Abstract Acute upper limb ischemia resulting from injury caused by chronic use of crutches is a rare event. Incorrect use of underarm crutches results in repeated compressions of the arterial segment and can cause localized trauma, leading to structural changes, formation of thrombus, and/or aneurysmal degeneration at the site, which in turn can lead to acute arterial obstruction. We present the case of a 53-year-old male with a history of chronic axillary crutch use due to childhood poliomyelitis who presented with acute right upper limb ischemia. Computed tomography angiography identified a right upper limb occlusion and was treated with a vein graft bypass. After recovery, he was guided and trained with special prosthesis to prevent recurrent thrombosis and subsequent embolization. This case report is intended to call attention to the type of clinical presentation found in this rare form of upper limb arterial occlusion and the importance of its prevention.

Glomus tumors are benign subungual lesions, causing excruciating pain. These lesions are small, rarely seen on the skin surface, and hence, diagnosis is often missed for years together. However, a proper history and clinical examination avoids unnecessary investigations, expenses, and delay in the treatment. We report the case of a middle-aged female with the left little finger pain, undiagnosed, and mismanaged for the last 20 years. A proper history and clinical examination favored a diagnosis of a glomus tumor, which was excised completely. The patient is now absolutely pain free after two decades of her painful miseries.

Abstract We report a rare coexistence of a cephalic vein aneurysm and a subungual glomus tumor in a 32-year-old woman who presented with a painless swelling over the right proximal forearm and a long-standing history of severe, cold-sensitive pain beneath the nail bed of the right middle finger. Clinical examination and imaging confirmed a primary aneurysm of the cephalic vein and a subungual glomus tumor. The patient underwent surgical excision of both lesions under regional anesthesia. Histopathological evaluation confirmed the diagnoses. The postoperative course was uneventful, with complete resolution of symptoms and no recurrence at 1-year follow-up. This combined report highlights the importance of recognizing and differentiating these conditions for effective management strategies. To the best of our knowledge, the first reported coexistence of these two rare conditions in the same limb.

Abstract Acute limb ischemia is usually caused by atherosclerotic or embolic disease; however, drug-induced vasospasm is an important but often overlooked differential diagnosis. Chronic ergot toxicity is a rare cause of lower extremity ischemia. A 54-year-old female with hypothyroidism presented with sudden-onset pain, sensory loss, and weakness of the left lower limb, with a preceding history of bilateral claudication. Computed tomography angiography showed diffuse tapering of the major lower limb vessels. Detailed pharmacological history revealed daily ergotamine use for migraine for 15 years. A diagnosis of ergotamine-induced peripheral vasospasm was made. The drug was gradually withdrawn, and ischemia was managed conservatively with medical therapies. The patient showed progressive improvement and remained asymptomatic at 1-year follow-up. This case emphasizes the importance of meticulous drug history, which helps in identifying reversible causes of limb ischemia and avoids unnecessary interventions.

