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Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Leiden and MTHFR mutations represents an unusual subset of patients. We are reporting a case of a 43-year-old man who presented with left iliofemoral deep venous thrombosis diagnosed on duplex ultrasound scan. At the time of catheter-directed thrombolysis with prophylactic IVC filter placement, a duplicated IVC system was observed. After thrombolysis, a stenotic lesion in the left common iliac vein and IVC was stented. IVC filters were retrieved after 6 weeks. On thrombophilia profile testing at 3 months, he was also found to have factor V Leiden and MTHFR mutations. After 12 months of follow-up, the patient is asymptomatic with a patent iliocaval venous system and is receiving lifelong anticoagulation. Keywords: Duplicated IVC, Catheter-directed thrombolysis, Deep venous thrombosis

Background: Vascular injury in extremity is a complication of both blunt and penetrating trauma. In Indian scenario, patients generally present late to the tertiary care center with mangled extremity for treatment. The aim of the study is to assess the risk factors affecting the outcome in the management of patients with lower extremity arterial trauma. Materials and Methods: A single-center, observational study was conducted at Sir Ganga Ram Hospital, New Delhi, from January 2013 to June 2017. Sixty patients of lower extremity arterial trauma who underwent revascularization were included and followed up for 6 months. All the risk factors (mode/mechanism of injury, time since injury, compartment syndrome, mangled extremity severity score [MESS], etc.,) and limb salvage were assessed at 6 months. Statistical analysis was performed using Chi-square test and Fisher's exact test. Results: Majority of the patients presented late (6–24 h) of injury and had high mean MESS (7.85). The most common mechanism of injury was blunt trauma (83.3%), and popliteal artery (72%) was the most commonly injured artery. Limb salvage was achieved in 75% of the patients. Time since injury and MESS score affected the limb salvage significantly. On multivariate analysis, MESS score was the single independent factor which affected the limb salvage (95% confidence interval, 0.231–0.769, P = 0.005). Conclusions: MESS is the most important predictors for limb salvage. Multidisciplinary team approach with timely diagnosis and immediate repair is the key to the ultimate goal of functional limb salvage.

Background: Vascular trauma can threaten both limb as well as life of the patient. Combat-related vascular injuries are different from civilian vascular injuries in terms of epidemiology, mechanism, pathophysiology, and outcome. Combat or military trauma is generally penetrating trauma (high energy weapons). Difficult evacuation and transportation from the battle field complicates the vascular injury and its outcome. Materials and Methods: This is a single-center, prospective, observational study conducted at a service hospital in Jammu and Kashmir. Twenty-five patients with mean age 25.76 years (18–43 years) who underwent vascular intervention for trauma from December 2013 to November 2016 were included. Data pertaining to vascular injury regarding to site of injury, associated injuries, type of vascular repair, outcome, and complications were recorded and analyzed. Results: Five hundred and eighty trauma patients were admitted during the study period with 4.3% of the patients having vascular injury. All the patients were males and most of them were in the second or third decade of life. The mean time interval between the trauma and arrival to the hospital was 7 h. Lower extremity was the most common site of trauma (52%) of the patients followed by upper extremity. In 56% of the patients, vessels were repaired with reverse saphenous vein graft harvested from the uninjured limb. Two patients (8%) had secondary amputation and one patient (4%) died due to sepsis. Conclusion: Expeditious evacuation, quick transfer, early diagnosis and management including advanced endovascular care are essential for the limb salvage and survival of the serving soldiers.

Endovascular aortic repair is becoming the standard of care for abdominal aortic aneurysm. Despite aorta being a high flow system, there is still a definite risk of endograft occlusion. Management of occluded aortic endograft is highly controversial. Successful endovascular relining in aortic endograft occlusion is a technically demanding and forthcoming secondary intervention, not been studied extensively. We are reporting a case of aortic endograft thrombosis in a morbidly obese, 64-year-old gentleman with multiple comorbidities presenting with lifestyle-limiting claudication. The patient had a history of abdominal aortic aneurysm repair with aorto-uni-iliac device and femorofemoral bypass. The patient was managed by relining of aortic endograft with graft thrombectomy and snorkeling of the left renal artery. Postoperative course was uneventful. After 1 year of follow-up, the patient is free of symptoms with patent endograft. More empirical evidence is yet required to make the standard guidelines for the management of aortic endograft occlusion.

