BackgroundBow Hunter's Syndrome (BHS) is a rare condition in which dynamic vertebral artery (VA) compression during neck rotation induces transient symptoms, such as vertigo, whereas major arterial occlusion is extremely uncommon. There is no standardized treatment for BHS, and management includes conservative, surgical, and rarely endovascular approaches. We report a unique case of BHS with acute VA occlusion successfully treated by mechanical thrombectomy followed by elective stent placement.Case ReportAn 87-year-old woman presented with right gaze deviation, dysarthria, right hemiparesis, and sensory disturbance. Magnetic resonance imaging showed acute infarcts in the left pons and cerebellum, while magnetic resonance angiography showed poor visualization from the VA to the basilar artery. Emergency cerebral angiography showed VA occlusion, and subsequent thrombectomy was performed, which resulted in successful recanalization. Post-recanalization angiography showed residual stenosis at the V3 segment and an anomalous course of the VA running caudal to the posterior arch of the atlas. A dynamic ultrasonographic examination with neck rotation showed occlusion of the VA, which confirmed the diagnosis of BHS. Stent placement was planned because compression of the left VA was confirmed to be caused by soft tissue rather than by bony structures. Balloon angioplasty showed resistance to external compression. Subsequently, a balloon-expandable stent was successfully deployed using a distal access catheter and a stiff micro guidewire. Follow-up imaging confirmed VA patency with preserved flow during head rotation. The patient showed neurological improvement without recurrence during 6 months of follow-up.ConclusionWe report a rare case of BHS presenting with acute VA occlusion treated effectively with endovascular therapy. BHS should be considered as a potential cause of large-vessel occlusion in posterior circulation stroke when abnormal arterial courses are identified. In selected cases, stent placement may be a feasible therapeutic option depending on the compressive structure.
Aim To compare wound healing and amputation free survival outcomes in patients with critical limb threatening ischaemia (CLTI) undergoing single-vessel (SV) vs multi-vessel (MV) crural recanalisation. Methods Electronic databases including OVID, MEDLINE, Pubmed and CINHAL was conducted up until October 1st, 2024. Eligible studies of all languages included adults with CLTI who underwent SV or MV endovascular revascularisation of the crural vessels and reported wound healing outcomes (primary outcome). Risk of bias was assessed using ROBINS-I and RoB 2 tools. Quality of evidence was assessed using the GRADE System. Results A total of 154 articles were screened, of which seven studies (n = 2081 patients; 2402 limbs) were included. Of these, 1520 limbs (63.8%) underwent SV and 882 (36.7%) MV recanalisation. Five studies assessed wound healing across follow-up periods ranging from 3 months to 3 years. No consistent or statistically significant differences in wound healing were found between SV and MV groups. Six studies reported amputation-free survival (AFS) at 1 year, with some showing improved outcomes in MV patients. Overall, the quality of evidence was very low due to high risk of bias, heterogeneity in outcome definitions, and imprecision. Conclusions There is no clear evidence that MV recanalisation improves wound healing compared to SV in patients with CLTI. While some studies suggest potential benefits in AFS and limb salvage in selected patients, the current evidence is insufficient to support the added benefit of MV strategies. High-quality randomised trials with standardised outcome reporting are needed.
IntroductionAortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), involving less than 1% of all AAA and about 3% of ruptured aortic aneurysms.The conventional management of aortocaval fistula involved an open surgical approach, burdened by high mortality rates, while the endovascular repair has progressively become the mainstay of the vascular treatment.Case ReportA 73-year-old male patient presented to the emergency room with acute respiratory failure and signs of heart failure. A computed tomography angiography (CTA) demonstrated the presence of a 10 cm AAA, with a spontaneous rupture into the adjacent inferior vena cava (IVC). A bifurcated aortic endograft was therefore successfully deployed to exclude the ruptured AAA, with an immediate resolution of symptoms and an improvement in hemodynamic parameters. Nevertheless, a type IA endoleak was detected at a post-operative control CTA: its perfusion was sustained by communication with the IVC. A secondary intervention was deemed necessary, including both the proximal sealing fixation and the fistula closure. The aneurysmal sac was embolized with coils passing through the ACF, then, after performing the Intravascular Lithotripsy (IVL) of the right iliac axis, the Heli-FX EndoAnchor ® system was advanced and used to fix the proximal sealing zone, with a good angiographic and long-term, post-operative result.ConclusionThe endovascular treatment of ruptured AAA with ACF has proven to have lower morbidity and mortality than the surgical treatment. Numerous endovascular treatments have been used to treat aortocaval fistula: in the present case, the choice was dictated by the need to occlude the aneurysmal sac and to seal the type Ia endoleak in the same intervention. The combination of the aneurysmal sac embolization passing through the IVC and the Heli-FX EndoAnchor ® system seems to be a safe alternative in ruptured AAA with ACF.
Introduction We present a case of acute limb ischemia (ALI) in a morbidly obese patient with prior femoro-popliteal artery PTFE bypass occlusion successfully treated with a hybrid femoral-to-posterior tibial artery bypass utilizing the previously occluded graft. Case Report A 69-year-old morbidly obese woman presented with acute left leg pain and numbness with preserved motor function. Computed tomography angiography (CTA) demonstrates chronic superficial femoral artery and femoro-popliteal PTFE bypass occlusion with a new native popliteal artery thrombosis and loss of tibial runoffs. After systemic heparinization, the leg was revascularized through a small medial thigh incision and a jump PTFE bypass to the posterior tibial artery. The previously occluded femoro-popliteal artery bypass was accessed to re-establish proximal flow through a retrograde endovascular construction using a 7 mm by 25 cm Viabahn (Gore, Flagstaff, AZ) stent. This stent was used as a bridge with distal deployment within a new 6 mm PTFE graft, which was then anastomosed in an end to side fashion to a Linton patch of the posterior tibial artery. There were no postoperative complications, and the ankle-brachial-index was measured to be 0.98 with a CTA with runoffs confirming bypass patency. Discussion ALI in the setting of a prior bypass occlusion in a morbidly obese patient reflects the typical contemporary patient and disease complexity, which demands corrective revascularization with appropriate mitigation/prevention of other postoperative complications. A limited thigh exposure to access a previously occluded bypass can successfully restore in-line flow in these high-risk patients. Conclusion Hybrid lower extremity revascularization is an alternative surgical modality to restore in-line flow to a lower extremity as a limb salvage option while avoiding groin re-exploration in a previously accessed groin for bypass construction in a morbidly obese patient.
A superior gluteal artery pseudoaneurysm is a rare vascular lesion that can mimic soft tissue masses, creating diagnostic uncertainty and posing significant risk during biopsy or intervention. This case describes a patient with a superior gluteal artery pseudoaneurysm and associated arteriovenous fistula (AVF) initially mistaken for a piriformis mass. We discuss the clinical presentation, emphasize the imaging findings that facilitated accurate diagnosis, and outline the endovascular techniques used to achieve occlusion of the pseudoaneurysm and associated AVF.
