Squamous cell carcinoma arising in a below-knee stump of a patient with chronic lymphocytic leukemia.

We report a case of localized squamous cell carcinoma arising in the ulceration at the site of a below-knee amputation in a patient with chronic lymphocytic leukemia on treatment with ibrutinib. The patient underwent local excision of the skin and soft tissue with histopathology showing a small focus of well-differentiated squamous cell carcinoma in the specimen. This case highlights the importance of clinical evaluation and histopathological review for underlying malignancy in the setting of amputation stump ulceration.

Clinical Patterns, Predictors, and Results of Graft Limb Occlusion following Endovascular Aneurysm Repair.

Background: To assess the incidence, clinical patterns, and outcomes of graft limb occlusion (GLO) following endovascular aneurysm repair (EVAR).

Methods: A retrospective study of patients undergoing EVAR from 2002 to 2017 at 2 mid-sized suburban teaching hospitals. The ipsilateral and contralateral aorto-common iliac artery (A-CIA) angle and common iliac artery-external iliac artery (CIA-EIA) angle were determined.

Acute limb ischemia secondary to external iliac and common femoral artery dissection in a body builder.

Spontaneous external iliac artery dissection in highly trained athletes is becoming more recognized, but the reason as to why they are occurring remains a mystery. We present a patient with acute limb ischemia secondary to arterial dissection after strenuous exercise. Imaging showed complete occlusion of the distal common iliac artery, and the patient underwent successful revascularization of the right lower extremity using a hybrid approach.

Management of phlegmasia cerulea dolens caused by a giant leiomyoma.

In the present report, we describe the case of a young woman with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent tissue plasminogen activator catheter thrombolysis and mechanical thrombectomy to temporize the condition until she could be evaluated by a gynecologic oncologist to remove the cause of the venous obstruction. Before the hysterectomy, a suprarenal inferior vena cava filter was placed.

Maldeployment of Celt ACD vascular closure device.

Vascular closure devices have become more popular in some clinical settings because they allow for quicker hemostasis and earlier ambulation. Although these devices have several benefits compared with manual compression, errors in deployment can result in a multitude of complications. We have presented two cases in which the Celt arterial closure device was maldeployed and caused significant patient morbidity.

Achenbach syndrome as a rare cause of painful, blue finger.

Paroxysmal finger hematoma, also known as Achenbach syndrome, is an underdiagnosed condition that causes apprehension in patients owing to the alarming appearance. It usually presents as a blue-purple discoloration of the volar aspect of one or more digits and can be associated with pain and paresthesia. This condition is benign and is usually self-limiting.

Ureteral stenosis following iliac artery stenting.

Ureteral complications after open aortoiliac reconstruction for aneurysmal and occlusive disease have been reported previously. However, ureteral complications from endovascular interventions for iliac artery disease are relatively rare. We describe a case of left ureteral stenosis resulting in hydroureteronephrosis after multiple endovascular interventions involving the left common and external iliac arteries.

Carotid endarterectomy in patients with high plaque.

Background: Difficult cephalad exposure during carotid endarterectomy in patients with high plaque (HP) may lead to increased incidence of complications after carotid endarterectomy. We report on our experience of carotid endarterectomy in patients with HP.

Methods: This is a retrospective review of 1,233 consecutive patients who underwent carotid endarterectomy by a single surgeon at 2 teaching hospitals between January 1989 to December 2018.

Timing of carotid endarterectomy after recent minor to moderate stroke.

Objective: Early carotid endartectomy is generally favored by vascular surgeons in patients after a minor to moderate stroke. Herein, we compared the results of early versus delayed carotid endartectomy in patients presenting with similar National Institutes of Health Stroke Scale findings after a recent minor to moderate stroke.

Methods: A retrospective analysis of 101 patients undergoing carotid endartectomy after a recent stroke in the distribution of the branches of the middle cerebral artery with >70% internal carotid artery stenosis from 2000 to February 2018 was performed.

Adventitial Cystic Disease: Complicated and Uncomplicated.

Three cases of adventitial cystic disease of popliteal artery are reported; 1 complicated with associated thrombosis of the popliteal artery and 2 uncomplicated. Operative management and follow-up are described.

Iatrogenic Major Venous Injury Is Associated with Increased Morbidity of Aortic Reconstruction.

Background: Major venous injury during open aortic reconstruction though uncommon often result in sudden and massive blood loss resulting in increased morbidity and mortality. This study details the etiology, management, and outcome of such injuries.

