Pre- or post-intervention, vascular surgical patients are expected to be on one or more antithrombotic agents. Antithrombotics have played a key role in reducing cardiovascular mortality in vascular patients. There are wide variations in the practice of prescribing antithrombotic agents in vascular services. Evidence-based current practice guidelines are often not strictly followed which puts some of these patients at increased risk of bleeding complications. This paper looks at the current practice guidelines on antithrombotics.

Deep vein thrombosis (DVT) has for long been under-diagnosed and ignored as one of the major causes of morbidity worldwide. Knowledge of the pathology and treatment of DVT has progressed many fold over the years. Inspite of it being common, knowledge of diagnosis and treatment of this potentially fatal condition remains limited. In this review article, we look at the DVT and the available options for diagnosis and treatment.

Background: The aim of the present study is to determine the role of simultaneous carotid artery stenting in high-risk patients with triple vessel coronary artery disease and to determine the safety and efficacy of the procedure in these cases. Materials and Methods: The present study is a retrospective analysis of 33 patients who underwent carotid artery stenting in the same setting in our institution from 2009 to 2016. There were 22 male and 11 females with a mean age of 65 years (53–76 years). Demographic factors clinical characteristics and atherosclerosis risk factors were documented. Results: Technical success was 100% in our series. Intraprocedural and postprocedural events in the form of hypotension and bradycardia due to hemodynamic depression were seen in 11 patients. We did not encounter hyperperfusion syndrome in any of our patients. Twenty-nine patients underwent cardiac bypass surgery after 3 weeks, and 4 patients were kept on medical management for coronary artery disease. No deaths or major strokes occurred in our series. Conclusion: Simultaneous bilateral carotid artery stenting is a safe treatment option even in patients with high-risk factors and can be considered as the therapeutic option in patients with significant bilateral carotid artery disease.

Background: Bleeding and vascular complications following retrograde common femoral artery access are studied. Access site complications, their incidence, and risk factors following antegrade access remain unclear. Materials and Methods: We retrospectively analyzed 189 patients from our prospectively collected database at Jain Institute of Vascular Sciences, Bengaluru, India. All patients had antegrade femoral access and underwent femoral and popliteal artery interventions from January 2013 to December 2014. We aimed to study incidence, risk factors, length of postintervention hospital stay, and early morbidity following antegrade femoral access. Antegrade direct arterial punctures resulted in a complication rate of 14.28%, which comprised 20 ecchymosis (74.07%), 5 groin hematoma (18.51%), and 2 pseudoaneurysm (0.07%). Two patients required blood transfusion. Groin hematoma was common in females (3 vs. 2 patients) than males but had less ecchymosis (7 vs. 13 patients). Age more than 69 years, female sex, 7 Fr sheath size, direct arterial puncture by palpation, and manual compression were associated with higher incidence of complications. Complicated patients had longer hospital stay (3.52 ± 1.19 days vs 1.34 ± 0.59; range 1–7 days; P = 0.0001). Conclusion: Several factors predict access site-related complications following antegrade femoral access, notably gender, age, ultrasound guidance, sheath size, and closure device. Knowledge of these findings could be useful to determine strategies to reduce access site vascular and bleeding risk and improve outcomes.

