Until recently, the Cook Zenith aortic endograft (Cook Medical Inc, Bloomington, Ind) was the only device used for physician-modified fenestration because its constraining wire allowed physicians to reconstrain the device after modifications. Although the Cook Zenith fenestrated endograft has been approved by the Food and Drug Administration, it is currently not available in the majority of the hospitals and is not applicable to the patients who need urgent or emergent aneurysm repair. With the redesign of the Gore C3 delivery system, the Gore Excluder aortic stent graft (W. L. Gore & Associates, Inc, Flagstaff, Ariz) can now also be reconstrained, which makes it suitable for physician-modified fenestration. We describe the technique for modification and implantation of the Gore Excluder aortic stent graft in a patient requiring 2-vessel bilateral renal artery fenestration. This application provides an additional option for treatment of patients with abdominal aortic aneurysms who are anatomically unsuitable for conventional endovascular aneurysm repair and are at high risk for open repair.

Transplanted kidney to iliac artery does not significantly deteriorate ischemia in adults with ipsilateral lower extremity peripheral arterial disease. Late developed ischemic complications may be due to the progression of underlying arterial disease.

).Thoracic endovascular aortic aneurysm repair (TEVAR) has become an attractive alternative for treatment of thoracic aortic pathology including aneurysm and dissection since its approval by US Food and Drug Administration in 2005. 1,2 In carefully selected patient with thoracic aortic aneurysm, TEVAR can be associated with improved outcomes as compared with traditional open repair. 1 Endovascular repair has also become the preferred modality for treatment of blunt thoracic aortic injury in suitable anatomy. 3,4 Up to 40% of patients undergoing TEVAR might require coverage of left subclavian artery (LSA) for adequate proximal landing zone. 5,6 In the practice guideline published by Society for Vascular Surgery, routine LSA revascularization is recommended for elective TEVAR when coverage of LSA is required. 7 LSA revascularization is traditionally performed with left carotid-subclavian bypass or transposition of LSA to common carotid artery. 7,8 Recently retrograde laser fenestration of endograft has emerged as feasible and effective method for LSA revascularization during TEVAR. 9 Branched and fenestrated devices have been used successfully but not widely available in the United States. 10 In this report, we present a novel alternative technique for percutaneous LSA revascularization using Outback LTD reentry catheter (Cordis, Bridgewater, NJ) which was performed in a patient who underwent TEVAR for a large thoracic aortic aneurysm. Case ReportWe report a case of TEVAR after carotid-carotid bypass and successful percutaneous LSA revascularization using Outback LTD reentry catheter in a 68-year-old male patient with asymptomatic 9-cm thoracic aortic aneurysm. His medical history was significant for coronary artery disease, chronic obstructive pulmonary disease, and chronic renal insufficiency with baseline creatinine of 4.0. His glomerular filtration rate was 18 and he was anticipated to be requiring permanent dialysis within next 6 months. Left brachial and radial pulses were palpable on physical examination. On review of his computed tomography (CT) scan, his large arch aortic aneurysm extended up to left common carotid artery (►Fig. 1), left vertebrate artery was dominant in posterior circulation, and AbstractLeft subclavian artery (LSA) revascularization is recommended during elective thoracic endovascular aortic aneurysm repair (TEVAR) when coverage is required for adequate proximal seal. Reported method for LSA revascularization includes open bypass, covered stent placement using chimney technique, and in situ laser fenestration. We reported a novel technique using percutaneous Outback reentry device for LSA revascularization in a 68-year-old male patient who underwent TEVAR for a 9-cm thoracic aortic aneurysm. This technique can be used as an alternative method for LSA in situ fenestration, and laser equipment is not required.

Objectives:Extracranial carotid artery true aneurysm is extremely uncommon, and definite treatment has traditionally involved open surgical repair. Although successful management of the internal carotid artery aneurysms using endovascular stenting and embolization has recently been reported, only a limited number of cases have been reported.Methods:We present a case of symptomatic carotid true aneurysm repaired with covered stent and coil embolization of the external carotid artery. We also review the English literature and discuss the epidemiology, causes, diagnosis, and management options of internal carotid artery aneurysms.Results:The patient did not have any complications, and was discharged home on the postoperative day 1 in stable condition.Conclusion:Our report suggests that endovascular procedure is feasible in the treatment of extracranial carotid artery aneurysms.

Popliteal vein aneurysms (PVAs) can have serious consequences, including pulmonary embolism and death. We report a case of PVA in a previously healthy 58-year-old female with a history of pain in her right popliteal fossa for the past 3 years. Patient had no history of trauma or claudication of the right leg. Following a preoperative venogram to confirm the diagnosis, the PVA was dissected circumferentially through a posterior incision. The aneurysm was resected and repaired with lateral venorrhaphy. Patient had an uneventful recovery. Due to the possibility of severe consequences, if left untreated, early surgical repair is highly recommended whether the patient has symptoms or not.