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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Tracheobronchial calcification can be seen normally in the elderly. Warfarin therapy leads to calcification at an early age. We present a 35-year-old man whose chest X-ray showed prominent calcification.

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Peripheral arterial disease, a significant contributor to morbidity and mortality, is an imperative marker of a coexisting subclinical coronary artery disease. Since most of the patients become symptomatic at a later stage, a surgical approach becomes inevitable in these patients. With the introduction of percutaneous transluminal angioplasty, it has been possible to preclude numerous amputations. However, this procedure comes with the drawback of restenosis on the long term. In order to overcome this problem, a plethora of inconsistent regimes, pertaining to anti-thrombotics are being prescribed. In the face of the current scenario, to overcome the preordained outcome of restenosis, this systematic review highlights the problem of restenosis experienced in daily practice. It also discusses some commonly used anti-thrombotics and their success in various clinical trials suggesting the absolute need of a protocol for prescribing these drugs before and after angioplasty.

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Aorto-iliac and mesenteric occlusive disease co-existing with thoraco-abdominal aortic aneurysm are a very rare clinical association, which poses a great therapeutic challenge and adds to the complexity of the open surgical repair. We describe a case of a 60-year-old male with symptomatic Crawford Type I thoraco-abdominal aneurysm with concomitant visceral and aorto-iliac occlusive disease successfully treated by aorto-bifemoral and mesenteric artery bypass followed by thoracic endovascular aneurysm repair. This novel technical approach turned out to be safe and effective strategy to tackle these co-existing tandem lesions, which minimized morbidity compared to stressful total open surgical repair, leading to excellent patient recovery.

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Internal iliac artery aneurysm occur less frequently. Surgical treatment was standard treatment before endovascular treatment options started. We report use of multiple balloon expandable ePTFE covered stents to treat an iliac artery aneurysm while preserving IIA.

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Trauma is one of the leading causes of mortality and morbidity especially in the young or middle age group. The lethal triad of trauma (hypothermia, coagulopathy, and acidosis) is almost always triggered by initial uncontrolled or concealed hemorrhage. Time is of utmost importance in terminating the vicious cycle. Endovascular interventions along with open surgical management in a hybrid suite not only decrease surgical time, avoid exposure to anesthesia, hasten recovery, but most importantly breakdown the catastrophic sequelae of ongoing bleed by rapid hemorrhage control. They allow vascular control at difficult surgical terrains such as subclavian or iliac vessels with much compared ease and rapidity. We present four interesting cases of peripheral and thoracic outlet vascular trauma and its sequelae managed with endovascular adjuncts at different points in the resuscitative and rehabilitation stations. In our first case of a stab injury over the right femoral artery with acute hemorrhage, a covered stent across the transected artery was curative as well as hastened recovery. In the second case in the hybrid suite, a long segment of balloon occlusion of the iliac artery allowed rapid physiology control and easier surgical repair of the transected common femoral vessels. The third case required a covered stent across the leak from a previously repaired subclavian vessel to prevent life-threatening hemothorax. In another interesting case of a badly mutilated posttraumatic shoulder with an axillary pseudo-aneurysm, a covered stent across the axillary vessel facilitated further reconstructive shoulder surgery.

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We report a case of infra-renal aortic aneurysm which was not suitable for standard endovascular aneurysm repair. Unsuitable neck was reconstructed by dacron graft cuff around the neck with fixing sutures. Following this, standard EVAR was performed.

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Context: Use of inferior vena cava filters (IVCFs) is associated with complications which can be minimized by early follow-up and retrieval. Aim: The aim of this study was to document types of retrievable IVCFs, complications after placement, and how to prevent them. Settings and Design: Institutional ethics committee approval was obtained to perform a retrospective review of hospital medical records for all patients who had an IVCF placed between Jan 2003 and Oct 2013. Patients and Methods: Retrospective data were collected from the picture communicating and archiving system radiology database. Patients' records and radiological imaging were reviewed. Data extracted included patient demographics, indications for inferior vena cava (IVC) placement, filter retrieval, follow-up, and complications namely IVC perforation, filter fracture, filter migration, and filter embolization. Statistical Analysis Used: The data collected were analyzed using SPSS version 21. The output data were summarized using tables and graphs as shown below. Results: A total of 182 patients (93 males) and (89 females) had retrievable IVCFs inserted. The most common indication for filter insertion (56.59%) was venous thromboembolism and contraindication to anticoagulation. Retrieval rate was 42.85%. Procedural success was achieved in 78 of 85 attempted filter retrievals (91.76%). Fourteen patients (7.69%) had IVCF related complications. Conclusion: Timely follow-up increases the likelihood of successful retrieval of optional IVCFs and reduces potential complications.

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This paper reviews the current rationale, methods and outcomes of interventions to reduce acute clot burden in deep vein thrombosis.

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