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   Table of Contents - Current issue
October-December 2022
Volume 9 | Issue 5
Page Nos. 339-427

Online since Friday, January 13, 2023

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Work and life – A surgical challenge Highly accessed article p. 339
Robbie George
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Comparing endovascular revascularization to open surgical revascularization for chronic mesenteric ischemia: A systematic review and meta-analysis Highly accessed article p. 341
Saeed Saad Alqahtani, Bader Menwer N Albilasi, Osama Mohammed Alenzi, Saleh Abdullah S Almoallem, Ali Nuwaysir S Alruwaili, Mohammed Hamoud Alkhaldi, Abdullah Mohammad G Alruwaili, Mohammed Amid S Alkhaldi, Raid Jawdat Almassaeed
Although the incidence of chronic mesenteric ischemia (CMI) is uncommon, it could become life threatening. With improvements in diagnostic imaging and endovascular therapy over the past few decades, the treatment of CMI has evolved. Even though endovascular revascularization for CMI is prominent, it is unclear if the early advantages outweigh the long-term patency rates. This study conducts a systematic review and meta-analysis to present comprehensive insights into the validity of endovascular revascularization versus open revascularization as effective therapeutic modalities. Studies up to 2022 were searched in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, and Embase. Additionally, references from earlier studies and review papers were manually searched for additional relevant reports. At least two authors examined all the results, making sure they fit the inclusion and exclusion criteria. In the event of disagreement, the authors were able to reach an understanding. Open revascularization is superior to endovascular approaches in maintaining vessel patency and reducing symptoms over the long term. Perioperative problems are more common in patients undergoing open procedures. Each patient's anatomy and physiology call for a different revascularization approach to be applied in treating this condition.
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Arterial thoracic outlet syndrome - Clinical presentation, surgical management, and outcome: An institutional experience of 10-year period Highly accessed article p. 349
Harish Kumar Ayyavoo, B Vella Duraichi, Narayanan Sritharan, K Jayachander, Paramasivam Ilayakumar, S Prathap Kumar, R Ranjith Babu, M Ramya, P Jan Sujith
Objective: The main objective of this study was to review the clinical presentations, surgical management, and outcome of surgical procedures for arterial thoracic outlet syndrome (TOS). Methodology: This is a retrospective analysis of arterial TOS patients admitted in our department (Institute of Vascular Surgery, Madras Medical College, Chennai) from August 2012 to July 2022. Results: This study enrolled 81 patients, with mean age of 41.13 (12-65 years) and 50.61% male (41) and 49.39% female (40), associated with distal arterial lesions - 63 (77.77%), among which 50.61% - occlusion in the brachial artery (33), 24.69% in forearm arteries (15), and 24.69% in the axillary artery (15). About 95.06% of patients had cervical rib (77), 2.46% - first rib abnormality (2), 2.46% - soft-tissue compression (2), 59.25% was SCHER Stage III (48), 33.33% SCHER stage I (27), and 7.40% SCHER stage II (6). All patients had undergone a supraclavicular approach. The most common arterial lesions were subclavian artery (SCA) thrombus in 53.08% (43), occlusion in 17.28% (14), and dilatation in 29.62% (24) cases. The cervical rib excision with anterior scalenectomy in 95.06% (77), and 1st rib excision with anterior scalenectomy 2.46% (2) and soft tissue resection with anterior scalenectomy 2.46% (2) of patients. SCA intervention/reconstruction was done in 88.88% (72) of cases. Two patients had underwent above elbow amputation (2.46%) and no mortality and SCA patency was 100%. Conclusion: Cervical rib excision with anterior scalenectomy with or without thrombectomy is an effective procedure for arterial TOS cases.
