Vascular surgery is considered a high-risk noncardiac surgery. It is associated with an increased risk of cardiovascular events in the perioperative period. Preoperative assessment of risk using validated scales such as Revised Cardiac Risk Index, helps informing patients, surgeons, and anesthetists on the potential risk of cardiovascular events. Cardiac biomarkers, such as NT pro-brain natriuretic peptide (pro-BNP)/BNP, improve the sensitivity of these scales, in predicting potential serious perioperative cardiovascular outcomes. It is cost effective and quicker than other invasive or noninvasive procedures, usually done before any vascular surgery. Several interventions have been tested in trials for potentially preventing an event, but none have given good quality evidence for benefit, except the use of statins. Postoperatively, use of drugs to prevent a cardiovascular event has not been as effective as in the nonsurgical setting (aspirin, β-blockers, α₂agonists, and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers). Monitoring of highly sensitive troponins better predicts 30-day mortality in patients undergoing any noncardiac surgery. This event is called myocardial injury after noncardiac surgery (MINS) or in short MINS. Currently, MINS is not detected in over 75% of vascular surgery patients as it is not routinely performed. As per the evidence reviewed in this article and as recommended by the Canadian Cardiovascular Society Guidelines, it is imperative we monitor all patients aged above 45 years undergoing vascular surgery. Even though there is no evidence for an effective intervention of MINS, detections help in better monitoring of the patient and initiating effective secondary prevention treatment, as indicated.

Congenital vascular malformations are one of the most challenging subgroup of diseases treated by vascular surgeons and interventionalists. Currently, there exists a lot of misunderstandings and controversies in terminology, diagnosis, and management of patients with these problems. This review article helps doctors with a concise and current understanding of classification, clinical features, complications as well as diagnostic and therapeutic guidelines.

Introduction: Surgical treatment of abdominal aortic aneurysms (AAA) has evolved over the past 15 years. Fenestrated endovascular of AAAs (FEVAR) and Chimney endovascular of AAA (Chimney EVAR) are techniques that have been introduced and utilized over the past few years as alternatives to open surgical repair with its high associated morbidity and mortality. The purpose of this study is to compare the results of FEVARs and Chimney endografts in a single institution from an Asian perspective. Materials and Methods: We retrospectively reviewed all patients who underwent FEVAR and Chimney EVAR from January 2011 to August 2014 in a tertiary vascular institution. Results: During this study period, a total of 19 patients underwent Chimney EVAR, and 12 patients underwent FEVAR. All FEVAR patients were operated electively while five patients who underwent Chimney EVAR were operated in an emergency setting. Operative time was longer for FEVAR and more vessels were reconstructed. There was no difference in intraoperative technical events, postoperative general and specific complications between the two groups. One patient passed away within 30 days of repair with Chimney EVAR. Conclusion: In this limited retrospective series, short-term results of FEVAR and Chimney EVAR had no statistical difference. Chimney EVAR is an attractive and useful alternative for patients who are unable to undergo FEVAR.

A true aneurysm formation in an arterialized vein graft used for lower limb arterial occlusive disease is a rare complication. The saphenous vein is the preferred conduit for infrainguinal bypass. For extra-anatomical bypass-like femorofemoral crossover, a synthetic graft is preferred. A successful outcome of femorofemoral crossover bypass with autogenous vein is well described. This case report is regarding a 67-year-old male who underwent femorofemoral crossover bypass with reversed saphenous vein graft 15 years ago for arterial occlusive disease, who now presented with degenerative aneurysm of the graft with an incidental infrarenal Abdominal Aortic Aneurysm. He underwent aortobifemoral bypass with jump graft to right internal iliac artery and resection of aneurysms. Histopathology of venous aneurysmal wall showed graft wall calcification with fibrin and collagen deposits. The causes of saphenous vein graft aneurysm have been described to be mostly atherosclerotic but it may be a part of systemic dilating pathology.

Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and <0 as low probability. Results: There were 68 patients with a history suggestive of DVT. Doppler ultrasonography being considered as gold standard for diagnosis confirmed 65 cases as DVT (95.6%) on the 1^st day and remaining 3 cases were confirmed on the 3^rd day in repeat Doppler ultrasonography. Mean age was 55.5 years (range: 34–75, standard deviation [SD] 11.3 years). Mean days of history was 3 days (range 1–10 days, SD 2.2 days). Pitting edema was present in 95.6% of cases which was the most common clinical characteristic in patients with DVT. This was followed by swelling of entire leg (67.6%), followed by localized tenderness along the distribution of deep venous system (64.7%). In 51 cases (75%), Wells' score was ≥3 (high probability), while in 14 cases (20.6), it was 1–2 (moderate probability) and in 3 cases (4.4%) it was <0 (low probability). In terms of positive Wells' score (≥2), there were 55 cases (80.9%). Conclusion: Wells' scoring can be used for diagnosis of DVT in lower extremities, but for further accuracy, it needs to be reconfirmed by Doppler ultrasonography.

Introduction: Based on angiosome concept to revascularize a particular artery, the microvascular and reconstructive surgeons must know the anatomy and variations in the arteries in that specific region of the body to achieve better results. Nowadays, dorsal metatarsal artery (DMTA) perforator flaps and toe grafts are becoming popular which also demand adequate information about normal anatomy and variants in these arteries for fruitful results. Materials and Methods: The authors studied normal anatomy and variations in the origin of DMTAs in 50 lower extremities of 25 embalmed cadavers. Results: The authors found many variations as the absence of DMTAs, origin of the DMTA from the deep plantar arch. The places wherever the arcuate artery was absent the lateral tarsal artery gave rise to dorsal metatarsal arteries. Conclusion: Being familiar with the incidence of anatomical variations in the origin of the DMTAs can increase vigilance in vascular and reconstructive surgeries leading to better prognosis. surgeries leading to better prognosis.

With the continued increase of video gaming around the world, we present a review of the literature on vascular injuries associated with gaming to explore any common mechanisms of vascular injuries sustained and make recommendations to prevent them. A 2017 systematic review of all reported vascular injuries associated with video gaming was performed using Medline and PubMed searches including the following keywords: “Thrombosis” or “Artery” or “Vascular” or “ethrombosis” and “Video game” or “Wii” or Nintendo” or “Wiiitis” or “Computer game.” A total of 11 case reports reporting 12 vascular injuries associated with gaming were identified. Nine vascular injuries from gaming were associated with venous thromboembolism (VTE). Nearly 67% of cases resulted in major pulmonary emboli, one fatal. In the majority of VTE cases, the only risk factor known was prolonged immobility. All cases had negative thrombophilia screens or no history of thrombophilia. Two injuries occurred from intense physical activity on Nintendo Wii causing internal carotid artery dissection and permanent disability. One case was of an intraventricular hemorrhage from an arteriovenous malformation rupture occurring during gaming causing neurological deficits. Most vascular injuries from gaming were related to VTE. Immobility appears to be the solitary risk factor reported in most of the cases, an unusual finding with regard to the multifactorial nature of VTE pathogenesis. We recommend gamers not remain immobile for more than one continuous hour, taking breaks to mobilize or perform lower limb exercises.

