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Background: Juxtarenal aortic occlusion (JRAO) is an infrequent form of aortic occlusion, resulting from a proximal progression of a distal aortic thrombus. The occlusion at or above the level of renal arteries may present with features of renal failure or intestinal ischemia along with increased severity of pelvic and limb ischemia. Surgical treatment of JRAO is complex and usually involves suprarenal clamping and poses a significant morbidity and mortality risk. Nevertheless, the current literature supports superiority of surgical bypass with excellent long-term outcomes and remains the preferred modality in JRAO. We reviewed the results of open surgical bypass in JRAOs, done at our center over a 5-year period. Materials and Methods: A retrospective analysis of 35 patients who underwent JRAO over the past 5 years was performed. Demographic data, comorbidities, clinical presentation, and surgical results were analyzed. Results: Of the 35 patients who underwent open surgical bypass, 34 were male, and one was female. The median age of the cohort was 56 years. All the patients had either disabling claudication, rest pain or tissue loss at presentation. The notable comorbid conditions were hypertension (91%), diabetes (51%), coronary artery disease (71%), and chronic obstructive pulmonary disease (37%). Direct aortic reconstruction was done in all cases, seven patients with critical limb ischemia underwent sequential infra-inguinal bypass, additional mesenteric bypass was done in one patient, renal artery revascularisation was done in three patients in the form of endarterectomy for two patients and aortorenal bypass in one patient. There was no perioperative mortality, and a 93% cumulative graft patency rate was noted. Conclusion: Open surgical reconstruction is a safe method for JRAO even in patients with comorbidities and offers excellent perioperative and long-term results.

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Introduction: A significant proportion (20%) of patients with complex infrainguinal arterial occlusions cannot be recanalized using a conventional antegrade endovascular approach. Most of these patients will be poor candidates for open surgical reconstruction owing to the concomitant cardiovascular and pulmonary comorbidities or poor venous conduit. We present our experience using the percutaneous retrograde pedal approach for revascularization of infrainguinal arterial occlusions after failed conventional endovascular options. Materials and Methods: This is a retrospective observational study of all the patients admitted in our center from May 2019 to May 2021 for chronic limb-threatening ischemia with infrainguinal occlusive disease and attempted retrograde tibial approach after failed antegrade transfemoral approach. Procedural success was defined as residual stenosis of <30% after balloon angioplasty or stenting. Limb salvage was defined as freedom from major amputation during the follow-up period. Results: In a total of 20 patients managed with retrograde tibial approach, procedural success was achieved in 18 patients (90%). Limb salvage was achieved in 17 of the 18 patients who had procedural success during the follow-up period. One patient underwent below-knee amputation due to spreading infection. Conclusion: Retrograde tibial approach to recanalize infrainguinal arterial occlusions after failed traditional endovascular methods is safe and effective and should be advocated to avoid more invasive, time-consuming, and high-risk procedures as it offers high technical and procedural success rates with minimal complications.

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Background: Peripheral vascular diseases (PVDs) are trigged by various risk factors. The presence of PVD is associated with higher cardiovascular morbidity and mortality. Ankle brachial index (ABI) is the sensitive and also cost-effective diagnosing tool for peripheral artery disease. ABI is important for screening of peripheral arterial disease in patients at risk and for diagnosing the disease in patients having lower-extremity symptoms. Materials and Methods: This prospective observational study was performed at J. N. Medical College, A. M. U., Aligarh, UP on 135 adult patients who are asymptomatic for PVD but have one or more risk factors. Demographic and clinical data were recorded. Systolic Blood pressure of both arms and lower limb were measured using sphygmomanometer and hand held Doppler. Ankle brachial pressure index (ABPI) is detected by dividing higher of the two ankle pressures by the higher of the two brachial artery pressure. Results: Majority of the patients were aged between 46 and 65 years, males more than females. It was observed that diabetes, hypertension, smoking, and dyslipidemia patients have significantly lower ABPI score (<0.9) compared to other patients. USG Doppler has showed 10.4% were having abnormal findings and the ABI (0.68 ± 0.17) was significantly lower than the normal ones (0.89 ± 0.09). Receiver operating curve shows that ABPI below 0.77 can be used as cut-off to predict the occurrence and risk of developing PVD for screening asymptomatic with sensitivity 88.4 and specificity 85.7 and accuracy 90.1%. Conclusion: Comorbid conditions such as smoking, diabetes, hypertension, and dyslipidemia increase the risk of PVD. ABPI is a valid method to screen PVD with high levels of sensitivity and specificity.