Introduction Therapeutic misadventure is defined as an injury or an adverse event caused by medical management rather than by an underlying disease. Femoro-popliteal bypass is the standard of care in a long segment femoral-popliteal occlusive lesion. Misadventure in the femoral-popliteal bypass in the form of distal anastomosis to the popliteal vein is a serious limb threatening event and is not reported by surgeons to the best of our knowledge. Case summary A 63 years old gentleman who had undergone femoro-popliteal bypass for disabling claudication presented with rest pain. The patient was suspected to have graft to vein anastomosis instead of graft to distal artery anastomosis on duplex examination. The patient underwent total endovascular management of the disease with endoluminal bypass and coil angio-embolization of the vein graft. The condition of the patient improved dramatically with relief of symptoms and improvement in his walking distance. Conclusion Glaring therapeutic misadventures of this kind must be averted. Evidence based medicine with protocol based surgery should be performed after acquiring a reasonable amount of structured training to eliminate medical and surgical disasters.

Neuropsychology is the scientific study of the relationship between brain and behavior. It bridges the disciplines of neurology and cognitive psychology and seeks to describe and explain how cognitions, emotions and behavior are mediated by different processes in brain. In clinical settings, different neurological and psychiatric disorders effect psychological functioning of the patients in terms of information processing, sensory-perceptual processes, attention, execution and other order brain functions. Neuropsychological functioning can be assessed by various sets of neuropsychological batteries available in India. It helps to understand the patients’ neuropsychological deficits and strengths too. The neuropsychological functioning helps in formulating cognitive retraining and holistic management of brain related and psychiaric disorders. The term syndrome entails the group and cluster of symptoms associated with any clinical condition. This paper will briefly focus on the anatomy, functions and various syndromes associated with parietal and occipital lobes and their corrosponding neuropsychological issues.

Intimal sarcoma is a highly aggressive and rare malignant tumor of the vascular system. We are reporting this unusual primary tumor of popliteal artery presenting as aneurysm in an infant. We report a case of an 8-month-old girl with the incidental observation of nontender and pulsatile swelling in the right popliteal fossa. An arterial duplex scan and computed tomography angiography revealed an intensely enhancing well-defined lesion (3.2 cm × 2.4 cm) of the popliteal artery suggestive of pseudoaneurysm/aneurysm. The patient underwent exploration of the popliteal artery with excision of aneurysmal sac. On histopathological examination and immunohistochemical staining, findings were suggestive of intimal sarcoma. Postoperative recovery was uneventful. At 1-year of follow-up, patient is clinically stable with no disability and any signs of recurrence or metastasis. Malignancy in peripheral arterial aneurysmal is extremely rare. More empirical evidence is yet required to make the diagnostic and therapeutic protocol to deal with this aggressive tumor of the vascular system.

Background: In dialysis-dependent end-stage renal disease patients, arteriovenous access (AV access) is the chief mode of hemodialysis access. Basilic vein transposition (BVT) is an alternative in patient with failed multiple AV access. The aim of the study is to assess the outcomes of BVT at 1 year of follow-up. Materials and Methods: This prospective, nonrandomized, observational study was conducted in the Department of Vascular Surgery at Sir Ganga Ram Hospital, New Delhi. Forty consenting patients with end-stage renal failure on maintenance hemodialysis having no other options utilizing superficial veins of the upper limb for AV access formation were included. All the complications, secondary interventions and patency rates were calculated at 1 year of follow-up. Statistical analysis was performed using Chi-square test, and patency rates were assessed using Kaplan–Meier survival curve. Results: Most of the patients were in the age group of 51–70 year with the mean age of 51.98 year. The mean basilic vein diameter was 2.84 mm. Fistula thrombosis was the most common complication and was seen in 17.5% cases followed by limb edema in 13% of cases. Re-interventions (fistula thrombectomy, balloon angioplasty etc.) were performed in 27.5% of the patients. The primary patency rate and secondary patency rate at 1 year of follow-up were 77.5% and 85%, respectively. Conclusions: BVT is a feasible and suitable surgical option to provide a durable and autogenous AV access to end-stage renal disease patients requiring maintenance hemodialysis.

Prenatal diagnosis of esophageal atresia remains a challenge for the imaging consultant. On antenatal USG, the finding of an absent or small stomach in the setting of polyhydramnios used to be considered suspicious of esophageal atresia. However, these findings have a low positive predictive value. The upper neck pouch sign is another sign that helps in the antenatal diagnosis of esophageal atresia. In this paper, I report a case of esophageal atresia that was diagnosed on USG at 27 weeks of gestation; the diagnosis was confirmed postnatally.

Congenital high airway obstruction syndrome (CHAOS) is a near fatal condition of multifactorial inheritence, in which the fetus has a dilated trachea, enlarged echogenic lungs, an inverted or flattened diaphagram, and ascites. A case of CHAOS, diagnosed antenatally on USG at 28 weeks of gestation, is being reported here.