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In the past 15 years, fenestrated-branched endovascular aortic repair (F-BEVAR) has progressively become the first-line option for management of most complex abdominal aortic aneurysms (AAAs); with increasing experience, as well as persistent technological refinements, F-BEVAR indications have been expanded to include rescue of failures after prior EVAR. Despite the feasibility and effectiveness, F-BEVAR procedures in the presence of prior infrarenal endografts may come with higher technical complexity that should be properly anticipated, and several anatomical challenges can be expected. Among these, presence of suprarenal bare stents from prior EVAR device are certainly a frequent scenario and may sometimes make target vessel cannulation more difficult because of encroachment on the target vessel origins. In this manuscript, we report a case intraoperative rescue of a dislodged renal stent during FEVAR for treatment of type 1 endoleak with the aim of showing the culprit of the complication, how to recognize it, and the off-label solution that was devised to solve it.

Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information.