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Our initial experience in optical coherence tomography in peripheral vasculature: A pictorial essay p. 353
Vikram Patra, Rishi Dhillan, Rohit Mehra, Ajay Kumar Dabas, Rahul Merkhed, VNM Dattatreya Chamiraju
Background: Optical coherence tomography (OCT) has been a cornerstone for intracoronary interventions for substantial years. The extrapolation of the benefits of this cutting-edge technology to the peripheral vasculature is still in its nascent stage. This pictorial essay was an endeavor to exhibit the role of OCT as a tool for visualization of peripheral vasculature. Aim: To ascertain adjunctive use of intravascular imaging through OCT of in vivo peripheral human arterial vasculature and to distinguish between lipid-rich, fibrous, and calcified atherosclerotic plaques and other lesions of peripheral vasculature. Subjects and Methods: OCT imaging was performed with commercially available OCT system which is a short mono-rail design with a fiberoptic imaging core integrated into a catheter. The optic imaging core rotates at a rate of 100–180 revolutions/s. OCT pull backs were performed in an automated fashion with simultaneous flushing of iso-osmolar contrast (Visipaque) and normal saline. The visualization of different lesions of peripheral human vasculature through the eye of OCT is presented here as a pictorial essay. Results: OCT has an evolving potential as a tool for monitoring, lesion characterization, assessment of retrogression, progression, and disease stabilization in peripheral vasculature. The technique provides optimal high-resolution lesion characterization akin to an optical biopsy. Conclusions: OCT as a tool for in vivo analysis of human peripheral vasculature provides superlative results. Larger studies will be required to validate a protocol for optimal usage in the peripheral human arteries.
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Prognosis of patients with venous thromboembolism and cancer in India p. 359
Kereena Chukka, Pritee Sharma, G Satyendra Ramnadh, Vamsikrishna Yerramsetty, Fayazuddin Mohammad, Prem Chand Gupta, Gnaneswar Atturu
Introduction: Venous thromboembolism (VTE) is common in cancer patients and is considered one of the leading causes of death. Although activation of coagulation system is linked to tumor biology and considered as poor prognostic feature, there are several temporary/provoking factors such as perioperative period, immobilization, and debility that may cause VTE in these patients. It is not clear whether patients with such provoked VTE have different prognoses compared to patients without provoked VTE. Aim: To understand the overall prognosis of patients with cancer-associated thrombosis deep vein thrombosis (DVT) and whether there is a difference in survival between patients who underwent surgery (with or without chemotherapy) and patients who did not undergo surgery. Materials and Methods: This is a combined retrospective and prospective study. Electronic medical records of all patients who underwent VTE treatment between September 2014 and September 2019 were reviewed. Only patients who had DVT in the lower limb associated with malignancy were included in the study. Demographics, clinical, type, stage and type of cancer, and prophylactic treatment received and mortality data were collected. Results: Of 1364 patients treated for VTE, 86 patients (6.3%) had cancer-associated DVT. The mean age was 57 years (range 26–80 years) and 52 patients (60.46%) were female. The most common malignancies were cervix (15.11%), breast (12.79%), and colorectal (12.79%). Majority (68.60%) of the cancer patients were in the stages III and IV, other than having malignancy the most common risk factors were age, obesity, and postsurgery. Forty-three patients had surgery (with or without chemotherapy/radiotherapy). The left leg was commonly involved (53.48%) and the site of thrombus was in iliac (51.68%), femoral (16.85%), or popliteal veins (2.24%). All patients were initially started on low-molecular-weight heparin (LMWH) and then switched to Non-Vitamin K antagonist oral anticoagulants (NOAC) in 29 patients (33.72%) and VKA in 43 patients (50%). In seven patients, LMWH was continued (8.13%). Fifty-seven out of 86 patients (66.27%) were available for follow-up. Eighteen out of 57 patients (31.57%) were alive with an overall mortality of 59.64% and 1 year mortality of 37.5%. In patients who underwent surgery (with or without chemotherapy/radiotherapy), the overall mortality was 58.13% compared to 85.71% in patients who did not undergo surgery. Conclusion: VTE in cancer patients is not uncommon in India and is associated with high mortality. Patients with provoked DVT due to surgery (perioperative period) might have better survival compared to patients who did not undergo surgery.
