Predicting the need for subclavian artery revascularization in thoracic endovascular aortic repair: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aims to investigate the effectiveness of left subclavian artery revascularization compared with non-revascularization in thoracic endovascular aortic repair, and to summarize the current evidence on its indications. METHODS: A computerized search was conducted across multiple databases, including MEDLINE, SCOPUS, Cochrane Library, and Web of Science, for studies published up to November 2023. Study selection, data abstraction, and quality assessment (using the Newcastle-Ottawa Scale) were independently conducted by two reviewers, with a third author resolving discrepancies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models and publication bias was assessed using funnel plots. RESULTS: In the 76 included studies, left subclavian artery revascularization was associated with reduced risks of stroke (OR, 0.67; 95% CI, 0.45-0.98; n = 15,331), spinal cord ischemia (OR, 0.75; 95% CI, 0.56-0.99; n = 11,995), and arm ischemia (OR, 0.09; 95% CI, 0.01-0.59; n = 8438). No significant reduction in paraplegia (OR, 0.56; 95% CI, 0.21-1.47; n = 1802) or mortality (OR, 0.77; 95% CI, 0.53-1.12; n = 11,831) was observed. Moreover, the risk of endoleak was comparable in both groups (OR, 1.25; 95% CI, 0.55-2.84; P = .60; n = 793), whereas the risk of reintervention was significantly higher in the revascularization group (OR, 1.98; 95% CI, 1.03-3.83; P = .04; n = 272). Both groups had similar risks of major (OR, 0.45; 95% CI, 0.19-1.09; P = .08; n = 1113), minor (OR, 0.21; 95% CI, 0.01-3.45; P = .27; n = 183), renal (OR, 0.61; 95% CI, 0.12-3.06; P = .55; n = 310), and pulmonary (OR, 0.59; 95% CI, 0.16-2.15; P = .42; n = 8083) complications. The most frequent indications for left subclavian artery revascularization were primary prevention of spinal cord ischemia, augmentation of the landing zone, and primary stroke prevention. CONCLUSIONS: Left subclavian artery revascularization in thoracic endovascular aortic repair was associated with reduced neurological complications but was not found to impact mortality. The study highlights important indications for revascularization as well as significant predictors of complications, providing a basis for clinical decision-making and future research.

Outcomes of carotid endarterectomy: Insights from a single-center retrospective cohort study.

OBJECTIVES: To analyze the outcomes of carotid endarterectomy in individuals with carotid artery stenosis in the context of a tertiary care center. METHODS: We carried out a retrospective cohort investigation between 2015-2022. Patient data includes demographics, risk factors, preoperative medications, and operative details. The primary outcomes were 30-day postoperative stroke and mortality rates, while the secondary outcome of the study was to assess the morbidity of the procedure. RESULTS: The mean age of the 54 patients was 66.9±9.88 years, and 57.4% were men. The 30-day stroke rate was 3.7%, and the mortality rate was 1.9%. Most patients did not develop postoperative complications; however, surgical site hematoma was the most common complication encountered (12.9%). Long-term follow-up showed disease regression in 68.5% of patients, with a minority of patients developing ipsilateral restenosis. Admission to an intensive care monitoring unit was the only independent predictor of postoperative complications. CONCLUSION: This study provided insights into the outcomes of carotid endarterectomy in patients with carotid artery stenosis, emphasizing the importance of careful patient selection and postoperative monitoring. Perioperative risks, including stroke and mortality, were within acceptable limits. Further research incorporating structured and non-structured data for predictive analyses, should explore refining patient profiling and optimizing treatment approaches for different carotid artery stenosis clinical and morphological presentations.

Thoracic endovascular repair of descending thoracic aorta aneurysm using thoracic stent graft in a challenging complex patient: An innovative access technique during an emergency using a mini-thoracotomy approach.

