Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We present two cases of vascular handlebar syndrome treated in our hospital and a systematic review of the literature using MEDLINE and SCOPUS databases. Literature review identified 20 similar cases. The median age of patients was 18 years, and in vast majority males in gender. In most cases, the common femoral artery injury was an intimal flap and lumen occlusion with intramural thrombosis followed by transection and intimal injury without occlusion or thrombosis. The median time between injury and diagnosis/treatment was half an hour. Clinical presentation ranged from asymptomatic to acute limb ischemia. The grade of acute ischemia was mostly Rutherford class I (n=14), while acute IIa (n=4), chronic ischemia (n=3), and no ischemia (n=1) were also noticed. The correct diagnosis was revealed by clinical examination only (n=1), or by the combination of clinical and imaging techniques including computed tomography angiography (n=7) and duplex ultrasonography (n=4) or both (n=10). Management of the handlebar trauma syndrome injuries was surgical in most cases. Outcome was favorable in all patients. Vascular handlebar syndrome is extremely rare and high suspicion is required for early diagnosis and definitive treatment, as the early management is effective and crucial for averting the devastating consequences. An individualized approach to the vascular trauma patient is to be applied with considerations taken to the age of the patient, the mechanism of the injury, the anatomy of the lesion, and symptomatology of the case.

Aim To determine radiologic, clinic and laboratory characteristics of COVID-19 positive patients with acute arterial occlusion and compare them with post COVID-19 and non-COVID-19 patients. Methods In this retrospective study, 53 patients with acute occlusion of peripheral arteries admitted to the University Clinical Hospital Mostar in the period between 29 February 2020 and 30 September 2021 were involved. The first group was made of COVID-19 positive patients, the second group were post COVID-19 patients and a control group were non-COVID-19 patients. Results Most patients were males, 37 (69.8%). The average age of COVID positive patients was 66.09±11.25 years, post COVID-19 patients 71.33±5.22 years and COVID-19 negative patients 69.82±1.99 years. Lower extremities were most affected, 38 (71.6%), without significant alteration in the coagulogram. Acute arterial occlusion occurred about 2 weeks after the beginning of COVID-19 or at the time of the first appearance of symptoms. Conclusion We have to take special care about patients with risk factors for developing acute arterial occlusion due to thromboembolism or thrombosis 10 days after the beginning of the disease. We also recommend the use of low molecular weight heparin (LMWH) and monitoring coagulation state due to anti Xa and thromboelastometry.

Pulmonary artery thrombosis in-situ is a term used to describe a pulmonary embolism occurs in the absence of deep vein thrombosis in the lower extremities. Most cases occur in a patient who had a recent traumatic injury to the chest. Other risk factors include the presence of hypercoagulable conditions, including inflammatory state, hypoxia and vascular endothelial injury. Although it has been discussed extensively in the acute COVID-19 disease, pulmonary artery thrombosis in-situ that occur in the setting of Post-Acute COVID-19 syndrome is not commonly reported and poorly understood.

Coronavirus disease 2019 (COVID-19) has been a devastating condition claiming millions of lives, crippling countless people, and causing economic turmoil all over the world since the outbreak started in Wuhan Province of China in December 2019. Numerous papers have been published in the literature about COVID-19-related complications affecting almost all systems in the human body. One of the severe complications of this disease is thromboembolism, which affects both the arterial and venous systems and is well documented. There are few reports about both arterial and venous system involvement in the same patient. Herein, we report the case of COVID-19, who presented with critical limb ischemia caused by both arterial and venous thrombosis.

Total occlusion of the abdominal aorta is a rare and life-threatening event. Risk factors most commonly include coagulopathy, vasculitis, trauma, abdominal aortic aneurysms, aortic thromboembolism, and aortic dissection. The most common complications include severe ischemic manifestations in the lower extremities, spinal cord, or viscera. Thus, management is largely dependent on presumed etiology. We present a case of a morbidly obese 52-year-old female with a past medical history of hypertension, diabetes mellitus, peripheral vascular disease, and coronary artery disease with a smoking history of three packs per day for over 10 years. The patient first presented to our emergency department with bilateral lower extremity paresthesia and pain at rest. Further evaluation through computed tomography angiogram thus revealed infrarenal occlusion of the abdominal aorta and bilateral common iliac arteries; the patient was treated with an aorto-femoral bypass without further sequelae. Our case report details the associated risk factors of acute on chronic aortic occlusion and its management.