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A descriptive study of concomitant vascular and bone injuries of the limbs in a tertiary care hospital in South India p. 364
Deepak Sulya, Siddhant Rajendra Vairagar, B V Saichandran, Durgaprasad Rath, S P Ramsankar, M Hemachandren, KSP Sreevathsa
Background: We studied patients with concomitant vascular and orthopedic trauma to limbs to assess their outcome and factors that affect the outcome of the limb. Methodology: We conducted a retrospective descriptive study and data from 68 patients was collected. Factors such as demography, mode of injury, and clinical parameters such as pulses, capillary refill time (CRT), sensory-motor function, compartment syndrome, type of bone and vessel injury, and ischemia time were compared and analyzed. Results: Out of 68 patients (n = 68) with concomitant vascular and orthopedic injury included in the study, 63 (92.65%) patients were males, and the mean age in the study was 30.16 ± 16.33 years; 56 (82.35%) patients sustained road traffic accident and 12 (17.65%) patients sustained fall from height, 7 (10.29%) patients were hypertensive, and 2 (2.94%) patients had diabetes mellitus; popliteal (30 patients – 22.06%) and brachial arteries (30 patients – 22.06%) are the most (total 44.12%) followed by femoral artery (seven patients, 10.29%) and radial artery (one patient, 1.47%); sensory function was absent in 20 (29.4%) patients; CRT was more than 3 s in 49 (72.06%) patients. No mortality occurred during the hospital stay in any of the 68 patients. The overall rate of amputation in the study was 20.59% (14 amputations). Significant association of amputation rate was found with increased CRT (P = 0.01), fracture (P = 0.05), open fracture (P = 0.05), transected vessel (P = 0.017), nonextremity injury (P = 0.01), and compartment syndrome (P = 0.002). Fasciotomy was done for 49 (72.06%) patients, and no significant association was found with the amputation rate. Mangled extremity severity score (MESS) was 7 or more than 7 in 23 (33.82%) patients. All the 14 (100%) patients who required amputation in the study had a MESS of 7 or more (P = 0.01), and limb salvage index (LSI) was 6 or more in 17 patients; among the 14 patients who underwent amputation, 13 patients had an LSI of 6 or more than 6 (P = 0.01). The vascular repair was redone in 3 (21.4%) patients, excessive bleeding requiring blood transfusion happened in 2 (14.3%) patients, and hypotension occurred in 4 (28.6%) patients. Intraoperative complications were associated with an increased rate of amputations (P = 0.001). The mean ischemia time was 15 ± 6.5 h with a median of 15 h; the shortest ischemia time was 10 h, and the longest was 19 h. The mean ischemia time was 14 h in the limb salvage group and 18.5 h in the amputation group. Long ischemia time was associated with increased amputation rates (P = 0.03). There was no significant difference in time between the time of injury and presentation to the hospital, the time between presentation and surgery, and the duration of surgery between the two groups (amputated vs. salvaged). Conclusion: The extent of soft-tissue injury and ischemia time are prime determinants of outcome in cases with concomitant vascular and skeletal injury. Early diagnosis, quick referral, addressing compartment syndrome, and proper vascular repair are the critical factors in salvaging a limb.