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Background: Varicose veins is a common disease in nearly 37.25% of the Indian population significantly affecting the quality of life. Endovenous thermal ablation has been the first-line treatment for superficial venous reflux. A new technique, available now, is nonthermal nontumescent vein sealing system (VenaSeal™), which comprises endovenous delivery of cyanoacrylate tissue adhesive into the vein causing obliteration of lumen and has shown better results in terms of safety and efficacy. Being a new modality, only handful of institutes across India perform this procedure and there is a scarcity of Indian data on its outcomes. Aims and Objectives: To evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in Venous Clinical Severity Score (VCSS). Materials and Methods: Single-centre prospective study of fifty patients over 1 year and 4 months with 3- and 6-month follow-up. Results: The study showed the mean age of the study group to be 43.8 years and the majority (90%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 89.1 cm, and the average glue used per limb was 2.95 ml. All patients showed improvement in VCSS score from preoperative average of 2.6 ± 1.4 to 0.32 ± 0.19 (P < 0.0001, n = 89) with target vein occlusion rate of 100% at 3 months and 97.75% at 6 months. Conclusion: Thus, VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates, minimal complications, and maximum patient acceptability. It is a feasible Out patient department (OPD) based procedure.

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Background: Acute limb ischemia (ALI) refers to a sudden decrease in blood flow to the limb which threatens its viability. Such a sudden event of decreased or absent arterial supply to the limb causes ischemia and poor perfusion outcomes. The most common causes of ALI include embolism and thrombosis. Others include acute on chronic peripheral arterial occlusive disease or major trauma. It is well known to us that COVID-19 is a hypercoagulable state. In this prothrombotic state, patients can also present with ALI, with clinical features of pain, paresthesia, pulselessness, pallor, poikilothermia, and paralysis of the affected limb. Such patients rapidly progress to severe stages of limb ischemia that need immediate treatment to save the limb. Thus, our study aims to revisit the clinical features and outcomes of procedures performed on such patients. Materials and Methods: This is a single-center, retrospective study. COVID patients with ALI who underwent any surgical procedure, from February 2021 to July 2021, were identified from the surgical operation theater's list of the hospital. Detailed information regarding these patients was obtained from the digital software of the hospital. Detailed computed tomography angiography findings were also obtained from the radiology department. A required statistical study was done. Results: Nineteen COVID patients presenting with ALI and requiring surgical treatment were identified during the study period of 6 months. A complete study of their clinical presentations, surgical procedures performed and the outcomes, is done. The study shows that the most common site affected was the lower limb (95%) with occlusion occurring mainly in the popliteal artery, i.e., the lower limb artery. Conclusion: Recognition of limb ischemia at an early stage, considering it as a symptom or complication of COVID-19, may allow for early and prompt diagnosis and treatment of this condition.

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Purpose: Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required as compared with contralateral common femoral access (CFA). However, this technique remains underutilized and understudied in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and efficacy of antegrade SFA access. Materials and Methods: An observational review of lower extremity peripheral arterial interventions was conducted from January 2014 to July 2021. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded. In addition, interventions potentially requiring large sheaths were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. Results: We identified 482 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in all these patients. Access was attained either through ultrasound or fluoroscopy guidance in 94.6% of patients. The overall rate of complications was low (access site complications, hematoma, pseudoaneurysm, etc.). Conclusions: Percutaneous antegrade SFA access can be performed safely and remains an effective alternative to retrograde CFA access with significantly less complications and is also associated with lesser utilization of fluoroscopy and contrast.

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We report on four patients, patient 1 with left upper quadrant pain as a result of splenic infarction; the patient was subsequently found to have a thoracoabdominal aortic thrombus extending through the celiac axis. Patient 2 with breathlessness due to COVID-19 and incidental finding of aortic thrombus. Patient 3 with right lower limb gangrene due to an embolus from a partial lumen occluding thrombus in the abdominal aorta and COVID-19 positive. Patient 4 with left lower limb ischemia As this remains a relatively rare disease, there is no consensus on the nature of disease, prognostic assessments, or optimal treatment strategy.

