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Spontaneous vascular thrombosis may occur after a short climb or prolonged stay at high altitude (HA). Both venous and arterial thrombosis has been reported in the literature and cause significant morbidity and mortality. Diagnosis is often difficult; treatment delayed and postthrombotic sequelae disabling. Experimental evidence is limited and trials to prove thrombogenecity of HA are technically challenging to conduct. A greater understanding and awareness of its varied presentations and management is required by all those engaged in treating such patients.

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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.

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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.

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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.

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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).

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Posttraumatic pseudoaneurysm of hepatic artery is an uncommon complication. However, when diagnosed, they need early treatment to prevent rupture. Currently, the treatment of choice for hepatic artery pseudoaneurysm is endovascular embolization depending on the location. We present a series of 4 cases of posttraumatic intrahepatic pseudoaneurysm in branches of hepatic artery who were successfully treated with n-butyl cyanoacrylate embolization.

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The Indian COVID-19 situation is and will demand more and more hospital bed capacity to manage. With diabetic foot disease (DFD) being a leading cause of hospital bed occupancy, managing these patients based on evidence-based guidelines can significantly reduce the rates of hospitalization. Every hospital bed that is not needed for a patient with DFD , gives room for occupancy by a patient suffering from COVID-19. The goal of doctors treating diabetic foot is aimed at early successful treatment of infections and preventing amputations, decreasing the hospital stay of inpatients, and effective cost reduction. Hence, changing our way of approach to managing a patient with diabetic foot and implementing new and unique ways is the need of the hour at this time of crisis. This guidance also has a section on managing diabetes in people with diabetic foot during the COVID19 pandemic.

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India with a population of about 1.3 billion and diverse cultures holds within its large land mass an encyclopedia of medical cases, several un/underdiagnosed. Klippel-Trenaunay syndrome (KTS) is one such condition. Over the years, as the understanding of our team increased about the condition, we were able to share the same with our colleagues across the institution and publish the brief article. This resulted in an increased referral pattern from within the institution and across the country. At our institution, we managed 127 cases of KTS between October 2009 and December 2017. In this article, we share our experience about managing the cases, lessons learnt, and the challenges we face.

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Patients with connective tissue disorders have benefitted from refinements in surgical technique and progress in molecular biology research. As many patients with connective tissue disorders now enjoy a longer life expectancy, non aortic root manifestations of their conditions are becoming more commonplace and vascular surgeons are tooled to address them. In this review, we will elucidate the triage and diagnosis of patients with connective tissue disorders and advance practical treatment strategies for these challenging vascular surgery patients.

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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.

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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.

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Mycotic aneurysms as a result of salmonella arteritis are rare in the era of broad spectrum antibiotics. However, few cases have been reported in cases of immunosuppression, presence of cardiovascular prosthetic materials or intravenous drug addiction. Though Salmonella infections cause aortitis and aortic aneurysms in elderly patients with atherosclerosis, it is rare to have common iliac artery aneurysms in young adults. High index of suspicion and aggressive investigation is required to detect these cases as the clinical presentation may be vague. Management of mycotic aneurysms is challenging, requiring emergency surgery. We hereby present a successful management of salmonella mycotic aneurysm of iliac artery in a young adult with no atherosclerotic risk factors.

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Carotid body tumors (CBTs) are rare benign tumors, but they do have a chance of turning into malignant tumors. Hence, the earliest mode of treatment is surgical resection. The high vascularity of the tumors poses a surgical and anesthetic challenge. Hereby, we present a successfully resected case of large CBT measuring 7 cm × 6 cm. In contrast-computed tomography angiogram of the neck, the hyperdense mass was noted in the left carotid space splaying the left internal carotid artery and external carotid artery. Conventional general anesthesia with controlled ventilation technique was used in the resection of this tumor. The final histopathology report was paraganglioma. She had an uneventful perioperative period and was doing well after 18 months of follow-up.

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Profunda femoris artery pseudoaneurysms (PFAPs) have been described as an iatrogenic phenomenon, principally following orthopedic procedures and open or closed trauma to the upper thigh, although remain rare. The diagnosis of PFAPs is challenging and often delayed due to the nonspecific manner of the presentation with clinical features including pain, swelling, and unexplained anemia as demonstrated in this case report of a PFAP following a stab injury to the thigh. The use of computed tomography angiography (CTA) or transcatheter angiography allows for early accurate diagnosis and treatment of vascular complications secondary to trauma, especially when there is concern of vascular injury and possible pseudoaneurysm formation in the clinical context.