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New classification for juxta renal aortoiliac occlusion-based on imaging for safe clamping and contemporary surgical management results p. 370
Ajay Savlania, Venkata Vineeth Vaddavalli, Sriharsha Balraj, Prashant Jain, Aswitha Ravi, M Ananthakumar, Arunanshu Behera, Ujjwal Gorsi, Lileshwar Kaman
Objectives: The objective is to decide the site of aortic clamping based on preoperative imaging and intraoperative findings and assess the outcomes on midterm follow-up in patients with juxtarenal aortoiliac occlusion (JRAIO) managed with aortic thromboendarterectomy and bypass grafting. Methods: Forty patients (39 males and one female) with JRAIO were managed with aortobifemoral bypass (ABFB). Two patients required concomitant superior mesenteric artery (SMA) bypass. The aortic clamping site was inter-renal, suprarenal, or supra-celiac, depending on the extent of thrombus relative to the renal artery and SMA ostia. We compared serum creatinine levels with renal ischemic time in the postoperative period. At the mean follow-up of 26.7 months, patients were assessed for graft patency, limb salvage, and survival rate. Results: The mean age of patients was 53.9 years, and 97.5% of patients were heavy smokers. Of the total patients, inter-renal clamping was done in 12.5%, suprarenal clamping in 70%, and supra-celiac clamping in 17.5%. Perioperative morbidity and mortality were 22.5% and 5%, respectively. Five patients with renal ischemic time ≥20 min developed acute kidney injury, showing a significant positive correlation (r = 0.465; P < 0.0001) with clamp time. Postoperative mean serum creatinine values also showed a significant difference (P = 0.0001) between <20 and ≥20 min groups. At follow-up, graft patency and limb salvage rates were 100%, and the survival rate was 97.4%. Conclusion: The risk of atheroembolic renal ischemia in ABFB for JRAIO can be lowered by good preoperative planning and safe intraoperative clamping technique, based on a simple classification for aortic clamping.
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Outcomes following spliced vein graft and composite graft as conduit for infrainguinal bypass: An institutional experience p. 377
S Arun Prasath, Arunagiri Viruthagiri, Nedounsejiane Mandjini
Background: Peripheral arterial disease is a significant health care burden globally. Treatment options for limb salvage include open surgical bypass or endovascular revascularization. One of the vital prerequisite for successful infrainguinal bypass is the availability of good conduit. Not all patients have good quality great saphenous vein of adequate length to facilitate bypass. In these scenarios, splicing of available autologous veins and synthetic graft with vein cuff are alternate options. Aim: To compare the outcomes of infrainguinal bypass done for patients with chronic limb threatening ischemia in two groups In Group I, non spliced GSV was the conduit used. In Group II, either spliced vein graft or synthetic graft with vein cuff was used. Materials and Methods: This is a retrospective study done in a tertiary care centre over a period of 40 months. Ipsilateral Great Saphenous Vein (GSV) was our preferred conduit. In the absence of good calibre GSV, splicing of available autologous veins were done. Only when autologous veins were not available synthetic graft was used with distal vein cuff. Results: A total of 52 patients have undergone bypass during the study period of which 15 patients (28.8%) did not have good calibre GSV. Splicing of autologous veins were done for 10 patients (19.2 %) and synthetic graft with vein cuff was used for 5 patients (9.6%). One year graft patency in group I was 81% and in group II was 66.6%. Limbs were salvaged in 86% of patients in either groups. The mortality rate was 8.1% and 6.6% in groups I & II respectively. Conclusion: When good caliber GSV is not available, splicing of available autologous veins provide comparable patency and should be preferred over synthetic graft. Synthetic graft provides acceptable limb salvage rate when used with an adjunctive procedure like vein cuff for tibial bypasses and should be used when autologous veins are not available or when the patient carries a high risk for major surgery.
