Objectives: To determine whether delayed vascular repair is feasible or has good results in delayed presented cases of vascular trauma, even after >48 h with ischemic changes in some cases. General literature said that <6 h is appropriate for limbs salvage but our study said that this time limitation can be extended to a greater extent. We have chosen this study because our adverse geographical conditions-desert, hilly and tribal, and roads conditions are not so apt that patients get accessible to surgical intervention in the time limit as stated in the literature. Hence, we consider these patients for surgery even after delayed presentation as limb loss is emotionally/psychological deterrent as well as economic hardship to the patient. To the best of our knowledge, this is the first report on delayed vascular trauma repair from our region of India. Materials and Methods: Prospective analyses of 100 patients operated for peripheral vascular injuries between August 2011 and April 2014 were done. Diagnosis tools included physical examination, pulse oximeter and handheld Doppler alone or in combination with computed tomography angiography. Primary end-to-end vascular repairs or embolectomies were carried out where possible; if not possible, interposition vein graft was placed. Patients with injury > 48 h, with obviously unsalvageable lower extremity injury requiring primary amputation, severe other body organ injury, on ventilator support, vascular injury below trifurcation of popliteal artery, and having ischemic line of demarcation were excluded from the study. Results: Of the 100 patients, 86 were males (86%) and 14 (14%) were females (14%), and their age ranging from 5 to 80 years. Mean duration of the presentation of our study cases was 56 hours after the injury. The most common etiological reason was road traffic accidents; nearly 67% of the patients in penetrating trauma group and 58% among blunt traumas. The incidence of concomitant orthopedic injuries was 74%. The most common injured artery was brachial artery 36%, followed by popliteal artery 30% and femoral artery 22%. Surgical intervention included primary repair with end-to-end anastomosis in 45%, and embolectomy in 15%, whereas interposition of vein graft were placed in 40% cases. Final outcome was – 77% had viable and functional limbs and 15% had viable, but nonfunctional limbs and amputation after repair was 8%. Conclusions: Delayed surgery in vascular injuries has a prognostic value for salvaging the extremity/limb and life of the patient as well as vascular injuries require immediate surgical intervention, regardless of localization but the extent of time limitation for vascular intervention can be widened. Patients suffering from vascular injuries to the extremities should be transferred to vascular surgery centers as soon as possible and consider the patient for surgery even after the delayed presentation.

Objective: To study the outcomes of the ultrasound guided foam sclerotherapy (UGFS) treatment for superficial venous insufficiency. Materials and Methods: Selected patients with varicose veins were treated with UGFS using sodium tetradecyl sulfate as sclerosant and followed up to 1-year. Total 148 legs in 123 patients, 98 unilateral limbs, and 25 bilateral limbs were treated by this method. Results: Out of 148 legs saphenofemoral junction (SFJ) incompetence was found in 42 and sapheno-popliteal junction (SPJ) incompetence in 49, perforator's incompetence in 11, while combination of SFJ and perforators and SPJ and perforators in 16 and 7, respectively. Great saphenous vein varicosity was found in 58, short saphenous vein in 56 and others 34. Twenty-four limbs had recurrent varicose veins previously treated by other modalities, and 124 limbs had primary varicose veins. Fifty-two limbs were treated for complicated varicose veins (CEAP 4-6) and 96 limbs for uncomplicated varicose veins (CEAP 2-3). Early outcome was 100% success rate. No recurrences were noted at 1-year follow-up. Early complications were: Superficial skin necrosis in 4 legs (2.70%), pain at injection sites in 21 legs (14.18%), superficial thrombophlebitis in injected vein in 21 legs (14.18%), bruising in 18 legs (12.16%), superficial vein thrombosis in 10 legs (6.75%), and skin staining around injected veins in 13 legs (8.78%). Conclusion: UGFS is a safe, good, and effective treatment modality of treatment for patients with varicose veins and found to be associated with significantly less bruising and pain.