OBJECTIVES: Repairing thoracic aortic aneurysms with endovascular aortic repair (TEVAR) is a safe and minimally invasive method with low morbidity and short postoperative recovery. We developed a novel method to treat descending thoracic aortic aneurysms using a mini-thoracotomy approach in complex patients with difficult access. METHODS: A 56-year-old male patient presented with a 3-day history of chest pain. His past surgical history included infrarenal aortic ligation and right axillobifemoral bypass. Thoracic computed tomography angiography (CTA) revealed a saccular aortic aneurysmal dilatation at zone 2 measuring 4.4 × 4 cm. Owing to his surgical history, vascular access through the femoral and iliac arteries or abdominal aorta was impossible. We developed a new technique using a left posterolateral mini-thoracotomy approach to gain vascular access and perform TEVAR, avoiding the need for an open thoracotomy repair. RESULTS AND CONCLUSIONS: Thoracic CTA performed before discharge revealed complete aneurysmal exclusion and no endoleaks. Postoperative follow-up CTA (6 months and annually thereafter) revealed no aneurysm formation or aortic restenosis. The femoral artery, followed by the iliac artery, is the traditional access route for TEVAR. Left posterolateral mini-thoracotomy may be required as an alternative access in complex patients.

Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience.

BACKGROUND: although liver injuries are one of the most critical complications of abdominal trauma, choosing when to operate on these injuries is challenging for surgeons worldwide. METHODS: We conducted a retrospective analysis of liver injury cases at our institution from 2016 to 2022 to describe the operative and nonoperative management (NOM) outcomes in patients with traumatic liver injuries. Baseline patient characteristics, liver injury details, treatments, and outcomes were analyzed. RESULTS: Data from 45 patients (male, 77.8%) were analyzed. The mean age was 29.3 years. Blunt trauma was the most common injury mechanism (86.7%), whereas penetrating injuries were 8.9% of cases. Conservative management was associated with 18.9% of complications. The overall complication rate was 26.7%; delirium and sepsis were the most common (13.3%), followed by acute renal failure (4.4%), pneumonia, biliary leaks, and meningitis/seizures. CONCLUSIONS: Notwithstanding its limitations, this retrospective analysis demonstrated that NOM can serve as a safe and effective strategy for hemodynamically stable patients with liver trauma, irrespective of the patient's injury grade. Nevertheless, careful patient selection and monitoring are crucial. Further investigations are necessary to thoroughly evaluate the management of traumatic liver injuries, particularly in the context of multiorgan injuries.

Percutaneous versus Cutdown Access for Endovascular Aortic Repair.

BACKGROUND: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair. METHODS: We retrospectively reviewed the medical records of 59 patients who underwent a thoracic/abdominal endovascular aortic repair at a single tertiary care hospital between 2015 and 2022. Based on their femoral access type, the patients were categorized into the "percutaneous" or "cutdown" groups. Using a computerized sheet, relevant patient data (including demographic information and patient risk factors) were collected. The operative duration, complication rates, mortality rates, intensive care unit admission and stay durations, and total hospital stay were compared between the two groups. The primary outcomes were differences in the postoperative morbidity and mortality associated with the two approaches. RESULTS: The cutdown and percutaneous groups comprised 24 (41%) and 35 (59%) patients, respectively. The two groups displayed comparable demographic and clinical characteristics (p > 0.05). However, the vascular anatomy differed with the common femoral artery diameter being larger in the percutaneous group compared to the cutdown group (9.63 ± 1.81 mm vs. 8.49 ± 1.54 mm, p = 0.028). The ratio of the sheath diameter to the common femoral artery diameter was significantly lower in the percutaneous group than in the cutdown group (0.73 ± 0.16 vs. 0.85 ± 0.20, p = 0.027). A ratio of ≥0.74 was associated with a higher risk of complications (odds ratio, 12.0; 95% confidence interval, 1.4-102.2; p = 0.023) and mortality (odds ratio, 5.79; 95% confidence interval, 1.13-29.6; p = 0.035). Additionally, the operative duration was significantly shorter in the percutaneous group than in the cutdown group (141.43 ± 97.05 min vs. 218.46 ± 126.31 min, p = 0.001). Compared to the cutdown group, the percutaneous group experienced a shorter total hospital stay (21.54 ± 21.49 days vs. 11.60 ± 12.09 days, p = 0.022) and lower intensive care unit-admission rates (66.7% vs. 40%, p = 0.044). CONCLUSION: The percutaneous approach is a viable and more time-efficient alternative to the traditional cutdown method for delivering vascular endografts. It is associated with a significantly shorter operative duration and briefer hospital stays. Additionally, the ratio of the sheath diameter to the common femoral artery diameter can help surgeons preoperatively predict and anticipate the risks of complications and mortality. Future in-depth research is necessary to better understand the association between this ratio and postoperative outcomes and complications.

