In total, 9 of 22 (41%) patients had addition risk factors that may precipitate thrombosis. Conclusions As in adults, the most common form of treatment seen in the literature is a combination of catheter-direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow up.Given the millions of coal-fired power stations worldwide and the generalization of co-firing technologies in the near future, the aqueous extraction experiments were taken to study the effects of oxides on Cr mobility in ashes through SiO2-Al2O3-Fe2O3-CaO system. The results identify that both the component and the species of Cr in samples are vital factors to govern the fate of Cr during combustion. Although Cr-oxide hardly reacts with Al2O3, SiO2, and mixtures at 900 °C, the immobilization of Cr in Si-Al glass is ascribable to the heat-driven phase transformation of Cr-rich clay. The strong capture of Cr-oxide by CaO leads to the primary extraction of active Cr with the high toxicity and mobility; however, the opposite effect is found by Fe2O3. But the interactions of Al-/Si- oxides with others can trigger some changes in Cr mobility, wherein there is the lowest mobility of Cr in the case of Cr entering into the structures of Fe-rich SiO2/Si-Al glass during combustion. Thus, without regard to the sample source, it is effective to reduce the environmental risk of Cr in ashes through raising SiO2 and reducing MCaO/MFe2O3 less then 5/4 prior to combustion.Background Gender-reassignment surgeries are technically challenging and associated with detrimental vascular complications. Methods A 49 year-old female status-post phalloplasty presented with peripheral vascular complication resulting in disabling claudication. Initial anastomotic attempt was rendered nonviable to sustain the constructed phallus resulting in superficial femoral artery stenosis. Covered stent placement corrected the stenosis and alleviated the claudication. Results As gender-reassignment surgeries increase, greater understanding of potential vascular complications is needed. Involvement of multidisciplinary teams is necessary to optimize patient safety and outcomes. Conclusions Vascular surgery should play a larger role in these complex revascularizations and vessel anastomoses to ensure quality blood flow to the reconstructed genitalia.Ascending aortic pseudoaneurysms are associated with prior cardiac surgery and have a high chance of rupture. Open surgery is challenging given its likely re-operative nature. Various endovascular therapies have been described but are sometimes complicated by stroke. We present a patient with a prior coronary artery bypass grafting who was referred for an incidental 3cm saccular ascending aortic pseudoaneurysm who was successfully treated with frame coiling under total cerebral embolic protection using the SENTINEL device. We propose that endovascular obliteration of ascending aortic pseudoaneurysms is a viable option in patients unfit for open repair and advocate for total cerebral embolic protection as an important adjunct.Objectives To describe a new technique based on a different deployment of the Endurant Stent-Graft System (Medtronic Cardiovascular, Santa Rosa, CA) during endovascular aortic aneurysm repair to guarantee a more precise deployment in presence of severe neck angulation (SNA). Technique The „step-by-step” deployment technique consists of an alternate partial release of the main body and of the free-flow suprarenal stents to approximate the radiopaque markers of the graft fabric to the aortic wall, obtaining a more precise delivery, reducing the possibility of downward dislodgments along the external curve of the infrarenal angle and asymmetrical deployments in presence of SNA. Conclusions The „step-by-step” technique is a simple, safe, and effective graft-deployment method, which allows a very precise release in SNA and possibly achieves better results in the long-term period in such difficult anatomies.Purpose to report a case of an axillary artery rupture treated by endovascular means using the dual bull’s-eye technique. Case report An 83-year-old woman with multiple comorbidities was diagnosed with axillary artery rupture after the reduction of a shoulder dislocation. An endovascular repair attempt was made but, despite the use of a double approach (antegrade and retrograde), reconnecting both ends of the severed artery was deemed not possible. 5-mm Amplatz GooseNeck snares were advanced from each access and superposed in a perpendicular plane. A percutaneous infraclavicular puncture with a lumbar needle was made through both snares and a V14 guidewire was subsequently introduced. The guidewire was recovered through femoral and brachial accesses and a 7 x 100 mm covered self-expandable stent was deployed. The final angiographic control did not show further haemorrhage and the patient recovered radial pulse. Follow-up showed complete patency and no complications at 9-months postprocedure. Conclusion The dual bull’s-eye technique can be used as a resource tool in cases of arterial rupture, when the arterial continuity cannot be re-established by conventional approaches.COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.Background Reinterventions after lower extremity revascularization (LER) are common. Current