Introduction Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg. Methods Dissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: ‘direct communication’, ‘approaching communication’ or ‘no evident communication’. Results A constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation. Conclusions Modern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray’s Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT is removed for bypass or flap surgery. A direct communication is rarely present and is never as robust as generally depicted in textbooks.

The study observed significant shortening of endografts and native aorta and iliac arteries in patients with severe aortoiliac tortuosity during EVAR. This shortening effect can have a negative impact on the distal sealing zone during EVAR. A longer main body or an extension limb should be considered when one is faced with severely tortuous aneurysms.

Objective: Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, focusing on comparison with symptomatic patients. The goal was to evaluate the hemorrhagic and overall outcomes of patients undergoing CEA after IVT and to compare them with a similar population. Methods: We retrospectively analyzed the data of 170 consecutive patients who have undergone CEA after stroke in our center from January 2011 to December 2016; 26 (15.1%) of them had undergone previous IVT. A comparative analysis between the non-IVT and the IVT groups was performed. Overall time between diagnosis of stroke and referral to a vascular specialist was also analyzed. Results: Age, sex, and cardiovascular comorbidities were similar in both groups. Median time between IVT and CEA was 8 days (Q1-Q3, 5-15 days), with nine (41%) patients undergoing CEA <7 days after IVT. There were two (1.4%) intracranial hemorrhages in the non-IVT group vs one (3.8%) in the IVT group (P ¼ .950). The overall combined stroke and death rate was 5.3%, with 4.9% in the non-IVT group vs 7.7% in the IVT group (P ¼ .913). Postoperative cervical hematoma requiring reoperation occurred similarly in both groups (2.1% vs 3.8%; P ¼ 1). Median modified Rankin score at 30 to 90 days of follow-up was 1 (Q1-Q3, 0-2), and it was similar in both groups (P ¼ .156). Median time between diagnosis of stroke and referral to a vascular specialist was higher for patients in peripheral centers (4 days; Q1-Q3, 2-7 days) compared with university vascular centers (1 day; Q1-Q3, 0-3 days; P < .001). Conclusions: In this retrospective analysis, CEA after IVT showed similar hemorrhagic and overall outcomes compared with the overall stroke-CEA population.

Objectives: Severely tortuous aortoiliac anatomy can influence the deployment of the endograft during endovascular abdominal aortic aneurysm repair (EVAR) and have a negative impact on distal fixation. The purpose of this study was to determine how severe aortoiliac tortuosity can change an aortic endograft's length and how it affects distal fixation.Methods: A retrospective review of a prospectively collected vascular surgery database at a university-affiliated medical center was used to identify the study patients. The goal was to identify patients who underwent EVAR with the main body device deployed to a severely tortuous iliac artery. Severe aortoiliac tortuosity was defined as aortoiliac or iliac angulation of <90 . Patients were excluded if more than one device was deployed distal to the main body device, which made accurate lengths measurements difficult.Results: A total of 469 patients underwent EVAR between 2008 and 2014. Of the 171 patients with severe aortoiliac tortuosity, in only 18 patients was the main body placed on the side of severe tortuosity without an extension limb. The mean length of the main body for EVAR was 169 mm, and this length significantly shortened to 147 mm once it was placed in the severely tortuous AAA (P < .001). Treatment length of the main body side measured from the lowest renal artery to the iliac bifurcation also significantly shortened from 179 mm to 170 mm (P ¼ .001). The most angulated portion of the artery on the main body side became significantly less post-EVAR, changing from 86 to 114 (P < .001). Analysis of the nontortuous side showed a nonsignificant change in treatment length (P ¼ .859) and angulation (P ¼ .195).Conclusions: Severe aortoiliac tortuosity can cause significant shortening of endografts, which can negatively impact distal fixation during EVAR. Consideration for a longer main body or an extension limb should be given in tortuous aneurysms.