Anthony Rios M.D.

Parsa, P., J. Eidt, A. Rios, D. Gable and J. Vasquez, Jr. (2018). “Case Report: An Innovative Endovascular Technique for Repair of Descending Thoracic Aortic Aneurysm following an Open Coarctation Repair.” Ann Vasc Surg 46: 205.

Full text of this article.

It was once postulated that open surgical repair of coarctation of the aorta during childhood patients was cured. However, long-term follow-up has been significant for late problems such as an aneurysm. The incidence of such aneurysm after open surgical coarctation repair is 11-24%. If such an aneurysm is left untreated, patients are at a high risk of morbidity and mortality. Prior to the endovascular era, patients would require a redo open repair which in itself is a highly morbid operation. Currently, thoracic endovascular aortic repair (TEVAR) has been reported as a feasible and safe alternative to open surgical reprocedures in this context. However, TEVAR might be challenging due to the proximity of the pathology to supraaortic vessels and the ongoing presence of the coarctation. We are reporting a unique case of a 48-year-old male undergoing TEVAR due to aortic aneurysm after previous surgical coarctation treatment and successful closure of the coarctation with a vascular plug device.

Rios, A., P. Parsa, J. Eidt and G. Pearl (2017). “A novel surgical approach to symptomatic left renal vein aneurysm.” J Vasc Surg Venous Lymphat Disord 5(6): 875-877.

Full text of this article.

Visceral venous aneurysms are uncommon and renal vein aneurysms are among the rarest in this subset. Renal vein aneurysms are frequently asymptomatic, but patients may present with flank pain or hematuria. Complications of untreated visceral venous aneurysms include thrombus formation and, very rarely, rupture. Treatment of renal vein aneurysms ranges from watchful waiting to surgical repair. We describe a patient with renal vein aneurysm presenting with recurrent pulmonary embolus with no other identifiable source. Furthermore, we propose a novel surgical treatment with complete resection of the aneurysm and reconstruction of venous return by transposing the inferior mesenteric vein to the remaining left renal vein.

McCullough, P. A., A. Rios and B. Smith (2017). “Dialysis fistulas and heart failure.” Eur Heart J: 2017 Mar [Epub ahead of print].

Full text of this article.

Defining the optimal care for patients reaching end-stage renal disease (ESRD) requiring haemodialysis continues to be a challenge for nephrologists, cardiologists, and vascular surgeons. It has been acutely recognized that temporary dialysis catheters used in ∼82% of those who start dialysis can be a nidus for intravascular infection and are associated with early mortality in ESRD.1 Accordingly, there has been a large emphasis on ‘fistula first’ or, in other words, having a permanent surgically created dialysis access conduit [arteriovenous fistula (AVF) or shunt with graft (AVG) material] and thus reducing the exposure to and the length of time with dialysis catheters.2 Permanent vascular access brings a new set of issues to the patient and physician, with complications such as low flow, clotting, infection, and need for revision.3,4 In this issue of the journal, Reddy and colleagues present data from 137 ESRD patients who underwent echocardiographic examinations before and 2.6 years after AVF/AVG creation.5 While there were modest improvements in left ventricular hypertrophy, access creation was associated with multiple adverse changes in right ventricular structure and function without a measurable increase in cardiac output.