outcome measures assessing durability of revascularization rely on freedom from reintervention but do not account for the frequency of repeated LER. The aim of this study is to compare the reintervention index, defined as the mean number of repeat LER, after open and endovascular revascularization. We hypothesized that endovascular procedures have reduced durability and increased frequency of reinterventions. Methods A retrospective review of the charts of consecutive patients undergoing LER for peripheral artery disease (PAD) in 2013-2014 by multiple specialties in a tertiary care center was performed. Patients were divided into open and endovascular groups based on the first LER procedure performed during the study period. Patient characteristics and outcomes were compared between the 2 groups. Multivariable regression was performed to determine factors associated with reintervention. Results There were 367 patients (Endo = 316, Open = 51). A total of 211 patients underwent 497 reinterventions (reintervention rate = 57.5%, reintervention index = 2.35 ± 2.02 procedures [range 1-11]). Patients in the open group were more likely to be smokers (P = 0.018) and to have prior open LER (P = 0.003), while patients in the endovascular group were older (P less then 0.001) and more likely to have cardiovascular comorbidities. On follow-up, there was no difference in overall or ipsilateral reintervention rates or reintervention indices between endovascular and open LER. Major amputation was significantly higher after open LER (19.61% vs. 8.54%, P = 0.013) but there was no difference in survival (P = 0.448). Multivariable analysis did not show a significant relationship between type of procedure and reintervention. Conclusions The reintervention index provides a measure to assess the frequency of repeat LER. Patients with PAD, in this study, are afflicted with similar extent of reinterventions after open and endovascular LER.Background The objective of this study was to compared outcomes of patients with aortoiliac occlusive disease (AIOD), limited to the common iliac artery, who underwent either aortoiliac thromboendarterectomy (AIE) or aortobiiliac bypass grafting (ABIB). Methods A single-center, retrospective analysis of consecutive patients with AIOD who underwent either AIE or ABIB between 2010 and 2019 from a prospective database. Patients with disease extending to the external iliac or common femoral arteries were excluded. Data collected included demographics, cardiovascular risk factors, indication for surgery, preoperative and postoperative ankle brachial indexes (ABIs), estimated blood loss, major adverse events (MAEs), and long-term patency. The study end point was clinical success, defined as improvement in ABIs with resolution of symptoms. MAEs included return to the operating room for any reason, postoperative myocardial infarction, stroke, pneumonia, or venous thromboembolism. Results Thirty-three patients, who me fourth patient. There were no differences in the intensive care unit or hospital length of stay between groups. Patients in both groups achieved return of normal ABI and complete resolution of their symptoms. At mean follow-up time of 43.4 ± 25.2 and 52.9 ± 35.4 months in the AIE and ABIB group, respectively, there was no symptomatic recurrence or need for reintervention while two patients in the ABIB group died of non-aortic-related issues. Conclusions Both procedures were safe, effective, and conferred high long-term primary patency with no need for reintervention in patients with AIOD limited to the common iliac arteries.Background Transtibial amputations (TTAs) of the leg have been associated with high rates of wound complications. We assessed outcomes of TTAs to determine if bundled interventions implemented at our hospital had an impact on lowering wound complications, including surgical site infections. Methods We assessed the impact of a surgical site infection prevention bundle (negative-pressure wound therapy, minimizing the use of staples, and a decontamination protocol for methicillin-resistant Staphylococcus aureus) on 90-day wound complications. The year of implementation of the prevention bundle was excluded, and the pre-eras and posteras were defined as the four-year period before and after implementation. The study sample consisted of a single-center cohort, with TTA cases identified using operating room scheduling software. Results A total of 182 TTAs were performed 110 in the pre-era and 72 in the postera. The wound complication rate decreased from 22 to 17% despite fewer two-stage operations, less imaging to identify peripheral artery disease, and an increased proportion of patients with end-stage renal disease. Wound complications and revision to a higher level of amputation were more associated with indication (especially no-option peripheral artery disease with ischemic rest pains) than with any particular aspect of surgical technique. The use of drains was associated with reoperations but not higher level revision. Conclusions Higher rates of wound complications and revision to a higher level of amputations should be expected among patients with no-option peripheral artery disease with ischemic rest pains undergoing TTAs. Drains should be avoided.