he shows no evidence of any PSA in his common carotid artery and experiences no neurological defects. This case highlights the need for early management of sharp FB-related cases in children and the critical role of close follow-up and multidisciplinary surgical care in treating further complications.

False aneurysms of the extracranial internal carotid artery are rare but clinically significant due to the high risk of rupture and thromboembolic ischemic stroke. Historically, these lesions were treated surgically by arterial repair, ligation and anticoagulation. In recent years; endovascular approaches, including angioplasty and stent placement, have become increasingly preferred. We report a case of a post-traumatic false aneurysm of the extracranial internal carotid artery successfully treated with a covered stent, resulting in a favorable postoperative course and long-term outcome.

Transcatheter aortic valve replacement infective endocarditis presenting as ascending aorta false aneurysm-a new clinical entity?

Performance of the MANTA Vascular Closure Device in Endovascular Aortic Procedures: A Single-Center Experience.

Visceral artery pseudoaneurysms (PA) are a rare but potentially fatal complication associated with pancreatitis. Among these, PA of the left gastric artery (LGA) are extremely rare. We describe a case of a 43-year-old male who presented with severe epigastric pain, hematemesis, and hypovolemic shock. He was a chronic alcoholic and a known case of recurrent pancreatitis. Resuscitation was initiated, and laboratory findings revealed severe anemia and elevated pancreatic enzymes. An urgent contrast-enhanced computed tomography scan identified acute-on-chronic pancreatitis with pseudocysts and a bleeding PA originating from the gastroduodenal arcade. Emergency celiac angiography confirmed a LGA PA with active extravasation. Successful super-selective glue embolization was performed, resulting in immediate cessation of bleeding. The patient stabilized hemodynamically had an uneventful recovery. This case highlights the life-threatening nature of visceral artery PAs as a complication of pancreatitis and emphasizes the critical role of timely imaging and endovascular intervention in achieving a successful outcome.

A 41-year-old serviceman. A year ago, while performing a combat mission in the Special Military Operations (SMO) zone, he sustained a blind shrapnel wound to his right lower extremity as a result of a shell explosion. The metal fragment was not removed due to its deep location in the tissue of the lower leg. The wound healed by primary intention, and he returned to military service 10 days after seeking medical attention. Six months later, he felt the development of a tumor-like rounded mass in his right popliteal region, which continued to grow. A year after the injury, he developed numbness in his foot and decreased sensation in his fingers. An ultrasound examination revealed a false aneurysm of the popliteal artery (PA) and an arteriovenous fistula (AVF) between the PA and popliteal vein (PV). Due to the risks of transporting the patient to a specialized hospital during active combat operations and the progression of tibial nerve neuropathy symptoms, a decision was made to perform reconstructive surgery at a military field hospital in the SMO zone. The following surgery was performed: removal of the PA false aneurysm, removal of the AVF between the PA and PV, and autologous vein grafting of the PA with a reversed great saphenous vein. The postoperative period was uneventful. Symptoms of tibial nerve neuropathy regressed 14 days after surgery. The patient was discharged and returned to military service 30 days after surgery.

