IntroductionPercutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using the Perclose ProGlide suture mediated closure device is currently performed on a global scale. A safe, effective, and cheap technique for achieving haemostasis during PEVAR is described that allows the reversible downsizing of the arteriotomy, without using any other devices.TechniqueThe procedure consists of pulling the blue thread of the pre-implanted ProGlide, advancing the knot close to the arterial wall by pushing it with the dilator of a small introducer sheath, and maintaining the system under tension by grasping the end of the blue thread with a haemostat until bleeding control is achieved.DiscussionSeventeen PEVAR femoral access downsizing procedures have been performed between February and June 2018 and no complications were observed. The technique could be useful in everyday practice and has now become the author's standard practice.

Introduction Acute thrombosis of an infrarenal abdominal aortic aneurysm (ATAAA) represents an uncommon but catastrophic pathology, which can lead to life threatening complications. This is a report of the infrequent use of an endovascular solution to successfully treat an ATAAA in a patient with COVID-19 viral pneumonia and ischaemia induced lower extremity neurological deficits. Report An 89 year old white male, with a history of cardiovascular comorbidities was admitted to the emergency room with a complaint of dyspnoea associated with a sudden onset of abdominal and back pain followed by partial motor and sensory deficits of both legs. The CT scan showed both an 8 cm infrarenal AAA with middle (inferior mesenteric artery patent) and distal thrombotic occlusion of the sac and non-aneurysmatic but thrombosed common iliac arteries. An additional finding was imaging features typical of interstitial pneumonia. After the molecular test detected active COVID-19 infection, the patient was treated emergently with an aorto-uniliac stent graft and femoro-femoral crossover graft. The post-operative course was uneventful with AAA exclusion and disappearance of ischaemic symptoms. No vascular complications occurred. At three month follow up the patient remained asymptomatic in good shape with autonomous handling of everyday life. Discussion This case supports the feasibility and safety of a mininvasive endovascular procedure to treat an ATAAA in selected patients with favourable anatomy and high risk of respiratory complications in the context of the COVID-19 pandemic.

No abstract

No abstract