IntroductionEndovascular abdominal aortic aneurysm repair (EVAR) is the primary treatment for abdominal aortic aneurysm (AAA). Despite favorable early outcomes, lifelong surveillance is essential as endoleaks remain a major cause of reintervention. Among these, type II endoleaks (T2E) remain controversial regarding optimal management. This study aimed to identify factors associated with intervention for T2E using time-to-event analysis and predefined anatomic thresholds. Secondary objectives included comparing outcomes between T2E patients with (intT2E) and without (nointT2E) intervention.MethodsA retrospective review of EVAR procedures from 2011-2024 was performed. Patients with newly diagnosed or persistent T2E were identified on completion and follow-up CT angiography. Patients were categorized as intT2E or nointT2E. Multivariable Cox regression evaluated time to first intervention, and logistic regression served as sensitivity analysis. Kaplan-Meier curves assessed freedom from intervention by inferior mesenteric artery (IMA) size.ResultsAmong 207 EVAR patients, 78 (37.6%) developed T2E over a mean 3.4 ± 2.4 years. Nineteen (24.3%) required intervention. IntT2E patients were younger (74.9 ± 6.8 vs 78.3 ± 7.9 years, P = 0.02), had more frequent anticoagulation use (47.4% vs 20.3%, P = 0.02), larger IMAs (4.2 ± 0.6 vs 3.3 ± 0.7 mm, P < 0.01), and more lumbar arteries (6.0 ± 1.2 vs 5.0 ± 1.3, P = 0.02). IMAs >4 mm occurred in 68.4% of intT2E vs 8.5% of nointT2E (P < 0.01). Mean sac growth was greater in intT2E (9.7 ± 5.3 mm vs -1.9 ± 6.5 mm, P < 0.01). Thirty-day complications following the index EVAR procedure, mid-term reinterventions, and overall mortality were similar between groups. Post-embolization, T2E resolved in 36.9%, with sac regression in 63.1%. Among embolized patients, 26.3% required a second embolization and one patient required 3 attempts without achieving resolution. IMA >4 mm independently predicted intervention (HR 7.18, 95% CI 1.97-26.16, P < 0.01). Logistic regression confirmed IMA >4 mm (OR 23.4, 95% CI 6.17-88.6, P < 0.01), >6 lumbar arteries (OR 4.2, 95% CI 1.10-15.98, P = 0.02), and anticoagulation (OR 3.4, 95% CI 1.17-10.6, P = 0.02) as predictors.ConclusionsApproximately one-quarter of T2E patients required embolization. IMA >4 mm was the strongest predictor of intervention, while anticoagulation and increased lumbar artery number also increased risk. Management should prioritize risk-stratified surveillance and selective intervention.
IntroductionFemoral vein adventitial cystic disease is an exceedingly rare vascular disorder characterized by mucin-filled cysts within the venous wall, leading to potential luminal obstruction and clinical symptoms. This case highlights the diagnostic challenges and management of this uncommon condition.Case PresentationA 58-year-old male presented with a 2-month history of progressive left lower extremity swelling and discomfort. Physical examination revealed pitting edema along the calf. Duplex ultrasound demonstrated a hypoechoic cystic lesion compressing the femoral vein. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a 3.1 cm × 1.4 cm × 2.1 cm cystic mass within the adventitial layer of the femoral vein, with partial luminal stenosis. No evidence of deep vein thrombosis or malignancy was observed.Intervention and OutcomeSurgical exploration via groin incision identified a translucent cyst arising from the femoral vein adventitia. Complete excision was performed with venous reconstruction. Histopathology confirmed a benign adventitial cyst with mucinous content and a single-layer endothelial lining. Postoperative recovery was uneventful, with resolution of symptoms and no recurrence at 3-month follow-up.ConclusionAdventitial cysts of the femoral vein, though rare, should be considered in patients with unexplained limb swelling. Multimodal imaging is critical for differential diagnosis, and complete surgical excision remains the definitive treatment. This case underscores the importance of recognizing atypical venous pathologies to prevent misdiagnosis and ensure optimal outcomes.
ObjectiveContrast-induced nephropathy remains a significant concern in patients undergoing endovascular aneurysm repair (EVAR), particularly those with pre-existing renal impairment. This study aimed to evaluate the feasibility and safety of using a one-quarter diluted contrast agent during EVAR to reduce contrast volume without compromising imaging quality or clinical outcomes.MethodsWe retrospectively reviewed EVAR procedures performed between July 2022 and September 2024. A total of 96 patients were included, with 50 receiving undiluted contrast and 46 receiving a one-quarter diluted solution. All procedures were conducted using the same angiographic system and protocol. Pixel values and signal-to-noise ratios (SNRs) were measured from digital subtraction angiography (DSA) images. Subjective image quality was independently evaluated by three vascular surgeons using a standardized 5-point scale. Postoperative type I/III endoleaks were identified on contrast-enhanced CT or ultrasound within 30 days. Statistical comparisons were performed using Welch's t-test, Mann-Whitney U test, chi-square test, or Fisher's exact test, as appropriate.ResultsProcedural success was achieved in all cases. The diluted group achieved a 70% reduction in contrast volume (19.8 ± 11.5 mL vs 67.7 ± 30.5 mL; P < .001). Pixel values (2.87 ± 8.75 vs 2.99 ± 5.59; P = .936), SNRs, and surgeon-rated image quality were comparable between groups. The incidence of type I/III endoleaks (2.0% vs 4.3%; P = .606) and radiation parameters did not differ significantly.ConclusionsUse of a one-quarter diluted contrast agent during EVAR provided image quality and safety comparable to undiluted contrast while significantly reducing contrast volume. This technique may represent a practical strategy to mitigate renal risk in patients with impaired kidney function.
