Notes

Your interplay involving EBV along with KSHV well-liked products and also NF-κB walkway within oncogenesis.
We present the unusual case of a mycotic right common iliac artery pseudoaneurysm caused by methicillin-susceptible staphylococcus aureus (MSSA) of indeterminate etiology in a healthy 57-year-old male with no risk factors for infection, trauma or malignancy. The patient initially presented with worsening subacute right lower quadrant pain and was found to have a pseudoaneurysm of the right common iliac artery. Given concern for rupture on a computed tomography angiogram (CTA), he underwent exclusion of the pseudoaneurysm with a covered stent. At the time of presentation, he had no signs or symptoms of infection. However, the patient developed fever, chills and worsening right lower quadrant pain thirteen days following the index operation and was found to have a leukocytosis, blood cultures positive for MSSA and progressive soft tissue changes involving the right common iliac artery on CTA consistent with infection. He was definitively treated with stent explantation, aggressive debridement and replacement with an in situ cryopreserved bypass, and short-term suppressive antibiotic therapy. OBJECTIVES Endovascular stent and prosthetic graft placement are commonplace techniques for correction of subclavian artery (SCA) lesions. However, when initial surgical repair of the SCA becomes complicated by subsequent infection or thrombosis of the repair site, stents and prosthetic grafts are no longer suitable for secondary repair due to the risk of recurrent failure and limited longevity. Autogenous tissue is more resistant to infection and has improved long-term patency, and thus may be a better option for secondary reconstruction in these complex clinical scenarios. The most commonly used autogenous conduit for SCA reconstruction is the great saphenous vein; however, the significant size mismatch makes this unsuitable in many circumstances. The autogenous femoral vein is a promising alternative conduit for SCA repair. Here we present three successful cases of its use as a salvage technique following iatrogenic complications of prior surgical repair. METHODS From 2015 to 2019, three patients underwenttion of the repair site. CONCLUSIONS The success of these cases demonstrates that the autogenous femoral vein is an effective and safe option for SCA reconstruction. It is particularly useful for secondary salvage when prior surgical repair via standard techniques is complicated by infection or thrombosis, and when target vessel size precludes the use of the great saphenous vein. This is an excellent choice of conduit that vascular surgeons should consider for use in complex SCA repairs. OBJECTIVES Type Ia endoleaks are common following thoracic endovascular aortic repair(TEVAR). However, the repair of type Ia endoleaks involving the distal arch is challenging because of the presence of the interventional endografts, potential damage to the aortic arch vessels, and the location and size of the aneurysmal body. We retrospectively reviewed our experience of the surgical treatment of type Ia endoleaks with distal arch involvement using left subclavian artery(LSCA)-left common carotid artery(LCCA) transposition with a stented elephant trunk. METHODS Sixteen patients (male=16; mean age, 47±9 years, range 31-63 years) with type Ia endoleaks involving the distal arch underwent LSCA-LCCA transposition with a stented elephant trunk from July 2010 to July 2018. TEVAR failure occurred in 12 patients, re-TEVAR was performed in two patients, hybrid aortic arch repair in one patient, and the chimney technique in one patient. RESULTS There were no in-hospital deaths. Fourteen patients required mechanical ventilation for less then 24h and one for less then 48h. One patient required re-intubation after mechanical ventilation for 19h and continuous renal replacement therapy because of renal failure. One patient received pericardial drainage, and recurrent laryngeal nerve injury occurred in one patient. Three patients died during follow-up. CONCLUSIONS LSCA-LCCA transposition with a stented elephant trunk can produce satisfactory results in patients with a type Ia endoleak involving the distal arch. Using this technique, it is possible to exclude the aneurysm sac distal to the LCCA origin and seclude the failed interventional endograft. These encouraging outcomes suggested that this technique could be a suitable surgical treatment for this type of lesion. BACKGROUND Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity. METHODS We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemo-radiotherapy for lingual base and oropharyngeal squamous cells carcinoma. The case was managed by a staged multidisciplinary approach of open arterial reconstruction, after initial endovascular hemorrhage control using stent-graft. RESULTS The patient was discharged to home with patent carotid artery, no sign of infection or bleeding and autonomous ambulation. A CT/PET scan performed 6 months later confirmed healing and absence of tumor recurrence. CONCLUSIONS A multi-disciplinary approach involving vascular surgeons, ENT surgeons, plastic and maxillofacial surgeons is particularly appropriate in the management of carotid blowout syndrome in order to warrant a durable and effective repair of all the anatomical structures involved. AIMS A distal approach in endovascular procedures for revascularization of lowers limbs can be considered in case of no re-entry in subintimal recanalization. The aim of this study is to evaluate the feasibility of a medial approach to the infrageniculate popliteal artery (IPA) using existing CT scan simulation and punctures performed on cadavers. METHODS AND RESULTS CT angiographies of lower extremities were used to simulate IPA puncture and puncture