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Purpose: We sought to scrutinize the current clinical profiles and postoperative outcomes, following aortic bifurcated bypass (ABB) for occlusive arterial disease, over the past ten years and compare them with our formerly published dataset. Methods: From January 2011 to December 2020, a prospective single hospital database was maintained for ABB procedures in patients with occlusive disease. Clinico-demographic profile and postoperative outcomes were surveyed and assessed for associations. Graft patency, amputation-free survival, and mortality were the primary end points. In addition, we did a comparison analysis with our historical cohort to appraise the shift in trends. Results: Over the past ten years, 140 patients (mean age of 54.5 years) underwent ABB procedures for aortoiliac occlusive disease (AIOD). Majority were males (94.3%) with chronic limb-threatening ischemia (88.6%). Atherosclerosis was the most common etiology (85.7%). There was a significant increase in smoking (P < 0.001), dyslipidemia (P < 0.001), coronary artery disease (P < 0.001), chronic kidney disease (P = 0.05), flow limiting infra-inguinal disease (P < 0.001), intermediate graft thrombosis and primary amputation rates in the contemporary cohort (P = 0.050). No significant changes were noted in the 30-day mortality rates. The contemporary primary patency rate is 76.9%, and secondary patency rate is 94.2%, compared to an overall patency of 84% in the historical cohort. Conclusion: Our study highlighted the epidemiological shift transpiring in patients affected by AIOD in India. Despite challenging clinical profiles, our outcomes remain unchanged and are comparable to western literature.

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Background: There is globally increase incidence in vascular trauma as a result of increase rate of civilian violence and increase rate of road traffic accident. Vascular injury affects young males and associated with high mortality and long-term morbidity. Here, we present our experience as tertiary health centers in the management of this type of injury, also we present our result as regards to primary and secondary amputation rates. The most important factors affecting these rates were ischemia time and condition of surrounding soft tissue. Aims and Objectives: Detect rate of limb salvage after trauma injury in assuit university hospital , and risk factors for limb loss. Materials and Methods: Our study is prospective study of all patients who vascular lower extremity trauma from January 2014 to January 2015 during the period of the study(from January 2014 to January 2015), 135 cases of vascular injury presented to Assiut University Hospital, 87 of them had lower limb vascular injury representing 64.4%. Results: Surgical intervention was done in 82 patients representing 94.3%, endovascular intervention was done in 2 patients representing 2.3, 1 patient had endovascular balloon control then surgical intervention representing 1.15%, and two patients had conservative management representing 2.3%. Conclusion: vascular trauma is prevalent health problem in our locality, which have huge socioeconomic impact in our community as it affects mainly young men. The main controlling factor in secondary amputation rate is ischemia time, infection which accompanies severe soft tissue damage. At the end trauma with vascular injury is considered, a complex process needs urgent intervention with multidisciplinary team in well-equipped facility.

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Purpose: The aim of our study was to quantify venous reflux in outpatient settings using color Doppler and document objective improvement in hemodynamic parameters post ablation. Methods: Venous reflux was measured using color Doppler using venous-arterial flow index (VAFI), recirculation index (RCI), and percentage diameter change (PDC) (n = 30) and compared with healthy volunteers (n = 30), adjusted for age, sex, and body mass index (BMI). Patients with concomitant peripheral arterial disease (PAD), past history of deep venous thrombosis, chronic venous insufficiency, and venous ulcers were excluded from the study. Patients with reflux underwent RFA and VAFI was measured 6 months after treatment. Data were analyzed using IBM SPSS statistics software version 25. Tests of normality were applied before choosing statistical tests. Box-and-whisker plots with outliers were used to illustrate the difference between case and control groups. VAFI scores were compared pre- and postoperatively and Wilcoxon signed-rank test was applied for the comparison. P < 0.05 defined statistical significance. Results: Thirty patients with primary GSV reflux along with 30 healthy volunteers were adjusted for age, sex, and BMI. Clinical part of CEAP classification was C₀ = 2, C₁ = 6, C₂ = 16, and C₃ = 6 in reflux group and C₀ = 26 and C₁ = 4 in (n = 30) in healthy volunteers. There was a statistical difference in RCI, PDC, and VAFI across both groups (P < 0.5). In addition, VAFI decreased significantly after treatment at 6 months (1.38 preoperative to 0.95 postoperative, SD P < 0.5). Of the 30 patients, 21 had pain as the primary presenting symptom; 81% (17) reported a significant decrease in pain scores associated with hemodynamic improvement. Conclusion: RCI, PDC, and VAFI are accurate quantitative measurements of reflux in outpatient settings. VAFI is useful in objectifying the results of treatment. Symptomatic improvement in terms of pain score can be used to supplement the hemodynamic improvement though further substantiation of the above would be required in a larger cohort.

