DR. NIMA NASSIRI, M.D.

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A 75-year-old man developed a dangerous leak inside his aortic stent graft caused by the graft components separating, allowing blood to re-pressurize a large aneurysm sac. Surgeons used two custom-modified endografts to bridge and seal the failed components while keeping blood flowing to the kidneys and other abdominal organs, without open surgery. The case illustrates that as endovascular aortic repairs age, complex failures can emerge that require creative solutions, and rigorous long-term imaging follow-up is essential.

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Two men with severe, hand-threatening arteriovenous malformations — abnormal high-pressure tangles of blood vessels — were treated entirely in an office setting using a medical glue injected through small punctures over multiple sessions spanning 8 to 12 months. All treated sessions were technically successful with no complications, and both patients healed their wounds, regained full hand function, and showed no recurrence at nine months. The approach, which used Doppler ultrasound flow measurements to track treatment response objectively, offers a safe outpatient alternative to hospital-based procedures for a condition that can otherwise require amputation.

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A kidney that had been transplanted into a living donor six years earlier was successfully transplanted again into a new recipient, demonstrating that previously transplanted kidneys can be reused rather than discarded. The case revealed several practical gaps in the current transplant system — such as misleading donor quality scores and insufficient tissue samples for compatibility testing — that complicate safe decision-making in this scenario. Addressing these system gaps is important because reusing functioning organs could expand the pool of available kidneys for patients on the waiting list.

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Researchers developed a flexible adhesive eye patch called OcuTAPE that sticks firmly to wet tissue and slowly releases an anti-inflammatory drug over five weeks. The patch uses tannic acid as a molecular bridge to lock drug-loaded particles into the hydrogel without any extra chemical steps, solving the common problem of nanoparticles falling out of adhesives. In animal testing the patch stayed in place, matched the mechanical behavior of the eye, and reduced inflammation, making it a promising tool for sealing eye injuries and delivering medication at the same time.

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An 86-year-old woman had a large, dangerous blood vessel tangle in her buttock that had worsened after an earlier failed surgery that tied off the feeding artery. Doctors used a staged, office-based approach — injecting a medical-grade glue to block the abnormal vessels, relieving vein compression, and then surgically removing the remnant — guided by the specific anatomy of her lesion. At one year she had no pain, full mobility, and no sign of recurrence, establishing a practical roadmap for treating this rare and life-threatening condition.

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Vascular specialists at Yale were surveyed about genetic testing for a variation (CYP2C19) that makes the blood thinner clopidogrel ineffective in some patients after leg artery procedures. While most clinicians recognized the issue, they were uncertain when to use the test and no consensus was reached on testing protocols across three rounds of structured discussion. The study identifies a clear need for clinical trial data to guide whether and when genetic testing should direct antiplatelet drug choices in peripheral artery disease.

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Doctors treated 25 patients with slow-flow vascular malformations — abnormal clusters of blood or lymph vessels — by directly injecting a targeted drug (an mTOR inhibitor) into the lesion rather than giving it systemically by mouth. All 33 procedures were technically and clinically successful, the drug stayed within the lesion, and the only side effect was temporary mouth sores in 21% of patients with no serious complications. Delivering this class of drug directly into the lesion eliminates the need for repeated blood tests and avoids the body-wide side effects associated with oral treatment.

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This study compared outcomes for 200 patients with a tear in the main chest artery (type B aortic dissection) who either received a stent graft at their initial hospitalization or were managed with medications alone. Patients who received the stent graft had zero in-hospital deaths versus 10% in the medication group, and their survival at three years was 92% versus 71%. These results support early stent grafting as the superior strategy for this condition, particularly for patients over 65.

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Researchers analyzed the fluid inside the eyes of glaucoma patients and found 31 metabolites that were abnormally elevated or reduced compared to healthy eyes, pointing to disrupted energy and fat metabolism. Two of the most reduced compounds — agmatine and thiamine — were then delivered into mouse eyes, where they reduced inflammation and protected retinal nerve cells from damage. These findings identify agmatine and thiamine as candidate drugs that could be developed to slow or prevent the nerve damage that causes vision loss in glaucoma.

