Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsa... more Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve.
Journal of vascular surgery. Venous and lymphatic disorders, Sep 1, 2017
Right lower extremity edema can be a presenting symptom of iliocaval compression syndrome, even i... more Right lower extremity edema can be a presenting symptom of iliocaval compression syndrome, even in the absence of deep vein thrombosis. It has been reported in idiopathic and rarely, iatrogenic, cases secondary to variant anatomy, arterial stents, and bony hardware. Classically seen in the more confined left common iliac vein as May-Thurner syndrome, it is rare on the right side. We report an unusual case of acute right common iliac vein compression after right iliac stent placement leading to symptomatic right leg edema. Venous stenting resulted in resolution of symptoms at the 6-month follow-up. (
Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and ... more Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter [40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3-6 months after onset. Prevention of chronic type B aortic dissection with aneurysmal degeneration and attainment of aortic remodeling with preemptive TEVAR are needed to free patients from the need for long-term strict control of blood pressure and periodic follow-ups involving radiological exposure and to avoid the eventual need for extensive open surgery.
Background:While the standard of care for suspected tracheo-innominate artery fistula (TIF) neces... more Background:While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence.Methods:An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria.Results:48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. ...
Journal of Vascular Surgery Cases and Innovative Techniques, May 1, 2021
Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transv... more Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transverse diameter. We have described a case of a patient who had presented for open repair of an 18-cm AAA and a review of reported cases of giant AAAs >10 cm in the maximum transverse diameter. Forty cases were compiled. The average maximum AAA diameter was 14.5 ± 4.1 cm. The AAA was ruptured on presentation in 12 patients (30%). Of the 40 cases, 34 (85%) were repaired with open surgery. The reported mortality was 15%. Despite the case complexity, five endovascular repairs were attempted.
Background: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an... more Background: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5-year vascular surgery residency program creating a 2-tiered system of training for vascular surgeons. The question remains if the new paradigm is equivalent to the traditional training. The true test of this may be looking at data from fully trained surgeons in their first years of practice. It is hard to obtain this data. There are surrogate methods that can be used. Operative experience of trainees is readily available as a substitute. The purpose of this study is to compare the operative experience of those graduating from the traditional (5 + 2) vascular training program with the integrated (0 + 5) program. Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2019. Mean case numbers were compared between integrated vascular residents and traditional vascular fellows (mean case numbers for vascular fellows included cases from their general surgery residencies). Results: The 5 + 2 trainees performed an average of 35% more total procedures than the 0 + 5 trainees (1,662 ± 7 vs. 1,084 ± 12). The greater number of overall procedures performed by the 5 + 2 trainees was primarily realized by an increased number of abdominal (e.g., biliary, small/ large intestine) cases. However, the 0 + 5 trainees performed 8% more vascular procedures (858 ± 10 vs. 794 ± 3). The greater number of vascular procedures performed by the 0 + 5 trainees was primarily realized by increased mean numbers of endovascular and venous procedure cases. Conclusions: The integrated 0 + 5 graduates performed more total vascular procedures than their 5 + 2 counterparts. The overall total operative experience remains greater for the traditional 5 + 2 graduates, given their additional 2 years of training. Further longitudinal studies will be needed to fully assess the effect of the newer integrated 0 + 5 training paradigm.
This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jef... more This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Phase 1 by an authorized administrator of the Jefferson Digital Commons.
Twenty-two patients who underwent surgical intervention for axillosubclavian vein thrombosis from... more Twenty-two patients who underwent surgical intervention for axillosubclavian vein thrombosis from 2009 to 2015 at our institution were retrospectively reviewed. Standard protocol with short term anticoagulation treatment was given after combination of surgical intervention including catheter directed lysis, balloon angioplasty, mechanical thrombectomy, and first rib resection. Fourteen patients (64%) received warfarin and 8 patients (36%) received rivaroxaban for postoperative anticoagulation regimen and followed up with ultrasound.
Journal of Vascular Surgery Cases and Innovative Techniques, Jun 1, 2022
Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysm... more Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysms as an alternative to open repair. However, complications can occur, including stent graft migration, kinking, and occlusion, leading to compromise of the excluded aneurysm walls and acute limb ischemia. In the present report, we have described a case of migration and kinking of an abdominal aortic stent graft in the main body that led to occlusion of the abdominal aorta and bilateral acute limb ischemia. The patient required emergent explantation of the stent graft and open repair of the abdominal aneurysm with a rifampin-soaked Dacron graft, which achieved a favorable outcome.
Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsa... more Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve.
