Stent graft for a longstanding femoral artery pseudoaneurysm with arteriovenous fistula- A case report of the first infra-inguinal application of the upside-down gore excluder limb technique.

Pseudoaneurysm with arteriovenous fistula is a rare presentation of penetrating trauma, occurs when trauma involves major blood vessels, and is traditionally treated surgically. Recently, these are more commonly treated using endovascular techniques which include stent graft placement and parent artery occlusion. In this case report, we present a case of femoral artery pseudoaneurysm and arteriovenous fistula with severe size difference between the arterial segments proximal and distal to the fistula site, treated successfully by using the upside-down gore excluder limb technique.

Case reports: mild COVID-19 infection and acute arterial thrombosis.

We present two cases of acute arterial thrombosis in patients who were confirmed to be SARS-CoV-2 positive. Neither of the patients had a background of underlying vascular morbidity. At the time of presentation, both patients exhibited only mild respiratory symptoms of COVID-19. After initial assessment and work-up, both patients underwent surgery for their respective vascular pathologies. They both did well post-operatively and were discharged home. This is an unusual presentation of acute arterial thrombosis in two patients with only mild symptoms of COVID-19 infection.

Common facial vein: an alternative patch material in carotid angioplasty.

Patch angioplasty is a popular adjunct to carotid endarterectomy to facilitate arteriotomy closure. The long saphenous vein is the common autogenous patch in use. We tested the feasibility of using the ipsilateral common facial vein (CFV), which is usually sacrificed during exposure of the carotid bifurcation. A consecutive series of 17 patients undergoing carotid endarterectomy was examined to show the use of CFV patch in arteriotomy closure in 18 procedures. During exposure of the carotid bifurcation, the facial vein was harvested and distended with heparinized saline to assess the size of the vein. If the vein had an adequate diameter, it was everted and used as a double-layered patch. Patients were followed up postoperatively with serial duplex scanning at 3, 6 and 12 months, and yearly thereafter. The median (range) age of the patients in the series was 66 years (52-72 years). Of the 18 CFV harvested, 2 were rejected because of small calibre. The median (range) length of the vein harvested was 5 cm (4-6 cm). The average diameter of harvested vein was 5 mm. The median (range) time taken for harvesting, distending and everting the vein was 10 min (8-12 min). There were no perioperative deaths or strokes. There was no significant re-stenosis during the follow up of 24 months (18-36 months), with a mean peak velocity of 0.86 m/s (0.58-1.29 ). The use of everted CFV patch in carotid angioplasty is safe, quick, convenient and durable, whereas saphenous veins are spared and lower limb incisions avoided.

Primary psoas abscess due to Streptococcus milleri.

Primary Psoas abscess (PPA) is an infrequent clinical entity with obscure pathogenesis and vague clinical presentation. High index of clinical suspicion is required for the diagnosis of psoas abscess. We also emphasises the importance of bacteriological confirmation of microorganism involved, although Staphylococcus aureus remains the commonest pathogen. We report an extremely rare case of PPA caused by Streptococcus milleri. Only one case has been reported in literature so far.