Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient’s symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.

Salvage of a megafistula causing high-output cardiac failure in a young adult with aneurysmorrhaphy and banding

We present the case of a 21-year-old male with significant lengthening and aneurysmal degeneration of his brachiocephalic arteriovenous fistula resulting in a megafistula and high-output cardiac failure. A computed tomography angiogram showed narrowing at the cephalic arch. Further evaluation during the operation revealed kinking and elongation of the fistula in addition to compression of the cephalic arch in the deltopectoral groove leading to outflow obstruction. The aneurysmal fistula was treated successfully with aneurysmorrhaphy of the remaining conduit and banding of the inflow. This case demonstrates a unique etiology of venous outflow obstruction for a fistula and describes the surgical approach to its treatment in a young patient suffering from cardiac failure.

Pregnancy Outcome in Patients with Budd Chiari Syndrome: A Single Centre Experience

Background Budd-Chiari syndrome (BCS) is a rare disease caused by hepatic venous outflow obstruction and results in hepatic failure due to sinusoidal congestion, decrease in the blood supply to the to the liver and increase the pressure in portal vein . Objectives The aim beyond this study is assessment of the maternal and foetal events in a group of women who became pregnant while having BCS. Patients and methods It is a prospective and retrospective study which was conducted on 32 patients with Budd- Chiari syndrome admitted to Ain Shams University Hospitals, Tropical Medicine department or attended the outpatient clinics during the period from May 2006 to March 2019 who became pregnant after diagnosis by BCS . Results Number of cases that underwent tips revision 3 cases and one case underwent liver transplantation after delivery and 2 cases had died during follow up.Using . of enoxaparin in 1st trimester in our cases as a significant protective factor against abortion. Conclusion BCS isn’t a contraindication to pregnancy in patients with a well-controlled disease. Fetal outcome remains relatively poor, which is at least partly due to the underlying prothrombotic disorders. so patients should be accurately informed about the risk of this pregnancies .

Fulminant intracranial hypertension as a result of otological surgery: case report and discussion of management

Background Dural venous sinus injury is a rare complication of otological surgery that can lead to life-threatening sequelae, the management of which is complex and poorly described. Case report This paper describes the case of a 40-year-old female who underwent routine right myringoplasty complicated by sigmoid sinus laceration. The patient subsequently developed right-sided lateral sinus thrombosis leading to fulminant intracranial hypertension. The patient underwent successful emergency management by surgical reconstruction of the sigmoid sinus, followed by endovascular thrombolysis, catheter balloon angioplasty and endovascular stenting. Conclusion Torrential haemorrhage following otological procedures is uncommon and rarely requires packing of a bleeding venous sinus. This case highlights that injury to a highly dominant venous sinus can lead to venous outflow obstruction and life-threatening intracranial hypertension. To our knowledge, the development of this complication following otological surgery and its management has not been reported previously.