Category Archives: Vascular Surgery

Print Release, Vascular Surgery

PUBLISHED: Thoracoabdominal Aortic Aneurysm Repair

Thoracoabdominal Aortic Aneurysm Repair
Andrew Del Re, MD1; Jahan Mohebali, MD, MPH2; Virendra I. Patel, MD, MPH2
1The Warren Alpert Medical School of Brown University
2Massachusetts General Hospital

Thoracoabdominal aortic aneurysms (TAAAs) are generally asymptomatic and are discovered incidentally on thoracic or abdominal imaging. When they are identified, management is often expectant, depending on the size of the aneurysm and its rate of growth. Surgery is indicated for larger aneurysms and those that expand rapidly so as to avoid the catastrophic rupture of the aneurysm.

This article presents the case of a 70-year-old female with a TAAA, whom had been followed with serial computed tomographic angiography scans. The decision to operate was made when the aneurysm began revealing growth in diameter. Her anatomy was not conducive to endovascular treatment; therefore, her aneurysm was repaired using a traditional open approach.

Print Release, Vascular Surgery

PUBLISHED: Transcervical Open Repair of Extracranial Internal Carotid Artery Aneurysm

Transcervical Open Repair of Extracranial Internal Carotid Artery Aneurysm
Miguel Angel Mendoza Romo-Ramírez, MD1; Jasanai Sausameda-García, MD2; Silverio Gutiérrez-Cruz, MD2; Kevin Johnson-Molina, MD2; Carlos Flores-Ramirez, MD1
1Hospital Central del Estado, Chihuahua, Mexico
2Hospital General Regional #1. IMSS. Chihuahua, Mexico

This article presents the case of a 1.8-cm carotid saccular aneurysm dependent on the left internal carotid, limited to the proximal portion of the bifurcation in a 66-year-old male with a history of hypertension and diabetes mellitus, successfully managed with an open surgical technique. Extracranial aneurysms of the carotid artery are rare and may be caused by atherosclerosis, trauma, infection, or other factors. These aneurysms are characterized by an increase in the diameter of the carotid artery and may require treatment to prevent complications such as embolism or rupture.

Treatment may include open surgery or endovascular techniques, and the choice of treatment depends on several factors, such as the location and size of the aneurysm. Medical management may also be considered in selected cases. Diagnosis is made through imaging tests such as duplex ultrasound, computed tomography, or magnetic resonance imaging. It is important to perform a careful evaluation to determine the best treatment option and prevent complications.

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Femoral Artery Cut-Down and Proximal Anastomosis Procedure (Cadaver)

Femoral Artery Cut-Down and Proximal Anastomosis Procedure (Cadaver)
Adrian Estrada1; Adam Tanious, MD2; Samuel Schwartz, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital

Femoral-to-popliteal/distal bypass surgery is a procedure used to treat femoral artery disease. It is performed to bypass the narrowed or blocked portion of the main artery of the leg, redirecting blood through either a transplanted healthy blood vessel or through a man-made graft material. This vessel or graft is sewn above and below the diseased artery such that blood flows through the new vessel or graft. The bypass material used can be either the great saphenous vein from the same leg or a synthetic polytetrafluoroethylene (PTFE) or Dacron graft.

This procedure is recommended for patients with peripheral vascular disease for whom medical management has not improved symptoms, for those with leg pain at rest that interferes with quality of life and ability to work, for non-healing wounds, and for infections or gangrene of the leg where there is a danger of loss of limb caused by decreased blood flow. This article demonstrates how to perform femoral artery cut-down and proximal anastomosis procedure in a cadaver. This procedure is commonly used when performing a femoral-popliteal below the knee bypass to restore blood flow to areas affected by arterial blockages or injuries․

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Thoracofemoral Bypass: A Retroperitoneal Approach

Thoracofemoral Bypass: A Retroperitoneal Approach
J. Miller Allan, MD; Victoria Aucoin, MD; Benjamin J. Pearce, MD
UAB Hospital

Surgical intervention for aortoiliac occlusive disease (AIOD) remains a vital tool in the management of AIOD. AIOD is caused by occlusion of the infrarenal and/or iliac arteries, often secondary to atherosclerosis. This article presents a case of a young, male patient with a history of familial hyperlipidemia and chronic tobacco use who underwent a thoracofemoral bypass (TFB) procedure via a retroperitoneal approach.

