Martin Duddy

Successful Glue Embolization of a Late Type 1a Endoleak Causing Abdominal Aortic Aneurysm Rupture

We describe the successful treatment with n-butyl cyanoacrylate embolization of a ruptured infrarenal abdominal aortic aneurysm caused by a late type-1A endoleak 10 years after endovascular aneurysm repair (EVAR).

Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts.

Objectives To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses. Methods An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months. Results A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively. Conclusion The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.

Factors Affecting Medium-Term Outcomes After Crural Angioplasty in Critically Ischemic Legs

Objectives: To study factors affecting patency and medium-term outcomes after crural angioplasty. Materials and Methods: All crural angioplasties between March 2003 and September 2010 were reviewed from a prospective database to analyze primary patency, amputation-free survival, and limb salvage. Results: Five hundred and twenty-seven limbs in 478 patients (58.7% male, mean age 73.9 ± 0.53 years) were treated. In all, 49.1% were diabetic patients and 7.4% were dialysis dependent. Primary patency was 65.5%, 57.8%, 48.5%, and 32.9% at 1, 6, 12, and 36 months, respectively. Amputation-free survival was 75.2% at 1 year and 59.0% at 3 years. Limb salvage at 3 years was 92.7%. Rutherford categories 5 and 6 had a consistent adverse effect on patency. This led to an adverse amputation-free survival and limb salvage at 3 years. Conclusion: Crural angioplasty is an effective treatment for limb salvage. Its outcomes are adversely affected by diabetes, renal disease, coronary disease, and worsening Rutherford grade.

Late Peripheral Thoracic Aneurysms following Aortic Root Surgery in Patients with Loeys–Dietz Syndrome

The Loeys-Dietz syndrome is a multisystem connective tissue disorder characterized by aortopathy, arterial tortuosity, peripheral aneurysms, and skeletal features. The peripheral arteriopathy is an important cause of morbidity and potential mortality. This report presents 2 cases: the first demonstrating a 5-cm pseudoaneurysm of the right internal mammary artery and the second demonstrating a 2.3-cm aneurysm of the left internal mammary artery, each following aortic root surgery. These were successfully treated with percutaneous techniques. No complications were seen at follow-up as long as 2 years. Patients with Loeys-Dietzs syndrome require comprehensive long-term vascular follow-up and are likely to require percutaneous vascular interventions.

Modification of a bifurcated stent graft for aortouniiliac endovascular aneurysm repair in a renal transplant patient.

Introduction. We describe a case of aortouniiliac (AUI) endovascular aortic aneurysm repair (EVAR) using combined iliac limb and bifurcated body stent graft modular system. Case report. This technique is demonstrated in a 58-year-old man with a 6-cm abdominal aortic aneurysm suitable for EVAR. The patient has a functioning cadaveric renal transplant anastamosed to the mid right external iliac artery, an occluded left iliac system and stenosed right iliac system. The renal allograft was protected with minimal passage across the transplant artery origin using this modified approach. The patient was successfully treated with a bifurcated main body deployed within a contralateral limb endoprosthesis. Subsequent scans confirmed no endoleaks or stent migration. Conclusions. The AUI conversion from existing Gore excluder stent graft system is safe and should be considered when faced with challenging anatomy of a pelvic renal transplant, slender access, and contralateral iliac occlusion.

Eosinophilic angiitis presenting with a true, fusiform, temporal artery aneurysm

Temporal artery aneurysm is a rare cause of temporal artery swelling in the absence of preceding trauma. Vasculitis other than giant cell arteritis, such as eosinophilic granulomatosis with polyangiitis, should be considered in such cases and a careful assessment of other medium‐sized arteries undertaken.

A "blush sign": radiological harbinger of delayed pseudoaneurysm formation after vein graft angioplasty.

Vein graft stenosis is a well-recognized complication of infrainguinal bypass surgery. Balloon angioplasty is an accepted method for managing vein graft stenosis in selected patients. This intervention is not without complication. We present 2 cases of delayed pseudoaneurysm formation after balloon angioplasty of vein graft stenoses. Both cases showed a persistent contrast stain or blush as an indication of vein wall damage and propose that this is a radiological harbinger of delayed rupture and pseudoaneurysm formation.

A painful swelling in the groin

A 76 year old woman presented with a 13 day history of severe pain and swelling in her right groin. She lived independently with her husband and normally had an active life, but walking was becoming increasingly difficult because of the groin pain. Although she denied any recent trauma, she had been treated for an incidentally discovered cerebral artery aneurysm three weeks earlier. The treatment had been successful and she said it had been performed using a “special needle in my groin.” She had been discharged from hospital one week after the procedure and had not had fever or discharge from the groin puncture wound. She was otherwise in good health. Her current drugs were aspirin and clopidogrel, which she took for ischaemic heart disease. On clinical examination she had a small, pulsatile, exquisitely tender mass in the proximal medial right thigh, just distal to the right groin skin crease. The healed needle puncture site was close to the mass. Distal pulses in the right lower limb were strong, and the limb was warm with no skin changes or visible bruising. A clinical diagnosis of iatrogenic right femoral artery pseudoaneurysm was made. A Doppler ultrasound of the right femoral artery was requested to confirm the diagnosis and guide further management. The Doppler ultrasound confirmed the presence of a large (4×3 cm) rounded sac superficial to the distal right common femoral artery. The sac was directly connected to the artery by a narrow neck and a high velocity jet of arterial blood was seen flowing into the sac, consistent with a pseudoaneurysm of the right common femoral artery.