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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Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. The majority of AVMs involve the extremities, head and neck, and lungs. We report a case of a 20-year-old female with a large, high flow AVM at unusual location. The perforators of this malformation were originating directly from lumbar arteries, revealed by computed tomography angiography. In the absence of facilities of embolizing feeder vessels, such large AVM gave us a great surgical challenge in terms of dissection, raising the mass, ligating perforators, and avoiding skin loss.

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Background: The success of hemodialysis depends on a functioning vascular access. The most important factor limiting the arteriovenous fistula (AVF) growth and patency is the availability of a good caliber venous segment: Cephalic veins smaller than 2.5 mm have been reported to have increased failure rates. Unfortunately, in the Indian population, we frequently come across patients with a poor cephalic vein diameter ≤2 mm. The present study was done to evaluate if primary balloon angioplasty (PBA) of these small cephalic veins could improve the primary patency rates and maturation time of autogenous AVFs, and also to compare this technique with the standard hydrostatic dilatation technique. Materials and Methods: Sixty patients requiring arteriovenous access surgery (but having small cephalic veins (≤2 mm) were randomized into two groups of thirty patients each. All patients underwent a thorough preoperative evaluation, after which they were subjected to AVF surgery. Thirty of these patients underwent standard hydrostatic dilatation (HD) whereas the remaining thirty were offered PBA of the vein before creating the fistula. These patients were followed up for 6 months and primary patency, reintervention rates, and maturation times were recorded. Results: Immediate technical success was 100% in the PBA group, with 6-month primary patency of 93.3%, whereas HD group had 73.3% immediate success and a 6-month primary patency of 63.3%. In HD group, 36.7% patients underwent re-intervention over a follow-up of 6 months, as compared to only 6.7% in PBA group. The average maturation time for PBA group was 32.83 days, whereas in HD group, it was 52.53 days. Conclusions: PBA of very small cephalic veins (≤2 mm) is a safe and feasible procedure. The technique is associated with excellent primary patency rates and decreased maturation time, significantly decreases the need for re-intervention, and is superior to the standard hydrostatic dilatation technique. It has the potential to maximize the number of patients with autogenous AVF by including those patients who have been rejected due to small cephalic veins.

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We report a case of true brachial artery aneurysm of idiopathic origin in a 53-year-old man complicated by distal thromboembolism resulting in acute critical upper limb ischemia. True aneurysm of the brachial artery is a very rare condition which may be asymptomatic or rarely present with acute thromboembolic episode. Surgical repair is the mainstay of treatment in these cases.

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Introduction: Reconstructing the internal iliac artery (IIA) may help to prevent pelvic ischemia during open repair of abdominal aortic aneurysms (AAAs) with iliac arterial lesions. Composite grafts combined with Y-shaped and straight vascular grafts have previously been used to reconstruct the IIA. However, multifurcated vascular grafts have recently been used to treat AAAs with iliac arterial lesions. We, therefore, assessed the viability of multifurcated vascular grafts for AAAs with iliac arterial lesions. Materials and Methods: We retrospectively reviewed 87 patients who underwent elective open repair with reconstruction of IIAs under infrarenal clamp for AAAs with iliac arterial lesions between April 2002 and August 2015. Forty-three patients received multifurcated vascular grafts including 23 patients who underwent reconstructed unilateral IIA, and 44 patients received composite grafts including forty patients with reconstructed unilateral IIA. We compared the multifurcated and composite graft groups among all patients and also compared among patients who underwent unilateral IIA reconstruction. Results: There were no significant differences between the two groups among all patients in terms of intra- and post-operative data. There were no cases of hospital death or buttock claudication. In propensity score matching analysis among patients with unilateral IIA reconstruction, 22 patients were extracted each group. There were no significant differences in any preoperative or perioperative parameters between the groups. Conclusions: We could not show the availability of open repair using multifurcated vascular grafts for AAA with iliac arterial lesions with comparable results compared to composite grafts.

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Malignant triton tumors (MTTs) are peripheral nerve sheath tumors: Perivascular origin is extremely rare. We report a sporadic perivascular MTT in a 37-year-old man. He presented with a swelling in the right popliteal fossa. Imaging revealed a solid lesion adherent to the popliteal artery. He underwent en bloc excision of the tumor with repair of the popliteal artery. We studied the histopathology and electron microscopy (EM) features of this tumor. He received local radiotherapy and remains disease-free at 2 years. EM may help prognosticate tumor behavior when these tumors occur in rare/nonneural locations.

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Introduction: The leading cause of failure for an autogenous or prosthetic arteriovenous hemodialysis access is venous anastomotic stenosis & central venous stenosis. Endovascular procedures have come a long way in treating such lesions without significant postoperative morbidity and reliable technical success rates.This study aims at studying the long term results of such central venous and anastomotic site stenosis treated with endovascular approach in our centre. Materials and Methods: A total of 26 patients were treated, for a duration of 33 months between March 2012 to November 2014 with central venous, anastomotic site angioplasty ± stenting. Patients were followed up for 9 months. We had re-intervention in 3 cases. Results: Inadequate dialysis, thrombosed graft were the commonest presenting symptoms. Primary patency at the end of 15 months was 34.6% (9 patients), & at the end of 20 months was 11.5 %( 3 patients). Conclusion: Endovascular treatment with angioplasty or stenting for central venous stenosis & access salvage is safe, with low rates of technical failure. Only angioplasty without stenting seems by far the preferred approach, since it is less invasive, highly repeatable.

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Case report of iliac artery pseudoaneurysm from the nephrectomized site of transplant kidney. Endovascular management of iliac artery pseudoaneurysm after transplant graft nephrectomy is rarely reported. Patient presented with abdominal pain and pulsating mass in the right lower abdomen. The diagnosis of pseudoaneurysm was made with computed tomography angiogram. Iliac artery stent graft across the aneurysm excluded the sac and treated the compressive symptoms of patient. The endografting decreases intimal hyperplasia and allowing vascular conduit for the lower limb. The endovascular stent-graft placement in iliac artery is a reasonable and durable alternative in selected patients.

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