John F. Reidy

Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?

Background:  Retroperitoneal haematoma is a rare clinical entity with variable aetiology, which is increasing in incidence mainly due to complications related to interventional procedures. There is no general consensus as to the best management plan for patients with retroperitoneal haematoma.

Mid-term results for second-generation thoracic stent grafts.

Thoracic stent grafts offer an alternative to open surgery for thoracic aortic disease, but their long‐term durability is unknown. This report includes mid‐term follow‐up for commercially available thoracic devices.

Comparison of extra‐anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra‐aortic trunks

Symptomatic stenosis of the supra‐aortic trunks (subclavian, innominate and common carotid arteries) can be treated by angioplasty/stenting or surgical bypass. The aim of this study was to compare the initial success and outcome of these two types of treatment.

Successful endoluminal repair of an infected thoracic pseudoaneurysm caused by methicillin-resistant Staphylococcus aureus.

Purpose: To report the successful endoluminal repair of an infected thoracic aneurysm secondary to methicillin-resistant Staphylococcus aureus (MRSA). Case Report: A 76-year-old man presented with an infected thoracic pseudoaneurysm 9 weeks after an elective infrarenal aneurysm repair. Blood cultures were positive for MRSA. Computed tomography (CT) showed an 11.5-cm false aneurysm of the descending thoracic aorta just proximal to the celiac axis. An Excluder stent-graft was used to successfully repair the lesion. Recovery was uneventful, and the patient was treated with linezolid for 6 weeks. Follow-up CT scans at 3 and 12 months confirmed exclusion of the aneurysm and progressive shrinkage of the aneurysm sac with no evidence of graft infection. Conclusions: Endoluminal repair is an alternative to open surgery for the treatment of infected aneurysms of the thoracic aorta.

Endoluminal repair of aneurysms associated with coarctation

BACKGROUND Late aneurysm formation is a well-recognized complication of surgery for aortic coarctation. Open surgery to repair these aneurysms is associated with significant morbidity and mortality. Endoluminal repair is an attractive alternative to open surgery. METHODS Data were collected prospectively on consecutive patients who presented with aneurysms associated with coarctation RESULTS Between June 1999 and October 2001, 5 patients underwent elective endoluminal repair for coarctation aneurysms. All procedures were technically successful and no patients died. Four patients previously had open surgery to repair aortic coarctation, and 1 presented with an aneurysm associated with a previously unrecognized coarctation. The median follow-up was 7 months (range, 3 to 29 months), and to date, all aneurysms remain excluded. CONCLUSIONS Endoluminal repair is a promising alternative to redo open surgery for thoracic aneurysms associated with previous surgery for aortic coarctation. Long-term follow-up is required to assess the durability of the stent grafts.

Embolization of a Bleeding Renal Angiomyolipoma in Pregnancy: Case Report and Review

A case is described of a woman 10 weeks pregnant who had severe bleeding, secondary to a renal angiomyolipoma (AML), that was treated with embolization. Subsequent pregnancy was uneventful and she delivered a normal female infant 28 weeks after the procedure. One month after delivery, liquefaction of the AML occurred, which eventually required surgical drainage. We review and discuss AML during pregnancy, its management and post-embolization complications.

Long-term surveillance with computed tomography after endovascular aneurysm repair may not be justified

There is a common perception that a large number of secondary interventions are needed following endovascular aortic aneurysm repair.

Repair of Secondary Aortoesophageal Fistula by Endoluminal Stent-Grafting

Purpose: To describe a case of secondary aortoesophageal fistula that was treated with an endoluminal stent-graft. Case Report: A 58-year-old woman presented with hematemesis and melena. In 1974 she had an interposition graft repair of an aortic transection sustained during a traffic accident. At the examination in 1998, angiography demonstrated a mechanical disruption of the proximal anastomosis forming an aortoesophageal fistula. A 28-mm × 3.75-cm AneuRx stent-graft was introduced via a right femoral arteriotomy and deployed across the defect. Follow-up CT scans at 18 months showed exclusion of the false aneurysm with no evidence of infection; the patient remains well at >2 years after stent-graft implantation. Conclusions: Endoluminal repair can be successful in achieving a satisfactory midterm outcome in cases of secondary aortoesophageal fistula.

Renal Angioplasty in Non-atheromatous Renal Artery Stenosis: Technical Results and Clinical Outcome in 43 Patients

This study retrospectively reviewed the technical and clinical results of percutaneous transluminal renal artery angioplasty (PTRA) for non-atheromatous renal artery stenosis (RAS) in a Tertiary Renal Referral Centre. Forty-three patients (including 9 children) underwent 49 PTRA procedures for stenoses of 63 arteries over the period 1984–2001 (14 patients had bilateral stenosis treated during one procedure. There were 29 females and 14 males (age range 1–72 years, median 37 years). The etiology of the RAS was classical beaded FMD (medial fibroplasia) in 24, atypical or “variant FMD” with a more focal stenosis (intimal fibroplasia) in 11, neurofibromatosis type 1 (NF) in 7 and Takayasu’s Arteritis in 1. Five of the NF patients had angioplasty for stenoses following vascular repair procedures. A technically good result was obtained in 34/34 arteries with “classical” RAS, 9/13 atypical arteries, 11/15 arteries of NF patients and in the one Takayasu’s case. Clinical follow-up for a mean of 16 months revealed a cure rate of hypertension in classical FMD of 35% with improvement in a further 55%. In the atypical FMD cases, follow-up was obtained on 6 patients with 2 cures and the other 4 demonstrating benefit. There was a better chance of cure in younger patients. In native artery PTRA in children with NF, only 1 out of 3 patients was ‘cured’ post-PTRA, and 2 out of 3 failed. However, in postsurgical stenoses in NF patients 1 out of 4 patients was ‘cured’ and 3 out of 4 improved. In conclusion, classical FMD responds well to PTRA with better results in younger patients. Atypical FMD, especially in children and when associated with NF, is less predictable. Stenoses consequent to revascularization surgery respond well to PTRA.

Successful Endovascular Repair of Acute Type B Aortic Dissection in Undiagnosed Ehlers-Danlos Syndrome Type IV

A 61-year-old man presented with an acute type B aortic dissection for which a stent-graft was introduced. He remains complication-free 4 years onwards and has since been diagnosed with Ehlers-Danlos syndrome type IV (EDS IV). His particular mutation is predicted to result in lesser levels of normal collagen and may explain his favourable outcome from endovascular intervention. Understanding the genotype-phenotype correlation may influence the choice of therapy offered to patients with EDS IV.