Prevalence of Asymptomatic Deep Vein Thrombosis in Preoperative State of Spine Surgeries.

BACKGROUND: Deep venous thrombosis (DVT) is considered the most common cause of preventable death among hospitalized patients. A few studies have investigated the risk of venous thromboembolic events in patients undergoing elective spine surgery and reported varying incidences. We aim to assess the incidence of preoperative lower limb DVT in patients with lumbar degenerative disease undergoing elective surgery. METHODS: This is a retrospective review of prospectively collected data on adult patients with lumbar degenerative spine diseases (lumbar stenosis [LST], lumbar spondylolisthesis [SPL], or lumbar disc herniation) who were scheduled for operative management. Each patient underwent a preoperative lower limb venous Duplex (LLVD). Incidence of DVT, risk factors, and clinical course of patients were reported. RESULTS: Forty-nine patients (32 females; 65%) were included. All patients were diagnosed clinically and radiologically with lumbar degenerative diseases; LST (44.9%), SPL (36.7%), and lumbar disc herniation (18.4%), requiring surgical management. Three patients (6.1%) were found to have positive DVT studies, leading to the cancellation or rescheduling of their procedures (P < 0.01). These included 1 patient with LST (P = 0.045) and 2 patients with SPL (P = 0.006). Among patients with LST and SPL, higher disability (modified Rankin scale ≥3) was significantly associated with positive LLVD (P = 0.035). CONCLUSION: Patients with LST or SPL with higher preoperative disability scores were at higher risk to have preoperative DVT. Further research is needed to evaluate the feasibility and value of preoperative LLVD to detect DVT in patients planned for lumbar degenerative surgery.

Exploring Understanding of Peripheral Artery Disease among Patients at High-Risk in Saudi Arabia: Results from an Interview-Based Study.

BACKGROUND: The level of awareness of peripheral artery disease (PAD) in Saudi Arabia, especially among populations at high risk, is not currently well known. Therefore, our objective was to assess the existing level of awareness among patients who are at high risk of PAD, as well as their comprehension of the disease. METHOD: An interview-based cross-sectional study included 1035 participants with risk factors for PAD and collected data on demographics and knowledge domains related to PAD. RESULTS: The statistical analysis was performed using t-tests and ANOVA. Overall, participants exhibited poor knowledge, with a mean score of 5.7 out of 26. The highest scores were observed in the risk factor and preventive measure domains, with means of 1.8 out of 7 and 1.8 out of 6, respectively. The factors associated with higher knowledge scores included older age, male gender, higher education, healthcare profession, interviews in vascular settings, previous awareness of PAD, and prior cardio-cerebrovascular interventions. CONCLUSION: This study underscores the inadequate knowledge of PAD among high-risk individuals. Targeted educational initiatives are essential to bridge this knowledge gap, potentially reducing the burden of PAD-related complications and improving patient outcomes. Efforts should focus on raising awareness about PAD, particularly among high-risk populations.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports.

