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Juxtarenal inflammatory aneurysm treated with bilateral iliac-renal bypass using the gore hybrid device and total sealing of the aneurysmal sac with a nellix device
No full textThe aim of this study is to present the treatment of a juxtarenal inflammatory aneurysm using a Nellix device (Endologix, Inc., Irvine, CA) to seal the entire aneurysmatic aorta combined with bilateral iliac–renal bypass using the Gore hybrid vascular graft (W. L. Gore & Associates, Inc., Flagstaff, AZ). A 63-year-old man was diagnosed with a 6-cm juxtarenal inflammatory aneurysm. It was initially decided to treat him with an aorto-aortic bypass and to revascularize the 2 renal arteries with “graft to renal artery bypass” using Gore hybrid vascular grafts. Due to the high intraoperative bleeding preparing the proximal neck and the tight adhesion of the aorta to the adjacent structures, we decided to change our plans and to treat the patient using the Nellix system combined with bilateral iliac–renal bypass using the Gore hybrid vascular grafts. Contrast computed tomography control at 1 month showed complete sealing of the aneurysm sac and patent iliac renal bypasses. The reported case demonstrated that the Nellix Endovascular Aneurysm Sealing system combined with Gore hybrid vascular grafts for bilateral iliac–renal bypass showed that it can be an effective modality for the treatment of juxtarenal, inflammatory aortic aneurysm and revascularization of the renal arteries from the distal iliac arteries
External carotid artery repair in cerebro-vascular insufficiency
No full textFrom January 1985 to October 1992 ten patients were submitted to reconstruction of the external carotid artery (ECA). Nine were males and one female with age that ranged from 64 to 74 years, mean 68. All were symptomatic due to TIAs in seven and amaurosis fugax in four of this group, previous completed stroke plus TIAs in two and chronic low perfusion in one. Associated risk factors were smoking (8 pts: 80%), coronary disease (5 pts: 50%), hypertension (4 pts: 40%), diabetes (4 pts: 40%) and peripheral arterial obstructive disease (2 pts: 20%). All patients were submitted to non invasive (Doppler C. W., Echo-color Doppler) studies as well as angiography. All the patients had an occlusion of the internal carotid artery (ICA) unilateral and homolateral to external carotid stenosis in 8 and bilateral in 2; in addition three patients had a non haemodynamic stenosis of the contralateral ICA. One patient had an occlusion of the common carotid artery with collateral supply to the ECA; nine had severe stenosis of the ECA at the origin. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Surgery was advised to correct amaurosis fugax, to increase external-internal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endarterectomy. All patients were operated upon under general anesthesia; an endarterectomy with a PTFE patch was performed in 9 cases, while in one a subclavian-ECA bypass was carried out using an autologous vein segmen
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