Aim: The aim is to assess risk and evaluate the usage of pharmacological thromboprophylaxis adhering to the American College of Chest Physicians (ACCP) recommendations for prevention of venous thromboembolism (VTE) during early days of hospital stay in critically ill and surgery patients at a tertiary care teaching hospital. Patients and Methods: A prospective study was conducted over 1 year where all patients admitted in Intensive Care Unit (ICU), and surgery wards were enrolled in the study after an informed written consent. A structured pro forma was designed, and effective risk stratification for VTE was done. Patients were followed until discharge to record any pharmacological thromboprophylaxis according to the ACCP prevention of thrombosis recommendations. Results: A total of 210 patients included in this study as per the Caprini VTE Risk Assessment tool. Of 210, 150 (60%) patients were critically ill and 60 (40%) were surgical patients with an average age of 65.3 ± 11 and 55.4 ± 12 years, respectively. Of 150 critically ill patients, 21.3% of patients were classified having moderate VTE risk, 33.3% of patients having higher and 45.3% of patients having highest VTE risks. Of 60 postsurgical patients, 13.3% of patients were categorized having moderate VTE risk, 36.6% of patients having higher and 50% of patients having highest VTE risks. Pharmacological thromboprophylaxis was administered to 35.2% of patients, of which, 46.6% and 6.6% were ICU patients and postsurgical patients, respectively. This shows underutilization of pharmacological thromboprophylaxis. Adherence to guideline recommendations (choice of drug, dose, and duration) was observed in all postsurgical patients and 33% of critically ill patients. Conclusions: Pharmacological thromboprophylaxis to higher and highest VTE risk patients was too low, particularly in both the units and very low in surgery ward. Efforts required improving patient safety practice, particularly in higher and highest risk categories.

Anterior tibial artery (ATA) pseudoaneurysm is a rare condition that occurs following lower extremity orthopedic intervention or after trauma. We report a series of cases of pseudoaneurysm which were treated surgically. The diagnosis was confirmed with computed tomography angiogram. Aneurysmal sac excision with ligation of ATA was performed.

Degenerative aortic and peripheral aneurysms are well known to present in the elderly at multiple sites at varying time. Aneurysms occurring in the arteries of the lower limb are most common after aneurysms of the infrarenal aorta. A strong association exists between the presence of true aneurysms of the femoral or popliteal arteries and those of the contralateral extremity and more importantly aortoiliac domain. Consequently, the discovery of a lower extremity aneurysm mandates careful observation, evaluation, or both for associated aneurysms in the opposite limb and abdominal aorta. Traditional open surgery is used to be mandated in ruptured aneurysm in previous years, whereas endovascular therapeutic modality is a mainstay in the current practice, especially in elderly and frail patients with short life expectancy. Herein, we present a report of successful outcome following open and endovascular repair of eight aneurysms in an octogenarian at varying times under a decade.

Primary infection of aorta, in absence of atherosclerosis, leading to aneurysm formation occurs in <1% of cases. Early diagnosis and surgical treatment are important to offset associated poor prognosis. A preoperative diagnosis is often missed due to nonspecific presentation. Computed tomography can confirm the diagnosis in suspected cases. Confirmation of diagnosis often warrants deviation from usual surgical techniques of management of abdominal aortic aneurysm. A case is described, of a toxic male patient, detected to have an infected aortic aneurysm with multiorgan dysfunction presented in septic shock. He could be successfully managed by an aggressive surgical and medical approach.

Ruptured suprarenal aortic aneurysms represent a huge challenge for surgeons. So far, developing endovascular procedures have failed to totally replace open repair when debranching is to be performed. The authors report their experience in the management of a ruptured mycotic aneurysm of the suprarenal aorta in a 36-year-old female patient diagnosed with active tuberculosis.

Ascending pharyngeal artery (APA) is a branch of the external carotid artery. Extracranial internal carotid artery (ICA) usually does not have any branches. We present here a rare case of anomalous origin of the APA from the extracranial ICA and discuss the clinical importance of this rare anatomical variant.

A 24 year old female presented with recurrent hemoptysis and the work up revealed a large right pulmonary artery aneurysm for which she underwent endovascular intervention with relief of symptoms. Her symptoms recurred after one month and now she had left pulmonary artery aneurysm, again treated with endovascular intervention. With systemic symptoms and absence of signs of Behcets syndrome led to diagnosis of Hughes-Stovin Syndrome. She symptom free at 18 months with immunosuppression.

Radiofrequency ablation (RFA) for varicose vein may have life-threatening complications such as deep vein thrombosis and pulmonary embolism (PE). Here, we reported a case report of PE following RFA, which required thrombolysis to save the patient.