Takayasu arteritis is a rare large-vessel vasculitis that often presents with asymmetric or absent pulses, vascular bruits, intermittent claudication, and cerebrovascular symptoms in over 50% of cases. Surgical intervention becomes essential in patients with severe, refractory disease. We report the case of a 30-year-old female presenting with upper limb claudication and decreased visual acuity in the right eye. Physical examination revealed bilateral carotid and subclavian bruits, significant blood pressure discrepancy between upper and lower limbs, and episodes of limb shaking. Vascular imaging demonstrated extensive involvement of the brachiocephalic trunk, common carotid, and vertebral arteries, with marked arterial wall thickening and gadolinium enhancement. Despite high-dose corticosteroids and tocilizumab therapy, the patient showed a poor clinical response. A successful aortobicarotid bypass was performed. This case underscores the importance of surgical revascularization in medically refractory Takayasu arteritis, offering symptom relief and improved quality of life.

Anatomic malformation as seen in subclavian steal syndrome leads to an alteration in the body's autonomic regulatory pattern, influencing varying physical manifestations. The autonomic nervous system provides situational regulatory feedback to the body, maintaining the body's desired point of homeostasis. We report the case of a 68-year-old male who initially came in with X-rays indicating retrolisthesis and calcifications in his carotids. A left-sided carotid bruit was also noted, as well as right-sided upper extremity weakness. Continued imaging studies indicated structural changes to his cervical regions and continued calcifications in the remainder of his arterial supply branching off of his carotid arteries. The patient's denial of surgical intervention led to treatments focused on symptomatic control until more conclusive data could be collected and interpreted.

Careful palpation and auscultation of carotid arteries, and palpation of superficial temporal arteries, provides vital information in evaluating both completed and threatened stroke, and sharpening risk assessment of asymptomatic persons with risk factors. Several measures allow firmer distinction of carotid bruits from transmitted cardiac murmurs, subclavian bruits, venous hums and fistular bruits. The maneuvers described are complementary to rather than in conflict with technologic advances to assess these vessels, and can be applied anywhere that a stethoscope is in the hand of an informed and practiced examiner.

Median arcuate ligament syndrome (MALS) is an uncommon vascular condition caused by external compression of the celiac artery by the median arcuate ligament. Although it predominantly affects young women, late-onset presentations in older men have been reported and may reflect a different underlying mechanism. We present a 62-year-old man with dyslipidemia and a 20-pack-year smoking history who came to the emergency department with chronic postprandial epigastric pain. Physical examination was unremarkable. There was no abdominal bruit and no tenderness to palpation. Routine blood work showed a mildly elevated prothrombin time (14.4 seconds; international normalized ratio (INR): 1.30), an intermediate Fibrosis-4 (FIB-4) score of 2.39, and an elevated mean platelet volume (MPV) (10.5 fL). Contrast-enhanced CT of the abdomen and pelvis at Bayonne Medical Center demonstrated moderate to severe stenosis of the celiac axis origin related to acute angulation, with post-stenotic dilatation, and findings correlating with median arcuate ligament syndrome per the final radiology report. No other cause of his symptoms was identified. He was transferred to a tertiary care facility and underwent a minimally invasive median arcuate ligament decompression without complications. This case raises awareness of MALS as a diagnosis that should be considered in older male patients with cardiovascular risk factors and unexplained postprandial pain. The severity of stenosis in this case, beyond what is typically seen in young women with classic MALS, suggests that intrinsic atherosclerotic disease may compound extrinsic ligamentous compression in older patients.

Carotid body paraganglioma is a rare hypervascular neuroendocrine tumor of the head and neck, and presentation in a 20-year-old woman is uncommon. We report a young woman with a painless left lateral neck mass present for more than 5 years, with more noticeable enlargement during the preceding year. On admission, a firm, mobile, non-tender mass was palpated along the anterior border of the left sternocleidomastoid muscle, without an audible bruit. Initial and targeted ultrasonography demonstrated a hypervascular lesion centered at the left carotid bifurcation. Preoperative contrast-enhanced computed tomography angiography (CTA) demonstrated a hypervascular mass centered at the left carotid bifurcation with widening of the bifurcation and separation of the internal and external carotid arteries; magnetic resonance imaging (MRI) showed a heterogeneously enhancing carotid-space mass with internal flow-void foci; and digital subtraction angiography (DSA) confirmed marked tumor blush, collectively supporting the diagnosis of carotid body paraganglioma. Surgical excision was performed under general anesthesia. Intraoperatively, the tumor crossed the carotid bifurcation, wrapped around the internal and external carotid arteries, and was extremely vascular; however, grossly complete, vessel-preserving excision was achieved with preservation of the carotid arteries, hypoglossal nerve, and vagus nerve. Histopathology confirmed carotid body paraganglioma with an organoid/nested architecture within a rich vascular stroma and immunohistochemistry showing synaptophysin (Syn)(+), chromogranin A (CgA)(+), S-100(+), and a Ki-67 labeling index of approximately 5%; the original pathology report did not specify a formal microscopic margin status. Balloon occlusion testing, biochemical catecholamine work-up, functional imaging, and genetic testing were not documented in the available record. The postoperative course was uneventful. Ultrasonographic follow-up on July 26, 2018 showed no definite recurrent lesion or obvious vascular abnormality, and long-term clinical follow-up by telephone revealed no recurrence-related symptoms, although no further imaging surveillance was available, and asymptomatic radiologic recurrence cannot be fully excluded. This case highlights the value of multimodal imaging in diagnosis and operative planning and shows that grossly complete, vessel-preserving excision can be associated with favorable short-term imaging and long-term symptom-based follow-up findings in a young patient.

