Pseudoaneurisma e fístula arteriovenosa da artéria femoral profunda após rotura completa do músculo vasto medial: tratamento endovascular / Pseudoaneurysm and arteriovenous fistula of the deep femoral artery after complete rupture of the vastus medialis muscle: endovascular treatment

Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.

Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.

Implante percutáneo de válvula aórtica transcatéter por vía femoral en paciente joven con obesidad extrema / Trans femoral TAVI in extremely obese patient with severe aortic stenosis

RESUMEN:TAVI transfemoral en una paciente con obesidad extrema y estenosis aórtica severa. Una mujer extremadamente obesa (IMC 62.5 Kg/M2) con estenosis aórtica severa fue descartada para cirugía bariátrica y reemplazo valvular aórtico. Se efectuó una TAVI por vía transfemoral, sin anestesia general. Se describen cuidadosas técnicas para efectuar la punción femoral y su sellado posterior. La paciente se recuperó sin incidentes, la gradiente transvalvular aórtica se redujo significativamente y hubo mínima insuficiencia valvular.

ABSTRACT: An extremely obese woman (BMI 62.5 Kg/M2) with severe symptomatic aortic stenosis was discarded for bariatric surgery or aortic valve replacement. A transfemoral TAVI was performed, without general anesthesia. Careful techniques to perform and seal the transfemoral puncture are described. The patient recovered uneventfully with a significant decrease in aortic valve gradient and minimal aortic insufficiency.

Efficacy and safety of "coronary artery bypass graft angiography" with right transradial access versus left transradial access and femoral access: a retrospective comparative study

Abstract Objective: Over the past 10 years, the rate of patients who have undergone coronary artery bypass graft (CABG) surgery has increased twofold in cases of coronary angiography. Today, transradial access is the first choice for coronary angiography. We aimed to compare the efficacy and reliability of radial versus femoral access for coronary angiography in post-CABG surgery in this study. Methods: Data from 442 patients who underwent post-CABG surgery between 2012-2017 were retrospectively compared. The right radial route was used in 120 cases, the left radial route in 148, and femoral route in 174. These three pathways were compared in terms of procedure time and fluoroscopy time, efficacy, and complication development. Comparisons among the three groups were performed with Bonferroni test for continuous variables and chi-square or Fisher's exact test for nominal variables as a binary. Results: Comparison results indicate that femoral access was better than left radial access and the left radial access was better than right radial access in terms of fluoroscopy time (10.71±1.65, 10.94±1.25, 16.12±5.28 min, P<0.001) and total procedure time (17.28±1.68, 17.68±2.34, 23.04±5.84 min, P<0.001). The left radial pathway was the most effective way of viewing left internal mammary artery (LIMA). No statistically significant differences were found among the three groups in other graft visualizations, all minor complications, total procedure and fluoroscopy time "Except LIMA imaging". Mortality due to processing was not observed in all three groups. Conclusion: The left radial route is preferred over right radial access for post-CABG angiography because the left radial pathway is close to the LIMA and is similar to the femoral pathway. In LIMA graft imaging, right radial access is a reliable route, even though it is not as effective as other pathways. We hope that the right radial pathway will improve with physician experience and innovations.

Fibrin sealant repair of a double-necked femoral pseudoaneurysm

SUMMARY Pseudoaneurysms are rare, but femoral artery false aneurysms have increased in recent decades. They are related to endovascular procedures performed on patients with increased risk for this complication. Pseudoaneurysms generally present with only one neck. This paper describes a femoral artery pseudoaneurysm with two necks that occurred after an endovascular procedure and was successfully treated by duplex-guided fibrin sealant. Pseudoaneurysms are rare, but femoral artery pseudoaneurysms have increased with a discrepant incidence reported from 0.5% to almost 4%, mainly related to the increase of endovascular procedures in recent decades. The double-necked pseudoaneurysm identification was of utmost importance to guide the clinical decision-making and allowed good outcomes for the patient.

RESUMO Os pseudoaneurismas são raros, mas os aneurismas falsos da artéria femoral aumentaram nas últimas décadas. Eles estão relacionados aos procedimentos endovasculares realizados em pacientes com risco aumentado para esta complicação. Os pseudoaneurismas geralmente apresentam apenas um colo. Este artigo descreve um pseudoaneurisma da artéria femoral com dois colos que ocorreu após um procedimento endovascular e foi tratado com sucesso por selante de fibrina guiado por duplex. Os pseudoaneurismas são raros, mas os pseudoaneurismas da artéria femoral aumentaram com uma incidência discrepante relatada de 0,5% a 4%, principalmente relacionada ao aumento dos procedimentos endovasculares nas últimas décadas. A identificação do pseudoaneurisma de colo duplo foi de extrema importância para orientar a tomada de decisão clínica e permitiu bons resultados para o paciente.