BackgroundMajor vascular injuries during orthopedic procedures such as open reduction and internal fixation (ORIF) of acetabular fractures are rare but potentially fatal. The iliac veins are particularly vulnerable during anterior approaches due to their close proximity to the pelvic brim.PurposeTo describe the management of an iatrogenic external iliac vein injury sustained during acetabular ORIF via a modified Stoppa approach and to highlight the role of endovascular techniques as a rescue strategy.Research DesignDescriptive case study and literature review.Study SampleSingle patient undergoing acetabular ORIF complicated by intraoperative external iliac vein injury.Data Collection and/or AnalysisIntraoperative findings, management strategy, and postoperative outcomes were systematically documented. A narrative review of the contemporary literature on endovascular management of iliac and inferior vena cava injuries was performed.ResultsThe injury resulted in sudden, massive hemorrhage that could not be controlled through open exposure due to limited visualization and significant bleeding risk. An intraoperative endovascular approach was therefore adopted. Sequential deployment of aortic cuff stent-grafts via femoral access achieved rapid hemostasis while preserving venous patency. Postoperative imaging confirmed patent stents without evidence of extravasation.ConclusionsEndovascular stent grafting represents a viable and potentially life-saving alternative to open repair for major iliac venous injuries, particularly in anatomically challenging settings. This paper demonstrates the importance of preoperative vascular preparedness and the integration of endovascular rescue strategies into orthopedic trauma surgery.
BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening emergency requiring urgent surgical repair. The Ascyrus Medical Dissection Stent (AMDS) has been introduced as an adjunct to facilitate true lumen expansion and promote positive aortic remodeling. However, device-related complications such as malposition and persistent false lumen perfusion can lead to aneurysmal degeneration and reintervention.Case PresentationWe report the case of a 53-year-old male patient with an ATAAD with an entry tear at the aortic root extending to the iliac arteries. Emergency repair included ascending aortic replacement with AMDS implantation, and brachiocephalic trunk reimplantation. Early postoperative imaging showed incomplete AMDS expansion and a perfused false lumen, with rapid aneurysmal progression of the descending aorta. A hybrid reintervention combining intrathoracic debranching and thoracic endovascular aortic repair (TEVAR) was performed successfully. At 18 months follow-up, further enlargement of the aortic arch (from 69 × 64 mm to 78 × 70 mm) was observed due to retrograde false lumen perfusion. A TEVAR extension with false lumen occlusion using a occluder was undertaken, achieving complete sealing and favorable postoperative recovery.ConclusionsAMDS malposition and persistent false lumen perfusion following ATAAD repair can be managed by hybrid and endovascular reinterventions, including false lumen occlusion techniques. Lifelong imaging surveillance and multidisciplinary management in specialized aortic centers are essential to ensure early detection of complications and optimize long-term outcomes.