BACKGROUND: One of the major perioperative complications for coronary artery bypass graft (CABG) is stroke. The risk of perioperative stroke after CABG is approximately 2%. Carotid stenosis (CS) is considered an independent predictor of perioperative stroke risk in CABG patients. The optimal management of such patients has been a source of controversy. One of the possible surgical options is synchronous carotid endarterectomy (CEA) and CABG. Here, we have presented 4 cases of successful synchronous CEA and CABG. CASE SUMMARY: Our center's experience with 4 cases of significant carotid artery stenosis, which were successfully managed with combined CEA and CABG, are detailed. The first case was a female who presented for CABG after a ST-elevation myocardial infarction. She had right internal carotid artery (ICA) occlusion and 90% left ICA stenosis. The second case was a male who was electively admitted for CABG. It was discovered that he had left ICA occlusion and 90% right ICA stenosis. The third case was a male with a history of stroke, two months prior to admission. He presented with non-ST-elevation myocardial infarction. Preoperatively, it was discovered that he had > 90% right ICA stenosis. The final case was a male who was electively admitted for CABG. It was discovered that he had bilateral > 90% ICA stenosis. We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG. CONCLUSION: Our case series demonstrated that synchronous CEA and CABG was safe. A multicenter study with additional patients is needed. It is necessary for clinicians to screen for CS in high-risk patients with features.

Carotid body tumor encounters over a two-decade period in an academic hospital.

Carotid body tumors (CBTs) are rare and mostly benign. Research outcomes usually arise from single-center data. We conducted this study to present the characteristics and outcomes of patients who underwent surgical resection of CBT at our hospital over the past 20 years. In this retrospective review, the records of CBTs in our hospital were reviewed between 1998 and 2021. All patients who underwent CBT resection were included. The follow-up period was 12 months. A total of 44 CBTs were treated in our hospital. The male-to-female ratio was 1:2.4. Only 4.5% of patients had Shamblin I tumors. Patients with Shamblin II and III tumors were 56.8% and 38.6%, respectively. Duplex scan was used to diagnose CBT in all of the patients. The majority of our patients (97.7%) did not receive any preoperative embolization despite an average tumor size of 4.9 cm. Cranial nerve injuries were observed in 29.5% of cases. Meanwhile, stroke was reported in only two cases (4.5%). No deaths were encountered. Surgery is the definitive treatment for CBT. Size and local extension appear to be the main reasons for adverse events rather than surgical techniques. Our results are consistent with those of previously published studies. Good outcomes are expected in high-volume centers with appropriate preoperative imaging.

Contribution of COVID-19 to the Total Cases of Pulmonary Embolism and the Potential Risk Factors: Single Academic Hospital Study.

BACKGROUND: There are limited data regarding potential triggering factors of pulmonary embolism (PE) in coronavirus disease 2019 (COVID-19) patients and its outcomes in comparison with non-infected PE patients. We aimed to identify the contribution of COVID-19 among patients diagnosed with PE and compare risk factors, laboratory results, and outcomes between COVID-19 PE patients and non-COVID-19 PE patients. METHODS: This was a retrospective study of all PE patients between March 2020 and December 2020. The patients were segmented into two groups based on a COVID-19 nasopharyngeal swab result. Statistical analysis was used to determine the differences in risk factors, laboratory values, and outcomes. RESULTS: A total of 58 patients were included. Females comprised 44.8% of the total sample. Overall, 16 patients (27.6%) were COVID-19 positive. Being non-Saudi was observed more in PE COVID-19 patients compared with non-COVID-19 patients (43.7% vs 4.8%, P = 0.001). Intensive care unit (ICU) admission occurred in 50% of COVID-19 PE patients. CONCLUSION: COVID-19 was associated with 27.6% of the PEs in our hospital. Being male or a foreign resident was observed to be associated with COVID-19 PE. Further studies with larger sample sizes are needed, but these results may help the medical community regarding the increased risk of PE among COVID-19 patients and provide evidence of some potentially predictive factors that can be used to identify COVID-19 in high-risk patients.