He presented with classic symptoms of bilateral leg pain when walking, nocturnal lower extremity pain, and correlated diminished lower extremity pulses. TFB was the preferred approach due to the aggressive, soft plaque burden extending into the suprarenal aorta, which precluded endovascular repair and would have increased risk for standard infrarenal aortofemoral bypass (AFB). This video and case report present a detailed explanation of a retroperitoneal approach to a TFB procedure.

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Carotid Endarterectomy (Cadaver)

Carotid Endarterectomy (Cadaver)
Meghan Robinson1; Laura Boitano, MD2; Samuel Schwartz, MD2
1Lake Erie College of Osteopathic Medicine
2Massachusetts General Hospital

Carotid stenosis is one of the leading causes of ischemic stroke worldwide. In the United States, nearly 800,000 strokes are reported each year, with ischemia accounting for 87% of them, and 15% traced to a carotid origin. Carotid endarterectomy represents an effective surgical treatment for carotid stenosis in preventing the risk of future ischemic stroke. This video-article demonstrates the surgical technique for carotid endarterectomy on a cadaver and discusses a typical case presentation of an individual who could potentially benefit from this procedure.

General Surgery, Orthopedics, Print Release, Vascular Surgery

PUBLISHED: Left First Toe Amputation (Ray, Cadaver)

Left First Toe Amputation (Ray, Cadaver)
Laura Boitano, MD; Samuel Schwartz, MD
Massachusetts General Hospital

Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.

General Surgery, Print Release, Vascular Surgery

PUBLISHED: Leiomyosarcoma of Inferior Vena Cava: Resection and Reconstruction

Leiomyosarcoma of Inferior Vena Cava: Resection and Reconstruction
Madhukar S. Patel, MD, MBA, ScM; Jahan Mohebali, MD, MPH; Parsia A. Vagefi, MD, FACS; Alex B. Haynes, MD, MPH, FACS
Massachusetts General Hospital

Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors with complex anatomical relationships. Surgical resection remains the primary approach for management, with selective use of preoperative radiation and chemotherapy. Given the propensity for local invasion of these tumors, radical resection of surrounding structures is often required.

This article describes the presentation, work-up, operative management, and outcomes of these lesions through the case of a patient with a tumor involving the middle segment of the IVC. Given the extent of involvement, IVC resection with en bloc right nephrectomy, right adrenalectomy, and partial left renal vein resection was performed with vascular reconstruction using a prosthetic graft. With appropriate preoperative planning and a well-coordinated multidisciplinary approach, aggressive surgical resection can be safely performed and patients can benefit from favorable long-term survival.

Print Release, Vascular Surgery

PUBLISHED: Femoral Endarterectomy for Severe Peripheral Arterial Disease

Femoral Endarterectomy for Severe Peripheral Arterial Disease
Katherine L. Morrow, MD; Anahita Dua, MD, MS, MBA, FACS
Massachusetts General Hospital

This case describes an 85-year-old gentleman with significant peripheral arterial disease and lifestyle-limiting claudication who had previously undergone an unsuccessful attempt at endovascular treatment of his significant right common femoral artery stenosis.

A right common femoral endarterectomy was performed to remove this patient’s significant plaque burden. Postoperatively, the patient noted significant improvement in his right lower extremity claudication, and his postoperative pulse volume recordings showed improved arterial inflow.

Announcement, Content, Print Release, Vascular Surgery

PUBLISHED: Creation Of A Radial-Cephalic Arteriovenous Fistula

Creation of a Radial-Cephalic Arteriovenous Fistula
Nahel Elias, MD FACS
Surgical Director
Kidney Transplantation
Massachusetts General Hospital

AV fistulas provide the crucial vascular access required for patients receiving hemodialysis, a life-saving procedure for end-stage renal disease. Such patients have irreversible kidney damage and must receive a new kidney. While waiting, patients rely on hemodialysis to filter their blood to stay alive, and AV fistulas provide the sustainable vascular access required for hemodialysis. 

Continue reading PUBLISHED: Creation Of A Radial-Cephalic Arteriovenous Fistula →
General Surgery, Preprint Release, Vascular Surgery

PREPRINT RELEASE: Carotid Endarterectomy (Cadaver)


Carotid Endarterectomy (Cadaver)
Harvard Medical School

Samuel Schwartz, MD
Assistant Professor of Surgery
Massachusetts General Hospital

Laura Boitano, MD
Resident Physician
Massachusetts General Hospital

In this case, Dr. Schwartz and Dr. Boitano demonstrate a carotid endarterectomy on a cadaver at Harvard Medical School.