SUSHRUTA, the father of Indian surgery mentions aneurysm, or "Granthi," in Chapter 17 of his great medical text "Sushruta Samhita." In his text, Sushruta wrote "(Granthi) in most cases is impossible to treat and in some, it can be cured only with the greatest difficulty." His views were also supported and recorded in the "Book of Hearts" from the Eber Scolls of ancient Egypt, dating back to 1550 BC. It stated that "only magic can cure tumors of the arteries." The surgical management of abdominal aortic aneurysms (AAAs) from impossible to possible dates back over 3000 years and has evolved greatly since its conception. Over the course of surgical history arose, three landmark developments in aortic surgery: crude ligation, open repair, and endovascular aortic repair (EVAR). EARLY LIGATION Antyllus is credited with performing the first recorded surgical interventions for the treatment of AAA. His method involved midline laparotomy, proximal and distal ligation of the aorta, central incision of the aneurysm sac, and evacuation of thrombotic material. Remarkably, a few patients treated without an aseptic technique or anesthetic managed to survive for some period. Antyllus' method was further described in the 7th century by Aetius, whose detailed article "On the Dilation of Blood Vessels," described the development and repair of AAA.[1] His approach involved stuffing the evacuated sac with incense and spices to promote pus formation in the belief that this would aid wound healing. Although this belief would wane as knowledge of the process of wound healing improved, Antyllus's method would remain largely unchanged until the late 19th century. MODERN LIGATION The modern period of AAA surgery began in 1817 when Cooper first ligated the aortic bifurcation for a ruptured left external iliac aneurysm in a 38-year-old man. The patient died 4 h later; however, this did not discourage others from attempting similar procedures.[2] Ten further unsuccessful cases were recorded before the turn of the 20th century. It was not until a century later, in 1923, that Matas performed the first successful complete ligation of the aorta for aneurysm, with the patient surviving 17 months and dying from tuberculosis.[3] Described by Osler as the "modern father of vascular surgery," Matas also developed the technique of endoaneurysmorrhaphy, which involved ligating the aneurysmal sac upon itself to restore normal luminal flow. This was the first recorded technique aiming to spare blood flow to the lower limbs, an early prelude to the homograft, synthetic graft, and EVAR. EARLY ALTERNATIVES TO LIGATION Despite Matas' landmark success, the majority of surgeons of the era shared Sushruta's millennia-old fear of aortic surgery. The American Surgical Association wrote in 1940, "The results obtained by surgical intervention have been discouraging." Such fear prompted a resurgence of techniques introducing foreign material into the aneurismal lumen with the hope of promoting thrombosis. First attempted by Velpeau with sewing needles in 1831, this technique was modified by Moore in 1965 using 26 yards of iron wire. Failure of aneurysm thrombosis was blamed on "under packing" the aneurysm. Corradi used a similar technique, passing an electric current through the wire to introduce thrombosis. This technique became known as fili-galvanopuncture or the "Moore–Corradi method." Although this technique lost popularity for aortic procedures, it marked the beginning of electrothrombosis and coiling of intracranial aneurysms in the latter half of the 20th century. Another alternative was wrapping the aneurysm with material in an attempt to induce fibrosis and contain the aneurysm sac. AAA wrapping with cellophane was investigated by Pearse in 1940 and Harrison in 1943. Most notably, Nissen, the pioneer of Nissen fundoplication for hiatus hernia, famously wrapped Albert Einstein's AAA with cellophane in 1948.[4] The aneurysm finally ruptured in 1955, with Einstein refusing surgery: "I want to go when I want. It is tasteless to prolong life artificially. It is tasteless to prolong life artificially." ANASTOMOSIS - THE BEGINNING OF RECONSTRUCTION Many would argue that the true father of modern vascular techniques is Alexis Carrel. He conducted the first saphenous vein bypass in 1948, the first successful kidney transplant in 1955, and the first human limb reimplantation in 1962.[5] Friedman states that "there are few innovations in cardiac and vascular surgery today that do not have roots in his work." Perhaps of greatest note was Carrel's development of the triangulation technique for vessel anastomosis." This technique was utilized by Crafoord in Sweden in 1944, in the first correction of aortic coarctation, and by Shumacker in 1947 to correct a four-centimeter thoracic aortic aneurysm secondary to coarctation. Before this time, coarctation was treated in a similar fashion to AAA, with ligation proximal and distal to the defect. These developments would prove to be great milestones in AAA surgery as the first successful aortic aneurysm resection with restoration of arterial continuity. SYNTHETIC GRAFTS Despite this success, restoration of arterial continuity was limited to the thoracic aorta. Abdominal aneurysms remained too large to be anastomosed directly and a different technique was needed. Carrel played a key role in the development of arterial grafting, used when end-to-end anastomosis was unfeasible. The original work was performed by Carrel and Guthrie (1880–1963) with experiments transplanting human and canine vessels. Their 1907 article "Heterotransplantation of blood vessels" began with: "It has been shown that segments of blood vessels removed from animals may be caused to regain and indefinitely retain their function." This discovery led to the first replacement of a thrombozed aortic bifurcation by Jacques Oudot (1913–1953) with an arterial homograft in 1950. The patient recovered well, and Oudot went on to perform four similar procedures. The landmark first AAA resection with the restoration of arterial continuity can be credited to Charles Dubost (1914–1991) in 1951.