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Kite string vascular injuries: Management of uncommon vascular injuries with common suggestions p. 381
Devender Singh, Aruna Sree Kottilliyil, Basavarajendra Anurshetru
Introduction and Objectives: Vascular injuries due to kite string are uncommon but are associated with significant morbidities and mortality. With the increase in the sharpness of the string, the incidence of these injuries is on the rise not only to flyer but also to the innocent other people. We present our experience as there is a relative paucity of data and literature on this subject and suggest measures to control. Methods: Between January 2016 and January 2022, six patients suffered vascular injuries due to kite string (manja) and were admitted to the vascular unit of tertiary care center. The medical histories of the patients were reviewed retrospectively and analyzed. Initial treatment included hemorrhage control by direct pressure or packing and fluid resuscitation and airway establishment by intubation (if required). Neck injuries were divided into three zones. All patients were subjected to computed tomography angiography followed by emergency exploration and repair. Results: Males are most commonly affected. The most common age group affected was 3050 years. Majority of these patients were travelling on a two wheeler. The neck was most commonly involved with primarily venous injuries. Four patients had injuries in Zone II and one patient in Zone I. One patient had a deep laceration around the ankle with vascular and significant soft-tissue injuries. The injuries were of the jugular veins, external carotid artery, trachea and tibial artery, nerve, and tendoachilles (complete tear). All the major vascular injuries were either repaired or ligated. There was no major morbidity or mortality. Conclusion: Kite flying is a popular sport in the Indian subcontinent. Vascular injuries due to sharp string can lead to grievous injuries or may be fatal. This study attempted to enlighten these dangers and emphasize that potential threats have to be understood and addressed adequately.
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Comparative study of cardiac risk indices to predict perioperative cardiovascular outcome in patients with peripheral vascular diseases p. 385
Vivek Kumar Singh, Sudhir Rai, Vembu Anand, Nitu Singh
Introduction: Existing methodologies and risk stratification indices for predicting peri-operative cardiac complications in vascular surgery patient lack sufficient predictive value and therefore cannot be recommended for risk stratification. There are no Indian studies for preoperative cardiac risk scores for patients who undergo vascular and endovascular procedures. Therefore, an attempt was made to risk stratify and compare two existing cardiac risk indices (i.e., Detsky's modified cardiac risk index vs. Revised cardiac risk index [RCRI]) to predict peri-operative morbidity and mortality due to cardiac causes. The aim of this study: (a) To compare Detsky's modified cardiac risk index and RCRI to predict perioperative cardiovascular outcome in patients with peripheral vascular disease undergoing surgical intervention. (b) To predict perioperative cardiovascular outcome based on cardiac risk index in patients with peripheral vascular disease undergoing surgical intervention. Materials and Methods: This is an observational, prospective, longitudinal, controlled cohort study, which assessed 103 patients admitted at vascular centre for a period of 2 years. All patients undergoing vascular surgical procedure and evaluated by a cardiologist in the preoperative period were included in the study. Results: Eighteen patients (17.4%) had cardiac complications. The Detsky's index was found to be a satisfactory predictor of postoperative cardiac events (P < 0.001) as compared to RCRI which had a P < 0.003. There were a total of 10 mortalities (9.7%). Detsky's model and RCRI had positive predictive value (PPV) of 73.3% and 31.4%, specificity of 94.1% and 72.7%, respectively. Discussion: The overall sensitivity, specificity, PPV, negative predictive value of the Detsky's risk index, and RCRI in the prediction of cardiac events were 31.4%, 94.1%, 73.3%, 72.7% and 73.3%, 72.7%, 31.4%, 94.1%, respectively. In our study, the area under ROC for Detsky class was 0.76 versus 0.75 and superior to C statistic. However, the area under ROC for RCRI class was 0.72 versus 0.75 and inferior to C statistic. One important inference from the study was that 77.6% patients were smoker in the study group which emphasize the direct relation of peripheral vascular disease with smoking. Conclusion: The study concluded that patients with good surgical risk and profile undergoing minor vascular procedures can be operated without further testing. For other patients, the next step would be to incorporate the Detsky index. A Detsky score of 20 or more is comparable to a major clinical predictor in the American College of Cardiology/American Heart Association scheme.