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True Profunda femoris artery aneurysm is extremely rare. Its lateral and deeper location in upper thigh causes delayed indentification making surgical management difficult. Mainstay management technique is surgical with excellent long term outcomes. We report our experience of a 18 cm giant profunda femoris true aneurysm management and review the literature.

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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.

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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.

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Introduction: Obturator artery is the branch of anterior division of internal iliac artery. Variations in its origin are quite common and are very important from surgical point of view. Methods: To study the variations in the origin of the obturator artery 35 dissected vessels were studied. Results: Commonest variation of its origin from the posterior division of internal iliac artery was found in five cases. Other variations like its origin from internal pudendal artery or from inferior gluteal artery were also found, which are also discussed along with its embryological basis and clinical significance. Conclusions: Knowledge of anomalous origin of obturator artery from posterior division is helpful to vascular surgeons while planning endovascular treatment.

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Objective: Intrinsic esophageal pathologies constitute prime cause for dysphagia clinically. However, thoracic esophageal domain is prone to extrinsic compression by various vascular afflictions including aneurysms with attendant therapeutic challenges. Herein, we present a case series of dysphagia aortica with emphasis on its appropriate management option based on grade of dysphagia. Methods: Patients who presented to the vascular division of our tertiary care referral institute between January 2014 and October 2015 with dysphagia due to extrinsic esophageal compression by aneurysmal thoracic aorta form the basis for this report. Prior to referral, all patients were evaluated elsewhere to rule out intrinsic causes and computed tomography angiogram performed delineating aortic aneurysm in four patients and penetrating aortic ulcer in one. Patient cohort included one female and four male patients whose age ranged from 40 to 68 years, with a median of 62 years. Left posterolateral thoracotomy provided access to an aneurysm which was repaired using interposition polyester graft in four patients. Due to severe comorbidities which precluded open surgery, one patient who presented with mild dysphagia was managed by endovascular stent graft repair. Results: Degree of dysphagia was assessed between grades 0 and 4 as in literature. All patients, including four open conventional and one endovascular, recovered well and left hospital totally symptom free. Conclusion: Dysphagia due to vascular diseases in the thoracic domain is an uncommon clinical entity. Patients with thoracic aortic aneurysm presenting with severe dysphagia deserve open surgical repair to provide optimal symptomatic relief in addition to saving life. The state-of-the-art endovascular stent grafting may be considered in very elderly patient having severe comorbidities presenting with mild dysphagia.

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Background: Carotid endarterectomy (CEA) using eversion technique has been used by vascular surgeons across the world. A simpler technique, modified eversion endarterectomy (MEE) is emerging as a promising option. Advantages are shorter clamping time, less neurological complications, and avoidance of prosthetic patch plasty. Selective shunting can be done whenever required. In the climate of carotid artery stenting versus CEA debate, one would consider this method to reduce the morbidity of CEA. Materials and Methods: This is a retrospective analysis of patients undergoing CEA at a single institution by four vascular surgeons over a period of 2½ years (January 2012–June 2014). Data were collected from computerized medical records and various parameters analyzed. Forty patients underwent MEE during the given period. The majority were symptomatic 34 (85%). Results: One patient (2.5%) required conversion to conventional endarterectomy with patch plasty because of the long length of the plaque. One patient (2.5%) had lateralizing transient ischemic attack (TIA) in the postoperative period. Two patients had hematoma of which one was returned to operating theater for evacuation. Seven patients underwent MEE along with coronary artery bypass grafting with uneventful recovery. Selective shunting was done for four patients (10%) who had a contralateral occlusive disease or poor back bleed from an internal carotid artery (ICA) on table. Average ICA cross-clamping time was 13 min. None of the patients had cerebrovascular accident/TIA in the follow-up period. Conclusions: MEE is a simpler and easier technique to perform with comparable results when compared with other conventional techniques. MEE, in our assumption, will be the technique of choice in the future for open CEA; however, larger studies with longer follow-up are required before final validation of this technique.

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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.

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Acute mesenteric ischemia (AMI) is a complex clinical problem with a high mortality. The mortality associated with AMI has declined steadily over the last three decades. This is due to higher index of suspicion among clinicians, advances in radiographic diagnostic modalities, aggressive surgical approach, endovascular intervention, nutritional supplementation, and better perioperative care. Early diagnosis and prompt, effective treatment are essential to improve the clinical outcome. This article reviews the etiopathogenesis, clinical features, management, and outcomes of AMI.

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