Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. PGE1 was the agent used since 1973 for cardiovascular diseases, mainly in patients with advanced PVD. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible and also as an adjunct when there is residual ischemia after revascularization. The review of literature and the use of PGE1 in CLI is presented here along with our experience in NIMS.

The lateral marginal vein is one form of truncular venous malformation seen commonly in Klippel–Trenaunay syndrome. It is characterized by avalvulosis and presents with features of chronic venous insufficiency. As there can be associated intravascular thrombosis, there is an increased risk of venous thromboembolism and pulmonary embolism. In children, it can cause vascular bone syndrome. Surgical excision is indicated when possible to prevent complications.

Introduction: Varicose vein of the lower extremity is a very common problem and is associated with severe morbidity if left untreated. Recurrence is inevitable if preoperative assessment of incompetence is not accurate. This study aims to compare the accuracy of clinical tests and Doppler ultrasound in the localization of incompetence with the Turner Warwicks bleed back sign at operation. Materials and Methods: This is a prospective study of patients with lower limb varicose veins admitted to the department of general surgery. 53 limbs were studied in 50 patients. They were evaluated by clinical tests and Doppler ultrasound. Results: Saphenofemoral incompetence was correctly diagnosed in all 53 limbs both by clinical test and Doppler ultrasound. In the evaluation of perforator competency, the sensitivity was 82.93% by clinical tests and 97.56% by Doppler ultrasound. Conclusion: Doppler ultrasound evaluation of the varicose veins should be done for accurate diagnosis in all patients before planning surgery.

Objective: Vascular interventions are associated with a substantial risk of major adverse cardiovascular events (MACEs) in perioperative period. We aimed to analyze the predictive value of plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) for early MACE following elective vascular intervention. Materials and Methods: We conducted a single-center, prospective, observational study at Jain Institute of Vascular Sciences, Bengaluru. One hundred and two patients undergoing elective vascular intervention were enrolled in the study. Results: A total of nine patients had MACE comprising seven acute coronary syndromes, one atrial fibrillation, and one congestive cardiac failure in perioperative period. Three patients had MACE preoperatively. Mean age was higher in MACE group (68 years vs. 62 years, P = 0.21). Receiver operator curve analysis demonstrated NT-ProBNP threshold cutoff >1580 ng/ml and >2020 ng/ml, pre- and post-operatively. In patients with MACE, mean plasma concentration of pre- and post-operative NT-proBNP was 13,293.34 ng/L and 5628.84 ng/L compared to non-MACE group of 664.60 ng/L and 818.75 ng/L, respectively. Positive and negative predictive values for pre- and post-operative NT-proBNP were 24%, 98.5% and 33%, 98.8%, respectively. Conclusion: Presence of hypertension and elevated pre- and post-operative NT-proBNP values is significantly associated with higher incidence of early MACE (30 days) and is not influenced by age, gender, and previous coronary artery disease. NT-proBNP can be considered for the quantification of perioperative cardiac risk in vascular surgery patients.

Introduction: Alongwith the increasing awareness of fistula for dialysis, there has been an increasing utilization of endovascular interventions to create and maintain native Arterovenous fistulas. So far the widely practiced corrective endovascular options are fistulogram and plasty. However with most target segments being superficial veins of the outflow channel with juxta anastomotic lesions, ultrasound guided fistuloplasty is a promising answer to such a clinical scenario. Methods: All patients with diagnosed outflow vein obstruction with dialysis disturbance and no evidence of central vein stenosis were subjected to the procedure. Results: Satisfactory dialatation was achieved in 84% of patients at the end of one month. Only four patients required adjunctive procedure prior to dialysis. The most common procedure related side effect was hematoma- in 08 ( 19%) of patients, however they were non expanding and self resolving- limited to the area around the plasty site. Conclusion: The procedure can be accomplished in office setting avoiding the exposure of dye and radiation. It also decreases the burden on health care in operating theatres and decreases cost and time of hospitalization. However central vein stenosis and cephalic arch stenosis are definitely limitations of the procedure.

Inferior pancreaticoduodenal artery (IPDA) aneurysm is uncommon. The incidence is about 2% of all visceral arterial aneurysms. The causes are multiples but usually associated with celiac axis stenosis or occlusion. There are mainly asymptomatic and often detected incidentally, but in 30% of cases, symptoms are present. The mortality rate after rupture remains high (40%–60%). Diagnose of an inferior pancreaticoduodenal artery aneurysm associated with celiac axis stenosis or occlusion can be difficult and requires a selective angiography or a multislice computed tomography scan reconstruction. We described the case of an asymptomatic inferior pancreaticoduodenal artery aneurysm associated with a celiac axis stenosis treated by endovascular approach (coils and stent).

Pseudoaneurysms of brachial artery are rare cause of upper limb mass. Their diagnosis is straightforward in the setting of a rapidly growing pulsatile soft tissue mass with bruit or distal limb ischemia. We hereby present a case of hard nonpulsatile left upper limb soft tissue mass in a 50-year-old female. Mass of 5-year duration was misdiagnosed clinically as soft tissue neoplasm and underwent trucut biopsy. The case came out to be a large pseudoaneurysm of brachial artery and was successfully excised.

Persistent sciatic artery is a very rare vascular development anomaly with prevalence of 0.03-0.06% based on angiography. Majority of these patients are asymptomatic and usually present due its complications such as aneurysmal dilatations, thrombosis & distal thromboembolic phenomena. We report a case of 50 years old women who presented with swelling and pain in left gluteal region. CT angiography and ultrasound showed, bilateral PSA, complete on left side and incomplete on right side with pseudo-aneurysm on left side. She was managed successfully by endovascular stenting and is under regular follow up.

Upper extremity aneurysms are quite uncommon when compared to other peripheral arterial aneurysms. Among them, giant (>5 cm) subclavian artery aneurysms (SCAAs) are extremely rare. We report a case of giant SCAA measuring 8.8 cm in its maximal diameter with an updated review of literature. Our case is unique in view of surgical exposure method used (modified trapdoor thoracotomy with claviculectomy).