Contributors: Gregory Westin and Paresh Shah Endovascular stent grafting (EVAR) is now the preferred approach to repair of abdominal aortic aneurysms for many patients. One of the most common complications associated with EVAR is the development of an endoleak, or continued flow of blood into the aneurysm sac outside the graft. Type II endoleaks, those due to retrograde flow through a branch vessel such as the inferior mesenteric artery (IMA) or a lumbar artery, are the most common. Options for treatment include transarterial embolization, translumbar embolization, and laparoscopic ligation. Embolization techniques require reintervention in approximately 20%, with less than half free from aneurysm sac growth at five years, though current evidence is insufficient to determine a clear threshold for intervention or optimal technique.[1,2] DOI#: http://dx.doi.org/10.17797/wu4visdfw2
Introduction The use of renal stents in atherosclerotic renal artery stenosis has been mired in controversy secondary to poorly designed randomized clinical trials which demonstrated minimal benefit over medical management. This publication illustrates the deployment of an isolated renal stent as an ancillary procedure for a patient with a 5.5cm juxtarenal AAA in need of fenestrated endovascular repair. Methods Under general anesthesia, the patient was prepped with the left arm tucked. Access via the right common femoral artery over the femoral head was obtained under ultrasound guidance. Using the Seldinger technique, a long sheath (Ansell) was inserted to the level of the infrarenal aorta. A Glidewire (Terumo) was used to enter the right renal ostia with the assistance of an Omniflush (Angiodynamics) catheter after an initial aortogram. A Rosen (Cook) wire was exchanged and the sheath was advanced past the stenosis over the dilator. The balloon mounted iCAST (Atrium) stent was positioned and the sheath pulled back. The stent was deployed and flared using a Flash ostial balloon (Cordis). Completion angiography demonstrated excellent flow through the right renal artery and into the terminal renal branches. Results The patient recovered uneventfully overnight with a stable Cr the next morning. Four weeks after his renal intervention, the patient was taken to the operating theatre for a successful 3-vessel fenestrated aortic repair. At the most recent 6-month follow-up, the patient had a stable Cr and residual aortic sac diameter. Conclusions While the use of renal stenting in hypertension related to atherosclerotic renal artery disease continues to remain controversial, this intervention can still be performed as an adjunctive procedure in select cases with excellent technical success and low morbidity. Additional Authors Raghu L. Motaganahalli Andres Fajardo
This patient is a 9-month-old with a macrocystic lymphatic malformation (LM) of the left neck. LMs, the second most common type of head and neck vascular malformation, are composed of dilated, abnormal lymphatic vessels thought to occur due to abnormal development of the lymphatic system. A complete resection was performed, and LM was confirmed by pathology. Soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process.
The patient was then nasotracheally intubated, prepped and draped in sterile fashion and the tongue injected with 2 cc lidocaine with epi. Bovie was used to incise lesion in ellipse down to its base which was sent for pathology. A tongue stitch was used for traction. Hemostasis was also achieved with Bovie. The site was closed primarily with vicryl, deep and superficial. Bipolar was used to treat small surface lesions. All instrumentation was then removed and the patient was turned back over to anesthesia, awakened, and transferred to the recovery room extubated in stable condition.
Penn State University
- Assistant Professor of Surgery and Interim Chief of Vascular Surgery
Dr. Faisal Aziz completed his General Surgery Residency at New York Medical College in Valhalla, New York and his Vascular Surgery Fellowship at Jobst Vascular Center in Toledo, Ohio. He currently works as an Assistant Professor of Surgery and Interim Chief of Vascular Surgery at Penn State University. Dr. Aziz has authored numerous book chapters and peer-reviewed publications, and was awarded the Servier Traveling Fellowship Award by American Venous Forum. Dr. Aziz also serves as the Section Editor for Venous Disorders, VESAP-4 and Examination Consultant for the American Board of Surgery.
- Assistant Professor of Surgery
Shadi J. Abu-Halimah, M.D. FACS is a Vascular/Endovascular Surgeon. He is Double Boarded in Vascular and General surgery. He was born in Riyadh, Saudi Arabia and currently resides in Charleston, WV. Dr. Abu-Halimah received his doctorate degree in 2000 from the University of Jordan in Amman, Jordan with Honors. He is licensed to practice in the state of West Virginia.
Currently, Dr. Abu-Halimah serves as Assistant Professor of Surgery at the Robert C. Byrd Health Science Center, West Virginia University (WVU), Charleston Division, as well as Clinical Assistant Professor of Surgery at WVU SOM in Lewisburg, WV.