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First femoropopliteal bypass for a critical limb ischemia: The saga of joy and sorrow p. 391
Devender Singh, Madavan Praveena, Shalini Aryala
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Obscure presentation of postthrombotic syndrome p. 393
Jayesh Patel, Manisha Rajesh Asrani, Arya Patel, Gazal Patel
Postthrombotic syndrome (PTS) will develop in 20% to 50% of patients within 1 to 2 years of symptomatic deep venous thrombosis (DVT). Limbs afflicted with PTS have more than three times the odds of having combined reflux and obstruction compared with limbs without PTS. Here, we present a case of an involvement of the right lower limb with classical features of PTS. Due to its low prevalence and similar presentations as those of chronic venous insufficiency lead to a missed diagnosis and prolonged follow up and complications of PTS. This can be prevented by employing CT venography as an early investigation modality. Here we treated the patient with open method as endovascular procedure was not successful.
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Isolated giant infrarenal abdominal aortic aneurysm with dissection: Case report of an extremely rare entity p. 397
Divij Jayant, Arunanshu Behera, Cherring Tandup, Satish Subbiah Nagaraj, Saroj Yadav
Although abdominal aortic aneurysm (AAA) is common in the atherosclerotic aorta in the elderly, isolated AAA (IAAA) is a rare entity. Only few case reports of IAAA associated with concomitant dissection are reported in the literature. Here, we present a case of a middle-aged male who presented with abdominal pain with stable hemodynamics. Abdominal examination revealed a pulsatile mass in the left paraumbilical region. CT angiography of the abdomen revealed an isolated infrarenal AAA with dissection extending into the bilateral common iliac arteries and an eccentric partial thrombosis of the false lumen. The patient underwent successful open aneurysmorrhaphy with PTFE graft. Postoperative course was uneventful, and the patient was discharged to follow up in clinics.
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A case of duplication of inferior vena cava and turner syndrome: Is it a rare association? p. 401
S BS Netam, Vishal Jain, Shubhkriti Agrawal, M Rashika
Turner syndrome is one of the most common sex chromosome disorders with many anatomical abnormalities that affect physiological systems of human body. The most common cardiovascular anomalies in Turner syndrome are bicuspid aortic valve and coarctation of aorta. The venous anomalies include partial anomalous pulmonary venous return and persistent left sided Superior vena cava. Duplication of inferior vena cava (IVC) is rare in occurrence. On extensive literature search, no such case of IVC duplication in Turner syndrome is found. We, herein, report an incidental finding of IVC duplication in a known case of Turner syndrome. Any patient with Turner syndrome should be evaluated for additional venous anomalies.
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Surgical management of a true aneurysm of the digital artery p. 404
Devender Singh, Madavan Praveena, Shalini Aryala
True aneurysms of the digital artery are exceedingly rare, and a few cases have been reported. They form an important differential diagnosis in any patient presenting with a lump in the hand. We present a case of a 44-year-old man with a true aneurysm of the left common palmar digital artery, who underwent successful repair, following excision and end-to-end anastomosis.
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Successful management of abdominal aortocutaneous fistula following emergency endovascular aneurysm repair for aortoenteric fistula in a patient with Takayasu arteritis p. 407
Rahul Ralph Sima, N Sekar, AB Gopalamurugan, Archana Rajan, Jithin Jagan Sebastian
Aortocutaneous fistula is an extremely rare complication after aortic endograft infection. We report on the management of a patient who presented with aortocutaneous fistula following emergency endovascular aneurysm repair (EVAR) of an aortoenteric fistula (AEF). A 50-year-old female with Takayasu arteritis who had undergone thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm, 23 years ago presented with a spontaneous abdominal AEF and another contained ruptured descending thoracic aortic aneurysm distal to the previous endograft. She underwent emergency bridge EVAR and redo-TEVAR. Thirteen months following EVAR, she presented with endograft infection and a spontaneous aortocutaneous fistula. She was successfully managed with an axillo-unifemoral bypass followed by EVAR endograft explantation. She was discharged on long-term antibiotics and has been symptom free for 12 months.