Vascular thoracic outlet syndrome: Registry of 30-years of patient's outcomes at King Saud University Medical City, Riyadh, Saudi Arabia.

OBJECTIVES: To outline our experience with both arterial vascular thoracic outlet syndrome (ATOS) and venous TOS (VTOS). METHODS: This was a retrospective review carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from 1992-2022. All patients were diagnosed based on clinical presentation, imaging, and underwent surgical decompression solely via the supraclavicular approach. The median follow-up period was 18 months (range: 4-36 months). RESULTS: A total of 90 limbs were diagnosed with vascular TOS in 69 patients. Females accounted for 69.6% of the patients and approximately 86.7% had ATOS. All patients were symptomatic and underwent plain thoracic inlet and cervical spine radiography, along with duplex scans in both rest and provocative positions. Total cervical rib resection was carried out in 60% of cases, while 2% had partial resection. First rib resection was carried out in 13.3% of cases and combined cervical and first rib resections were carried out in 23.3%. Vascular procedures were needed for arterial repair in 20% of cases, while venous repair were carried out in 2.2%. No recurrence or post-operative mortality had been reported. Post-operative complications were observed in 18.9% of cases. CONCLUSION: Careful patient selection and diagnosis using advanced, but less invasive radiological imaging coupled with adequate surgical treatment can improve the patient's outcome.

Tuberculous Aortic Aneurysm - A Review

ABSTRACT Introduction: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. Methods: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. Results: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. Conclusion: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

Tuberculous Aortic Aneurysm - A Review.

INTRODUCTION: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. METHODS: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. RESULTS: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. CONCLUSION: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

Tuberculous Aortic Aneurysm - A Review.

INTRODUCTION: Tuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes. METHODS: Case studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020. RESULTS: Case reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases. CONCLUSION: Postoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

A Patient-Tailored Approach to Management of Acute Limb Ischemia in Patients with COVID-19: A Case Series.

BACKGROUND Coronavirus disease 2019 (COVID-19) has a tremendous impact on the respiratory tract. In severe COVID-19 infections, patients may experience shock and multiple organ failure. We described 4 cases of severe arterial thrombosis induced by COVID-19 with and without other stressors and their responses to treatment measures. CASE REPORT In Case 1, a 61-year-old man was hospitalized for COVID-19 pneumonia 2 weeks prior to the presentation of acute upper-limb ischemia after intravenous forearm line insertion. He was classified as IIB and thus underwent emergency thrombectomy followed by 3 months of enoxaparin. Case 2 was a 41-year-old female patient with granulomatosis who was admitted to the Intensive Care Unit due to COVID-19 pneumonia and developed acute upper-limb ischemia. A medical approach using therapeutic heparin was used. Case 3 was a 65-year-old man who was admitted due to COVID-19-related pneumonia and was otherwise medically and surgically free. We assessed and managed a new onset of the lower-limb IIB acute limb ischemia (ALI). Case 4 was a patient with the first COVID-19 presentation of ALI, which was managed accordingly. CONCLUSIONS The development of a thrombotic event in patients with COVID-19 was previously reported. Moreover, different management options and outcomes have been reported in the literature. Therefore, careful planning is needed for procedures such as cannulation or central line insertion to prevent such events. In addition, short-term anticoagulation therapy might be of clinical benefit when planning a procedure or if the patient exhibits minor arterial complications.

Are primary care physicians aware of peripheral artery disease risk reduction and management in the Saudi healthcare transformation era? A health cluster observational study.

