Iatrogenic arteriovenous fistula after lumbar disc surgery: Case reports and review of literature

Iatrogenic arteriovenous fistulas (AVF) after intervertebral disc surgery are rare. The presentation can be varied from potentially fatal to those, which present years after the index surgery with features of, deep vein thrombosis, leg edema, and cardiac failure. The history and physical findings can be indicative of an AVF and the diagnosis is confirmed by computed tomography (CT) CT angiogram (CTA) or digital subtraction angiogram (DSA). Open surgery and endovascular approach can be both used for the treatment of this condition, both with good results, although the endovascular approach is associated with minimal morbidity

Persistent sciatic artery aneurysm: A rare cause of acute limb ischemia

Persistent sciatic artery (PSA) is a rare but pertinent clinical entity that may pose a threat to the viability of the lower extremity. The incidence of PSA has been estimated to be between 0.01% and 0.05%. PSAs are prone to high incidence of aneurysm formation, thrombosis, distal embolization, and rupture. Early detection of a PSA as the main vascular supply to the lower limb helps in early surgery and avoids potential severe complications such as limb ischemia. We report a case of a female patient who was diagnosed with a case of lumbar disc compression and sciatica but had a PSA aneurysm with thrombosis and distal embolization leading to acute limb ischemia

Rubber catheter eroding into the pelvic bone: An unusual complication of unsafe abortion

A majority of unsafe abortions are performed by untrained quacks leading to multiple complications which contribute to significant maternal morbidity and mortality. We report an unusual and late complication of unsafe abortion, where a red rubber tube which was believed to be left in the patient's body during an abortion conducted at home about 1 year ago, later got extruded out of the patient's body, through abdomen and eroding the pelvic bone, but fortunately causing no damage to any abdominal organs

Neo aortoiliac system repair of burkholderia cepacia infected mycotic aneurysm with impending rupture

Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis, and extensive para-aortic infection. We report a case of a middle-aged man with a 2-week history of fever, abdominal pain, and backache. Computed tomography angiogram was done which showed infrasaccular aneurysm with impending rupture. The patient underwent neoaortoiliac system repair which was done by harvesting bilateral superficial femoral vein. We report a case of an infected mycotic aneurysm caused by Burkholderia cepacia, a Gram-negative lactose nonfermenting bacterium which is commonly seen in livestock and has not been reported earlier

COVID-related acute limb ischemia: The Indian data

Introduction and Objective: The reported incidence of COVID-related acute limb ischemia (CRALI) ranged from 3.7% to 9.6% in the literature. We report on consolidated data of patients with CRALI from 21 centers across India, which spanned the first two waves of COVID-the period of May 2020 to June 2021. Materials and Methods: Study design: Multicenter study from May 2022 to June 2021. Retrospective analysis of prospectively collected data was done. Inclusion criteria: All patients who presented with signs and symptoms of acute limb ischemia or acute on chronic limb ischemia and who also tested positive for COVID through rapid antigen test or real time polymerase chain reaction. Results: Data for 268 patients from 21 centers across India was available for analysis. 71% were males and 85% were >45 years of age. Majority of patients (n = 191) presented with acute symptoms. Best medical management with antiplatelets and anticoagulants was the only treatment in 34% of patients. Open embolectomy was attempted in 42%, endovascular procedures in 8% and amputation as primary procedure in 14.5%. Higher grades of ischemia were associated with significantly poorer limb salvage, amputation and mortality in the immediate and 14 days follow up (P < 0.001). At 14 days 173 limbs were salvaged (64.5%). Eighty patients underwent amputations (29.8%); 26 of the 80 (32%) were minor amputations (trans-metatarsal and less), so the major amputation rate was 20.1%. Maximum number of deaths were in the group that had undergone medical management (23%), while the least number of deaths were seen in the patients that had undergone some form of intervention, open surgical (2%) or endovascular procedure (4%). Looking at 14-day outcomes, the numbers of deaths in the patients managed with medical methods increased to 30%, open surgical to 7% and endovascular procedures to 8%. Conclusion: CRALI presented both as a primary presentation or developed later during the disease. Early surgical and endovascular interventions in these patients can help in achieving decent limb salvage rates

Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA. A Prospective Multicenter Study

Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA. Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists. Methods: As part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality. Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]). Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks