Phlegmasia Cerulea Dolens: A Rare Vascular Emergency.

Phlegmasia cerulea dolens (PCD) is a rare condition characterized by near-complete to total occlusion of an extremity, leading to discoloration, cyanosis, and pain caused by venous thromboembolism (VTE). The inciting events leading to VTE formation can vary widely and may include factors such as trauma or malignancy. In many cases, the underlying thrombus can be managed with anticoagulation.

Salvage of a megafistula causing high-output cardiac failure in a young adult with aneurysmorrhaphy and banding.

We present the case of a 21-year-old male with significant lengthening and aneurysmal degeneration of his brachiocephalic arteriovenous fistula resulting in a megafistula and high-output cardiac failure. A computed tomography angiogram showed narrowing at the cephalic arch. Further evaluation during the operation revealed kinking and elongation of the fistula in addition to compression of the cephalic arch in the deltopectoral groove leading to outflow obstruction.

Cystic adventitial disease of the popliteal artery presenting with features of entrapment syndrome.

Cystic adventitial disease is an uncommon cause of lower extremity claudication resulting from accumulation of mucinous fluid in an arterial subadventitial layer, typically of the popliteal artery. A popliteal bruit and/or reduced distal pulses with knee flexion may be seen on examination. Alternatively, popliteal artery entrapment syndrome triggers claudication via an aberrant arterial pathway or muscular hypertrophy.

Shear rate is a better marker of symptomatic ischemic cerebrovascular events than velocity or diameter in severe carotid artery stenosis.

Objective: This study was designed to test the hypothesis that the high shear rate of flow in the area of carotid stenosis is associated with the incidence of ischemic symptoms in patients with a high degree of carotid stenosis.

Methods: This is a case-control study of patients with >70% stenosis of the internal carotid artery (ICA) identified by duplex ultrasound in an Intersocietal Accreditation Commission-accredited laboratory during 1 year. Symptomatic patients were included in the study group, and asymptomatic patients served as controls.

Anatomical and technical predictors of perioperative clinical outcomes after carotid artery stenting.

Background: A few other studies have reported the effects of anatomical and technical factors on clinical outcomes of carotid artery stenting (CAS). This study analyzed the effect of these factors on perioperative stroke/myocardial infarction/death after CAS.

Methods: This was a retrospective analysis of prospectively collected data of 409 of 456 patients who underwent CAS during the study period.

Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume.

Background: Several studies have demonstrated better outcomes for carotid endarterectomy with high-volume hospitals and providers. However, only a few studies have reported on the impact of operator specialty/volume on the perioperative outcome of carotid artery stenting (CAS). This study will analyze the correlation of CAS outcomes and provider specialty and volume.

A case report of intraoperative endoscopic ultrasound during robotic assisted Heller myotomy for severe esophageal achalasia.

Esophageal achalasia is the best described primary esophageal motility disorder. Endoscopic ultrasound (EUS) is considered a useful adjunct for grading and establishing the prognosis of these patients. Recent experience using Da Vinci robotic assisted myotomy has demonstrated that this is a safe and effective approach of treatment.