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The World Health Organization was notified on December 31, 2019, that a cluster of pneumonia patients with an unknown origin had been discovered in Wuhan City, Hubei Province, China. Severe acute respiratory syndrome coronavirus 2 caused the pneumonia (coronavirus disease 2019 [COVID-19]). Fever, dry cough, and shortness of breath are among the most prevalent symptoms described by COVID-19 patients. In this case series, we discuss three cases of patients presenting with deep vein thrombosis for which they underwent inferior vena cava filter placement with thrombolysis and mechanical thrombectomy. These cases were unusual as they belong to the moderate category of COVID rather than severe category which commonly presents with coagulopathy.

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Pseudoaneurysm of the renal artery is a presentation of blunt abdominal injury. We present the case of a 40-year-old male with a history of road traffic accident with a complaint of severe abdominal pain and distention of the abdomen. Contrast-enhanced computed tomography (CECT) shows large perinephric hematoma with free fluid in the abdomen. He was treated conservatively for 48 h but having persistence hypotension with increase free fluids in the abdomen, so mesenteric injury and bowel ischemia was suspected and laparotomy performed and found retroperitoneal hematoma and rest are normal. After that he had persistent hematuria with shock. Repeat CECT showed large pseudoaneurysm of the right renal artery with extravasation of contrast with clot in the bladder. In view this condition, renal artery angioembolization was done.

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The surgical repair of thoracoabdominal aortic aneurysm (TAAA) remains one of the most technically demanding surgical procedures in vascular surgery. High-volume centers still have significant morbidity and mortality rates of 12%–15%. Emergence of thoracic endovascular aneurysm repair (TEVAR) improved these figures but was limited by the availability of customized grafts and cost factors. An effective alternative approach hence is a hybrid procedure that involves the combination of open technique for debranching of viscerorenal aorta and use of standard TEVAR stent graft to cover aneurysmal segment. We report a case of an elderly male who underwent a successful staged Hybrid TEVAR procedure for Type 3 equivalent TAAA.

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Background: Vertebral artery pathologies are not as common on ultrasound examination. Careful ultrasound examination of the vertebral artery can provide useful information about the proximal brachiocephalic vessels as well as the intracranial portion of the vertebral artery. Objectives: To illustrate a variety of vertebral artery pathologies on ultrasound and their abnormal color Doppler findings with confirmation of some cases on magnetic resonance imaging. Materials and Methods: A 3-12 MHz linear ultrasound probe was used to examine the vertebral artery segments. The examination began with a B-mode examination of the first and second portions of the vertebral arteries, followed by color Doppler examination to determine the direction of blood flow. Spectral Doppler is used to identify flow anomalies. Conclusion: Evaluation of proximal great vessels by ultrasound can sometimes be difficult, so careful examination of vertebral artery by ultrasound can be an important tool to detect occlusions or stenosis of proximal great vessels. In addition, vertebral artery waveforms in the cervical segment provide useful information regarding the intracranial portion of the vertebral artery.

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Postdialysis compartment syndrome is a rare but very devastating condition which needs emergent diagnosis and treatment. This can happen due to bleeding from puncture site due to inadequately applied pressure/coagulopathy. This case report illustrates a case of postdialysis pseudoaneurysm formation followed by forearm compartment syndrome. The patient was managed by emergency forearm fasciotomy and skin grafting along with rotation flap. This diagnosis should always be kept in mind when evaluating a patient with sudden onset of pain and swelling postdialysis. This will help in salvage of the patient's upper limb as well as of the precious arteriovenous fistula.

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