Lymphatic complications (lymphoma and lymphorrae) following vascular access or interventions in the groin are frequently benign but may increase the risk of wound infection, need for reintervention, and prolong the length of the hospital stay. Several management strategies have been developed so far, including percutaneous drainage, chemical sclerotherapy, and surgery, but a validated treatment algorithm has yet to be established in the current literature. In this paper, the authors investigated the indications and outcomes of currently available strategies for treating groin lymphocele following surgical dissection of the femoral vessels and suggested an algorithm for treating this potentially severe complication.

Background: COVID-19-related deep vein thrombosis (DVT) in patients with pre-existing congenital anomalies or genetic diseases of the cardiovascular system has been rarely reported, and a clear definition of best treatment in this setting remains undefined. Methods: We report the rare case of a 36-year-old male patient affected with a congenital cardiovascular anomaly, presenting extensive venous thrombosis following COVID-19-induced coagulopathy. An insight into current treatment strategies in this setting is also reported. Results and Conclusions: COVID-19 disease appears to be a determining factor in the development of extensive DVT in patients with congenital anomalies and genetic disorders. Anticoagulation should be tailored to the individual risk factors, balancing the risk-benefit between prevention of VTE and hemorrhagic complications.

The chimney endovascular aneurysm repair (Ch-EVAR) technique has progressively increased in popularity in the treatment of complex aortic aneurysms. However, the long-term results of this technique still must be assessed, especially in comparison to custom-made solutions. The patency of chimney grafts has always been one of the important issues with the Ch-EVAR technique. However, interactions between nonstented aortic side branches and chimney stent grafts have rarely been discussed. In the present case report, we describe a rare case of mesenteric ischemia due to superior mesenteric artery ostium coverage by the misalignment of a renal stent graft in a Ch-EVAR.

Thoracic endovascular aortic repair is nowadays the preferred option to manage descending thoracic aorta diseases. However, despite feasibility and safety of the procedures, several complications may occur. We report the case of an 83-year-old female patient with inadvertent iliac rupture occurred during thoracic endovascular aortic repair. To limit massive bleeding, considering the patient’s comorbidities contraindicating open surgical repair and the morphology of the arterial injury (circumferential rupture of the artery from its origin), we chose to perform a homolateral hypogastric and common iliac artery embolization and an aorto-uniliac balloon expandable stent graft deployment from the distal aorta to the contralateral common iliac artery. A femoro-femoral crossover bypass graft was performed to restore both lower limbs perfusion. Final angiography documented correct positioning and regular patency of the implanted grafts and bypass with no blood loss from the right iliac vessels. Despite careful preoperative assessment, iliac artery injury can represent a challenging complication of thoracic endovascular aortic repair, particularly in the setting of inadequate iliac diameter, calcification and vessel tortuosity, or when large-caliber introducers are required. The hybrid approach we describe is a valid and effective solution to minimize blood loss and avoid major consequences in the management of iatrogenic iliac artery rupture during endovascular procedures.

We report the case of a 65-year-old male patient who was deemed unfit for open surgery and underwent zone 0 endovascular repair with a physician-modified fenestrated endograft for a symptomatic penetrating ulcer. A thoracic stent graft was modified creating a large fenestration for the innominate artery and the left common carotid artery, and a second small fenestration for the left subclavian artery and the left vertebral artery, which had a common origin. No bridging stent was used for the left subclavian artery to avoid coverage of the left vertebral artery. The postoperative course was uneventful, and no leaks nor other complications were detected on postoperative computed tomography angiography. Although long-term durability needs to be better assessed, our experience suggests that physician-modified fenestrated endografts are a feasible option for the emergent treatment of aortic arch lesions in unfit patients and provide satisfactory results in the short term.