Background: Post-cholecystectomy vascular complications are rare, but serious. The surgical anatomy of the hepatic arteries is notoriously variable and increases the potential risk of injury during hepatobiliary surgery. Normally the hepatic artery proper bifurcates into right and left hepatic arteries. But, in one third of cases the aberrant right hepatic aretery (aRHA) may originate from the superior mesenteric, gastroduodenal, right gastric artery or the coeliac trunk. Trauma from surgical clips or electrocautry can damage the aRHA during dissection at the Calot's triangle, with subsequent formation of pseudoaneurysm. This presents late after surgery, mostly as GI bleed, right upper quadrant pain and jaundice—the Quincke's triad. This case report presents pseudoaneurysm formation after injury to aRHA during cholecystectomy which was subsequently managed with coil embolization. The Case: A 65-years-old gentleman presented with right hypochondrial pain of 5-months duration which was confirmed to be due to gallstones on ultrasonography. He was admitted for cholecystectomy. Intraoperatively, during laparoscopiccholecystectomy Calot's triangle was identified and cystic artery and duct were clipped under vision and cut. While removing the gallbladder massive bleeding was observed for which the procedure had to be converted to open cholecystectomy. Upon inspection an aberrant right hepatic artery was found which was ligated, while 02 pints of blood were transfused. After hemostatic control, bile leak was observed, for which T-tube was placed in the common bile duct. Postoperatively, there was a gradual decrease of his t-tube output. On the 10th post-operative day, patient became apprehensive and there was massive bleeding from T-tube site and in the sub hepatic drain. He developed shock, for which he was resuscitated. Over next week bleeding progressively decreased. Meanwhile, ultrasound showed no intra-abdominal collection but a hypo-echoic area at the porta hepatis. CT angiogram showed a pseudo-aneurysm of RHA and it was aberrantly arising directly from the celiac trunk. The case was discussed in multi-disciplinary meeting, and it was decided that patient needed coil embolization of the pseudo-aneurysm. Procedure was performed by interventional radiologist through right femoral access with 4 Fr C2 catheter. Wire was advanced into the distal right hepatic artery and embolization done with a long 6 mm coils. Coiling was done distal and proximal to the neck of the pseudo-aneurysm. No complications were observed. Post embolization patient remained stable with no bleeding episode. Hemoglobin and liver functions showed improving trend after the intervention. T-tube was removed after an unremarkable cholangiogram. Patient was discharged and follow-up after 2 and 4 weeks showed clinical improvement and no further episode of bleeding. Post-embolization angiogram at 2-week follow-up showed no filling of the pseudo-aneurysm with filling of the distal right hepatic artery branches via collaterals. Conclusion: This case underscores the importance of knowledge of hepatobiliary vascular anatomy in clinical practice, which enables a surgeon to anticipate challenges and tailor operative strategies accordingly. When an unexplained hemorrhage occurs in the post-cholecystectomy period, CT angiography should be used promptly to detect the causeincluding pseudo-aneurysm of aRHA and endovascular coil embolization is an effective minimally invasive intervention with good results.

The article presents a rare clinical case of long-term survival of a patient after an undiagnosed penetrating stab wound to the right ventricle of the heart. A 56-year-old man was urgently hospitalized in the cardiology department of a multidisciplinary hospital with decompensated heart failure against the background of tachyform atrial fibrillation. He had not sought medical care for many years. From the anamnesis it was established that 30 years ago the patient underwent surgery in a district hospital for multiple penetrating stab wounds to the chest and abdomen. After discharge, he felt satisfactory for a long time, performed heavy physical work. During the examination as part of this hospitalization, a false aneurysm and a defect in the wall of the right ventricle were detected. The patient was referred for consultation to a cardiac surgeon. He categorically refused the proposed operation. The clinical case is interesting due to the casuistry of the patient's survival with a penetrating stab wound to the chest and into the cavity of the right ventricle of the heart with the development of a false aneurysm of the right ventricle and long-term compensation of blood flow

To develop an optimal diagnostic and treatment algorithm for patients with vascular injuries and suspected gunshot traumatic arteriovenous fistulas (AVF) of limbs. There were 102 patients with injuries of great vessels of extremities complicated by traumatic AVFs. We observed 55 cases of isolated traumatic AVF and 47 cases of traumatic AVF with false aneurysm. We evaluated verification rate of traumatic AVFs by ultrasound specialists who performed routine scanning (daily) and those who used ultrasound in fast-protocol format. We analyzed the causes of diagnostic omissions at the stage of primary diagnosis. Necessary diagnostic measures depending on localization of traumatic AVF were determined. Algorithm of traumatic AVF treatment was developed. Original diagnostic and treatment algorithm based on topographic localization of traumatic AVF and posttraumatic false aneurysm considers prognosis of limb movements and function, as well as allows to choose optimal diagnostic strategy, type and extent of surgical intervention. Small incidence of this pathology often does not allow different specialists to detect, recognize and refer such patients to special hospitals in timely manner. Moreover, there are no clear diagnostic algorithms and methods for choosing surgical intervention.

