Purpose: Endovascular techniques offer a minimally invasive approach to the management of obstructive lesions of Innominate and Subclavian arteries. However, literature on long-term data on the efficacy of this option is sparse. The aim of this study is to report clinical and imaging results of a 17 years experience of the endovascular management of these lesions with evaluation of end-points at 3 years follow-up. Material and Methods: A retrospective review of prospectively collected data was undertaken on 112 patients (116 limbs) (mean age 58.9 years, range 36-84) who underwent endovascular treatment by the senior author (robotic kidney transplantation) from 1996 to 2013. There were 141 symptomatic innominate or subclavian arterial occlusive lesions. Endpoints of this study were primary patency, secondary patency and blood pressure differential in the affected limb at 1, 2 and 3 years follow-up. Results: Initial technical success was achieved in 134 (95.03%) lesions. Cumulative primary patency was 97.77% at 6 months, 95.48% at 1-year, 86% at 2 years and 85.3% at 3 years and secondary patency was 98.5% at 6 months, 95.48% at 1-year, 90% at 2 years and 87% at 3 years. A sustained nonrecurrence of symptoms and a BP differential improvement by >10 mmHg was observed in 82.7% cases at 3 years. Sub-analysis of data revealed that for nonostial stenotic lesions, balloon angioplasty performed as well as stenting, whereas for ostial stenosis and total occlusions, stenting was superior to balloon angioplasty (P = 0.003). There was a complication rate of 7.8% (2.84% major, 4.96% minor) with an associated mortality rate of 0.89%. Conclusion: Endovascular interventions can be accomplished safely with a high degree of technical success and excellent long-term clinical results. In accordance with current thinking, it should be the first line of treatment for intrathoracic supra-aortic arterial occlusive disease. In addition, primary stenting for all ostial and total occlusions is recommended.

Aim: The aim was to evaluate the various factors predicting patency following fistulography and percutaneous interventions in the management of nonfunctioning native vascular access. Materials and Methods: Retrospective analysis of 61 patients with native arteriovenous fistulae (AVF) who underwent fistulography and percutaneous interventions from January 2010 to December 2013. Mean patient age was 47 (23-78) years. 69% (42 of 61) of the patients were males. 56% (34 of 61) of patients underwent elbow AVF creation, and the remaining were forearm AVFs. Median time from fistula creation to fistulography was 9 months. On fistulography, hemodynamically significant (>50%) stenosis were identified in 93% (57 of 61) of patients. Angioplasty was attempted in 88% (54 of 57) of fistulae. In 14% (8 of 54) of cases, stent was placed. Results: Technical success was achieved in 98% (53 of 54) of fistulae following angioplasty. Clinical success (ability to use the AVF for successful hemodialysis) was noted in 87% (47 of 54) of cases. About 52% (32 of 61) of the fistulae had multiple stenosis. The most common location of stenosis was the venous limb of the fistula (70%). The primary patency rates were 75.4%, 68.9%, and 30% at 3, 6 and 12 months. The secondary patency rates were 100%, 89%, and 70% at 3, 6 and 12 months. The absence of palpable thrill postprocedure was found to be a risk factor for both primary, as well as secondary patency rates. Conclusions: Our results demonstrate that fistulography and percutaneous interventions in the form of angioplasty and stenting are helpful in maintaining the patency of nonfunctioning native vascular access. We found that the most important predictor of fistula patency following percutaneous interventions is the presence of palpable thrill. Our study also showed that stent placement is effective in treating venous stenotic lesions in native arteriovenous fistula hemodialysis patients after unsatisfactory balloon dilatation.

Introduction: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Methods: From August 2010 to January 2014, descending thoracic aorta to femoral artery bypass grafting was used to re-vascularize the lower limbs of the patients in our center. We analysedd our results Results: Primary indication was lack of a suitable site for aortic clamping. Average duration of surgery was 2.5-4.5 h, and blood loss was 100-400 mL. We use BARD®, IMPRA® expanded polytetrafluoroethylene vascular graft for thoraco-bifemoral bypass surgery. There was one mortality due to myocardial infarction. Major morbidities were graft occlusion in one patient that was managed by embolectomy and ascites in another patient, managed conservatively. Conclusion: Thoracic aorta to femoral artery bypass is a simple extra anatomic bypass technique, which can be used in case of difficulty to use abdominal aorta for lower limb re-vascularization.