Deep vein thrombosis (DVT) that develops in a hospitalized pediatric patient can has serious consequences. Prophylactic strategies with unfractionated or low molecular weight is not practised in children like it is practised by clinicians in adults. It is important to identify high-risk pediatric patient who has risk factors for developing DVT, so as to prevent in-hospital morbidity, mortality and increased hospital stay.

Secondary aorto-enteric fistula (SAFE) is a late but dreaded complication of abdominal aortic surgery with an overall mortality ranging from 30% to 70% in different series. Most commonly the patients with SAFE, present with the massive gastrointestinal bleed or other symptoms such as sepsis, lower extremity ischemia, abdominal pain, septic arthritis, and multicentric osteomyelitis. Treatment requires prompt diagnosis, and surgery. We present a case of para-prosthetic graft to bowel fistula in a patient who was asymptomatic and has presented for treatment of ventral wall incisional hernia.

Glomus tumor is a rare benign neoplasm that arises from the neuroarterial structure called a glomus body and accounts for 1–2% of soft tissue tumors in the hand. The patients with glomus tumor will present with excruciating pain, disproportionate to their signs, as the majority of the time there are no visible manifestations. Hence, these patients are treated with all the specialties (including psychiatrists) with different combinations of analgesics, anxiolytics, and antidepressants. A strong clinical suspicion and a properly planned surgery remain the treatment. We present a case of a 36-year-old male suffering from excruciating pain, demanding to the extent of amputation, was diagnosed clinically based on his history and treated for subungal glomus tumor of a left middle finger.

A 4-year-old male child was admitted with a history of difficulty in swallowing, failure to thrive and recurrent respiratory tract infections. On investigations, cardiac computed tomography was suggestive of a double aortic arch (DAA) and a virtual bronchoscopy was suggestive of tracheomalacia. After ligating the nondominant part of the DAA, the child had symptomatic relief.

Hemangiomas are one of the commonest benign soft tissue tumors of vascular origin affecting females more than males. Deep soft tissue hemangiomas are uncommon and usually involve skeletal muscles. Intramuscular hemangiomas commonly involve muscles of the lower extremity and rarely the upper extremity. Clinical diagnosis is often missed/delayed as chronic pain and/or swelling are often the only symptoms. We present a case of intramuscular cavernous hemangioma of the triceps muscle in a young male with brief review of literature.

A rare case of right frontal bleed in elderly gentleman secondary to anterior cranial fossa dural arteriovenous fistula was detected on computed tomography angiogram, and complete endovascular embolization was achieved through ophthalmic arteries using glue as embolic material. Successful endovascular treatment along with surgical evacuation of subdural hematoma resulted in excellent recovery of the patient. Quick in-and-out approach using flow directed microcatheters and fast embolizing potential of glue may allow for rapid, safe, and successful embolization of such fistulas. The rarity of the location and the transarterial glue embolization of the nidus by micro catheter through both ophthalmic arteries makes this an interesting case for discussion.

Collateral circulation in the brain is important for maintaining a sufficient cerebral blood flow in case of obstructive disease of arteries. In case of hemodynamic compromise to the anterior circulation, the posterior circulation supplies the anterior circulation via the collaterals. Simultaneous anterior and posterior circulation stroke is a very rare occurrence. It can occur due to cardioembolic stroke or due to anatomical variants of the circle of Willis. Fetal origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), persistent trigeminal artery, and persistent hypoglossal artery are known to present with posterior circulation stroke due to occlusive disease of ICA. Here we report a 85-year-old man who presented to us with left hemiparesis. On evaluation, he had right middle cerebral artery (MCA), anterior cerebral artery (ACA), and PCA infarct. Our case most likely had fetal PCA, which can readily explain the PCA infarction in ICA occlusion. Although cases of simultaneous MCA and PCA infarction had been reported in past, we report the first case with simultaneous ACA, MCA, and PCA infarction secondary to fetal PCA.