[6] His patient, a 51-year-old man, received the aorta of a young girl harvested 3 weeks previously. This brief period of excitement quickly subsided when it was realized that the long-term patency of aortic homografts was poor. It did, however, lay the foundations for the age of synthetic aortic grafts. SYNTHETIC GRAFTS Arthur Voorhees (1921–1992) can be credited with the invention of synthetic arterial prosthetics. In 1948, during experimental mitral valve replacement in dogs, Voorhees noticed that a misplaced suture had later become enveloped in the endocardium. He postulated that "a cloth tube, acting as a latticework of threads, might indeed serve as an arterial prosthesis." Voorhees went on to test a wide variety of materials as possible candidates from synthetic tube grafts, resulting in the use of vinyon-N, the material used in parachutes. His work with animal models would lead to a list of essential structural properties of arterial prostheses. Vinyon-N proved robust and was introduced by Voorhees, Jaretski, and Blakemore. In 1952, Voorhees inserted the first synthetic graft into a ruptured AAA. Although the vinyon-N graft was successfully implanted, the patient died shortly afterward from a myocardial infarction. By 1954, Voorhees had successfully implanted 17 AAAs with similar grafts. Schumacker and Muhm would simultaneously conduct similar procedures with nylon grafts. Vinyon-N and nylon were quickly supplanted by Orlon. Similar materials with improved tensile strength are used in open AAA repair today, including Teflon, Dacron, and expanded polytetrafluoroethylene.[7] MODERN OPEN SURGERY The golden age of open AAA repair started with the development of suitable synthetic graft material. The focus would now be largely on the Americans, particularly with surgeons DeBakey (1908–2008) and Cooley (1920) leading the way in Houston, Texas. In the early 1950s, DeBakey and Cooley developed and refined an astounding number of aortic surgical techniques. Debakey would also classify aortic dissection into different types depending on their site. In 1952, a year after Dubost's first success in France, the pair would perform the first repair of the thoracic aneurysm, and a year later, the first aortic arch aneurysm repair. It was around this time that the risks of spinal cord ischemia during aortic surgery became apparent. Moderate hypothermia was first used and then enhanced in 1957, with Gerbode's development of extracorporeal circulation, coined "left heart bypass." In 1963, Gott expanded on this idea with a heparin-treated polyvinyl shunt from ascending to descending aorta. By 1970, centrifuge-powered, left-heart bypass with selective visceral perfusion had been developed. In 1973, Crawford simplified DeBakey and Cooley's technique by introducing sequential clamping of the aorta. By moving clamps distally, Crawford allowed for reperfusion of segments following the anastomoses of what had now become increasingly more complex grafts.[8] The work of DeBakey, Cooley, and Crawford paved the way for the remarkable outcomes available to modern patients undergoing open AAA repair. Where once feared by surgeons and patients alike, inhospital mortality following elective, open AAA now has a 30-day all-cause mortality of around 5%. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR The advent of successful open surgical repair of AAAs using synthetic grafts in the 1950s proved to be the first definitive treatment for AAA. However, the procedure remained highly invasive and many patients were excluded due to medical and anatomical contraindications. Juan Parodi's work with Julio Palmaz and Héctor Barone in the late 1980s aimed to rectify this issue. Parodi developed the first catheter-based arterial approach to AAA intervention. The first successful EVAR operation was completed by Parodi in Argentina on September 7th, 1990.[9] The aneurysm was approached intravascularly through a femoral cutdown. Restoration of normal luminal blood flow was achieved with the deployment of a Dacron graft mounted on a Palmaz stent. There was no need for aortic cross-clamping or major abdominal surgery. Similar noninvasive strategies were explored independently and concurrently by Volodos, Lazarus, and Balko. The Food and Drug Administration approved the first two AAA stent grafts for widespread use in 1999. Since then, technical improvements in device design have resulted in improved surgical outcomes and increased ability to treat patients with difficult aneurysmal morphology. Slimmer device profiles have allowed easier device insertion through tortuous iliac vessels. Furthermore, fenestrated and branched grafts have made possible the stent-grafting of juxtarenal AAA, where suboptimal proximal neck anatomy once meant traditional stenting would lead to renal failure and mesenteric ischemia.[10] CONCLUSION The journey toward a truly effective surgical intervention for AAA has been a long and experimental one. Once regarded as one of the most deadly pathologies, with little chance of a favorable surgical outcome, AAAs can now be successfully treated with minimally invasive procedures. Sushruta's millennia-old fear of abdominal aortic surgery appears well and truly overcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Knee arthroplasty procedures are common and with the advancement in the technique involved, arterial complications are rare; however, the sequelae can be disastrous. An anomalous high origin of tibial arteries in the knee joint remains a potential risk for complications. We report a case of popliteal artery pseudoaneurysm following total knee arthroplasty, presented clinically as large painful pulsatile swelling. She was found to have an anomalous high origin of the anterior tibial artery. She underwent complete excision of the pseudoaneurysm with arterial repair using a vein graft.

