Introduction: Acknowledging the superior long term patency of infrainguinal saphenous bypass to distal popliteal artery, debate continues regarding the choice of alternative conduits and possible surgical adjuncts to improve inflow and graft salvage. The objective of this retrospective study was to determine the effectiveness of proximal anastomotic patch as adjunct to open surgical below the knee popliteal revascularization. Material and Methods: In a series of 132 distal popliteal bypass operations 63 non-reversed vein, 18 in situ vein and 51 Omniflow bypass conduits were used. Proximal anastomotic patch was applied in overall 28 patients: 19% in the non-reversed (12 patients), 50% in the in situ group (9 patients) and 13.7% in the Omniflow group (7 patients). Results: The reintervention rate was 7.9% in the non-reversed, 33.3% in the in situ and 31.4% in the Omniflow group. The most often complication was the proximal anastomotic stenosis (5.3%), followed by bleeding (3%), infection (1.5%) and distal anastomotic stenosis (1.5%). Patch reconstruction did not decrease incidence of reoperation (21.4% vs. 21.2% in the non-patch group), nor significantly influence bleeding, infection or thrombosis, however it reduced the overall rate of proximal anastomosis stenosis (0% vs. 6.7%, p=) and significantly improved patency rate at 3 years in the in situ group compared to the non-patch group (100% vs. 55.6%, p=0.02).

Objectives: To assess the outcomes of infra-inguinal aneurysms admitted to a regional vascular unit. Methods: All patients admitted with a primary diagnosis of infra inguinal aneurysms were identified from clinical coding lists over a four-year period (January 2008–May 2012). All patients were identified through clinical coding and records were checked to confirm diagnosis, management and outcome, with data analysed using SPSS v18. Results: 39 patients (mean age 58.3yr, range 18-98), of which 27 were male, were identified (24 PseudoAneurysms (PA), 12 True Aneurysms (TA) and 3 Mycotic Aneurysms (MA)). The majority of the PAs were secondary to Intravenous Drug Abuse, IVDA (41%), followed by interventional procedures (29%), vascular anastomotic sites (13%), orthopaedic surgery (13%) and penetrating trauma (4%). 11/12 (92%) TAs were popliteal in origin, with 22/24 (92%) of PAs located at or around the femoral bifurcation. 22/24 of PA (12 surgical; 4 endovascular stenting; 1 ultrasound guided thrombin injection; 4 ultrasound guided compression; 1 embolisation), 8/12 of TA (7 surgical; 1 endovascular stenting) and 3/3 MA (2 surgical; 1 combined surgical + endovascular stenting) required intervention. One patient underwent primary major amputation (popliteal TA) with a further three patients requiring major amputation post intervention (1 MA post bypass procedure, 1 PA post vessel ligation, 1 PA secondary to percutaneous intervention presenting with distal embolization requiring vessel ligation). Overall 30-day mortality was 5.1% (n=2). Conclusions: Our results suggest that the risk of major amputation and mortality secondary to infra-inguinal aneurysms as a pathology is significant.

A 70-year-old male presented with two days increasing dyspnea. His past medical history was notable for deep venous thrombosis with consecutive pulmonary embolism (PE). Diagnostic workup showed normal blood pressure (130/80mmHg), sinus tachycardia with SIQIII-pattern on electrocardiogram, and elevation of thrombolysis-catheter with a staged infusion protocol since the patient was hemodynamically stable. For this purpose, an ultrasound assisted catheter (EkoSonic MACH4e Endovascular System, EKOS Corporation, Bothwell, WA) was positioned into the left lower PA-branch via the right femoral vein and rtPA-thrombolysis was administered over 16h (0.8mg/hour) until the next morning. On the next day, a second venous access was placed into the left femoral vein and with the help of a 6F-right-amplatz-catheter, the thrombolysis troponin (0.22ng/nl). Immediate chest computed tomography (CT) demonstrated PE in both pulmonary arteries (PA) and right ventricular (RV) dilation compatible with PE of intermediate-high risk for early mortality (Figure 1).

Purpose of study: Hemoptysis is a common emergency coming to the pulmonary medicine and general Medicine department. Massive hemoptysis has high mortality even after surgical treatment. Bronchial artery embolization is an effective alternative to surgery for controlling hemoptysis, with high success rate. Material and methods: 74 consecutive patients coming to our hospital with moderate to severe hemoptysis were subjected to bronchial artery embolization (BAE). Femoral arterial puncture was the commonest approach. Some patients, where the culprit vessel was arising from subclavian artery, were approached from radial artery puncture. All patients were embolized with poly vinyl alcohol particles. Results: Out of 74 patients, 54 were male and 20 were female. The mean age was 46.67±14.58 yrs. Cause of hemoptysis was tuberculosis in 64 patients, bronchiectasis in two, aspergillosis in two and in six, the cause was not known. Total 192 vessels were embolized, 86 bronchial, 43 from subclavian, 53 intercostal and 20 internal mammary. Within one year, recurrence occurred in 13 patients three of whom died. In 9 patients, the bleeding was controlled with repeat BAE.

