UNASSIGNED: Osseous dysplasia (OD) is a benign fibro-osseous lesion classified as periapical, focal or florid with some rare cases being diagnosed as expansive OD.
UNASSIGNED: A 43-year-old female presented with gross mandible expansion and tooth displacement.
UNASSIGNED: Imaging scans revealed an expansive lesion in the anterior mandible, with varying opacity in the central region, and other smaller lesions in the region of teeth #37 and #47, consistent with expansive OD.
UNASSIGNED: Surgical resection followed by immediate reconstruction of the mandibular defect using a microvascularized fibular graft.
UNASSIGNED: The patient had a 4-year follow-up, with adequate mandibular bone continuity, mastication, swallowing, and speaking ability reestablished.
UNASSIGNED: Immediate reconstruction after large surgical resection is required as tissues retract over time, hampering late reconstructions. Microvascularized fibular graft aims at adequate and functional rehabilitation with osseointegrated implants and long-term follow-up is needed as florid OD may evolve into expansive OD.

Complex cerebrovascular bypass operations may confer an increased risk of intraoperative complications, such as graft thrombosis. Novel techniques are needed to optimize the management of these challenging cases.
A woman in her late 20s was incidentally diagnosed with a 1.5-cm basilar apex aneurysm, which grew to 3.5 cm over 2 years of active surveillance. Definitive treatment was then recommended with flow reversal and Hunterian ligation of the basilar trunk planned as a radial artery graft (RAG) bypass: M2 (S-Ec) RAG (E-Sc*) P2. Intraoperative graft thrombosis prompted multiple attempted salvage maneuvers; however, complete excision and repeat anastomosis were ultimately required. The procedure was completed using a novel double-interposition technique, with ligation of the index RAG approximately 1 cm proximal to the distal anastomosis (final bypass: M2 [S-Ec*] RAG [E-Ec*] RAG\' [E-Sc] P2). These technical modifications yielded a less deep recipient site for the repeat bypass and an end-to-end anastomosis rather than an end-to-side anastomosis, collectively facilitating a more efficient and facile salvage. The patient recovered well from surgery, and flow reversal was successfully achieved within the aneurysm.
Despite the increased risk of intraoperative thrombosis with complex cerebrovascular bypass operations, facility with salvage techniques can lead to technically and clinically excellent outcomes. We report the successful use of a novel fourth-generation double-interposition bypass that shortens the working distance and uses a more favorable anastomosis technique. This bypass may facilitate safe and efficient microsurgery in patients who require complete revision of an intracranial-intracranial construct.

BACKGROUND: An infected popliteal pseudoaneurysm has never been described in the pediatric population. Physicians need to be aware of its presentation and management, in order to diagnose and treat this medical condition adequately.
METHODS: We describe the case of a 14-year-old boy who developed myositis and cellulitis centered at the popliteal fossa after playing basketball. A treatment of intravenous cefazolin was started. 5 days later, he experienced a knee pain flare-up, which turned out to be a popliteal pyomyositis with a pseudoaneurysm of the popliteal artery. A saphenous vein graft bypass of the popliteal artery and an excision of the popliteal pseudoaneurysm were performed. Intravenous cefazolin was continued for 6 weeks and prophylactic acetylsalicylic acid for 6 months.
CONCLUSIONS: This case highlighted the importance of repeating radiologic investigations if a patient suffering from soft tissue infection has persistent pain after several days of appropriate antibiotics. A popliteal pseudoaneurysm can be diagnosed with ultrasound imaging and treated with a popliteal-popliteal bypass. Our patient needed a catheter-guided dilation of the anastomosis at the vein graft 6 months post-surgery, and then evolved favorably and went back to playing basketball 6 months post-dilation.

Popliteal artery entrapment syndrome (PAES) is a rare vascular disease, and cases of bilateral PAES associated with distinct symptoms in each of the affected legs are very rare. In an effort to improve current understanding regarding the presentation and treatment of this condition, a case of bilateral PAES is herein described with a corresponding review of the associated literature. The overall process of diagnosing and treating one patient affected by bilateral PAES was retrospectively assessed to provide comprehensive insight regarding this disease. This patient was diagnosed via contrast-enhanced computed tomography (CT), and right-sided symptomatic PAES was successfully treated via autogenous saphenous venous graft arterial bypass surgery. In contrast, the asymptomatic left-sided PAES in this patient was subject to close follow-up monitoring. Over a 2-year postoperative follow-up period, this patient did not experience any symptoms or complications. As such, autogenous saphenous venous graft arterial bypass surgery represents a safe and efficacious means of treating PAES, whereas surgery may not be required for cases of asymptomatic PAES even in patients with a bilateral presentation.

A 62-year-old man was presented with transient ischemic attack 1 day after percutaneous coronary intervention. Magnetic resonance imaging demonstrated fresh cerebral infarction in the left hemisphere. Digital subtraction angiography showed left Riles type 1A common carotid artery occlusion (CCAO). Blood flow in the internal carotid artery (ICA) was derived from the external carotid artery, which came through the anastomosis between the left occipital artery and a muscular branch of left vertebral artery. We performed short jump graft from CCA to ICA using saphenous vein, followed by ligation of CCA. The graft remained patent at the 1-year follow-up.

