Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis, with a prevalence of 29% in those older than 70 years or aged 50-70 years who are either smokers or diabetic [1,2]. The majority of persons with this condition are asymptomatic, and less a fifth report typical intermittent claudication [3]. The literature shows us that the risk of limb loss for those who do not have diabetes is 2% or less [4] and, also, that this risk increases three-fold in patients with diabetes requiring pharmacological therapy (oral or insulin) [5].

Introduction: A congenitally absent inferior vena cava (IVC) is a rare condition that is recognized to be associated with deep venous thrombosis (DVT), especially in young adults. It may be not apparent until later in life. Case presentation: a previously healthy 24 years old male presented with left leg swelling and pain during walking, two years ago. During this admission he was investigated and diagnosed as absent IVC. He developed same manifestation but this time of the right side one year later. Conclusion: patients with congenital IVC anomalies associated with DVT are significantly younger in comparison to patients with isolated DVT of the lower limbs.

We report a case of effective trans catheter repositioning of an ICD lead that was displaced during a trans venous extraction procedure of another malfunctioning ICD lead. This original technique was effective also in screwing-in the active fixation tip of the lead. Skilled operators could take into account this technique to avoid the re-opening of the device pocket, when dealing with specific situations at high risk of infection.

A 73-year-old male patient was diagnosed with thrombotic obstruction of the left common iliac vein (LCIV). Computed tomography imaging revealed a known -under follow-up- isolated aneurysm of the right common iliac artery that seemed to directly obstruct the LCIV. Given the patient’s renal insufficiency as well as the size and anatomy of the aneurysm, the patient underwent open repair. The decision between open and endovascular repair, given the proximal DVT, is a dilemma, considering the risk for pulmonary embolism perioperatively as well as the venous thrombosis outcome postoperatively. Therefore, we present such an unusual case and discuss proper management.

A 65 year old male presented to the causality department of our hospital with one day history of burning chest pain in the right upper half of the chest radiating to the right axilla & the left precordial region associated with diaphoresis. No history of fever, cough or rash was evident. Vitals were normal. An X ray chest done was normal and ECG showed RBBB (Figure 1). A Troponin T (qualitative) test along with cardiac enzymes was done in view of possible acute coronary syndrome which were noncontributory as well. The patient was given symptomatic treatment by the resident on duty but on the second day he returned back with a vesicular eruption in the upper part of the trunk on the right side which extended to the axilla and the right mammary area (Figures 2a, b).

A 56-year-old man with past medical history of hypertension on treatment with valsartan and left fibula fracture 15 years ago, presented with a 2-month history of paresthesia on the left lower limb after working many hours on a vineyard in a squatting position. During the physical exam, the patient presented symmetric pulses on all extremities and a palpable, pulsatile mass on the left popliteal fossa. CT scan showed a patent popliteal artery with a saccular aneurysm of 37 millimeters in diameter (Figure 1), which was confirmed intraoperatively (Figure 2). A popliteal-popliteal bypass was done with the left great saphenous vein through a posterior approach (Figure 3). Blood, arterial wall and thrombus cultures were negative. Pathology confirmed diagnosis of pseudoaneurysm and no malignant cells were present. At 12-month follow-up the patient is asymptomatic with good distal pulses and no signs of bypass restenosis on ultrasound. The incidence of popliteal artery aneurysm is 0.1-1% [1], while traumatic pseudoaneurysm represents 0-3.5% of all popliteal aneurysms.

In a patient with a known history of aortic surgery, presence of upper gastrointestinal bleeding requires a high index suspicion for the possibility of aorto-enteric fistula. Aorto-enteric fistula is an uncommon but known complication occurring after abdominal aortic reconstruction. However, there are few reported cases of enteric fistulas arising after splanchnic artery aneurysm repair. We report a unique case of a celiac artery graft – duodenal fistula in a 60-year-old male, who developed upper gastrointestinal bleeding two months after initial open resection of a celiac artery aneurysm and placement of an aorto-celiac artery graft. The patient underwent successful repair of the fistula and the resection of the involved graft with ligation of the common hepatic artery and splenectomy. Our case report highlights the rare entity of celiac arterio-enteric fistula after open repair of a celiac artery aneurysm and reviews the diagnostic and treatment modalities available for successful management of this rare complication.