Custom-Made Bifurcated Prosthetic Graft for Aortoiliac Aneurysm Repair

Revascularization of the internal iliac artery during open repair of aortoiliac aneurysms can be challenging, especially if there is a significant distance between the orifices of the internal and external iliac arteries owing to common iliac aneurysmal dilatation. We describe a technique involving insertion of an 18-mm tube graft between the proximal aortic neck and aneurysmal common iliac artery bifurcation. Revascularization of the contralateral external iliac artery is accomplished through an 8-mm side arm graft.

Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature

Background Coronary artery-to-pulmonary artery fistula is a rare disorder characterized by abnormal vascular communication between the coronary artery and pulmonary artery. While most patients remain asymptomatic, some might exhibit symptoms of myocardial ischemia, congestive heart failure, or even sudden cardiac death if coronary aneurysm, thrombosis, infective carditis, or other congenital cardiac defects coexist. Case presentation We present a 66-year-old male complaining of angina pectoris with a history of hypertension and active smoking. He was diagnosed with a coronary aneurysm based on coronary computed tomography angiography. We subsequently identified a coronary artery-to-pulmonary artery fistula with giant aneurysmal dilation on coronary angiography. Ultimately we conducted surgery ligation and aneurysmorrhaphy. During surgery, we discovered newly formed thrombus within the aneurysmal cavity. Histological analysis of the aneurysmal wall supported the diagnosis of the congenital disorder. Our patient was successfully discharged and remained asymptomatic at two months of follow-up. Conclusion We presented a rare and complex combination of congenital coronary artery-to pulmonary artery fistula, giant coronary aneurysmal dilatation, and thrombosis through multi-modality evaluations.

Polyarteritis nodosa presenting with catastrophic involvement of the intra-abdominal arterial tree

We report a case of a 63-year-old female presenting with abdominal pain, who suffered a dramatic deterioration in her condition following a diagnosis of bilateral renal infarcts on imaging. Within days she had developed widespread aneurysmal dilatation, dissection and thrombosis of the intra-abdominal arterial tree, requiring emergency transfer to a tertiary vascular centre for treatment of polyarteritis nodosa. She responded well to intravenous cyclophosphamide and is now receiving treatment on an outpatient basis.

An Unusual Complication of Infective Endocarditis Involving Bicuspid Aortic Valve

Bicuspid aortic valve is commonly associated with infective endocarditis with serious peri annular complications. We report a case of 37-year-old male patient presented with infective endocarditis involving bicuspid aortic valve with leaflet perforation and severe aortic regurgitation. Mitral valve was involved secondary to aortic valve endocarditis as a kissing lesion with severe mitral regurgitation. Anterior mitral leaflet (AML) had aneurysmal dilatation with mobile vegetations inside it. In colour Doppler, AML aneurysm was looking like a fireball inside the left atrium. Patient was treated with antibiotics and referred to surgery for aortic and mitral valve replacement.

Congenital kinking of aorta – A rare aortic arch anomaly

Congenital kinking of aorta or pseudocoarctation is a rare anomaly of the aortic arch with elongation and kinking of aorta at the level of ligamentum arteriosum. This anomaly is not a true coarctation as there is no significant hemodynamic obstruction or pressure gradient across the lesion. We report two cases with this anomaly diagnosed during the evaluation for incidental finding of murmur. Both patients had flow gradient across the kinked segment of aorta by echocardiography but did not require any intervention. Long term complication is aneurysmal dilatation and rupture beyond the kinked segment. Computed tomography of the aorta is a simple noninvasive diagnostic modality for the definitive diagnosis. Surgical repair should be performed for all symptomatic individuals. Regular periodic follow up is mandatory for all asymptomatic patients.