Featured Article

Ulnar artery aneurysms are uncommon and have been linked with traumatic injuries to the hand. These aneurysms are most commonly seen in workers who use the hypothenar eminence of their hands as a hammer and can be accompanied by a constellation of symptoms. Both penetrating and blunt trauma have been documented as sources of ulnar artery aneurysms and its subsequent sequela. In this case report, we describe a 45-year-old gentleman who presented with digital ischemia of his 4th and 5th digits and other clinical symptoms of the hypothenar hammer syndrome after performing manual labor. His initial management, method of diagnosis, operative intervention, and peri-operative management are discussed. Ulnar artery aneurysms, while uncommon, can lead to a limb-threatening event. A high index of suspicion for ulnar artery aneurysms must be considered in patients with an antecedent history of acute or repetitive trauma. While there are multiple diagnostic modalities and minimally invasive altern

The technique of fenestrated endografting has allowed for the extension of stent-grafts into areas of the aorta containing branches, and thus, enables the treatment of juxtarenal and thoracoabdominal aneurysms with endovascular techniques. Herein, we describe the techniques and results from a single-center study at the Cleveland Clinic. Although complex, the techniques are evolving and simplifying. Early and midterm results from specialist centers are encouraging. This technique provides an endoluminal option for some of the 40% of all abdominal aortic aneuryms (AAAs) who are precluded from conventional endovascular repair, many because of inadequate neck length.

Embolization following percutaneous intervention is a universal problem occurring in all vascular beds, including the periphery. Embolic filter protection (EFP) is effective in capturing macrodebris following percutaneous peripheral interventions (PPI). Predictors of distal lower extremity embolization appear to be a recent onset of symptoms in patients with total or subtotal occlusion, long, irregular and calcified lesions, degenerative grafts, intraluminal filling defects, and the use of the Silverhawk atherectomy device and mechanical thrombectomy. Filters have their own set of potential problems, and filter retrieval is probably one of the key steps where problems are likely to occur. In this manuscript, we discuss embolization in the lower extremity following PPI, and provide tips on how to avoid problems with embolic filter protection use.

Background. Although clinical trial data suggest that the incidence of hemorrhagic vascular complications associated with invasive coronary procedures is relatively low, contemporary data from tertiary care centers are lacking. Objective. The purpose of the study was to determine the incidence and potential predictors of hemorrhagic vascular complications after invasive coronary procedures, either diagnostic alone (contrast angiography [CA]) or combined with an interventional procedure (percutaneous coronary intervention [PCI]). Methods. Clinical characteristics and procedural data in 200 consecutive patients undergoing an invasive coronary procedure (CA = 124; PCI = 76) at a single large urban tertiary care center were collected prospectively during their hospital stay. Multivariate logistic regression methods (SAS v9.1) were used to identify independent predictors of hemorrhagic vascular complications. Results. The overall incidence of hemorrhagic vascular