INTRODUCTION Inferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication. METHODS We describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000. FINDINGS The main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique. CONCLUSIONS The incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.

Percutaneous revascularization with balloon expandable stent placement and/or balloon angioplasty has been proven to be an effective alternative for renal artery bypass surgery for management of renal artery stenosis. Endovascular stent deployment has been proven to be superior to balloon angioplasty alone, especially for ostial lesions in terms of maintaining long-term patency. Here we describe a case report for deployment of two Palmaz stents with simultaneous utilization of brachial and femoral routes. Technical aspects for this procedure, especially adaptation of coronary guide wire systems in management of renal artery stenosis were discussed.

Purpose: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. Methods and Results: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. Conclusions: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.

This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.