A 52-year-old male patient underwent surgical correction of interrupted CoA at the age of 20 years using EABG from the LSCA to the descending aorta. He presented with transient sudden central chest pain with sweating. He is a known smoker for more than 30 years and hypertensive for almost 10 years, on losartan 100 mg once daily. The blood pressure (BP) was 140/90 mmHg, equal in four limbs with no brachiofemoral delay. There was no ischemic electrocardiography (ECG) changes or rise in cardiac biomarkers. His transthoracic echocardiography (TTE) revealed normal left ventricular (LV) function, mild bicuspid aortic valve (BAV) regurgitation, and dilated aortic root. The patient was taken to the cardiac catheterization laboratory and underwent coronary and aortic angiography, which revealed normal coronaries, dilated ascending aorta (3.8 cm), post-ductal aortic interruption, and patent EABG with complex pseudoaneurysm at the distal anastomosis site measuring 2x2.5 cm (Figure ).\nAfter the heart team discussion, endovascular treatment was deemed more feasible and safer than redo-surgery. We implanted two overlapped Valiant Thoracic Stent Graft (Medtronic Vascular, Santa Rosa, CA) proximally 22 mm X 100 mm and distally 28 mm X 100 mm. The aortic angiography revealed complete exclusion of the pseudoaneurysm and patent stent graft with no gradient (Figure ).\nThe patient did very well and was discharged home after two days. A follow-up computed tomographic (CT) angiography revealed a widely patent stent graft with no endoleaks (Figure ).
Our patient was an 18-year-old girl with recent onset right leg pain and swelling with extension to her inguinal area. She also had dyspnea with respiratory distress. At the time of presentation, she was ill and febrile. She also had pitting edema of right leg and significant size difference between circumferences of her two legs. On the day of admission, she suddenly presented with dyspnea and severe thoracic pain on the right side. All other physical examination was normal.\nShe had no predisposing factor for venous thrombosis. Besides, she had no known a history of DVT, clotting disorders, recurrent abortion, peripheral vascular disease, non-healing ulcerations on the extremities, cerebrovascular accidents or taking oral contraceptive pills.\nHer laboratory data showed only mild normochromic, normocytic anemia, elevated erythrocyte sedimentation rate (ESR) to 75 (normal range less than 25) and CRP = 16 (normal less than 8). Other laboratory test including renal, electrolytes, liver, and urine analysis and culture were normal.\nColor duplex ultrasound study demonstrated deep venous thrombi in the right popliteal, superficial and common femoral veins, with external iliac vein.\nIn addition, hypercoagulable workup was revealed no abnormal finding and also negative for antiphospholipid syndrome and lupus anticoagulant antibodies.\nA multi-detector computed tomography (CT) pulmonary angiography of the chest defined pulmonary emboli in the territory of right main and segmental branch pulmonary artery and suggesting extensive infarction of the right middle pulmonary lobe. She was subsequently started on a low molecular weight heparin (Clexane®: 60 mg, every 12 h SC). Subsequently, CT of the abdomen and CT angiography with IV contrast injection carried out after the procedure confirmed duplication of the IVC []. Both two IVC originate in the pelvis, run parallel to each other, bordering the aorta and left-sided IVC drained into the left renal vein. There was no other pathologic finding in thoracic and abdominopelvic CT studying.\nAfter fully anticoagulated with low molecular weight heparin for 5 days and starting warfarin international normalized ratio (INR) range was between 2 and 3, she was discharged from hospital and was not symptomatic in her follow-up until next 3 months. According to the previous studies, for this patient we planned to continue anticoagulant therapy for 6 months.[]