Browsing by Author "Kovačević, Vladimir (36093028200)"

Introduction Endovascular treatment of chronic total occlusion (CTO) represents a true challenge even for experienced interventional radiologists. We are presenting a case of hidden antegrade dissection of the external iliac artery (EIA) after a failed attempt to recanalize CTO of the common femoral artery (CFA). Case outline A 52-year-old male patient was admitted for multidetector computed tomography (CT) angiography. Left common iliac artery (CIA) stenting was performed, followed by “crossover” attempt of recanalization of right CFA CTO that failed. The next day, left femoral superficial artery angioplasty was performed and after one month, angioplasty of the left popliteal and the bellow-knee arteries. A month later, the patient was readmitted for surgical reconstruction of the CFA. After desobstruction, excellent inflow was obtained and a Dacron graft was inserted. A few hours postoperatively, Fogarty catheter thrombectomy was performed. The next morning, pulsations were weakened again and CT angiography showed antegrade dissection of the EIA. Stenting of the EIA was performed with two stents and a favorable outcome was achieved. After a detailed analysis of the CT, hidden thrombosed antegrade dissection of the EIA was noted in the lateral view, which was not seen in the posterior/anterior view and was presented as fibrous plaque with mural thrombosis. Dissection occurred after failed attempt of CFA recanalization and was clinically silent until flow was established triggering opening of the false lumen and the release of thrombotic masses. Conclusion In patients with failed angioplasty of CTO of the CFA and CT characteristics of fibrous plaque proximal to the site of attempted angioplasty, thrombosed antegrade dissection should be considered. © 2022, Serbia Medical Society. All rights reserved.

Introduction Splenic artery aneurysm (SAA) represents the third cause of abdominal aneurysms, just after abdominal aorta and iliac arteries aneurysms, with overall prevalence of 1%. Pancreatitis has been linked with pseudoaneurysm formation of SA due to destruction of arterial wall by pancreatic enzymes, however true SAA associated with pancreatitis has not been described yet. We are presenting the first case of true SAA in a patient with chronic pancreatitis and primary biliary cholangitis successfully treated by surgical excision, direct arterial reconstruction and spleen preservation. Case outline A 74-year-old male patient was admitted for multidetector computed tomography angiography due to suspected SAA and renal artery aneurysm (RAA). He was previously treated for chronic pancreatitis and primary biliary cholangitis. Upon admission, computed tomography arteriography showed SAA 32 mm in diameter and RAA 12 mm with SAA being in direct contact with superior margin of the pancreas. Surgical treatment of SAA was indicated while RAA was treated conservatively. Intraoperatively, SAA adherent to the superior margin of pancreas was noted, followed by complete exclusion of the aneurysm and end-to-end splenic artery anastomosis. Histopathology showed atherosclerotic degeneration of arterial wall with all three layers presenting as true aneurysm. Two years after the surgery, control computed tomography angiography showed regular postoperative findings without further progression of RAA. Conclusion This is the first case to describe a true SAA aneurysm originated on the field of previous episodes of chronic pancreatitis and primary biliary cholangitis. Surgical treatment including aneurysm resection and direct arterial reconstruction with spleen preservation showed satisfactory results. © 2021, Serbia Medical Society. All rights reserved.