Background/Objectives: The increasing use of endovascular procedures with common femoral artery (CFA) access has led to a rise in iatrogenic arterial injuries at this site. The most frequent injuries are pseudoaneurysms (PSA), retrograde dissections (RD), arteriovenous fistulas (AVF), and arterial perforations. Surgical repair is the standard treatment; however, the use of covered stents (CS) may represent a valid alternative, despite current instructions for use (IFU) not recommending CFA implantation. Methods: We conducted a single-center retrospective study on a prospectively maintained database. Patients undergoing transcatheter aortic valve repair (TAVR), endovascular aortic repair EVAR, diagnostic or therapeutic coronary angiography, or peripheral percutaneous transluminal angioplasty, who were subsequently treated for CFA injury with CS implantation between February 2015 and May 2024, were included. Endpoints were technical success (complete arterial repair), 30-day mortality, overall mortality, reintervention rates, and long-term stent patency. Results: A total of 41 patients were included: 10 (24.4%) PSA, 3 (7.3%) AVF, 27 (65.8%) perforations, and 2 (4.9%) RD. Of which 28 (68.3%) were treated with self-expandable CS and 13 (31.7%) with balloon-expandable CS. Additionally, 33 (80.5%) underwent urgent treatment. Technical success was achieved in 97.5%. Thirty-day mortality was 7.3%, with no procedure-related deaths. At a mean follow-up of 50.8 months (range 1–109), survival was 63.4%, with 100% stent patency and no procedure-related reinterventions. Conclusions: CS implantation for CFA iatrogenic injuries achieved high technical success and excellent long-term patency, representing a viable alternative to open repair. Further studies are needed to integrate CS use for CFA injuries into treatment algorithms and to update device IFUs accordingly.

This case report describes a false aneurysm of the brachiocephalic artery in a 78-year-old woman who presented at our hospital with dyspnea and chest pain caused by impending rupture. The infectious aneurysm was strongly suspected. Brachiocephalic artery aneurysms are very rare but life-threatening, and are difficult to treat especially in cases of infected false aneurysms. The treatment option performed on the patient was intended to save the patient's life, despite the risk of worsening the infection. This study indicated that the combined use of endovascular and bypass surgery is an effective strategy for the treatment of brachiocephalic false aneurysms.Clinical ImpactWe believe that our study makes a significant contribution to the literature because it describes how the treatment option of combining endovascular treatment and artificial vessel bypass surgery successfully saved the patient's life despite the risk of worsening infection. We believe that this paper will be of interest to the readership of your journal because currently there are no clear guidelines in the literature for the treatment of false aneurysms of the brachiocephalic artery, so case reports are valuable references for cardiologists.

The authors describe a rare but extremely severe complication of endovascular treatment of descending thoracic aortic aneurysm (fungal infection of stent-graft). Despite prompt diagnosis and antibacterial/antifungal therapy, infection progressed with subsequent false aneurysms within stent graft attachment zones accompanied by episodes of hemoptysis. Surgical intervention included extraanatomical ascending-descending bypass, total aortic arch debranching, removal of infected stent graft, debridement and omentoplasty. Thanks to timely surgical intervention and comprehensive treatment, clinical status stabilized. Further follow-up demonstrated satisfactory results (no signs of reinfection, competent vascular anastomoses and favorable clinical status). This case highlights the role of timely diagnosis of infectious complications of stent grafts, as well as the need for individualized approaches including extraanatomical bypass grafting and omentoplasty.

ABSTRACTWhen ascending aortic aneurysm is saccular and the histories associated with false aneurysm do not exist, imaging differential diagnosis whether true or false aneurysm is generally difficult, and definitive diagnosis can be done merely with histopathological examinations of the aneurysm wall.