INTRODUCTION: Patients with peripheral artery disease (PAD) are often underdiagnosed and undertreated. This study aimed to assess the knowledge of the recommended target levels of blood pressure, low-density lipoprotein cholesterol, glycosylated hemoglobin A1C, and knowledge and attitude about PAD risk reduction therapies among physicians working in primary care settings in Saudi Arabia. METHODS: This observational cross-sectional study included family medicine consultants, residents, and general practitioners working in a health cluster in the capital city of Saudi Arabia using a self-administered questionnaire. RESULTS: Of the 129 physicians who completed the survey, 55% had completed PAD-related continuing medical education hours within the past 2 years. Despite this, the knowledge score of the recommended target levels was high in only 13.2% of the participants. Antiplatelet therapy was prescribed by 68.2% of the participants. CONCLUSION: Here we identified the knowledge and action gaps among primary care providers in Saudi Arabia. Physicians had an excellent attitude about screening for and counseling about risk factors. However, they showed less interference in reducing these risk factors. We recommend addressing these knowledge gaps early in medical school and residency programs.

Diabetic Foot Care: A Screening on Primary Care Providers' Attitude and Practice in Riyadh, Saudi Arabia.

Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.

Review of Renal Artery Stenosis and Hypertension: Diagnosis, Management, and Recent Randomized Control Trials.

Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). Renal artery stenosis-induced HTN can occur in the presence of unilateral or bilateral narrowing and a solitary kidney with stenotic artery, which may subsequently lead to renal insufficiency (e.g., ischemic kidney disease) or pulmonary edema. Renal artery stenosis can be diagnosed using multiple modalities, including Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or selective angiogram. Although atherosclerotic renal artery stenosis management in patients with HTN has been greatly controversial, it is inevitable in the treatment of some selected cases. These cases can be treated by either percutaneous angioplasty (with or without stenting) or less common, open surgical approach revascularization, both of which have excellent primary patency rates. Generally, several trials on renal artery angioplasty or stenting in patients with atherosclerotic disease have shown that the long-term benefits in terms of blood pressure control and renal function over pharmacological management is not substantial. Furthermore, studies could not demonstrate a prolongation of event-free survival after renal vascularization. Moreover, endovascular procedures have substantial risks. Careful patient selection is required when considering revascularization, for including those with refractory HTN or progressive renal failure, to maximize the potential benefits. This paper discusses the epidemiology of atherosclerotic renal artery stenosis and its clinical presentation, diagnosis, treatment, prognosis, and future perspectives.

Axillary artery aneurysm associated with Arteriovenous malformations of the upper extremity: A case report.

INTRODUCTION AND IMPORTANCE: Axillary artery aneurysms are an uncommon upper extremity pathology. While trauma is the most common cause, degenerative aneurysms may occur in high-flow vascular conditions, such as upper extremity arteriovenous fistulas. Arteriovenous malformations (AVMs) are a rare cause. CASE PRESENTATION AND DISCUSSION: We herein describe a 41-year-old male with multiple congenital high-flow AVMs in the left upper extremity who presented with an asymptomatic axillary artery aneurysm. The aneurysm was successfully treated with open resection and revascularization using a reversed basilic vein interposition graft. CONCLUSION: Clinicians should be aware of the possibility of an axillary artery aneurysm in patients with upper extremity AVMs.

The Emergency surgery score (ESS) accurately predicts outcomes of emergency surgical admissions at a Saudi academic health center.

BACKGROUND: The emergency surgery score (ESS) has emerged as a tool to predict outcomes in emergency surgery (EGS) patients. Our study examines the ability of ESS to predict outcomes in EGS admissions. METHODS: All EGS admissions to King Saud University Medical City (KSUMC) from January 2017 to October 2019 were included. ESS was calculated for each patient. Correlations between ESS and 30-day mortality and complications were evaluated. RESULTS: 1607 patients were included. 30-day mortality rate was 2.2% while complication rate was 18.7%. Mortality increased as ESS increased, from 0.3% for ESS≤2, to 30.1% for ESS >10, with a c-statistic of 0.88. Complication rates were 2.2%, 40%, and 100% at ESS of 0, 6, and 15, respectively, with a c-statistic of 0.82. CONCLUSIONS: ESS accurately predicted outcomes at our tertiary center. ESS could be useful in identifying high risk EGS admissions and in benchmarking quality of care across Saudi institutions.