Almost 8% to 14% of patients undergoing coronary artery bypass grafting (CABG) have significant internal carotid artery stenosis requiring treatment [1]. A carotid artery disease, especially when a high-risk plaque is present, represents an important risk factor for stroke after cardiac surgery, in particular after CABG. For these reasons carotid endarterectomy (CEA) before or concomitantly to cardiac surgery [1–4] has been proposed, but these procedures have been reported to carry a 10% to 12% cumulative risk of death, stroke, or myocardial infarction (MI) [5]. To date, no consensus exists for the best approach for the management of combined severe carotidand coronary or other than coronary cardiac disease. Carotid artery stenting (CAS) has been evolving in these last decades to be a valid alternative to traditional carotid endarterectomy for CABG patients in consideration of their high-risk profile [6-7]. CAS followed by CABG after several weeks has been proposed as a staged approach, but the increased risk of myocardial infarction in the interval [8-9] may represent a major limitation. Moreover, the need for dual antiplatelet aggregation therapy for 3 to 4 weeks after CAS increases the risk of bleeding if surgery is urgently required in the meantime [9].

Introduction Renal artery aneurysms (RAAs) are rare. They are often identied incidentally during abdominal computed tomography (CT) screening for other diseases. They are occasionally identied as a rare abdominal emergency due to rupture of a left renal artery aneurysm. In recent years, endovascular therapy such as coil embolization or stentgraft with the coil embolization was successful for treating RAAs, but complex AAs may require aneurysmectomy and renal artery reconstruction by in-situ repair or ex-vivo. Observation We report the case of a 54-year-old-man with a history of hypertension and smoking, followed in urology for lower back pain. Renal ultrasound suspected the presence of a pre-hilar aneurysm, confirmed by CT angiography (Figure 1A) which showed a large and distal aneurysm, extended to the division of arterial branches. The complexity of the lesion has justified the use of ex-situ repair (Figure 1B,C ).

Introduction Primary tumours of the heart are not common and the prevalence of cardiac tumors ranges from 0,001% to 0,3% at autopsy [1]. Over 70% of primary cardiac tumors are benign and the most common form of these primary tumours are myxomas. Most of the myxomas are located in the left atrium (%75–80), arising from the interatrial septum at the border of the fossa ovalis [2]. Larger tumors are more likely to be associated with cardiovascular symptoms [3]. Commonly observed symptoms and signs are dyspnea, pulmonary edema, cough, peripheral edema and fatigue. Constitutional symptoms (fever, weight loss) are seen in around 30% of patients. Laboratory abnormalities (anemia and elevations in the erythrocyte sedimentation rate, C-reactive protein) are present in 35 % of patients [4]. This case report show us discrepancy between giant right atrial myxoma and atypical symptom of patient. Once a cardiac myxoma is diagnosed, surgical excision should be performed without delays because of the risk of thromboembolic events [5-7], syncope and sudden cardiac death. Generally, surgical treatment is definitive and recurrence is uncommon.

The International Diabetes Federation (IDF) reported that the global prevalence of diabetes (DM) in adults was 8.3% in 2013 expecting to rise beyond 592 million by 2035 with a 10.1% global prevalence [1]. Guidelines have been published for the treatment of this major disease and its complications [2,3]. Recently, cilostazol has been proposed for the treatment of diabetic patients and their complications. Cilostazol is a selective inhibitor of phosphodiesterase type 3 that appears to have both antiplatelet and anti-proliferative effects [4]. Cilostazol inhibits platelet aggregation in response to ADP, epinephrine, collagen and arachidonic acid, and suppresses the production of platelet derived endothelial cell growth factor [4].

Objectives: Diabetic patients are prone to early development of vasculopathy, resulting in lower limb ischemia, which can lead to non-healing ulcers, foot infection, loss of limb, and even death. These patients need revascularization of their limb either using endovascular or open surgical techniques.Not all patients are suitable for endovascular treatment warranting the open surgical revascularization techniques. The objective of this study was to evaluate the patency of arterial bypass grafting using reverse saphenous vein graft in the treatment of peripheral vascular disease of the lower limbs in diabetic patients. Patients and Methods: Between January 2004 and December 2014, 218 diabetic patients with lower limb ischemia of Fontaine class III and IV underwent distal arterial bypass grafting with autologous reverse saphenous vein graft. Another group of 103 patients where the saphenous vein was ether previously used or not suitable as conduit underwent revascularization using synthetic ePTFE graft. Patency of the grafts, overall effectiveness of revascularization, improvement in symptoms, and healing of ulcers were assessed at short-term (three months) and long-term (mean 20.6 ±6.6 months) follow-up.

Objectives: Recently, the model for End-Stage Liver Disease (MELD) was proposed for the prediction of survival in transjugular intrahepatic portosystemic shunt (TIPS) patients. We therefore compared the prognostic accuracy of the MELD model and the Child-Pugh score, in an unselected cohort of TIPS patients followed long-term. Methods: A retrospective chart review and statistical analyses were done on 120 patients consecutively admitted for portal hypertension from 2009 to 2013 in the Jinling hospital (Nanjing, China). Results: The survival rate for all patients was 95.8% at 3 months, 90% at 1 year, and 85.8% at 3 years. Significantly lower survival rates were found in patients with MELD scores of 15 or more in comparison to those with MELD scores of 15 or less (p<0.001).There was no significant difference in survival rate between patients with Child-Pugh classifi cation A and those with Child-Pugh classifi cation B, while the patients with Child-Pugh classification C has a signifi cantly lower survival rate than those with Child-Pugh classification A and B (p<0.001). The discrimination powers of MELD (c statistics: 0.772, 0.680, 0.647 for 3-month, 1-year, and 3-year survival) were not signifi cantly different from the discrimination powers of Child-Pugh score at the same time points (c statistics: 0.795, 0.732, 0.678).