May-Thurner syndrome or iliac vein compression syndrome is associated with deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right common iliac artery. Historically, May-Thurner syndrome has been treated with anticoagulation therapy. However, this therapy can be problematic when given alone, because it prevents the propagation of the thrombus without eliminating the existing clot. Furthermore, it does not treat the underlying mechanical compression. Consequently, syndrome who was managed by anticoagulation therapy alone, there is a significant chance that the patient will develop recurrent deep vein thrombosis or post thrombotic syndrome or both. Recently, both retrospective and prospective studies have suggested that endovascular management should be front-line treatment; endovascular management actively treats both the mechanical compression with stent placement and the thrombus burden with chemical dissolution. We report our case of 53 years old male patient with May Thurner syndrome who managed by endovascular treatment.

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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was <1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower–middle versus high: odds ratio, 0.08 [95% CI, 0.04–0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07–5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84–4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70–9.42]) were significantly associated with increased odds of MTA. Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are <3 cm in diameter. Giant true splenic artery aneurysms are rare and very few lesions >10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.

Embolization of bone and soft tissue tumors has a broad range of indications, from curative treatment to palliation. The main purpose of embolization is to occlude as much of the tumor blood supply as possible. The outcome ranges from complete tumor devascularization and necrosis to degrees of ischemia and hypovascularity. Thus, the tumor will shrink, bleeding will be reduced, borders between the tumor and surrounding tissue will become clear, and resection will be easier. The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone or soft tissue tumors.

230JNA is a rare vascular tumor that accounts for 0.05% to 0.5% of all head and neck neoplasms; however, it is the most common tumor of the nasopharynx in young males 1 . The etiology of JNA remains unknown; however, the association with androgen receptors, chromosomal alterations and growth factors has been described 2-4 .The term angiofibroma was first used by Friedberg in 1940. The name indicates fibrous and vascular components, which of these is the origin, is a matter of debate 5 . CT and MRI imaging could achieve the diagnosis.The aim of this presentation is to report a case of Juvenile Nasopharyngeal Angiofibroma, which was managed by superselective embolization prior to endoscopic surgical resection. THE CASEA sixteen-year-old male presented with a one-month complaint of unilateral nasal blockage and frequent epistaxis. No other physical or laboratory abnormality detected. Plain paranasalsinuses and CT revealed left-sided posterior nasal polypoidal mucosal thickening occluding the left choanae and extending posteriorly through nasopharyngeal cavity and widening of left sphenopalatine foramen with bowing of posterior maxillary wall "Holman-Miller sign". Appreciable infiltration of the medial wall of the base of pterygoid plates was found, see figure 1.Enhanced MRI revealed a posterior nasopharyngeal mass measuring 3.2 cm x 2.2 cm, appearing iso intense on T1 weighed images and of heterogeneous intensity at T2WI with subtle hyperintense foci, and thin flow voids visible on T2 weighed images, see figure 1.Juvenile nasopharyngeal angiofibroma (JNA) is a benign highly vascular tumor. It almost exclusively affects male adolescents and young adults. Nasal blockage and recurrent epistaxis are the classic symptoms. Cross-sectional imaging is vital for accurate diagnosis and operative planning. Pre-operative embolization is frequently performed to decrease blood loss and has especially facilitated endoscopic resection.A sixteen-year-old male presented with one-month complaint of unilateral nasal blockage and frequent epistaxis. Angiofibroma was diagnosed by CT and MRI. Angiography followed by embolization was performed 24 hours prior to endoscopic surgical resection. The reported blood loss was less than 50 ml. No complications were encountered.

Carotid blowout syndrome is described as rupture of the carotid artery most commonly following head and neck dissection. It is an uncommon complication that can be fatal if not diagnosed and managed promptly. This report will discuss the case of a 45-year-old male, who developed carotid blowout syndrome following receiving several therapies for his laryngeal cancer. It will include how careful assessment of the patient's current state and taking into consideration his previous history and risk factors can lead to a case-tailored management plan to be performed in a timely manner, maximizing the chances of a successful life-saving procedure.

Background Angiodysplasia (AD) is an abnormal, ectatic dilated, tortuous blood vessel that is found in the mucosa and the submucosa of the gastro-intestinal tract (GIT). While colonic angiodysplasia is a recognized finding of the lower intestinal tract in the elderly, small intestinal angiodysplasia is rare. However, it is an important reason of GIT bleeding so its detection and proper management can be a challenge. It should be considered among the differential diagnosis in the scenario of mild or intermittent GIT bleedings of obscure cause. Case presentation A 71-year-old woman was presented to our emergency department with hypovolemic shock due to lower GIT bleeding, and she was suffering of melena and severe anemia. The revision of past medical history revealed a history of hypertension, diabetes mellitus, and chronic renal disease. After stabilization, she underwent abdominal computed tomography (CT) which revealed a small abnormal vascular lesion along the anterior and posterior wall of the 2nd part of the duodenum. It appeared as blush of contrast in the arterial phase (representing dilated mucosal capillaries draining into tortuous submucosal vein) suggestive of vascular lesion (duodenal angiodysplasia). The patient was transferred to undergo an angiogram which confirmed the diagnosis of duodenal angiodysplasia. Super selective cannulation of the feeding artery was performed followed by post coiling angiogram which revealed successful embolization. No acute complications were encountered during or immediately after procedure. Conclusion AD is a rare but important cause that should be considered in the differential diagnosis of GIT bleeding especially in the older patients. It should be looked for in CT angiography done in such a clinical situation. Superselective coil embolization is a safe and effective technique to manage bowel AD.