Coronavirus disease 2019 is associated with a significant venous thromboembolic risk. Phlegmasia cerulean dolens is a severe form of deep vein thrombosis that can lead to acute limb ischemia. In this report, we present a 58-year-old woman who developed a delayed-onset left lower extremity phlegmasia cerulean dolens 8 weeks after coronavirus disease 2019 onset that led to compartment syndrome and acute limb ischemia from external compression of the arterial vasculature from edematous muscle. The patient received an emergent minimally invasive percutaneous mechanical thrombectomy and four-compartment fasciotomy, resulting in adequate perfusion and ultimately made a full recovery.

Popliteal artery injury following knee dislocation is associated with significant morbidity and high amputation rates. The complex and multi-disciplinary input required to manage this injury effectively can take time to arrange, prolonging the time to revascularization. Furthermore, open surgical bypass or interposition graft can be technically challenging in the acute setting, further prolonging ischemic time.Temporary intravascular shunts can be used to temporarily restore flow but require surgical exposure which takes time. Endovascular techniques can decrease the time to revascularization; however, endovascular popliteal stent-grafting is controversial because the biomechanical forces relating to flexion and extension of the knee may increase the risk of stent thrombosis. An ideal operation would result in rapid revascularization, eventually leading to a definitive and durable surgical solution.We hypothesize that a staged approach combing extracorporeal shunting, temporary endovascular covered stent placement, external fixation of bony injury, and definitive open repair provides for a superior approach to popliteal artery injury than current standard of care. We term this approach lower extremity staged revascularization (LESR) and the aim is to minimize the known factors contributing to poor outcomes after traumatic popliteal artery injury.

The incidence of deep vein thrombosis (DVT) has been related to a number of risk factors, including genetic and acquired prothrombotic conditions, infections, inflammatory diseases, hematologic disorders, trauma, and drug use. Dehydration is a known independent risk factor for the development of thrombosis; however possibly insufficient evidence to form a strong association. The purpose of this case report is to present a 30-year-old male with DVT provoked by acute gastroenteritis-induced dehydration. The patient presented to the emergency department (ED) with a recent history of watery diarrhea for four days, for which he was diagnosed with gastroenteritis and managed at an outpatient care facility. The patient visited the ED again with a complaint of a one-day history of progressively worsening continuous pain in his left lower calf associated with swelling. The ultrasound-Doppler/duplex scan for the left lower limb venous system showed negative augmentation signs and non-compressibility of the deep venous system with partial occlusion/echogenic thrombosis extending from the external iliac vein, saphenofemoral junction, superficial femoral vein, popliteal vein, anterior tibial vein, and posterior tibial artery vena comitans. The patient was diagnosed with acute extensive DVT (multiple emboli). Patient care (medical treatment plan/therapeutic anticoagulation) was started in the ED and continued in the Critical Care Unit for close monitoring and care for a couple of days, after which he was transferred to the ward and then discharged in stable condition. He was prescribed a three-month course of appropriate medication regimen. This rare case presentation is a reminder to emergency physicians that dehydration might induce DVT and all patients, regardless of age, diagnosis or comorbidities, should always be risk assessed upon presentation and discharge, and prophylaxis should be provided according to their risk profile.

The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection not only affects the respiratory system but also induces coagulation abnormalities and thrombosis. We report a middle-aged woman who presented during the Covid-19 pandemic with sudden-onset acute left upper limb ischaemia of short duration, with no history of dry cough, breathlessness or fever, and tested positive on TrueNAT for SARS-CoV-2. Later, she developed deep venous thrombosis of the right lower limb during isolation in the hospital.

