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We describe the use of a snare to dissect the subintimal space and allow the passage of a wire up, over and across a totally occluded iliac artery. The technique was used with both retrograde and up-and-over wires in the subintimal space. It is a useful adjunct in technically challenging cases. Key words: iliac occlusion, recanalization, stenting, snare

Sinus of Valsalva aneurysms (SVA) are extremely rare, seen more often in Asian populations and males. They typically produce few or no symptoms and therefore go undiagnosed until the third and fourth decades of life, when rupture can manifest as acute heart failure. Surgical repair has a low operative mortality rate (5%), and subsequent survival approaches the healthy population, making prompt diagnosis and treatment of this condition essential. We report the unique experience of witnessing the rupture of a right SVA into the right ventricle, causing immediate severe cardiogenic shock in a 33-year-old male successfully treated with medical stabilization and surgical repair. We include transthoracic, transesophageal and angiographic images of this unusual case. Key words: aneurysm, sinus of Valsalva, rupture, cardiogenic shock, heart failure

We present two patients with sub-capsular renal hemorrhage treated with arterial embolization. One patient developed the hemorrhage secondary to a presumed perforation of the renal cortex by a guidewire during renal artery stenting, while hemorrhage was spontaneous in the other patient. Anticoagulation was a common factor in both. Computer tomography (CT) of the abdomen with arterial phase scans was useful in defining the sites of hemorrhage and planning intervention. The radiological findings and intervention are discussed with review of the relevant literature. Key words: sub-capsular renal hemorrhage, guidewire perforation, interventional management

The end-organ consequences of arteriosclerosis, namely heart attack, stroke and renal failure, are the leading cause of mortality and morbidity in the western world. Advances in percutaneous interventional techniques have meant that a fair proportion of this disease burden can be dealt with by percutaneous and nonsurgical options. Coronary angioplasty is an established way of dealing with simple and increasingly complex coronary disease. Carotid and renal stenting are also gaining favor as the preferred treatment options, compared to either medical therapy or surgical treatment. Overall, the endovascular approach to treating increasingly complex arterial atherosclerosis is increasing. As the use of stenting increases, so the drive to reduce potential complications and improve success rates intensifies. Although embolization from local atheroma has long been recognized as a potential complication in vascular surgery, direct evidence of this phenomenon was also observed during saphenous

Background. Severe calcification of the carotid artery has been reported as a contraindication to stenting because the calcium prevents complete expansion of the stent. Cutting balloon angioplasty (CBA) may facilitate carotid stenting of severely calcified lesions by altering plaque morphology. We report the first case series of using CBA to facilitate stenting of heavily calcified carotid arteries. Methods. From August 2004–December 2005, 178 patients underwent carotid artery stenting at Baptist Medical Center-Princeton in Birmingham, Alabama. Of these patients, 23 (13%) had heavily calcified arteries, as determined by angiography and form the basis of this report. Mean patient age was 75 ± 18 yrs and 70% were asymptomatic. All patients were high risk for carotid endarterectomy (CEA). Cerebral protection was used in all but one patient (96%), where severe tortuosity precluded delivery of the protection catheter. Results. Quantitative angiographic analysis revealed baseline stenosis