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Objectives Arteriovenous malformations (AVMs) are high-flow, aggressive lesions that cause systemic effects and may pose a risk to life. These lesions are difficult to treat as they have a tendency to recur aggressively after excision or embolization. So, it requires a regulating free flap with robust vascular flow averting the postexcisional ischemia-induced collateralization, parasitization, and recruitment of neovessels from the surrounding mesenchyme—a phenomenon precipitating and perpetuating the recurrence of AVM. Materials and Methods Sixteen patients (12 males and 4 females) with AVMs Schobinger type 4 involving face were treated from March 2015 to March 2021 with various free flaps: three free rectus abdominis flaps, one free radial forearm flap, and twelve free anterolateral thigh flaps were used for reconstruction following the wide local excision of Schobinger type 4 facial AVM. The records of these patients were analyzed retrospectively. The average follow-up period was 18.5 months. The functional and aesthetic outcomes were analyzed with institutional assessment scores. Results The average size of the flap harvested was 113.43 cm2. Fourteen patients (87.5%) had good-to-excellent score (p = 0.035) with institutional aesthetic and functional assessment system. The remaining two patients (12.5%) had only fair results. There was no recurrence (0%) in the free flap group versus 64% recurrence in the pedicled flap and skin grafting groups (p = 0.035). Conclusion Free flaps with their robust and homogenized blood supply provide a good avenue for void filling and an excellent regulating effect in inhibiting any locoregional recurrences of AVMs

Introduction: Secondary regional vascular insufficiency (RVI) is a pathophysiological state that occurs most commonly following the successfully involved perforosome-directed distal revascularization (IPDDR). This IPDDR renders bounding pulse in the vicinity of diabetic foot ulcer, which shows no signs of early granulation (the sign of healing potential) for variable time. This is the main cause for delaying the definitive reconstruction in the successfully revascularized diabetic foot. Aim: The aim of this study is to evaluate the effectiveness of microvascular and nonmicrovascular reconstructions (NMVRs) in the treatment of secondary RVI of the neuroischemic diabetic foot following successful IPDDR. Endpoints assessed in this study were as follows: (1) Time taken to render a stable and shoe able foot or foot residuum following successful revascularization of the neuroischemic diabetic foot. (2) Time interval between IPDDR and definitive reconstruction in both groups. (3) Rate of complications including recurrence of foot ulcers and failures of reconstruction in each group. Patients and Methods: From 2014 to 2017, 128 neuroischemic diabetic foot patients (a multicenter study) after successful IPDDR for their critical limb ischemia subsequently underwent various types of reconstructions. All had a variable period of secondary RVI following successful revascularization. A retrospective study was conducted by dividing them into two groups – MVR group with 69 patients and NMVR group with 59 patients. The interval between the IPDDR and definitive reconstructions in each group was called the “latent period.” All were followed up for an average period of 30 months. The standard postoperative care and offloading techniques were followed in both groups. Results: The average time taken for obtaining shoeable and stable foot or its residuum in the MVR group was 55.5 days and NMVR group was 76.5 days. By statistical analysis, the MVR group had lesser latency period (P = 0.042), lesser ulcer recurrences (P = 0.044), and lesser flap and reconstruction failures leading to amputation (P = 0.0345). Conclusion: The MVR by bringing tissue from above or at the level of hip area produces sound and early healing of secondary RVI with higher limb salvage rate following the successful revascularization of neuroischemic diabetic foot.

Peripheral Arterial Disease (PAD) is defined as chronic atherosclerotic disease of the lower limbs. Patients with lower extremity PAD present with wide spectrum of symptoms ranging from asymptomatic to minor exertoinal leg pain, significant walking impairment and ulceration or gangrene. The first step in decision making for the treatment of PAD is to confirm PAD with history, physical examination and non invasive vascular laboratory tests. Decision making regarding revascularization is based on symptom status and patient comorbidities. Treatment strategies for intermittent claudication is medical management and for critical limb ischemia is revascularization in the form of either endovascular or surgical management to avoid amputation.

Anterior tibial artery (ATA) pseudoaneurysm is a rare condition that occurs following lower extremity orthopedic intervention or after trauma. We report a series of cases of pseudoaneurysm which were treated surgically. The diagnosis was confirmed with computed tomography angiogram. Aneurysmal sac excision with ligation of ATA was performed.

Case report of iliac artery pseudoaneurysm from the nephrectomized site of transplant kidney. Endovascular management of iliac artery pseudoaneurysm after transplant graft nephrectomy is rarely reported. Patient presented with abdominal pain and pulsating mass in the right lower abdomen. The diagnosis of pseudoaneurysm was made with computed tomography angiogram. Iliac artery stent graft across the aneurysm excluded the sac and treated the compressive symptoms of patient. The endografting decreases intimal hyperplasia and allowing vascular conduit for the lower limb. The endovascular stent-graft placement in iliac artery is a reasonable and durable alternative in selected patients.