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A multicenter study evaluated a custom-assembled stent graft system used to repair complex aortic aneurysms involving the abdominal organs in 139 patients who were too high-risk for open surgery. The procedure achieved 100% technical success, kept all targeted vessels open at one year in 97% of cases, and carried a 30-day mortality of 3.6%, with low rates of paralysis and stroke. The results support this approach as a safe option for patients with extensive aortic disease who have no other surgical alternatives.

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This chapter reviews evidence and guidelines on glaucoma screening, focusing on Black and Hispanic populations who face a higher risk of the disease. Current guidelines do not recommend widespread population screening because it is not cost-effective, but targeted screening of high-risk groups — particularly older adults and those with a family history — is supported. Emerging technologies like telemedicine and artificial intelligence are expanding access and making targeted screening more practical for underserved communities.

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Surgeons developed a simplified technique for placing a branched stent graft that preserves blood flow into the pelvis during aortic aneurysm repair, eliminating the need for a guidewire passed through both groins — a step that adds complexity and limits which patients qualify. The new approach achieved 100% technical success in all 20 patients with no deaths or complications at 30 days. By removing the anatomic restrictions of the standard technique, this method makes the procedure available to more patients.

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A prospective trial tested the RelayPro stent graft in 56 patients with severe type B aortic dissection complicated by poor blood flow to the kidneys, legs, or intestines, with 30-day mortality of just 1.8% — far below the prespecified benchmark. The device maintained vessel openness through three years without rupture, component failure, or device migration. These results establish RelayPro as a safe and durable option for one of the most urgent presentations of aortic dissection.

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Researchers reviewed outcomes in 38 patients who underwent a two-part repair of complex aortic arch and descending aorta disease — first an open bypass of the arch vessels and then a stent graft to seal the rest of the aorta. At about 15 months of follow-up, the true channel of the aorta grew significantly at nearly every measured level, indicating the dissected aorta was healing and remodeling as intended. The lower portions of the aorta (below the stented segment) may still need additional treatment to achieve complete healing in all patients.

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A multicenter study tested a slim-profile stent graft in 50 patients with traumatic aortic injuries from car accidents and similar events, finding a 30-day mortality of 2% — well below the 25% performance benchmark and the historically expected 8%. Freedom from death and major complications remained near 98% through four years of follow-up, with no strokes and only one case of leg paralysis. These results confirm the device is safe and effective and may give trauma patients a survival advantage by allowing minimally invasive repair even through smaller access vessels.

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A patient who had previously received a lung transplant went on to receive both a heart and a kidney transplant, becoming one of very few people in the world to have received three separate organ transplants. The case highlights the growing complexity of managing patients who require multiple organ replacements over time, as well as the medical progress that makes such outcomes possible.

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Researchers examined the bacteria living on ureteral stents — small tubes placed inside the kidney drainage system — from patients with kidney stones versus kidney transplant recipients, and found that the bacterial communities differed significantly between the two groups. The two populations harbored distinct species with different abilities to form the protective biofilm coatings that make infections hard to treat. Understanding these differences could help doctors anticipate what type of stent infection a patient is most likely to develop and guide prevention strategies.

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A 47-year-old woman developed a life-threatening infection in her chest wound after aortic arch surgery caused by bacteria resistant to all standard antibiotics. Her infection was cured using bacteriophage therapy — viruses that specifically kill bacteria — delivered directly through drains in her chest, and she remained infection-free two years later. The case adds evidence that phage therapy is a viable rescue option for untreatable surgical wound infections.

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This review summarizes how the chemotherapy drug mitomycin C is used in eye surgery to prevent scar tissue from blocking surgical outcomes in procedures including pterygium removal, glaucoma filtering surgery, eyelid duct reconstruction, and laser vision correction. Dosing varies by procedure and remains debated, and potential complications must be weighed against benefits. The authors call for larger randomized trials with longer follow-up to establish clearer dosing standards and reduce long-term risks.