There is a pair of large arteries in the thorax arising from the arch of the aorta (left) and brachiocephalic trunk (right) known as subclavian arteries. The subclavian artery continues as the axillary artery. It gives off various branches including the vertebral arteries, which supply about 20% of blood to the brain.[1] Like many other arteries, the subclavian artery is also prone to disease, and one common problem is subclavian artery thrombosis. Subclavian artery thrombosis is typically underdiagnosed by physicians. Harrison, in 1829 was the first to uncover stenosis of the initial segment of the subclavian artery.[2] Bachman and Kim, in 1980 performed the first angioplasty of the subclavian artery.[3] The disease is more common in the left subclavian artery by four-fold as compared to the right.  Subclavian artery stenosis can cause significant ischemic symptoms in the upper extremities, brain, and rarely in the heart. 

The authors report a case in which an acute thrombosis of a pre-existing arterial stent occurs in a patient's lower extremity during a lumbar spinal fusion surgery. The event was detected by acute changes in somatosensory evoked potentials (SSEPs) which were being monitored during the procedure. The neurophysiology technologist reported a 10 % increased latency and 50 % loss of amplitude in the left posterior tibial nerve recordings. While still in the operating room, further investigation, including doppler and arteriogram, demonstrated a complete occlusion of one of the two contiguous stents within the superficial femoral artery (SFA). A vascular surgeon was then able to emergently perform trans-arterial thrombectomy and restore flow through the extremity while still in the operating room. The observed events demonstrate the ability of SSEP monitoring to potentially detect arterial occlusion early, allowing for a rapid diagnosis and expedient treatment, in this case immediate, thus avoiding significant limb threatening morbidity.

Arterial thrombosis encountered during sars-cov2 infections is a rare complication with a poor prognosis compared to venous ones. They generally occur in severe and critical clinical forms of covid19 [1,2]. The physiopathology of arterial thrombosis, even if not completely understood highlights hypercoagulability and excessive inflammation as risk factors with a major role of the endothelial lesions in their occurrence. The presence of cardiovascular risk factors in patients infected with covid19 is also discussed as a predisposing factor for arterial thrombosis [2,3]. We report the case of a North African male patient hospitalized for acute respiratory distress syndrome (ARDS) secondary to covid19 pneumonia, complicated by the occurrence of multiple arterial thrombosis of the aorto-iliac axis with the rare finding of two free floating thrombus in the aorta and the right common iliac artery. Clinically, the patient had developed acute bilateral lower limb ischemia and multi-organ failure and the evolution was dramatic with rapid worsening of the patient...s health and eventually his death. Thromboembolic complications are frequent during covid19 infection but the aortic localization is very rare. Its diagnosis is difficult and it has a poor prognosis. Our objective through this case report is to increase knowledge about arterial thromboembolic events while discussing their link to the sars-cov2 viral infection.

In the absence of known thrombophilia or factors associated with thrombotic tendency, clinicians are more likely to think of antiphospholipid syndrome in patients presenting with venous thrombosis than in those with arterial thrombosis. We present a case of acute lower extremity arterial ischemia in a female smoker. Despite multiple surgical interventions and treatment with several different anticoagulants, our patient developed bilateral lower extremity thrombi. Ultimately, after developing a pulmonary embolism, she accepted to be on warfarin. She switched to warfarin without recurrence of her arterial thrombosis. We describe the challenging management of her critical limb ischemia and review the pertinent literature on the controversy surrounding optimal anticoagulation in such patients.

Neonatal limb ischaemia is a rare disease entity with devastating morbidity, including compartment syndrome, tissue loss, limb loss, reduced limb growth, irreparable neuropathies and Volkmann's syndrome. We report a case of limb revascularisation and salvage due to intrauterine brachial artery thrombosis. Published literature is limited to case reports and case series, with various treatment modalities discussed. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of life-long morbidity. A male baby at (36+6week) gestation was born to a nulliparous mother with gestational diabetes via uncomplicated elective caesarean section. Aetiology was due to dense fibrotic circumferential constriction of the brachial vessels and plexus. Successful revascularization was achieved with a contralateral interposition reversed great saphenous vein graft. Though extremely rare and the clinical presentation varies with the location and timing after birth, the surgeon should maintain a low threshold for suspicion of in the presence of the characteristic sequelae of ischaemia. Doppler ultrasonography can aid the diagnosis where ambiguous, and therapy should be individualised based on the clinical presentation; this case emphasises the role of surgery in limb salvage.