trajectory. Tissues damaged during the trajectory between the puncture site and the access related injuries were analyzed. Anatomical punctures on cadaverous model were also performed. Corpses were placed in supine position, the hip in slight flexion (40°) and abduction (external rotation of 60°). A 16G needle was used for the IPA puncture. Twelve CT angiography simulations were made. Out of these 12 simulations, 9 revealed an isolated lesion of the popliteal vein, 2 isolated lesions of the tibial nerve. A lesion of the tibial nerve and the popliteal vein on the same simulation was once observed. Damage to the medial gastrocnemius muscle could not be avoided in each case. Ten punctures were performed on cadavers with technical success. There were 6 popliteal vein lesions, 3 tibial nerve lesions and 1 case without lesion. In all cases, damage to the medial gastrocnemius muscle was seen. CONCLUSION This medial approach was feasible and is accompanied by trauma of elements of the popliteal pedicle. Preoperative CT angiography could anticipate best site of puncture and potential access related injury. OBJECTIVES Popliteal artery aneurysms (PAA) are the most common peripheral aneurysms. Although rare and often asymptomatic there is a significant risk of thrombosis, embolism and limb loss. The aim of this study was to evaluate the eligibility for endovascular repair of patients treated for symptomatic and asymptomatic PAA according to the instructions for use (IFU). MATERIAL AND METHODS All patients treated for PAA with open surgical repair between the years 2010 - 2017 were analysed if suitable for endovascular treatment. Preoperative imaging was reviewed for applicability with an interventional radiologist and two vascular surgeons. Evaluation was performed according to the following criteria adapted from the IFU of Gore ® Viabahn stent graft at least a single vessel tibial run-off, proximal and distal landing zone more than 2 cm, no large difference in vessel diameter proximal and distal to the aneurysm, no overstenting of significant collaterals necessary and no inadequate kinking of the artery. The patients were classified in three categories the patient was eligible, endovascular treatment was feasible and endovascular treatment was not appropriate. RESULTS 51 patients with 61 symptomatic and asymptomatic PAA were identified. 45 cases were asymptomatic, 11 cases showed clinical symptoms such as claudication and in 5 cases the patients presented with acute ischemia. Endovascular intervention was eligible in 24 patients, 14 cases were feasible and in 23 cases was not appropriate according the IFU. CONCLUSION In this study more than one third of the patients with PAA were not eligible for endovascular treatment according to the IFU and another 23 % showed substantial reasons against endovascular treatment. This data suggests that endovascular repair remains a treatment option for selected patients only. Cross-sectional imaging is mandatory for procedure selection. BACKGROUND Distal entry tears have undesirable influence in type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR), including inhibition of aortic remolding and increase of late aortic events. Therefore, distal entry tears should be managed. Nowadays, main strategies for managing distal entry tears included total and selective strategies. However, which strategy is better still remains controversial. OBJECTIVES To investigate the outcomes of selective strategy for distal entry tears after TEVAR in TBAD. METHODS A total of 43 consecutive TBAD patients with distal entry tears after TEVAR were administered with selective strategy for distal entry tears, including occlusion of the tear in the thoracic aortic segment, thrombosis of reverse blood flow channel in the false lumen and selective occlusion of distal entry tears. Mortality, complications and aortic remolding in early follow-up (12 months after operation) were analyzed. RESULTS All 43 patients survived during the follow-up period. Operation was performed again for femoral artery reconstruction in one patient who had occlusion of the approach vessel during the follow-up period, and the remaining 42 patients had no uncomfortable symptoms and operation-related complications. The Maximum diameter of the aorta was （32.03±6.35）mm and（27.36±4.92）mm, respectively for before and after reintervention, and the difference was significant (t=5.899, P less then 0.001）. The unthrombotic range of the false lumen after reintervention was significantly shrunken in all patients, compared with before reintervention. CONCLUSIONS Selective strategy was safe and effective, at least in early follow-up. Its effectiveness should be further verified by more clinical observation results and long-term follow-up results. OBJECTIVES The present study evaluates aneurysmal sac remodeling and the loss of intercostal arteries after the first step of staged treatment of thoraco-abdominal aortic aneurysms (TAAA). The purpose of this approach is to keep the aneurysmal sac temporarily perfused in order to induce progressive thrombosis of the aneurysm while simultaneously allowing the spinal cord to establish adequate perfusion thereby promoting the development of collateral circulation. METHODS All patients with Type II or Type III TAAA having undergone two-step endovascular treatment with at least a two-branch endoprosthesis at our institution between April, 2017 and May, 2019, were retrospectively evaluated. Thirty-day mortality and spinal cord ischemia was assessed. The mean number of intercostal and lumbar arteries, coverage length between the left subclavian artery and the stent graft proximal landing zone, total volume of the aneurysmal sac, lumen volume, and thrombosis volume were measured by pre-operative and first-step post-operative Computed Tomography Angiography.
Website: