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We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.

Objectives Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. Methods A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively. Results Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements. Conclusions The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.

Introduction Endovascular management of aortic occlusive disease is an alternative to open surgery. This case describes the use of a Nellix graft to treat infrarenal aortic stenosis, outwith the graft indication for use. Case report A 71 year old man with multiple comorbidities, presented with bilateral buttock claudication. A computed tomography angiogram (CTA) showed significant infrarenal aortic stenosis. Under local anaesthetic, using a percutaneous approach, Nellix grafts were inserted. The patient was discharged within 24 hours. His claudication improved significantly. A 6 month follow-up CT showed stent patency. Conclusion Although further research is necessary, this case suggests that Nellix is safe and effective for primary stenting of the stenotic infrarenal aorta., Highlights • Aortobifemoral bypass has been considered the gold standard for aortic occlusive disease. • Endovascular treatment of aortic occlusive disease has evolved rapidly in the last 20 years. • Covered stent and bare metal stent are commonly used in management of isolated aortic occlusive disease. • In this case report, the Nellix® endovascular aneurysm sealing (EVAS) system was used as a novel technique for managing aortic occlusive disease.

Introduction The optimal management for patients with diabetes and peripheral vascular disease—intermittent claudication or critical limb ischemia (CLI)—remains undetermined. Methods In a single-center retrospective analysis, we compared 1- and 5-year amputation-free survival rates in patients undergoing angiography subsequently treated with medical therapy or revascularization. Results 78 patients were included, 56 with CLI (mean age 77 years); 22 with claudication (mean age 75 years). Of the CLI cohort, 30 patients were medically treated. Their 1-year amputation-free survival rate was similar to those treated with revascularization (46.7% versus 50.0%, respectively). 8 patients in the claudicant cohort were treated conservatively. The 1-year amputation-free survival rate was 75.0% for conservative treatment versus 78.6% in those revascularized. Within the CLI cohort, in those conservatively treated 20% underwent major, and 16.7% minor amputations, compared to 15.4% and 23.1% in those revascularized. At 5 years in the claudicant cohort, the amputation-free survival rate was 37.5% with medical treatment, versus 71.4% for those treated with revascularization. For CLI, the 5-year amputation-free survival rate was 10% for conservative treatment, versus 26.9% for revascularization. Conclusion We found similar rates of amputation at 1 year for patients treated medically or revascularized. However, at 5 years, the amputation-free survival rate was markedly higher in revascularized patients compared to those medically managed. Our study highlights the potential role of predicting life expectancy when considering treatment, with the option of surgical treatment offered to those in whom survival is predicted to be longer than 5 years. However, larger studies with matched cohorts are now needed to confirm these findings. Electronic supplementary material The online version of this article (doi:10.1007/s13300-015-0131-1) contains supplementary material, which is available to authorized users.

Purpose: To present a case of aortic sac occlusion using an Amplatzer vascular plug II (AVP). Case report: A patient with sigmoid malignancy and an infrarenal aortic aneurysm ultimately required an axillobifemoral graft for acute limb ischemia. The sac was ligated at subsequent laparotomy. Persistent filling of the sac was seen post surgery, and the sac was successfully occluded with placement of an AVP in the neck of the sac in conjunction with coil embolization of lumbar arteries. Sac occlusion was confirmed at follow-up CT. Conclusion: The AVP was successfully used to occlude an aortic sac after failed surgical ligation, another novel indication for this versatile embolic device.

The intra-aortic balloon pump (IABP) is an implanted cardiac assist device that utilises the principle of counterpulsation to provide temporary assistance to the failing heart. The balloon inflates during diastole (relaxation) and deflates before systole (contraction). This has two primary effects. First, it causes a decrease in the peak aortic blood pressure during systole, called systolic unloading. Second, it causes an increase in the mean aortic blood pressure during diastole, called diastolic augmentation. Systolic unloading decreases the oxygen demand of the heart and is enhanced by earlier balloon deflation. Diastolic augmentation increases the oxygen supply to the heart and is enhanced by later balloon deflation. The IABP therefore improves the myocardial oxygen balance and this can help the failing heart to recover. Furthermore, fine adjustment of the balloon deflation time can maximize this improvement. This article introduces the medical theory and need for intra-aortic balloon pumping. A brief historical background is then presented. The techniques and principles of counterpulsation are then described. The article concludes with an examination of current developments and problems in this arena. Keywords: intra-aortic balloon pump; diastolic augmentation; systolic unloading; left ventricular failure

Objective/Background The objectives were to report the management and outcomes of a 96-year-old man who presented with an acutely swollen right leg due to a ruptured popliteal aneurysm, and to review the relevant literature. Methods A ruptured popliteal artery aneurysm is a rare diagnosis and is one that is often missed at time of presentation. Previous case reports have documented successful outcomes following surgical repair, and a smaller number following endovascular repair. This is a case report of a 96-year-old man who eventually underwent endovascular repair of a ruptured popliteal artery aneurysm after a delay in diagnosis. A literature review was performed to analyse published data in this field. Results The patient underwent an uncomplicated endovascular repair with a GORE® VIABAHN® stent. A 15-week follow-up ultrasound demonstrated biphasic flow in a patent stent-graft with an unchanged aneurysm sac size and no evidence of an endoleak. A review of the literature demonstrated nine cases of ruptured non-mycotic popliteal artery aneurysms treated endovascularly. Seven cases survived the postoperative period, three had no follow-up recorded, and four cases had patent stent-grafts at time of follow-up. Conclusion Safe and effective endovascular repair of a ruptured popliteal artery aneurysm with endograft patency seen at the 15-week follow-up is reported. Review of the literature suggests that open repair remains the first-line management choice; however, endovascular repair is a valuable alternative. There is a further need for longer-term monitoring of endograft patency following endovascular repair., Highlights • Ruptured popliteal aneurysm is rare. • Diagnosis is easily missed unless specifically considered. • Endovascular repair appears to be safe and effective.