Gradual treatment of arteriovenous fistula in femoral vessels as a complication of coronary angiography

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Canalización vascular ecoguiada: Experiencia en el paciente pediátrico crítico / Ultrasound-guided vascular cannulation: Experience in critically-ill pediatric patients

Introducción. La canalización vascular central en niños presenta alta complejidad técnica y dificultades. La ecografía vascular puede facilitar este procedimiento. Objetivo. Describir las características de las canalizaciones vasculares ecoguiadas en el paciente pediátrico crítico. Población y métodos. Las variables de interés registradas prospectivamente fueron los vasos más comúnmente canalizados, su localización, la medición del diámetro/profundidad, la tasa de éxito y las complicaciones presentadas, entre otras. Resultados. En 86 pacientes pediátricos, se realizaron 124 punciones vasculares. Los accesos vasculares fueron la vena femoral (39,7%), seguida de la arteria femoral (27,2%) y la vena yugular interna (14,7%). Los vasos femorales se localizaron a una profundidad de 0,75 ± 0,25 mm con un diámetro medio de 0,31 ± 0,16 mm. La profundidad de los vasos venosos yugulares fue menor (0,64 ± 0,24 mm) y su diámetro global, mayor (0,44 ± 0,19 mm). El número medio de intentos en las canalizaciones vasculares ecoguiadas fue de 2,2 ± 1,3. La tasa de éxito fue del 79% asociada a un mayor diámetro del vaso (0,39 ± 0,20 mm vs. 0,28 ± 0,13 mm, p 0,01) y un menor número de intentos (1,90 ± 1,16 vs. 3,45 ± 1,77, p= 0,001). Las complicaciones, fueron la punción accidental de otro vaso (5,3%) y el desarrollo de un hematoma durante la punción (2,3%). Conclusiones. La canalización vascular ecoguiada en los pacientes pediátricos estudiados permite visualizar los vasos y medir su profundidad y diámetro; presenta una alta tasa de éxito y se asocia a una baja tasa de complicaciones.

Introduction. Central vascular cannulation in children is a highly complex technique and poses many difficulties. Vascular ultrasound can make this procedure easier. Objective. To describe the characteristics of ultrasound-guided vascular cannulation in critically-ill pediatric patients. Population and methods. Outcome measures prospectively recorded were vessels most frequently cannulated, their localization, the measurement of their diameter/depth, the success rate and complications developed, among others. Results. One hundred and twenty four vascular punctures were performed in 86 pediatric patients. Vascular accesses were the femoral vein (39.7%), followed by the femoral artery (27.2%) and the internal jugular vein (14.7%). Femoral vessels were localized at a depth of 0.75 ± 0.25 mm, with a mean diameter of 0.31 ± 0.16 mm. The depth of jugular vein vessels was smaller (0.64 ± 0.24 mm) and their overall diameter, larger (0.44 ± 0.19 mm). The mean number of attempts in ultrasound-guided cannulations was 2.2 ± 1.3. The success rate was 79% and was associated to a larger vessel diameter (0.39 ± 0.20 mm vs. 0.28 ± 0.13 mm, p= 0.01) and a lower number of attempts (1.90 ± 1.16 vs. 3.45 ± 1.77, p= 0.001). Complications were accidental puncture of another vessel (5.3%) and hematoma formation during puncture (2.3%). Conclusions. In the pediatric patients studied, ultrasound-guided vascular cannulation allowed vessel visualization and measurement of their depth and diameter; the success rate was high and it was associated to a low complication rate.

Aneurisma da artéria isquiática persistente: relato de caso de tratamento endovascular / Persistent sciatic artery aneurysm: case report of endovascular treatment

A persistência da artéria isquiática é uma anomalia vascular congênita rara cuja principal complicação é a dilatação aneurismática. O quadro clínico pode incluir sintomas decorrentes da dilatação arterial e da isquemia, causada por trombose ou embolização distal. O tratamento dessa afecção rara conta com opções diversas que abrangem desde a ligadura do aneurisma até a correção endovascular. O presente relato descreve o caso de uma paciente do sexo feminino com queixa de tumoração pulsátil na região glútea. Foi encaminhada ao serviço de referência e realizou angiotomografia, que evidenciou persistência completa da artéria isquiática bilateralmente, com dilatação aneurismática à esquerda. A paciente foi submetida a tratamento endovascular do aneurisma, através de punção contralateral, com implante de dois stents revestidos com manutenção da perviedade distal da artéria. A manutenção da perviedade é particularmente importante nos casos da forma completa dessa variação anatômica. A paciente cursou com boa evolução