Glomus tumors, also known as paragangliomas or chemodectomas, are usually slow–growing, benign, highly vascular tumors of neuroendocrine origin. Glomus tumors (paragangliomas) represent 0.6% of neoplasms of the head and neck and 0.03% of all neoplasms. In head-and-neck region, these common paragangliomas originate from the jugular bulb, carotid body, and vagus nerve. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Multicentric paragangliomas are seen in 10% of sporadic patients and 30%–40% in familial forms. We report an extremely rare case of multicentric, nonfamilial, nonfunctional right glomus jugulare with bilateral carotid body tumors and the surgical management.

Popliteal vein aneurysms are uncommon but can be life-threatening vascular disorders. The primary risks associated with these aneurysms are thromboembolic events, particularly pulmonary embolism, which poses a significant risk to life and demands swift diagnosis and intervention. As a potentially treatable source of recurring pulmonary embolism, the true incidence of popliteal vein aneurysms is thought to be underreported. Diagnostic imaging tools such as ultrasound, computed tomography, and magnetic resonance imaging are most commonly preferred to identify this condition. Early surgical intervention is recommended, when possible, for both symptomatic and asymptomatic popliteal vein aneurysms, as they carry an undefined risk of pulmonary embolism and mortality if left untreated. This case report discusses a 26-year-old previously healthy male who presented with left knee pain, which worsened during physical activity, and was successfully treated with surgery. (JVS-Vascular Insights 2025;3:100227.)

Background: Primary venous aneurysms (PVA) in extremities result in the risk of pulmonary embolism (PE), deep vein thrombosis (DVT), and chronic venous insufficiency. Owing to the rarity of these aneurysms, a consensus for their treatment has yet to be established. Aims and Objectives: The aim of the present study is to review the presentation, treatment options, and outcome of primary venous aneurysms in extremities. Material and Methods: We performed a retrospective analysis from June 2022 to June 2024 and found 7 patients were treated for primary venous aneurysms in extremities. A venous aneurysm was defined as saccular or fusiform with an aneurysm/vein ratio of >1.5. Patients with varicose veins, A-V fistulas, and pseudoaneurysms were excluded from this study. Results: There were 7 patients with primary venous aneurysms, with male preponderance (6:1). The ages ranged from 25 to 60 years. 5 aneurysms were located in the lower extremity and 2 in the upper extremity. In 3 patients, lower extremity aneurysms occurred in the deep system. Patient’s symptoms were swelling associated with pain (5) and mass (2). Thromboembolism occurred in 2 patients, DVT in 1, and PE in 1. Diagnosis was made by colour duplex scanning, Computed Tomography (CT) Venography, or magnetic resonance imaging. The aneurysm sizes ranged from 4 to 6 cm. Management consisted of tangential excision with lateral venorrhaphy in 3 (42.9%) and total excision in 4 (57.1%) patients. Postoperative anticoagulation is recommended for at least 3 months. Conclusion: Primary venous aneurysms in extremities are uncommon, and their presentation ranges from asymptomatic, to life-threatening PE/DVT or rupture with bleeding. Open surgical repair remains the “gold standard,” either ligation and total excision, or tangential aneurysmectomy with lateral venorrahaphy.