BackgroundVisceral artery aneurysms (VAAs) are uncommon vascular lesions, representing less than 2% of all arterial aneurysms, yet they carry significant clinical relevance owing to their frequently silent course and potential for catastrophic rupture. Within this group, celiac trunk aneurysms (CTAAs) and hepatic artery aneurysms (HAAs) constitute a minority of cases but pose distinct diagnostic and therapeutic challenges. Endovascular therapy has gained prominence in recent years; however, open surgical repair remains an essential treatment modality, particularly in complex anatomical settings or when endovascular options are unsuitable.MethodsWe present a case series of 3 patients managed at our institution: 2 with CTAAs and 1 with an HAA. All patients underwent open surgical repair using tailored vascular reconstruction strategies, including splenic artery interposition, aorto-hepato-splenic bypass with a great saphenous vein graft, and superficial femoral artery interposition. Patient selection and operative planning were guided by preoperative imaging, aneurysm morphology, and comorbid conditions.ResultsThere was no perioperative mortality. Major postoperative complications occurred in 2 cases, including gastric ischemia requiring total gastrectomy and postoperative hematoma requiring re-exploration. At 1-year follow-up, all patients demonstrated 100% graft patency and preserved end-organ perfusion.ConclusionsThis experience highlights the importance of individualized surgical decision-making in the management of VAAs. While the rarity of these lesions limits large-scale comparative studies, our series reinforces that open surgical repair remains a safe and durable option when tailored to patient-specific anatomy. In the era of endovascular techniques, elective open surgical repair remains associated with low mortality and high technical success when performed by an experienced surgical team, offering satisfactory early and mid-term outcomes.
BackgroundPeripheral artery disease (PAD) is a major global health problem with marked regional disparities. Updated estimates are needed to better characterize these differences and inform priority-setting in prevention and management.MethodsUsing GBD 2021 data, we estimated PAD prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) in High-income North America (HINA), the Caribbean, and Sub-Saharan Africa (SSA). Outcomes were reported as counts, crude rates, and age-standardized rates (ASRs), with stratification by sex, socio-demographic index (SDI), and age. Temporal trends from 1990 to 2021 and risk factor-attributable DALYs were also assessed.ResultsFrom 1990 to 2021, PAD cases increased by 72% in HINA, 127% in the Caribbean, and 137% in SSA, while DALYs increased by 84%, 168%, and 203%, respectively. Prevalence and DALY ASRs declined slightly in HINA, increased moderately in the Caribbean, and rose more markedly in SSA. Women showed higher prevalence and YLD burden, whereas men had higher YLL and mortality. Tobacco use and high fasting plasma glucose contributed more prominently to the attributable burden in HINA and the Caribbean, whereas high systolic blood pressure and kidney dysfunction were more prominent in SSA. PAD burden increased substantially after age 60 and peaked in the oldest age groups.ConclusionPAD burden continues to rise, with SSA showing the least favorable age-standardized trends. These findings highlight substantial regional heterogeneity and may help identify priorities for earlier detection, risk-factor control, and long-term PAD management, particularly in lower-resource settings.
BackgroundPopliteal artery aneurysms are the most common peripheral artery aneurysms, treated by endovascular stenting or open surgical repair by bypass. Short medial bypass is the predominant open surgical repair; however published outcomes frequently combine all techniques (medial and posterior, short and long, vein and prosthetic), preventing accurate interpretation of technique-specific results.MethodsWe present a retrospective cohort study of across 2 UK tertiary centres between January 2014 and December 2019. All patients underwent short exclusion bypass with autologous saphenous vein only. Short bypass was defined as inflow from mid-distal superficial femoral artery or above-knee popliteal artery to outflow at below-knee popliteal artery, tibioperoneal trunk, or crural vessel.Results69 limbs in 59 patients underwent short bypass over this period. Median age was 71 years, 96% were male and a PAA median size of 35 mm. Five-year outcomes demonstrated overall survival of 83.1% (95% CI: 74.0 - 93.2%), amputation-free survival of 76.3% (95% CI: 66.2 - 87.9%), and secondary patency of 90.1% (95% CI: 82.9 - 98.0%). Thirty percent required reintervention, predominantly for graft stenosis or ongoing sac perfusion. There was no evidence of proximal inflow disease progression that required intervention.ConclusionsShort medial bypass requires reintervention in 1 in 3 patients within 5 years for sac perfusion or graft stenosis but achieves excellent secondary patency.