Objectives: The objective of this study was to evaluate the efficacy, safety, and clinical outcome of percutaneous chemical lumbar sympathectomy (PCLS) in Buerger's disease (thromboangiitis obliterans [TAO]). Design: This was a retrospective comparative study. Methods: TAO patients who underwent PCLS in surgery department of a teaching hospital in Central India. Diagnosis of TAO was made on clinical grounds and color Doppler study. PCLS was done under image guidance after amputation of gangrene or before if a clear line of demarcation was lacking. After PCLS, patients were followed up on next day and after 2, 4, 8, and 12 weeks. Outcome monitored were improvement in rest pain (using visual analog scale) and healing of ischemic ulcers. Results: All patients were males, chronic bidi smokers, mostly in the third decade of life. All had involvement of lower limbs either ischemic rest pain or ischemic ulcers or gangrene of toes/forefoot. A total of 167 PCLS (20 bilateral) were performed on 147 TAO patients from June 2008 to January 2016. Imaging modalities were computed tomography scan (n = 67), digital X-ray (n = 50), and C-arm fluoroscopy (n = 50). Success rate for chemical neurolysis was > 82%. Excellent long-lasting rest pain relief was obtained in > 80% patients. Ulcer healing was seen in majority of patients. Large number of limbs (103/167) had gangrene of toe/multiple toes/part of forefoot. Those with patent popliteal artery fared better. Conclusions: PCLS can provide safe and efficient treatment for rest pain and healing of ischemic ulcers in TAO.

Nontraumatic acute limb ischemia (ALI) may cause significant morbidity and death if not addressed in time and need to be promptly recognized and treated. Perfusion should be thoroughly assessed using available multiple methods, and patients should be considered for revascularization (endovascular or open surgery) to restore blood perfusion as soon as possible. Underlying conditions, which caused ALI, need to be assessed and treated accordingly.

Renal artery pseudoaneurysm is a very rare complication after blunt trauma. Congenital anomalies like horseshoe kidney, ectopic kidney, pelvi-ureteric junction obstruction, etc., make it more vulnerable to trauma. We report a case of a 21-year-old male admitted to our hospital 3 days after blunt abdominal trauma with complaints of lower abdominal pain, hematuria, and hypotension. The diagnosis of ectopic right kidney with interlobar laceration was established by ultrasonography. Computed tomography angiography showed interlobar renal artery pseudoaneurysm in ectopic right kidney. Successful superselective endovascular coil embolization of the pseudoaneurysm was performed.

Acute carotid blowout syndrome (CBS) is the most dreaded complication in an invasive head-and-neck malignancy. The syndrome occurs in 3%–4% of all head-and-neck cancer patients. This report is inquisitive about the effectiveness of preservation of carotid artery during a life-threatening acute carotid blowout in an invasive CBS.

True aneurysm of upper limb arteries is a rare entity with very few reported cases. Here, we report a case of true aneurysm of proximal radial artery starting from its origin at brachial artery bifurcation. A 50-year-old female presented with a painful pulsatile mass in the left cubital fossa of 1 year duration. Duplex examination revealed partially thrombosed large aneurysm of proximal radial artery. Aneurysmal segment was resected and end of distal brachial artery anastomosed end-to-end with ulnar artery. Radial artery was reconstructed with interposition reversed saphenous vein graft from side of brachial artery to end of radial artery.

We report a case of an arterio-enteric fistula between an Right iliac artery and otherwise healthy cecum, presenting with torrential lower gastrointestinal bleed in an 14-year-old patient. Whilst fistulization to the aorta and common iliac arteries has been reported, to our knowledge no previous cases of post traumatic fistulization between an right iliac artery and normal cecum has been reported. Successful open exploration primary repair of iliac artery rent with ileostomy and colostomy was done. Later stoma reversal was done successfully.

Knee arthroscopy is a common procedure to treat sports injuries. It is a safe procedure with less injury to soft tissues and very few complications. Pseudoaneurysm of the popliteal artery and/or arteriovenous fistulae is a rare complication of arthroscopic procedure of the knee. We report a case of popliteal artery pseudoaneurysm with arteriovenous fistulae after arthroscopic procedure of the knee in a younger sportsman.

Pulsatile swellings in the leg are uncommon. Almost all the reported cases in the literature are due to the result of an arterial wall injury, presenting as either pseudoaneurysm or aneurysm. A small number of arteriovenous fistula, vascular malformation, and vascular tumors have also been reported. We report a rare case of pulsating skeletal muscle metastasis from renal cell carcinoma, mimicking as an anterior tibial artery aneurysm. The aim of presenting this case is to highlight the importance of detailed clinical history and need for imaging modalities and to keep the possibility of even remote causes in the initial workup.