Abstract Endovascular aneurysm repair (EVAR) is now an established method of treating abdominal aortic aneurysms. Endovascular stent graft infection is a rare but life-threatening complication of EVAR. The early diagnosis is difficult because of its nonspecific clinical manifestations, which range from weakness, fever, and back pain to fatal sepsis or rupture. The management of these patients poses a significant challenge as majority of these patients are unfit for further surgery. However, surgical removal of the infected endograft, restoration of aortic blood flow, and long-term antimicrobial therapy are the main components of the treatment. This case report details our experience with the first case of aortic endograft infection (AEI) encountered at our institution. This patient presented with symptoms of chronic low back pain, abdominal distention, and recurrent pyrexia suggestive of infection following EVAR. Diagnostic imaging and microbiological analysis confirmed the presence of AEI. Our management approach included a combination of surgical intervention and prolonged antibiotic therapy. We outline the diagnostic process, therapeutic strategies, and outcomes of this case, thus providing insights into the clinical presentation, diagnostic considerations, and treatment modalities for AEI, contributing to a better understanding of this critical condition and aiding future clinical decision-making.

Surgical excision of carotid body tumors still continues to be a challenge due to multiple arterial feeders leading to hypervascularity. The hypervascularity is primarily receiving blood supply from the branches of the external carotid artery (ECA). The ascending pharyngeal artery, a branch of the ECA, is the primary feeder, but other branches such as the occipital artery, superior thyroid artery, and even the internal carotid artery or vertebral artery can contribute in some cases. The glomic artery, although rare, can contribute significantly to the hypervascularity. We present the two cases of glomic artery supplying carotid body tumor. A detailed knowledge of arterial supply with the identification of rare arterial feeders such as glomic artery helps in proper planning, avoiding cerebrovascular events during preoperative embolization and reducing perioperative bleeding.

Objectives: To describe the different presentations, evaluations, management and outcome of delayed vascular complications of gun shot wound following peripheral vascular trauma. Materials: A retrospective study of three years from January 2021 to December 2023. All the patients with peripheral vascular injuries following gun shot wound missed at the time of causative trauma were included. Patients with acute presentations were excluded. All the cases were evaluated with CT angiography and managed with various open vascular surgical techniques and their results were assessed. Results: Five patients with delayed vascular complications following gun shot wounds underwent vascular repairs. Age ranged from 25 - 40 yrs. One female and four were males. The time interval between injury and presentation ranged from 10 to 15 years. All the patients presented with high flow Arterio -venous fistula with extensive limb swelling. Also associated with giant venous aneurysms in three, nonhealing ulcers with venous hypertension in three and limb ischemia in one. Lower limb vessels were affected in 4 cases and upper limb in 1. Superficial femoral and popliteal arteries were more frequently involved. Ligation and excision of high flow a-v fistula with vein bypass was performed in all. In cases with giant venous aneurysm, tangential excision with lateral venorraphy was done. Postoperatively all the patients were on anticoagulation. Follow up showed good recovery. Conclusions: High flow A-V fistula is the commonest delayed presentation with extensive limb swelling following gun shot wound injury. In most cases it was found to be associated with giant venous aneurysms and venous hypertension. Open vascular surgical procedures provides durable long term results and should be considered as the first choice in these young patients.

Primary venous aneurysms are uncommon solitary dilatation of a vein that can occur throughout the venous system. Superficial venous aneurysms of the lower extremities are more often reported as esthetically displeasing bulges or incidental findings and are asymptomatic. A painful primary venous aneurysm is an extremely rare clinical entity. We report a case of painful thrombosed venous aneurysm of the great saphenous vein in a young male and managed surgically.

Primary superficial venous aneurysms (VAs) are uncommon solitary dilatations of a vein and are usually asymptomatic. Superficial VAs are manifested more frequently in the lower extremities than in the upper extremities. Primary superficial VAs of the upper extremities are more often reported as esthetically displeasing bulges or incidental findings. Here, we report the rare case of a giant basilic vein aneurysm in the proximal forearm that presented with a recent increase in size and pain.