How to approach a patient with peripheral arterial disease

Peripheral Arterial Disease (PAD) is defined as chronic atherosclerotic disease of the lower limbs. Patients with lower extremity PAD present with wide spectrum of symptoms ranging from asymptomatic to minor exertoinal leg pain, significant walking impairment and ulceration or gangrene. The first step in decision making for the treatment of PAD is to confirm PAD with history, physical examination and non invasive vascular laboratory tests. Decision making regarding revascularization is based on symptom status and patient comorbidities. Treatment strategies for intermittent claudication is medical management and for critical limb ischemia is revascularization in the form of either endovascular or surgical management to avoid amputation

Endograft Placement for Iliac Artery Pseudoaneurysm Following Graft Nephrectomy

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

Anterior Tibial Artery Pseudoaneurysm-Case Series

Anterior tibial artery (ATA) pseudoaneurysm is a rare condition that occurs following lower extremity orthopedic intervention or after trauma. We report a series of cases of pseudoaneurysm which were treated surgically. The diagnosis was confirmed with computed tomography angiogram. Aneurysmal sac excision with ligation of ATA was performed

An extremely rare case of an incidentally detected renal vein aneurysm and review of literature

Congenital renal vein aneurysms are a truncular type of venous malformation and are believed to be the outcome of defective development during the later stage of embryogenesis while the venous trunk is being formed. There have been 9 case reports so far. Here, we add the report of a patient who was incidentally detected to have a renal vein aneurysm on computed tomography angiogram. In addition, this is the first description of inferior vena cava thrombosis associated with a thrombosed saccular aneurysm of the renal vein

Regulating Microvascular Free Flaps Reconstruction in “Schobinger Stage 4” Arteriovenous Malformations of Face

Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme—a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm2. Fourteen patients (87.5%) had good-to-excellent score (p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups (p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVM