Pseudoaneurysms are not rare and can occur due to varied reasons including percutaneous vascular access. If left untreated, pseudoaneurysms can be fatal. Here, we have presented a classic case study where a large pseudoaneurysm of left femoral artery with very wide neck was closed using stent graft. A 55 years old male was presented with severe painful large mass in left groin. The mass was soft tissue swelling with severe tenderness and pulsatile in nature. The doppler suggested it to be filled with blood and communicating with femoral artery hence diagnosed as pseudoaneurysm. Attempt was made to compress the neck which was large not clearly defined, hence failed. Multiple interventional and surgical options of closure of pseudoaneurysm was discussed. Patient was taken for stent graft deployment in cath lab. Check angiogram showed nicely flowing femoral artery with no signs of pseudoaneurysm. The patient immediately improved with decrease in pain and swelling.
The abnormal connection between pulmonary arterial and venous circulation is known as Pulmonary Arteriovenous Malformation (PAVM). It was first described by Churton in 1897. The presentation varies from incidental findings to shortness of breath, haemoptysis, chest pain, syncope and cyanosis. Patients with hereditary haemorrhagic telangiectasia are prone to develop PAVM. PAVMs are quite rare, the frequency ranges from 2-3 per 1,00,000 population. Treatment options include surgical intervention and embolisation, the former is now used seldom. The surgical intervention is more invasive than the percutaneous intervention procedure also known as embolotherapy or embolisation. In the present case, authors encountered a rare case of a 30-year- old male presented with giant PAVM with 13 mm diameter (60.65×35.32 mm in dimensions), where patient presented with fever since two months and vomiting. Considering his symptoms, he was initially suspected as Coronavirus-2019 (COVID-19) positive. However, his Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test was reported negative. It was decided to treat him with vascular plug embolisation. A 16 mm Ampletzer vascular plug II was deployed in such a way that it does not occlude the lower branches of Left Pulmonary Artery (LPA). After deploying the vascular plug, the patient was stable and tolerated the procedure well. He was discharged after two days of observation considering his haemodynamic stability.
More than 422 million people are suffering from Diabetes Mellitus (DM) worldwide. Majority of the affected population resides in lower and middle income countries. This chronic, metabolic disease gradually does serious damage to heart, blood vessels, eyes, kidneys and nerves; eventually causing cardiovascular diseases, peripheral vascular diseases, retinopathy, nephropathy and neuropathy. Here, a rare case of a 58-year-old male was present who had history of uncontrolled DM with dry gangrene in right forefoot, acute kidney injury and Coronary Artery Disease (CAD) involving Left Main (LM) bifurcation presented with recurrent acute coronary syndrome with heart failure. Patient in view of multiple co-morbidities was unfit for Coronary Artery Bypass Grafting (CABG) was managed successfully with complex coronary intervention involving LM bifurcation.
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