A persistent sciatic artery is a rare congenital vascular anomaly. The most common complication is aneurysm. Clinical presentation may include symptoms resulting from arterial dilatation and ischemia caused by thrombosis or embolization. There are diverse options for treatment of this rare condition, ranging from ligature of the aneurism to endovascular repair. This report describes the case of a female patient complaining of a pulsating mass in the left buttock. She was referred to a Vascular Service where an angiotomography showed complete bilateral persistence of the sciatic artery, with an aneurysm of the left sciatic artery. The aneurysm was treated with endovascular techniques, via a contralateral approach, with placement of two stent grafts and preservation of distal patency. Patency is particularly important in cases of this anatomical variation in which the persistent sciatic artery is complete. This patient recovered well

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Uso de curativo a vácuo como terapia adjuvante na cicatrização de sítio cirúrgico infectado / Using vacuum therapy as an adjunctive treatment for healing of infected surgical sites

Resumo Infecções de sítios cirúrgicos com envolvimento de próteses sintéticas constituem grande desafio para tratamento. Apresentamos o caso de uma paciente com múltiplas comorbidades, histórico de enxerto aortobifemoral há 6 anos e reabordagem das anastomoses femorais por reestenoses há 5 anos. Apresentou dor inguinal esquerda e abaulamento súbitos com diagnóstico de pseudoaneurisma femoral roto e instabilidade hemodinâmica. Foi submetida a correção emergencial com interposição de prótese de dácron recoberta por prata e correção de grande hérnia incisional abdominal com tela sintética ao mesmo tempo. No pós-operatório, manteve-se por longo período sob terapia intensiva com dificuldade de extubação. Nesse ínterim, apresentou deiscência das suturas e fístula purulenta inguinal esquerda em contato com a prótese vascular. Optou-se pelo tratamento conservador, com desbridamento das feridas e aplicação de curativo a vácuo. A paciente evoluiu com melhora e cicatrização das feridas. Essa pode se constituir em ferramenta importante em casos similares.

Abstract Infections at the sites of surgery involving synthetic prostheses are challenging to treat. We present a case of a patient with multiple comorbidities who had undergone an aortobifemoral bypass 6 years previously and then re-intervention at the femoral anastomoses for restenosis 5 years previously. The patient presented with acute left inguinal pain and swelling and was diagnosed with a ruptured femoral pseudoaneurysm and hemodynamic instability. A repair was conducted by interposition of a silver-coated Dacron graft in the emergency room, and a large abdominal incisional hernia was repaired with synthetic mesh during the same intervention. After surgery, the patient remained intubated in intensive care for a long period. Meanwhile, she presented dehiscence of sutures and a left inguinal purulent fistula that was in contact with the vascular prosthesis. Conservative treatment was chosen, with debridement of wounds and vacuum therapy. The patient improved and the wounds healed. This could be an important tool in similar cases.

Endovascular revascularization of TASC C and D femoropopliteal occlusive disease using carbon dioxide as contrast / Revascularização endovascular de doença oclusiva fêmoro-poplítea TASC C e D com o uso de dióxido de carbono como meio de contraste

ABSTRACT Objective To analyze the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with no formal contraindication to iodine, aiming to decrease allergic reactions and potential nephrotoxicity in high-risk patients. Methods We describe the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with high risk for open revascularization and no formal contraindication to iodine. We analyzed feasibility of the procedures, complications, quality of the angiographic images, clinical and surgical outcomes, and costs of C and D lesions treated using CO2 as contrast medium. Results The use of CO2 in C and D lesions needed iodine complementation in most of the cases (nine cases) but decreased the potential nephrotoxicity of iodine contrast medium by the reduction of its volume in this group of high-risk patients. The extension of the arterial lesions was the factor that most contributed to the need for iodine supplementation due to the difficulty to visualize the refill after a long arterial occlusion. Conclusion The use of CO2 as contrast in patients with C and D lesions with no restriction for iodine contrast medium was an alternative that did not dismiss the need of iodine supplementation in most of the cases, but could decrease the potential nephrotoxicity of iodine constrast medium.