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Giant true inferior pancreaticoduodenal artery aneurysm associated with celiac axis occlusion: A first case of successful treatment with covered balloon-expandable stent grafting using VBX p. 411
Animesh Singla, Ye Tan Cai, Krishna Kotecha, Walid Mohabbat
Giant visceral artery aneurysms are uncommon. Branch vessel aneurysms, particularly of the pancreaticoduodenal territory are challenging to treat due to their location, anatomy, and access to an aneurysm. While open surgical resection is associated with significant morbidity, endovascular treatment is becoming increasingly mainstream. The utilization of coil embolization, particularly in the setting of rupture has been well described. Access and platform in these settings often involve the celiac axis. We describe unusual care of a large inferior pancreaticoduodenal aneurysm and associated retroperitoneal bleed, being fed through an ectatic superior mesenteric artery. This was associated with an occluded celiac axis. Due to the unusually large proximal and distal landing zones, a covered balloon-expandable stent was deployable with the successful exclusion of the aneurysm. This is the first reported case report of successful management of retroperitoneal rupture and associated pancreaticoduodenal aneurysm treated with a covered stent graft. This technique allowed for rapid access and exclusion of the aneurysm. In addition, it allowed the preservation of foregut flow through the collateral pathway and successfully excluded the large aneurysm.
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Spontaneous pseudoaneurysm of posterior tibial artery with deep vein thrombosis and compartment syndrome p. 415
Neelamjingbha Sun, Sriram Manchikanti, Aditya Gupta, Shivanesan Pitchai
Posterior tibial artery (PTA) aneurysms are rare and associated with trauma and orthopedic interventions. We present a rare case of spontaneous pseudoaneurysm of the PTA, complicated with deep vein thrombosis and compartment syndrome. The patient was managed with popliteal to PTA bypass using contralateral limb reversed saphenous vein graft, and yielded good results.
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Giant femoral aneurysm in giant cell arteritis p. 418
Muhammed Bayram, Zihni Mert Duman, Elif Gokce Devecioglu, Baris Timur
Giant cell arteritis (GCA) which mostly causes thoracic aortic aneurysm is the most common vasculopathy of medium and large vessels, especially in people over 50 years of age. A 63-year-old male patient presented with pain and swelling in the right inguinal region. On examination, a pulsatile mass was palpable in the right femoral region. Computed tomographic angiography showed aneurysm enlargement reaching 70.9 mm in diameter at the level of the right common femoral artery (CFA). Aneurysm excision and Dacron graft interposition surgery was performed for the patient with local pain symptoms. The patient who had no postoperative complication was discharged 3 days later. Two weeks later, the pathology result of the aneurysm was obtained. Pathological examination of the aneurysm was GCA, and also, temporal artery biopsy was also performed to clarify the diagnosis. In this case report, we report the first defined CFA aneurysm caused by GCA and its surgical treatment. In the patient whom we did not think of as inflammatory arteritis at the first stage, we reached the actual diagnosis with pathology examination. Therefore, we recommend that all surgically removed aneurysm tissues be sent for pathology examination.
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Clinicoradiographic aspects of arteriovenous malformations involving the orofacial region: A case series p. 421
Shilpa J Parikh, Harmi P Patel, Jigna S Shah, Sadhana Kothiya
Vascular malformation consists of a group of tumors that emerge from the vascular origin caused by vascular or lymphoproliferation. Arteriovenous malformations (AVMs) contribute high-flow, creating direct vein artery contact without regular capillary network. AVMs are present at birth or in congenital. Acquired AVMs occur later in life due to hormonal changes or trauma. AVM of the head and neck is a rare vascular anomaly but when present is persistent and progressive in nature and can represent a lethal benign disease and an incomplete resection frequently leads to recurrence of the lesion. Here, we present a series of three cases of AVM reported during 2019–2022 involving the orofacial region.
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Anthologies in vascular surgery-12 p. 426

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