Juxtarenal abdominal aortic aneurysm (AAA), a variant of infrarenal AAA forms a formidable therapeutic challenge in both open and endovascular strategies in view of its domain bearing viscero-renal arteries. Reported conventional surgical approach mandates supracoeliac/suprarenal aortic cross clamping that leads to significant renal morbidity and rarely mortality. We describe, a threefold adjuvant in surgical strategy namely division of left renal vein, interrenal aortic cross clamping and transaortic ostial instillation of renal preservation fluid through lower renal artery, that provided safe operating conditions leading to excellent results.

Distal DVT comprises of thrombosis of the infra-popliteal veins. This subgroup lacks standard clinical practice guidelines due to differing viewpoints on the etiopathogenesis, natural history, treatment and outcome. Most originate in the calf and resolve spontaneously. Detection also depends on the diagnostic modality used with invasive methods like venography yielding a higher incidence. It is seen more often in patients with transient risk factors (recent surgery, recent plaster immobilization, recent travel). Thrombus propagation/ extension can occur in 25%- 36% with symptomatic PE in 6-36%. Recurrence occurs in 4-29 % , chronic venous insufficiency( post thrombotic syndrome) can occur in 4- 23 %. The overall event rate (death, PE, extension, bleeding) is about 5% which can be further lowered with treatment

Iliac arterial injury in blunt pelvic trauma is rare, associated with fracture pelvis, massive retroperitoneal bleeding from the presacral, prevesical and venous plexuses, which is self-limiting but carries high mortality rate if it is allowed to re-expand after it was sealed. Most of the vascular injuries range from intimal injury with intimal flap formation to complete transection and total or partial occlusion by thrombus formation. Advances in endovascular therapy significantly change management of such vascular injuries and serves as a damage control helping the recovery from acute systemic injury and delay open surgical intervention. External fixation and endovascular management have increased in frequency and become the preferred method of intervention as it is safe with low complication rate. These are two case reports of two young males suffered blunt pelvic trauma, with huge retroperitoneal bleeding; left external iliac artery thrombosis managed with balloon mounted covered stent.

We present a rare case of brachial artery thrombosis following a penetrating injury on the right arm following a camel bite. A 57-year-old man presented with arm pain following a camel bite to the right arm. Brachial, radial and ulnar pulses were not palpable. Neurological examination revealed no motor deficit. Intraoperatively the brachial artery was thrombosed, thromboembolectomy was done following that the limb pulses were restored.

Accidental impaction of small fish bone in upper gastro intestinal tract is relatively common. Most of the time people ignore such small fish bone impaction as they become asymptomatic with subsequent swallowing of food. Rarely, it may perforate esophagus and cause serious complications and may even be fatal. A 28-year-old male was referred to us with a 4 day history of painful swallowing, and rapidly enlarging right sided neck swelling for last 3 days. He had a history of a fish bone impaction 2 weeks ago on the same side which he felt had resolved with subsequent dry rice swallow. Radiological investigation showed a pseudoaneurysm of the right common carotid artery (CCA) with impacted fish bone in the neck outside gastro intestinal tract impinging on the wall of CCA. The neck was explored; the CCA repaired, and patient was discharged in good health. This is an unusual complication of fish bone impaction. Urgent surgical intervention, rapid resuscitation and multidisciplinary approach are necessary for a good patient outcome.

Mycotic aneurysms are rare and usually occur secondary to embolization of septic foci. Early diagnosis is the crucial. They have high risk of rupture/complications and can pose a difficult management challenge especially in an acute setting. We describe the management of four patients with mycotic aneurysms in our case series.

A common celiaco-mesenteric trunk is the rarest of the anatomical anomalies of Coeliac axis seen in 1-2% of patients. A 55-year-old male was admitted with postprandial angina for 2 months with significant weight loss. He underwent a successful retrograde infra renal aorta to common celiaco-mesenteric trunk bypass with expanded polytetrafluoroethylene graft. Postprocedure symptoms improved well during the follow-up period with good weight gain.