Surgical resection remains the best choice for the treatment of liver tumors. Hepatectomy combined with artificial vascular reconstruction has been proven as an alternative to treating tumors involving the main hepatic veins. As the cutting-edge surgical technique, robotic liver surgery is a novel procedure expanding the field of minimally invasive approaches, especially in complex reconstruction. This study reports, for the first time, on a robotic hepatectomy with middle hepatic vein (MHV) reconstruction using an expanded polytetrafluoroethylene (ePTFE) graft for a patient with hepatic adenoma. The tumor, which was located in segment 8, was adjacent to the MHV. Robot-assisted resection of segment 4 and partial segment 8, and MHV reconstruction using a ePTFE graft were performed. During the post-operative examination and follow-up, the blood flow of the ePTFE graft was patent, and liver function recovered well. Thus, robotic hepatectomy with MHV reconstruction is a safe, minimally invasive, and precise surgery that may provide a novel approach for patients with liver tumors that are invading or adjacent to the main hepatic veins.

A 47-year-old male with Leriche syndrome presented with digital gangrene due to TASC II type-D occlusion of the distal aorta and common iliac arteries. Open revascularization was performed using a Dacron aorto-biiliac bypass graft; however, the postoperative course revealed a nondisclosed history of intravenous opioid abuse as he went into withdrawal psychosis. Our report highlights ways to mitigate infection risk associated with prosthetic aortic grafts in suspected or confirmed intravenous drug abusers. The literature review suggests alternative strategies like aortoiliac endarterectomy, total endovascular approach using non-covered stents, or a hybrid approach. The primary use of autologous venous grafts should be considered as a last resort so that the veins are retained for future use in case of graft infection. Patient factors like comorbidities, fitness to undergo surgery, anatomical extent of occlusion, and availability of facilities/expertise can further guide the management plan owing to a lack of evidence-based guidelines.

Intraoperative iliac artery dissection during kidney transplantation is a rare but serious complication that requires prompt intervention. We present a case of right external iliac artery dissection during deceased donor kidney transplantation. A 57-year-old male patient underwent standard pretransplant evaluation and had no signs of either significant aortoiliac occlusive disease or peripheral arterial occlusive disease. Diabetic nephropathy, arterial hypertension and smoking were the underlying causes of the patient\'s end-stage renal disease. Transplantation was performed in the standard fashion. The kidney was positioned in the right iliac fossa and the venous end to-side anastomosis was performed first. A significant dissection of the right external iliac artery was found on arteriotomy. Immediate ilio-femoral bypass with a vascular prosthesis was performed. During two years of follow-up the kidney function is stable and there are no signs of lower limb vascular insufficiency.

Presented in the article is a clinical case report regarding successful treatment of a patient with infection of a vascular graft after bifurcation aortofemoral bypass grafting by means of partial removal of the graft\'s branch with extra-anatomical graft-to-femur prosthetic repair through the iliac wing. The patient was admitted 6 months after bifurcation aortofemoral bypass grafting with a purulent and ligature fistula, discharge in the inguinal area. The findings of computed tomography showed no infection of the central anastomosis in the retroperitoneal space, with however periprosthetic infection in the area of the distal branch and severe comorbid background, thus not allowing complete removal of the prosthesis. A decision was made to perform operation in the scope of resection of the graft\'s branch, with extra-anatomical bypass grafting through a hole created in the iliac wing and debridement of the wound in the groin. In the postoperative period, no lower limb ischemia was observed, with blood circulation compensated completely. The patient was discharged in a satisfactory condition on POD 64 with no signs of either local or systemic infection.
В статье представлен клинический случай успешного лечения пациента с инфекцией сосудистого протеза после бифуркационного аорто-бедренного шунтирования путем частичного удаления бранши протеза с экстраанатомическим протезо-бедренным протезированием через крыло подвздошной кости. Пациент поступил спустя 6 мес. после бифуркационного аорто-бедренного шунтирования с лигатурным и гнойным свищом, отделяемым в паховой области. По данным компьютерной томографии инфицирования центрального анастомоза в забрюшинном пространстве не было, однако имелась парапротезная инфекция в области дистальной бранши и наблюдался тяжелый коморбидный фон, что не позволяло выполнить полное удаление протеза. Было принято решение об операции в объеме резекции бранши протеза с проведением экстраанатомического шунтирования через созданное отверстие в крыле подвздошной кости с дебридментом и санацией раны в паху. В послеоперационном периоде ишемии нижних конечностей не отмечено, кровообращение полностью компенсировано. Пациент выписан в удовлетворительном состоянии на 64-е сутки после вмешательства без признаков местной и системной инфекции.

To examine the relationship between trap location and cerebral infarction in the anterior choroidal artery (AChA) region and associated risks in ruptured internal carotid artery blood blister-like aneurysm (BLA) treatment with high-flow bypass and lesion trapping.
We included 26 patients diagnosed with BLAs and treated with high-flow bypass and trapping. We examined clinical characteristics including age, aneurysm trap location, final prognosis, cerebral infarction on postoperative magnetic resonance imaging, and modified Rankin Scale score at discharge. We also searched the literature for similar studies.
The modified Rankin Scale score at discharge was 0-2 in 20 patients, 3-5 in 2 patients, and 6 in 2 patients. In 19/26 patients (73.1%), the trapped segment was between the posterior communicating (PcomA) and the ophthalmic arteries. In 2 patients (7.7%), the trapped segment included the PcomA and the AChA; in 4 patients (15.4%), the trapped segment was within the PcomA. In these patients, the PcomA was occluded, and blood from the high-flow bypass flowed out to the AChA alone. No patient showed cerebral infarction. Our systematic review identified 70 patients. Of all 96 patients, 12 had AChA cerebral infarction; however, the infarction affected the prognosis of only 2 patients.
When treating BLAs with high-flow bypass and lesion trapping, the frequency of AChA cerebral infarction is low even when the PcomA is occluded, leaving the AChA as the only outflow vessel during high-flow bypass. However, PcomA occlusion may be associated with risks when treating patients with advanced arteriosclerosis near C1-2.