Journal of vascular surgery. Venous and lymphatic disorders, Sep 1, 2017
Right lower extremity edema can be a presenting symptom of iliocaval compression syndrome, even i... more Right lower extremity edema can be a presenting symptom of iliocaval compression syndrome, even in the absence of deep vein thrombosis. It has been reported in idiopathic and rarely, iatrogenic, cases secondary to variant anatomy, arterial stents, and bony hardware. Classically seen in the more confined left common iliac vein as May-Thurner syndrome, it is rare on the right side. We report an unusual case of acute right common iliac vein compression after right iliac stent placement leading to symptomatic right leg edema. Venous stenting resulted in resolution of symptoms at the 6-month follow-up. (
Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and ... more Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter [40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3-6 months after onset. Prevention of chronic type B aortic dissection with aneurysmal degeneration and attainment of aortic remodeling with preemptive TEVAR are needed to free patients from the need for long-term strict control of blood pressure and periodic follow-ups involving radiological exposure and to avoid the eventual need for extensive open surgery.
Background:While the standard of care for suspected tracheo-innominate artery fistula (TIF) neces... more Background:While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence.Methods:An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria.Results:48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. ...
Journal of Vascular Surgery Cases and Innovative Techniques, May 1, 2021
Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transv... more Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transverse diameter. We have described a case of a patient who had presented for open repair of an 18-cm AAA and a review of reported cases of giant AAAs >10 cm in the maximum transverse diameter. Forty cases were compiled. The average maximum AAA diameter was 14.5 ± 4.1 cm. The AAA was ruptured on presentation in 12 patients (30%). Of the 40 cases, 34 (85%) were repaired with open surgery. The reported mortality was 15%. Despite the case complexity, five endovascular repairs were attempted.
Background: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an... more Background: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5-year vascular surgery residency program creating a 2-tiered system of training for vascular surgeons. The question remains if the new paradigm is equivalent to the traditional training. The true test of this may be looking at data from fully trained surgeons in their first years of practice. It is hard to obtain this data. There are surrogate methods that can be used. Operative experience of trainees is readily available as a substitute. The purpose of this study is to compare the operative experience of those graduating from the traditional (5 + 2) vascular training program with the integrated (0 + 5) program. Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2019. Mean case numbers were compared between integrated vascular residents and traditional vascular fellows (mean case numbers for vascular fellows included cases from their general surgery residencies). Results: The 5 + 2 trainees performed an average of 35% more total procedures than the 0 + 5 trainees (1,662 ± 7 vs. 1,084 ± 12). The greater number of overall procedures performed by the 5 + 2 trainees was primarily realized by an increased number of abdominal (e.g., biliary, small/ large intestine) cases. However, the 0 + 5 trainees performed 8% more vascular procedures (858 ± 10 vs. 794 ± 3). The greater number of vascular procedures performed by the 0 + 5 trainees was primarily realized by increased mean numbers of endovascular and venous procedure cases. Conclusions: The integrated 0 + 5 graduates performed more total vascular procedures than their 5 + 2 counterparts. The overall total operative experience remains greater for the traditional 5 + 2 graduates, given their additional 2 years of training. Further longitudinal studies will be needed to fully assess the effect of the newer integrated 0 + 5 training paradigm.
This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jef... more This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Phase 1 by an authorized administrator of the Jefferson Digital Commons.
Twenty-two patients who underwent surgical intervention for axillosubclavian vein thrombosis from... more Twenty-two patients who underwent surgical intervention for axillosubclavian vein thrombosis from 2009 to 2015 at our institution were retrospectively reviewed. Standard protocol with short term anticoagulation treatment was given after combination of surgical intervention including catheter directed lysis, balloon angioplasty, mechanical thrombectomy, and first rib resection. Fourteen patients (64%) received warfarin and 8 patients (36%) received rivaroxaban for postoperative anticoagulation regimen and followed up with ultrasound.
Journal of Vascular Surgery Cases and Innovative Techniques, Jun 1, 2022
Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysm... more Endovascular aneurysm repair has dramatically changed the management of abdominal aortic aneurysms as an alternative to open repair. However, complications can occur, including stent graft migration, kinking, and occlusion, leading to compromise of the excluded aneurysm walls and acute limb ischemia. In the present report, we have described a case of migration and kinking of an abdominal aortic stent graft in the main body that led to occlusion of the abdominal aorta and bilateral acute limb ischemia. The patient required emergent explantation of the stent graft and open repair of the abdominal aneurysm with a rifampin-soaked Dacron graft, which achieved a favorable outcome.
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