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Six patients with a rare syndrome causing eye inflammation, bleeding, and pressure problems (uveitis-glaucoma-hyphema syndrome) were managed using a miniature endoscopic camera inside the eye, which revealed the exact sources of trouble that conventional external examination had missed. The endoscope identified hidden foreign fragments, displaced lens components, vascular abnormalities, and structural problems at the back of the iris that directly guided surgical correction in each case. Intraocular endoscopy proved essential for diagnosing and treating the root causes of this syndrome when standard methods were insufficient.

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Among roughly 4,000 ruptured abdominal aortic aneurysms in a national database, 12% ruptured at a smaller size than the standard threshold for elective repair, and these patients were more likely to be younger, Black, and have high blood pressure. After adjusting for patient differences, small ruptured aneurysms carried the same risk of death as large ones, meaning smaller aneurysm size does not protect against a fatal outcome once rupture occurs. The higher rate of rupture at small sizes in Black patients points to a need to reconsider whether current size thresholds are equally appropriate across racial groups.

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A patient's previously placed surgical elephant trunk graft — used as a bridge during staged aortic arch repair — kinked and migrated into the wrong channel of a dissected aorta, creating a dangerous situation. Surgeons corrected this using a hybrid technique: first placing a stent graft from below, then threading a second graft from above through a chest incision to reposition the trunk back into the correct channel. The approach resolved the complication without requiring a full open chest operation.

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A patient with a rare connective tissue disorder called Loeys-Dietz syndrome developed a very large iliac artery aneurysm, an unusual and technically demanding problem since the standard branched stent graft requires anatomy that this patient's disease had distorted. Surgeons adapted the repair technique to work around the abnormal anatomy and successfully preserved blood flow to the pelvis. The case demonstrates that branched endovascular repair can be extended to patients with genetic vascular disorders who fall outside typical device guidelines.

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A national database analysis compared open surgery versus stent placement for repairing popliteal artery aneurysms (behind the knee) that had caused acute leg-threatening blood clots, covering 571 urgent cases from 2010 to 2021. Open surgery was associated with more bleeding and longer hospital stays, while endovascular repair patients had shorter stays but higher short-term mortality — likely because sicker patients were selected for the less invasive approach. Endovascular repair for this urgent condition has grown dramatically and is generally safe, but patient selection explains the mortality difference rather than the procedure itself.

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Eighty-four patients with advanced glaucoma and a previously implanted drainage tube that was no longer controlling eye pressure were treated with a laser procedure called micropulse transscleral laser therapy. Eye pressure dropped by 23 to 35 percent across all follow-up visits up to three years, and the number of pressure-lowering eye drops patients needed also fell significantly, with no cases of dangerously low eye pressure. The results confirm the laser treatment works in this difficult-to-treat group even when prior surgery has failed.

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A 74-year-old man with a dangerous ballooning of the lower aorta needed repair, but his only remaining intestinal artery had a narrow opening and his other major intestinal vessels were completely blocked. Surgeons used a combination of two stent graft systems to repair the aneurysm while simultaneously placing a small stent to keep the critical intestinal artery open, avoiding potentially fatal bowel ischemia. At one year the aneurysm was smaller and the intestinal artery remained open, showing this approach can solve technically demanding anatomic situations.

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A 49-year-old man had a large abnormal blood vessel cluster inside his rectum — a venous malformation — that was successfully treated by injecting a sclerosing agent directly into it through a minimally invasive anal approach, avoiding major abdominal surgery. Recovery was uncomplicated aside from a brief expected inflammatory response. This is the first reported use of this combined approach for treating colorectal vascular malformations and suggests it could be applied more broadly.

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In preparation for the first human bladder transplant, surgeons practiced a robotic technique for removing and reimplanting a vascularized bladder in pigs, human cadavers, and brain-dead donors, achieving successful blood flow restoration in most attempts. Operating time improved with each successive case, and reinspection of the bladder up to 12 hours after replanting confirmed healthy tissue and intact lining. This preclinical work lays the technical foundation for a UNOS-approved first-in-human clinical trial of bladder transplantation.