RESUMO Objetivo Analisar os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes sem restrição ao meio de contraste iodado com o objetivo de diminuir reações alérgicas e potencial de nefrotoxicidade em pacientes de alto risco. Métodos Descrevemos os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes de alto risco para revascularização aberta e sem contraindicação formal a iodo. Analisamos possibilidade de execução dos procedimentos, complicações, qualidade das imagens obtidas, desfechos clínicos e cirúrgicos e custos das lesões C e D tratadas com CO2 como meio de contraste. Resultados O uso de CO2 nas lesões C e D necessitou de complementação de iodo na maioria dos casos (nove casos), porém reduziu o potencial de nefrotoxicidade do meio de contraste iodado, diminuindo seu volume nesse grupo de pacientes de alto risco. A extensão das lesões arteriais foi o fator que mais contribuiu para necessidade de suplementação de iodo, devido à dificuldade de visualizar o reenchimento após oclusão arterial longa. Conclusão O uso de CO2 como contraste em pacientes com lesões C e D sem restrição ao meio de contraste iodado foi uma alternativa que não excluiu a necessidade de suplementação com iodo na maioria dos casos, porém pôde diminuir o potencial de nefrotoxicidade do meio de contraste iodado.

Migration of a sirolimus-eluting stent from the ostium of the left main coronary artery to the right deep femoral artery

No abstract available.

Fatal pseudo aneurysm in common femoral artery a case report.

Pseudoaneurysm is a rare condition arising from disruption in arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rise due to increase in endovascular procedures, hemodialysis and intravenous drug abuse. Here we report an young male who was found by a NGO worker, lying on roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to emergency department of LN Hospital. He was a rickshaw puller and known drug addict. The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonogrphy. He was referred to CTVS department and admitted there for surgery. In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of femoral artery. In this report the gross and histopathological findings of pseudo-aneurysm of common femoral artery were described in autopsy.

Post catheter diagnostic coronary angiography thrombotic complications at femoral vascular access site- an ultrasound based study

To determine the frequency of atherosclerotic plaques in common femoral artery in patients undergoing coronary angiography. Identify any significant post procedure change in plaque morphology. Determine the number of patients who develop thrombosis at the access site. Descriptive study. The study was carried out in Radiology Department, Military Hospital, Rawalpindi from 10 Aug 2005 - 09 Feb 2006. The patients undergoing coronary angiography were included in the study. Doppler ultrasound of the right common femoral artery [vascular access site] was done prior to and following coronary angiography. The ultrasound examinations were performed on ALOKA Prosound SSD 5500 using 7.5 MHz linear array probe. Out of the 100 patients included in the study, atherosclerotic plaque was detected in 10 patients at the femoral access site. Out of these 10 patients, having a plaque at access site 01 patient developed a thrombus at the access site. The post procedure diameter of the femoral artery was significantly reduced. Despite the advancements in technique and equipment a thrombus can form at the vascular access site. Doppler ultrasonography proves an ideal diagnostic tool in evaluation of cases with suspected access site complications

Comparative study of the radial and femoral artery approaches for diagnostic coronary angiography

Femoral artery access is the standard approach for coronary procedures; however, the radial approach has gained sound recognition as an alternative to femoral access. We present our early experience with the transradial approach. A prospective, non-randomised study of 221 candidates for diagnostic coronary angiography was carried out at Sultan Qaboos University Hospital, Oman between December 2008 and April 2009. The patients had their procedure performed from radial or femoral access according to operator discretion and the results were compared. Femoral and radial groups included 116 and 105 patients respectively. Results: Radial access was associated with a significantly higher rate of procedural failure [17.1%] versus 0% in femoral group [p=0.001]. There were no local vascular complications in the radial group as opposed to 12.1% in the femoral group [p < 0.01]. Hospital length of stay was significantly reduced in the radial group [4.06 versus 23.5 hours, p < 0.01]. Total procedure time was longer in the radial group [23.7 +/- 13.7 min versus 20.1 +/- 7.4 min, p < 0.001], but radiation exposure was similar in both groups. There was a trend for a higher risk of major adverse cardiac events noticed in the femoral group; however, it did not reach statistical significance. The transradial approach for coronary angiography is associated with significantly reduced local vascular complications and shorter hospital stays. The femoral approach is the standard access site for coronary angiography; however, interventional cardiologists should acquire experience in the radial approach as an alternative in specific situations

value of lipoprotein [a], homocysteine and doppler of carotid and femoral arteries in assessment of atherosclerosis in asymptomatic cardiovascular risk patients

Atherosclerosis is a major health problem and a common cause of death in our locality. Traditional cardiovascular risk factors do not predict most future cardiovascular events. The aim of this study is to evaluate role of non traditional biochemical markers, carotid and femoral doppler in early detection of atherosclerosis in asymptomatic cardiovascular risk patients. This study was conducted on seventy two patients with various cardiovascular risk factors [22 diabetic. 15 hypertensive, 20 smokers and 15 obese], in addition to eighteen apparently healthy subjects as a control group. All patients and controls were subjected to complete history, physical examination anthropometric measurements, calculation of Framingham risk score [FS]. Measurement of serum levels of lipoproteln [a] [Lp[a]], homocysteine, insulin and C-reactive protein [CRP] as well as microalbumin in urine [UAER], in addition to lipid profile, serum glucose and calculation of insulin sensitivity [QUICKI] were done for all subjects. Also intinia-media thickness [IMT] and plaque formation were assessed in both carotid and femoral arteries using high resolution ultrasound [B mode]. According to FS patients were classified into 3 groups: group [A] 40 patients FS< 10, group [B] 25 patients FS 10-<20% and group [C] 7 patients FS >/= 20%. Also according to presence of atheroma patients were classified into two groups, group I patients without atheroma [62 patients] and group II patients with atheroma [10 patients]. Mean values of serum insulin, homocysteine, CRP, UAER and left common carotid IMT revealed significant elevation in diabetic, hypertensive, obese and smoker groups compared to controls [P<0.01 for all and P <0.05 for CRP in smoker group]. Insulin sensitivity [QUICKI] showed significant reduction in all studied groups compared to controls [P<0.01 for all]. Mean value of Lp[a] showed significant elevation in smoker group compared to controls [P<0.01], but in other groups the mean values of Lp[a] were higher but statistically insignificant. In group C [FS >/= 20%] the mean values of triglycerides, Lp[a] and IMT of both right femoral and right carotid showed significant elevation compared to group [A] FS < 10% [P<0.01 for all]. In group II [patients with atheroma] mean values of systolic blood pressure, serum insulin, triglycerides and CRP revealed significant elevation compared to patients group I [without atheroma] [P< 0.05 for all], while insulin sensitivity showed significant reduction [P<0.05]. Univariate analysis showed significant positive correlations between IMT of left carotid artery and BMI, systolic and diastolic blood pressure, cholesterol, LDL-c., triglycerides, CRP, homocysteine and FS and negative correlation with HDL-c, Also there were positive correlations between triglycerides with CRP and between Lp [a] with homocysteine. Age, waist circumference, waist/hip ratio, homocysteine, triglycerides and CRP were predictors of IMT of carotid artery: while age, CRP and triglycerides were predictors of atheroma. Non traditional biochemical markers were elevated in all cardiovascular risk groups. IMT of carotid artery correlated positively with traditional risk factors [systolic and diastolic blood pressure, BMI lipogram and FS] and negatively with HDL-c. Also it correlated positively with non traditional risk factors [CRP and homocysteine]

Deep Femoral Artery Aneurysm Presenting as Lower Limb Swelling: A Case Report

We report a rare case of lower limb swelling due to compression of the superficial femoral vein by a solitary deep femoral artery aneurysm. The patient was a 58-year-old man presenting with acute swelling of the right lower limb caused by deep venous thrombosis. A multi-detector computed tomographic scan (CT) confirmed the diagnosis of a deep femoral artery aneurysm and revealed no evidence of aneurysms or occlusive lesions in the other arteries. Aneurysmectomy and ligation of the deep femoral artery were successfully performed. Preoperative multi-detector CT scanning is a valuable, non-invasive diagnostic tool to delineate not only the state of the aneurysm, but also that of the distal arterial tree.

Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm.

The formation of pseudoaneurysm in the femoral artery after cardiac catheterization is a well-recognized complication occurring in 1%-4% of cases. It is traditionally managed surgically and has a high morbidity. Prolonged ultrasound-guided compression of the neck of the pseudoaneurysm, and ultrasound-guided injection of thrombin into the aneurysm are newer modalities of treatment especially for small aneurysms. We describe the case of a giant pseudoaneurysm of the right femoral artery, post-arteriography, which was successfully managed with ultrasonographically guided percutaneous thrombin injection.

Slow pathway ablation without femoral access.

An 80-year-old woman presented with almost daily episodes of tachycardia. She was found to have drug refractory atrioventricular nodal re-entry tachycardia. As she was found to have bilateral common iliac vein occlusion, radiofrequency ablation of the slow pathway was performed via the subclavian vein. This unique experience raises technical issues for catheter positioning.