Methods: A retrospective review of 945 patients (1981-2017) undergoing aortic reconstruction from 2 midsized (350 bed each) teaching hospitals was conducted.

The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC.

Objective: To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease.

Methods/results: Between 2010-2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion.

Rupture of Abdominal Aortic Aneurysm in Patients with and without Antecedent Endovascular Repair.

Background: Reported results of ruptured abdominal aortic aneurysm (rAAA) in patients with antecedent endovascular aneurysm repair (EVAR) to those presenting with de novo rupture show a similar or slightly improved outcome. The aim of this study was to compare differences in the presentation and outcomes of rAAA with and without prior EVAR.

Methods: A retrospective review of 121 patients with rAAA, ruptured identified 2 groups.

If not now, when? Prescription of evidence-based medical therapy prior to hospital discharge increases utilization at 6 months in patients with symptomatic peripheral artery disease.

We evaluated the impact of the prescription of evidence-based medical therapy (EBMT) including aspirin (ASA), beta-blockers (BB), ACE-inhibitors or angiotensin receptor blockade (ACE/ARB), and statins prior to discharge after peripheral vascular intervention (PVI) on long-term medication utilization in a large multi-specialty, multicenter quality improvement collaborative. Among patients undergoing coronary revascularization, use of the component medications of EBMT at hospital discharge is a major predictor of long-term utilization. Predictors of EBMT use after PVI are largely unknown.

Selective shunting for carotid endarterectomy in patients with recent stroke.

Objective: Many surgeons favor routine shunting during carotid endarterectomy (CEA) in patients with recent stroke who otherwise prefer selective shunt placement for other indications of CEA. We analyzed the results of CEA in this group of patients with the strategy of selective shunting.

Methods: A retrospective review was performed of 59 patients (group A) undergoing CEA ≤8 weeks of a stroke (2000-2014) from two midsized teaching hospitals with stroke certification; of these, 38 patients had CEA ≤2 weeks and 21 other had CEA >2 weeks but <8 weeks.

Contemporary outcomes with percutaneous vascular interventions for peripheral critical limb ischemia in those with and without poly-vascular disease.

Given the very ill nature of patients with critical limb ischemia (CLI), the use of percutaneous vascular interventions (PVIs) for limb salvage may or may not be efficacious; in particular, for those with polyvascular arterial disease. Herein, we reviewed large, multi-institutional outcomes of PVI in polyvascular and peripheral arterial disease (PAD) patients with CLI. An 18-hospital consortium collected prospective data on patients undergoing endovascular interventions for PAD with 6-month follow-up from January 2008 to December 2011.

Hemodynamic changes in patients undergoing carotid endarterectomy under cervical block and general anesthesia.

Background: The objective of this study was to assess differences in hemodynamic stability for patients undergoing carotid endarterectomy (CEA) under general anesthesia (GA) as compared with cervical block anesthesia (CBA).

Methods: An institutional review board-approved, retrospective review of 651 patients from 1998 to 2012 undergoing CEA was performed: 254 patients underwent CEA under CBA and 397 under GA. Comprehensive chart review including preoperative, postoperative, and 30-day follow-up was conducted.

Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause.

Results of iliac stenting and aortofemoral grafting for iliac artery occlusions.

Objective: To compare long-term results of percutaneous iliac artery stenting (PCIS) with aortobifemoral (ABF) grafting for patients with symptomatic iliac artery occlusions.

Methods: A retrospective review of 229 patients (January 2000 to December 2011) with symptomatic iliac artery occlusions was performed. In 100 patients, 103 PCIS procedures were performed, and 101 patients underwent ABF grafting.

Iatrogenic arterial injuries of spine and orthopedic operations.

Objective: To describe the results of contemporary management of iatrogenic arterial injuries following spine and orthopedic operations.

Methods: Patients with major arterial injuries following spine and orthopedic operations in four teaching hospitals (Henry Ford Hospital, Detroit, Mich; Henry Ford Macomb Hospital, Clinton Township, Mich; St John Macomb Hospital, Warren, Mich; and St John Hospital, Detroit, Mich) over the last 10 years were studied. Data were collected on a continuous basis from vascular registries and analyzed retrospectively.

Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease.

Objective: The purpose of this study was to compare the outcomes of aortoiliac stenting (AIS) to those of aortobifemoral grafting (ABF) for patients with TransAtlantic Inter-Society Consensus (TASCII) C and D aortoiliac occlusive disease.

Methods: From 1998 to 2007, 32 patients underwent ABF and 40 patients underwent AIS. Kaplan-Meier estimates for patency were used.