Acute limb ischemia (ALI) is a medical emergency that can be due to prolonged tourniquet application, peripheral arterial disease, arterial embolization, and/or arterial thrombosis. To prevent associated morbidity and mortality, ischemia time should be minimized by urgent or emergent revascularization. However, revascularization can lead to ischemia-reperfusion injury (IRI), a devastating complication that can cause limb loss, multi-organ failure, and/or death. Currently, management of IRI largely relies on preventative measures and supportive care. In Part 2 of this two-part review article, we will briefly review the pathophysiology of IRI discussed in Part 1, and then discuss contemporary interventions to perfuse an acutely ischemic limb, clinical strategies that have been used to reduce and/or prevent IRI, and lastly, randomized controlled trials that have investigated pharmacological interventions to neutralize or mitigate IRI toxicity.
Penetrating injury to the subclavian vein is an uncommon, but potentially life-threatening event. Surgical repair is technically demanding due to the vessel's deep location beneath the clavicle, the narrow operative field, and the proximity of vital structures. Reported experience on endovascular techniques for subclavian venous injuries (SVI) remains limited. We present the case of a 60-year-old woman who sustained iatrogenic injury of the left subclavian vein during lateral cervical lymph node dissection for invasive thyroid carcinoma. Attempts at open hemostasis were unsuccessful, due to the depth and extent of the injury. Emergency endovascular repair with rapid deployment of an 11 × 50 mm Viabahn® self-expanding stent-graft resulted in immediate exclusion of the injury. The patient recovered uneventfully, and was discharged on postoperative day 3, under anticoagulation with direct oral anticoagulant at therapeutic dosage. Follow-up colored Duplex ultrasonography demonstrated good stent-graft patency. Contrast-enhanced computed tomography venography at 12 months confirmed the durable results, without thrombosis, stenosis, or migration. At 2-year follow-up, the patient remains asymptomatic, with a fully patent venous stent-graft. This case highlights the feasibility, safety, and durability of endovascular repair in managing SVI, and underscores the importance of rapid decision-making, proper anticoagulation, and rigorous postoperative surveillance in these rare but critical scenarios.
IntroductionWe present a rare case of mycotic pseuodaneurysm in elderly patient following a previously untreated upper respiratory tract infection.Case ReportA 78 year old gentleman complaining of hoarseness and abrupt formation of pulsatile neck mass was admitted to vascular surgery department. Three weeks earlier he exprienced symptoms of upper respiratory tract infection ("common cold") for which he did not seek medical attention. A contrast computed tomography scan (CT) revealed pseduoaneurysm of left internal carotid artery (ICA) compressing the laryngeal wall. Surgical excision of the pseudoaneurysm was performed with restoration of blood flow using a saphenous vein graft interposition. Microbilogical report confirmed bacterial infection caused by Pseudomonas oryzihabitans.DiscussionMycotic pseudoaneurysms of the extracranial ICA are rare and challenging to manage. In our case, presumed mechanism of pseudoaneurysm formation was direct microorganism invasion of arterial wall via periarterial lymphatics and vasa vasorum. To our knowledge, this is the first reported case describing the opportunistic bacterium Pseudomonas oryzihabitans as a causative agent.
Background/ObjectivesIn treating Peripheral Artery Disease (PAD), the contralateral femoral artery is commonly used for endovascular access. When antegrade access is not feasible, retrograde access via tibial or pedal vessels may be used. This study evaluates the impact of retrograde access on longitudinal outcomes using propensity score matching to emulate a randomized trial.MethodsThis retrospective analysis included patients who underwent endovascular revascularization at two institutions between 2014 and 2022. Retrograde access was defined as access via the anterior tibial, posterior tibial, peroneal, or dorsalis pedis artery. Major Adverse Limb Events (MALE) included arterial bypass, minor amputation, or major amputation. Propensity score matching was performed using known predictors of retrograde access: chronic kidney disease, gangrene, prior PAD surgery, chronic total occlusion, number of patent tibial vessels, age, and gender. Full matching minimized data loss. Univariate logistic regression estimated the effect size of retrograde access on MALE, reintervention, and death.ResultsAfter matching, 57 retrograde and 276 antegrade access patients were included. Covariate balance was achieved, with all absolute mean differences <0.1. Retrograde access was not significantly associated with reintervention (OR = 1.88, CI: 0.97-3.73, P = .065), death (OR = 1.74, CI: 0.84-3.46, P = .12), or MALE (OR = 1.32, CI: 0.67-2.51, P = .4).ConclusionRetrograde access does not significantly impact the odds of adverse outcomes and is a viable option when antegrade access is not feasible. However, elevated odds ratios and limited sample size suggest further study is warranted.
