A proportion of abdominal aortic aneurysms is anatomically unsuitable for endovascular repair using standard stent-grafts, due to the absence of an adequate infrarenal neck. Fenestrated endovascular repair has been developed for use in such patients and has become well-established over the last decade. This article aims to provide an overview of the principles and technique of implanting a fenestrated endovascular aneurysm repair.

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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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Introduction: The carotid body tumor is a rare neoplasm that has generated much literature over the last century, and for which continued controversy exists regarding natural history, biologic behavior, proper technique of excision, and the risk of morbidity and mortality. Methods: The present study reviewed a 7-year experience of managing carotid body paraganglioma between 2007 and 2013. There were 10 consecutive patients aged between 18 and 50 years, and median follow-up was 5-year. Preoperative information was derived from spiral computed tomography (CT) scanning, magnetic resonance imaging, color Doppler imaging (CDI), and four-vessel digital subtraction arteriography. Results: In five patients, the tumor excision was attempted before they were referred to our tertiary care hospital. Two patients had bilateral tumors. Four patients had preoperative embolization, and blood loss was minimal, and excision was relatively easier in them. There was difficulty in deglutition (nasal and laryngeal regurgitation) in three patients with large tumors. Conclusion: Surgical planning and prediction of peri-operative complications can be obtained by digital subtraction angiography, spiral CT angiography, and CDI. The peri-operative blood loss can be reduced by preoperative embolisation.

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Introduction: This was a retrospective study of the experience with extremity vascular trauma at a tertiary level referral center in North India. The objective of this study was to analyze the cause of injury, surgical approach, outcome, and complications in patients with vascular trauma operated from 2003 to 2013. Materials and Methods: A retrospective analysis of records of patients who were operated for peripheral vascular injuries in the last 10 years (November 2003 to November 2013) was done. Diagnosis was made by physical examination and hand Doppler alone or in combination with computed tomography angiography. There were 3948 patients; primary vascular repair was carried out where possible; if not possible an interposition vein graft was placed. Patients with isolated venous trauma or unsalvageable lower extremity injury requiring primary amputation were excluded from the study. Results: Of 3948 patients, 3347 were male (84.78%), and 601 were females (15.22%); their ages range was 5-80 years. Mean duration of the presentation was 11 h after the injury. Road traffic accidents were the most common cause of injury: 67% in those with penetrating trauma and 58% in those with blunt trauma. The incidence of concomitant orthopedic injuries was very high in our patients (73.6%). The most common injured artery was the brachial artery (36.4%), followed by the popliteal (30.4%) and femoral artery (21.7%). Primary repair was performed in 58.3%, interposition vein grafts in 41.4%. Majority of patients had a good outcome-78% had functional, viable limbs. About 13% had a nonfunctional, but viable limb; the secondary amputation rate was 9%. Conclusion: Early diagnosis and treatment of vascular injuries is crucial for saving the patient's limb and life. Our study is the largest study from a single center in India/South West Asia: Increased awareness is required to ensure that patients identified to have a vascular injury are transferred to a specialist vascular surgery center at the earliest. Vascular injuries require immediate localization and surgical intervention. Prompt and decisive management maximizes patient survival and limb salvage- and as we demonstrate, this is possible even in patients with delayed presentation or when early ischemic changes are present. Protocols must be established in the management of associated injuries to avoid delay.

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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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EVAR has emerged as procedure of choice for morphologically suitable AAAs. Due to direct perfusion of aneurysm sac at systemic blood pressure, types I & III endoleaks are indicated for interventions even when patients are asymptomatic or have stable aneurysm size. Disconnection of components of modular endograft system and defect in the stent-covering graft fabric has been classified as type III a & b endoleaks respectively. Due to an overall smaller incidence, descriptive management of Type III endoleaks has been limited to very few case reports and needs to be individualized. We present a case of complex Type III a endoleak, 2 years following EVAR, where complete disjunction of main body and contralateral limb occurred with increase in aneurysm sac diameter. It was managed by brachio-femoral realignment and interposition stent graft. We also review the current literature on type III endoleak, its classification , risk factors and their management in current practice.

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Aortoenteric fistula (AEF) is a very rare but disastrous complication of open abdominal aortic repair. The traditional approaches to the repair of secondary AEF (SAEF) are associated with average mortality rates of 21-59% and numerous major complications. Here, we report a patient who presented with recurrent episodes of hematemesis, melena and at presentation had hematochezia, however, had no signs of infection or sepsis. He underwent aorto-bi-femoral bypass for abdominal aortic aneurysm 2 years back. An urgent contrast-enhanced computed tomography (CT) confirmed an SAEF from a pseudoaneurysm from proximal aortic and of graft anastomosis. In view of active bleeding and multiple comorbidities, open surgery was deemed very high-risk. A stent graft was successfully deployed across the previous anastomotic site. Patient symptomatically improved and was discharged on long-term oral antibiotics due to the risk of persistent graft infection. He has been planned for close follow-up by CT scans at 1, 3, and 6 months, then every 6 months till 2 years, after which the follow-up would be on a yearly basis.

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