Charles B. Ross

Endovenous stent-assisted coil embolization for a symptomatic femoral vein aneurysm

An 83-year old man presented with recurrent pulmonary embolism originating from a distal left superficial femoral vein aneurysm despite therapeutic anticoagulation. We treated the patient transluminally using the technique of stent-assisted coil embolization via percutaneous transpopliteal venous access. Follow-up by serial duplex ultrasonography and computer tomographic venography (CTV) demonstrated resolution of the aneurysm. Our case demonstrates that stent-assisted coil embolization may effectively exclude a saccular venous aneurysm and prevent recurrent pulmonary embolization.

Carotid Artery Stenting for Stenosis Following Cervical Radiotherapy: Report of Early Failure With Associated Stent Fracture

Experience with carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CE) for management of carotid stenosis continues to evolve. We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses.