Approach to Different Types of Inferior Vena Cava Leiomyosarcomas: A Vascular Surgeon's Perspective.

Leiomyosarcoma (LMS) is a rare smooth muscle tumor, and only a few cases have been reported with involvement of the inferior vena cava (IVC). Inferior vena cava LMS is more often silent and usually has a poor prognosis as the patients present late. We present this case series to showcase the different approaches to surgical resection, as each tumor had a different location in the IVC. We emphasize preoperative surgical planning to achieve a tumor-free margin and maintain hemodynamics at the same time.

Guillain-Barre Syndrome-A Rare Cause of Quadriparesis after the Bentall Procedure for Type A Aortic Dissection.

Neurological complications following aortic surgery are most often cerebrovascular accidents due to embolism, or spinal infarcts resulting in hemiparesis or hemiplegia. Guillain-Barre syndrome is a rare cause of quadriparesis. Here, we report a 49-year old male who presented with acute aortic dissection and underwent the Bentall procedure following which he developed quadriparesis, subsequently diagnosed to be a case of Guillain-Barre syndrome. He was successfully treated with intravenous immunoglobulin.

How Can We Manage Penetrating Neck Injury with Blunt Carotid Injury and Spinal Injury: Case Report and Review of Literature.

The Neck is a cylindrical structure containing vital neurovascular and visceral structures tightly packed in a relatively small volume. Mortality rate increases when there is an injury to vascular structures especially the carotid artery, surrounded by other vital neurovascular structures; injuring the neck leads to devastating morbidity when compared to other injuries. With increased awareness of screening techniques and improved detection rates, there is an urge in opting for selective neck exploration and initial aggressive antithrombotic therapy for blunt carotid artery injuries. Here we report a case of a 20-year-old male, with a lacerated injury of the right side of the neck causing transection of the right internal jugular vein, grade 4 (Denver classification) blunt carotid injury, along with cervical vertebral fractures without neurological deficits. The patient underwent emergency surgical neck wound exploration, flush ligation of transacted Right Internal Jugular Vein, and conservative management for blunt carotid artery injury using anti platelets (Aspirin and Clopidogrel) avoiding any immediate neurological deficits. Whenever lacerated neck wounds are evaluated, the chance of blunt injury to the carotid is to be borne in mind and such an injury can be managed with double antiplatelet therapy, if there are no demonstrable neurological deficits.

Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review.

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.