On-pump techniques are the methods of choice for organ protection and heart support during thoracoabdominal aortic aneurysm surgical repair. We present a case of a patient with a symptomatic saccular aneurysm of the visceral segment of a severe atheromatous aorta requiring a surgical type IV aortic repair during which we adopted a temporary passive arterial shunt from the left axillary artery to ensure visceral and distal aortic perfusion. The old-fashioned technique of passive shunting to ensure visceral and distal aortic perfusion seems to offer an appealing alternative to on-pump techniques in selected patients.

Peripheral arterial bypass in pediatric patients is a rare but essential surgical intervention, often performed in cases of trauma, congenital abnormalities, or severe vascular occlusion. Unlike adults, children present unique anatomical and physiological challenges owing to their smaller vessel size, rapid growth, and different responses to vascular injury and repair. This review aims to provide an overview of current knowledge, surgical techniques, and outcomes of peripheral arterial bypass in pediatric patients, with a focus on trauma-induced vascular injuries. Additionally, we present a case study involving a 5-year-old patient with a complex traumatic injury requiring arterial bypass.

Introduction: Isolated true subclavian artery aneurysm (SAA) is a rare form of peripheral arterial aneurysm that poses significant anatomical challenges to endovascular repair, especially in cases requiring planned vertebral artery (VA) sacrifice. The Balloon Occlusion Test (BOT) is a critical preoperative tool for evaluating collateral circulation before VA embolization. Case Report: A 74-year-old male was admitted with a pulsatile mass in the left supraclavicular fossa, and a 65 mm aneurysm of the intrathoracic segment of the left subclavian artery (LSA) involving critical arterial branches was diagnosed by computed tomography angiography. Due to his comorbidities, the patient was judged unfit for an open surgical repair of the aneurysm, and a two-stage endovascular subclavian aneurysm repair (EVSAR) was planned. The first step included embolization of the internal mammary artery and thyrocervical trunk, followed by BOT of the left VA, which confirmed an adequate perfusion of the posterior cerebral and cerebellar circulation that allowed safe VA embolization. The second step included zone 2 thoracic endograft placement (TEVAR) with LSA coverage and vascular plug occlusion of the proximal segment of the LSA and the axillary artery. Postoperative monitoring revealed no neurological deficit, and the patient was discharged home without complications. Follow-up imaging up to 24 months confirmed complete aneurysm exclusion and significant sac shrinkage. Conclusions: EVSAR with thoracic endograft and VA sacrifice, preceded by BOT, may be a safe and effective minimally invasive approach for the treatment of intrathoracic SAA.

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.