The aims of the present study were to develop and validate a predictive model for lower limb Varicose Veins, and to visualize the results using a web calculator for assessing the probability of patients developing Lower Limb Varicose Veins. A convenience sampling method was employed to select 421 patients from December 2023 to April 2024 at the health check-up center and vascular surgery outpatient clinic of a tertiary hospital in Xuzhou City. Based on the results of univariate and logistic regression analysis, a prediction model was constructed using logistic regression in machine learning and internally validated. The results were visually presented through a web calculator. This prediction model was developed based on variables such as gender, age, body mass index, standing time, exercise, education level, smoking, and family history. All tested indicators showed that the model has reliable discrimination and calibration. For clinical medical personnel, the web calculator prediction model can quickly and accurately identify patients with lower limb varicose veins, providing reference for developing personalized intervention measures. Furthermore, the web calculator provides a convenient and practical screening tool for primary healthcare providers and the public.Reporting MethodThis study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Backgroung: External iliac artery (EIA) endofibrosis is a rare, non-atherosclerotic condition affecting endurance athletes, commonly presenting as exercise-induced claudication. It is typically underdiagnosed and misattributed to musculoskeletal or neurological causes. Case Summary: We present our management of 3 cases of EIA endofibrosis in endurance athletes. The first patient, a 55-year-old male cyclist, underwent surgical revascularization for right EIA stenosis. The second case involved a 43-year-old female physical education teacher, who was treated with a prosthetic bypass graft for a loop configuration of the EIA. The third case, an amateur triathlete, presented with acute ischemia and underwent urgent revascularization using an interposition graft. All patients experienced complete resolution of symptoms and successfully resumed their athletic activities. Conclusion: EIA endofibrosis is an important consideration in athletes with exertional leg symptoms. Surgical treatment, including venous or prosthetic bypass grafts, is effective in relieving symptoms and ensuring long-term recovery. Early diagnosis is crucial to avoid complications, particularly in cases involving acute ischemia.
BackgroundPopliteal artery entrapment syndrome (PAES) is a rare vascular condition resulting from abnormal anatomical relationships between the popliteal artery and surrounding musculoskeletal structures, often causing limb ischemia. This study presents a case series of PAES patients treated surgically at a single academic center in Chile.MethodsA retrospective review was performed on patients diagnosed with PAES from January 2012 to December 2023. Data included demographics, symptoms, diagnostic modalities, PAES type, limb involvement, surgical approach, and outcomes. All patients underwent pulse volume recordings with dynamic maneuvers and confirmatory imaging. Follow-up was conducted regularly, and data were analyzed using SPSS v25.ResultsTwelve patients (83.3% male) with a median age of 40 years (range: 22-63) and 13 affected limbs were treated. Intermittent claudication was the most common symptom (58.3%), followed by critical (25.0%) and acute limb ischemia (16.4%). Imaging confirmed PAES in all cases, predominantly type I (46.1%) and type III (38.4%). All patients underwent surgical decompression, and 46.1% required arterial revascularization. Postoperative complications occurred in 16.6%, and median hospital stay was 2.5 days (range: 1-7). Median follow-up of was 70.5 months (range: 12-105), primary patency rate was 92.3%, and 83.3% of patients remained asymptomatic during follow-up.ConclusionSurgical treatment of PAES is safe and effective, offering favorable mid-term outcomes with low morbidity. Early diagnosis and a multidisciplinary approach are essential to prevent irreversible arterial injury and optimize long-term results.