Background: Children with end stage renal disease (ESRD) face lifelong increases in morbidity and mortality. A well-functioning and reliable vascular access are an absolute requirement to provide life-sustaining treatment for patients on hemodialysis. This study compared the outcome and complications of radio-cephalic and brachio-cephalic arteriovenous fistula (AVF) in pediatric patients with end stage renal disease (ESRD). Methods: This is an observational study conducted at the department of vascular Surgery, Bangladesh Medical University (BMU) for 12-months following ethical approval. A total of 68 ESRD patients were included and divided into two groups (34 patients with radio-cephalic AV fistula in group A and 34 patients with brachiocephalic AV fistula in group B). Following informed written consent from parents or guardians, a detailed history and thorough clinical examination were carried out along with relevant investigations. Duplex scan was done before and after 8 weeks after operation. Data were collected in semi-structured questionnaire and analyzed by SPSS 24.0. Results: Mean age of the study population was 12.94±3.79 (SD) years with male predominance (54.4%). Average BMI of the study children was 21.04±2.47 kg/m2 wherein almost 1/3rd was overweight/obese (30.9%). Both groups were statistically similar in terms of socio-demographic profile like age, sex, residence, and BMI (p>0.05). After 8 weeks, brachiocephalic AVF had significantly greater maturity rate (91.2% vs 70.6%, p=0.031) and higher maximum arterial flow rate (674.74±91.29 vs 555.03±75.64 mL/min, p<0.001) than radio-cephalic AVF. Pre-operative diameter of vein <2 mm was significantly associated with AVF failure (p=0.046). Brachiocephalic AVF had lower rate of post-operative hematoma (8.8% vs 11.8%), infection (5.9% vs 11.8%) and pseudo aneurysm (5.9% vs 8.8%) than radio-cephalic AVF without any significance (p>0.05). However, post-operative edema was equal in both groups (8.8% in each). Conclusion: Brachio-cephalic AVF shows better outcome in comparison with radio-cephalic AVF for hemodialysis in pediatric patients with ESRD.

A single-center experience in the management of combat-related extremity vascular injuries.

Radial artery pseudoaneurysm (PSA) is an uncommon but clinically relevant complication increasingly encountered with the expanding use of radial access in cardiology and critical care. Presentation and management vary widely according to etiology, patient frailty, and arterial wall integrity. We describe two representative cases: an elderly diabetic woman who developed a PSA after complex transradial coronary stenting and was successfully treated with selective coil embolization, and a man with cardiogenic shock and sepsis who developed a PSA following prolonged invasive monitoring and was managed with vascular plug devices. These cases illustrate the heterogeneous mechanisms leading to PSA and emphasize the need for individualized endovascular strategies in complex patients.

Despite the latest advances in pharmacological, endovascular and surgical treatment of patients with coronary artery atherosclerosis, coronary artery disease is still the leading cause of disability and mortality. Since 2019, more than 10% of coronary artery bypass grafting surgeries have been performed after previous coronary artery stenting. With expansion of indications and high classes of recommendations for percutaneous coronary interventions, patients with total stenting of ≥1 coronary artery are common. This creates a very serious problem for coronary artery bypass surgery. The phenomenon of total metallization of coronary artery, known as a full metal jacket, has arisen. We have encountered a rare case of previous recanalization of chronic prolonged occlusion and subsequent stenting of the right coronary artery along the entire length complicated by multiple perforations and false aneurysms. We present a patient with such a complication who required surgical treatment and manipulations with totally metallized right coronary artery.

<p>Introduction: Pseudoaneurysm (PSA) is defined as a defect in the arterial wall at the puncture site, leading to an extraluminal blood collection surrounded by fibrous tissue, and represents the most common vascular complication after coronary angiography. The aim of this study was to identify risk factors for PSA development after coronary interventions and to define criteria for surgical treatment. Materials and Methods: A retrospective analysis was conducted on 32 patients treated at CHC Zemun over a ten-year period (2012–2022). During the observed period, 16,787 coronary procedures were performed (10,498 coronary angiographies, 6,289 PCIs). The study group included 17 patients with PSA, and 15 patients in the control group with a hematoma that did not progress to PSA. Demographic data, comorbidities, laboratory parameters, therapy, smoking habits, procedural details, and PSA characteristics were recorded, with comparison between surgically and conservatively treated patients. Results: The mean time to PSA diagnosis was 3.29 ± 4.7 days, whereas hematomas were diagnosed within 24 hours. No significant differences in sex or age were observed between groups. More than half of the patients had hypertension, hyperlipidemia, and chronic cardiac or renal diseases. Low hemoglobin, thrombocytopenia, and INR >3 were identified as independent risk factors. Most interventions were performed via the right femoral artery, with PSA most commonly located in the common femoral artery. Median PSA diameter was 44 mm in surgically treated patients and 19 mm in conservatively treated patients. No deaths occurred; the most common postoperative complication was residual hematoma. Conclusion: The first 72 hours after intervention represent the most critical period for PSA detection. PSA diameter is a key factor in therapy selection, lesions >2 cm and complicated ones require surgical intervention, while smaller lesions can be treated conservatively. Timely diagnosis and treatment improve outcomes, and our findings may help optimize patient monitoring protocols and early surgical intervention selection.</p>