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Engineers built and validated a custom instrument to measure the magnetic properties of large superconducting materials without cutting or destroying them, filling a gap left by existing commercial devices that cannot handle bulk samples of this size. The device was calibrated against standard instruments and correctly measured the magnetic behavior of a high-temperature superconductor at the temperature of liquid nitrogen. The ability to characterize intact, centimeter-scale superconductors non-destructively is useful for developing practical superconducting applications.

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This is a published correction to an earlier article on somatic gene mutations that cause cutaneous and liver vascular lesions, correcting a specific content error in that paper.

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A patient with a chronic aortic dissection and a 10-cm aneurysm posed an extreme access challenge: the standard approach through the groin arteries was blocked on one side, and the other side's blood supply ran through the wrong (false) channel of the dissection. Surgeons accessed the false lumen intentionally, then punctured through the dividing wall to place a stent graft in the correct true channel — a trans-septal technique rarely described. The case demonstrates how creative access strategies can make endovascular repair possible even in the most anatomically hostile situations.

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A single surgeon's experience with 46 patients receiving a specific bifurcated aortic stent graft (AFX2) was reviewed to identify when this device is the best choice over conventional modular alternatives. The graft was primarily selected for aortas with a narrow true channel — 78% had a maximum diameter under 5 cm — where modular devices are harder to deploy. Over a median follow-up of nearly two years, there were no type I or III leaks, and reintervention was needed in just 2% of cases, confirming the device fills a defined technical niche.

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Thirty men with intermediate-risk prostate cancer whose first focal ablation treatment (using ultrasound or freezing to destroy the tumor) did not fully eliminate the cancer underwent a second round of the same type of treatment. Quality of life scores for urinary and sexual function were unchanged after the second treatment, there were no surgical complications, and the cancer was undetectable on biopsy in about half the patients afterward. Repeat focal ablation is a reasonable option when the first treatment fails, offering a chance at cancer control with minimal side effects.

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A 19-year-old man with a testicular germ-cell tumor was found to have abnormally high levels of both male and female sex hormones, along with suppression of the brain signals that normally regulate them — a combination not previously well recognized for this tumor type. The case is reported to raise awareness that germ-cell tumors, not just the classically associated Leydig cell tumors, can cause hormonal syndromes. Young men with suspected testicular cancer should be screened for signs of hormone excess so they can receive appropriate monitoring and counseling.

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When laser trabeculoplasty was applied to one eye to lower its pressure in glaucoma patients, the untreated fellow eye also showed a measurable pressure drop — a phenomenon called consensual ophthalmotonic reaction. This pressure-lowering effect in the untreated eye lasted up to about nine months before fading. While the effect is real, it is too weak and short-lived to rely on as a deliberate treatment strategy for the other eye.

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This study followed 365 eyes in 288 patients suspected of having glaucoma for five years to identify which early measurements best predicted who would actually develop the disease. Eyes that progressed showed worse visual field pattern variability (pattern standard deviation) and more severe damage in the lower portion of the optic nerve fiber layer at the start of the study. These two findings at baseline are the strongest early warning signs that a glaucoma suspect will convert to true glaucoma within five years.

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This review summarizes laboratory and clinical research on using focused ultrasound beams — directed from outside the body — to treat blocked or clotted arteries without surgery or catheters. In animal studies, focused ultrasound slowed the buildup of arterial plaques and promoted new blood vessel growth in ischemic limbs; in humans, early trials showed reduced plaque, improved blood flow, and successful clot dissolution after stroke. The technology shows promise but needs more targeted research to define the right settings and patient populations before it can be widely adopted.

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Thirty-three patients with eye pain and migraine headaches caused by inflammation of the trochlea — a small cartilage pulley near the inner corner of the eye — were treated with ibuprofen for 15 to 30 days. Pain scores dropped dramatically, and all associated symptoms including light sensitivity, difficulty looking upward, and pain during reading resolved; at six months, no symptoms had returned. Ibuprofen is an effective non-invasive treatment for trochleitis when the condition is correctly identified.