Since 2000, Dr. Abu-Halimah has completed extensive post-doctoral training, as follows: (2000-2001) General Surgery Internship at the Ministry of Health Hospitals in Amman, Jordan; (2001 – 2003) General Surgery Residency at Ministry of Health Hospitals in Amman, Jordan; (2003 – 2004) General Surgery Prelim at WVU in Charleston, WV; (2004 – 2009) General Surgery Residency at WVU in Charleston, WV; and (2009 – 2011) Vascular Surgery Fellowship at University of North Carolina in Chapel Hill, NC.
Dr. Abu-Halimah currently belongs to several professional societies, including the Eastern Vascular Society, the Southern Association for Vascular Surgery, the Society for Vascular Surgery, and the American College of Surgeons. Moreover, from 2011 to present day, Dr. Abu-Halimah has served on numerous medical committees ranging from national, departmental, and institutional levels across the country.
Dr. Abu-Halimah’s previous teaching responsibilities include undergraduate medical education and supervision of medical trainees in a weekly outpatient clinic; at the graduate level, he was Attending Physician for the University V2 Vascular Surgery Service and delivered presentations at various conferences in areas of general surgery and vascular education.
He is a consultant for various medical/device companies involved in developing and teaching new technologies across the country. This involves case reviews, monitoring, and proctoring physicians at the national, local, and institutional levels.
Dr. Abu-Halimah has participated extensively in numerous lectures around the world where he was invited to deliver presentations on various topics of general and vascular surgery. He has been widely published in peer-reviewed articles, and research and clinical trials where he served as primary investigator and sub-investigator, as well as numerous book chapters around the world.
- Associate Program Director of Plastic Surgery
- Northwell Health
- Associate Professor of Plastic Surgery
- Hofstra Northwell School of Medicine
Dr. Neil Tanna is a Double Board Certified Plastic Surgeon with clinical interest in cosmetic and reconstructive surgery. He is among a very small group of Plastic Surgeons in the world to have completed formal training in Otolaryngology, Plastic & Reconstructive Surgery, and Microvascular Surgery.
After receiving his medical degree from Albany Medical College, Dr. Tanna completed a full Otolaryngology – Head & Neck Surgery residency at The George Washington University. He pursued further training and completed a second full residency in Plastic & Reconstructive Surgery at the University of California, Los Angeles (UCLA). He then completed a fellowship in advanced reconstructive and microvascular surgery at the Institute of Reconstructive Plastic Surgery at New York University (NYU).
Beyond his plastic surgery clinical practice, Dr. Neil Tanna is a mentor, respected educator, and prolific author. Currently, he serves in many leadership roles. He is Chief of Plastic Surgery at one of the one of the Northwell Health hospitals. He is an Associate Professor with the Hofstra University School of Medicine, where he is engaged in the education of students. He also serves as Associate Program Director for the Plastic Surgery Residency with Northwell Health System. He trains resident physicians in becoming Plastic Surgeons.
The medical work and clinical research of Dr. Neil Tanna have been widely published in national and international medical journals. He has authored over 75 publications in major peer-reviewed medical journals and written over 10 textbook chapters. Given his interest in aesthetic and reconstructive surgery of the head and neck, breast, and body, Dr. Tanna has been invited to present at over 75 national and international meetings. He presents the latest advances in plastic surgery to his colleagues and other surgeons from all around the world.
Dr. Neil Tanna has been recognized in the 2015 and 2016 New York Times Super Doctors List for his noteworthy and outstanding achievements.
- Assistant Professor, Vascular & Endovascular Surgery
Dr. Nitin Garg is an Assistant Professor in Vascular & Endovascular Surgery at Wake Forest University School of Medicine in Winston Salem, North Carolina. He graduated from the prestigious All India Institute of Medical Sciences (AIIMS) in New Delhi and pursued a Master’s in Public Health at Johns Hopkins Bloomberg School of Public Health in Baltimore. Dr. Garg completed General Surgery internship and residency at Creighton University in Omaha and Vascular Surgery Fellowship at the Mayo Clinic in Rochester.
Dr. Garg has a strong interest in clinical education and firmly believes that the adequate training of the next generation of surgeons is the responsibility of the surgeons in practice. He also believes that education of patients is critical for their buy in into their own health. Dr. Garg’s clinical interests include complex arterial and venous reconstructions, using both open and endovascular (or hybrid) techniques.
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