We report a 50-year-old male who sustained a right abdominal stab wound 20 years ago requiring laparotomy and extensive repair, now presenting with worsening dyspnea on exertion and palpitations. Physical examination was remarkable for jugular venous distention, bilateral lower extremity edema, and a right abdominal pulsatile mass with audible bruit. Transthoracic echocardiogram revealed a left ventricular ejection fraction (LVEF) of 30%-35% and a severely dilated inferior vena cava (IVC) with turbulent flow. Computed tomography venography of the abdomen revealed a fistula between the IVC and right renal artery, with aneurysm of the IVC measuring 8 cm. Cardiac catheterization confirmed a high cardiac output of 12 l/min. The patient underwent endovascular repair of the fistula with the use of an Amplatzer septal occluder, and subsequent improvement in symptoms and LVEF. This case highlights a unique etiology of high output heart failure, treated successfully by novel endovascular means.

Takayasu arteritis (TA) is a rare chronic granulomatous large-vessel vasculitis predominantly affecting the aorta and its major branches, leading to stenosis, occlusion, or aneurysm formation. It typically presents in young women, though atypical cases can occur in older adults. Diagnosis is often delayed owing to nonspecific symptoms and a lack of reliable biomarkers. We report a case of a 57-year-old woman who presented with recurrent syncope, dizziness, and chest tightness. Physical examination revealed a significant blood pressure discrepancy between arms and carotid bruits. Although erythrocyte sedimentation rate (ESR) was normal, other inflammatory markers were elevated. Angiography and computed tomography angiography demonstrated multi-vessel involvement, including subtotal occlusion of the right subclavian artery, complete occlusion of the left subclavian artery, and stenosis of the right vertebral artery and abdominal aorta. The patient met the 2022 American College of Rheumatology classification criteria for TA. Treatment with glucocorticoids and cyclophosphamide resulted in symptomatic improvement, with no recurrence during a six-month follow-up. This case underscores that syncope can be a rare initial manifestation of TA, and normal ESR does not exclude active disease. Thorough clinical evaluation and vascular imaging are essential for timely diagnosis and management to prevent serious complications.

Scalp arteriovenous fistulas (sAVFs) are rare vascular lesions that may cause cosmetic deformity, bruit, headache, and recurrence after incomplete treatment. We report a patient in their 30s with a recurrent left frontotemporal sAVF previously embolized with PHIL 25, who presented with progressive enlargement, audible bruit, and headache. Digital subtraction angiography demonstrated a high-flow fistula supplied by bilateral superficial temporal and ophthalmic artery branches. Direct-puncture embolization with 12 mL of ihtObtura 20 achieved complete angiographic occlusion without complications. Clinical and imaging follow-up at 3, 6, and 12 months showed durable symptom resolution, no recurrence, progressive loss of radiopacity, reduced imaging artifacts, absence of skin tattooing, and volume reduction of the treated mass. This case suggests that ihtObtura may be useful for selected superficial recurrent vascular lesions in which cosmesis, durable occlusion, and artifact-free follow-up imaging are clinically relevant.

Takayasu arteritis is a chronic large-vessel vasculitis that predominantly affects young women and may lead to severe vascular complications. This case series is noteworthy because it describes Takayasu arteritis revealed by severe cardiovascular and neurovascular complications, including ischemic stroke and advanced heart failure, in young women without traditional cardiovascular risk factors. We report three cases of Takayasu arteritis observed at Ibn Rochd University Hospital in Casablanca in 2024. The median age was 38 years. Two patients presented with ischemic stroke, while one presented with advanced heart failure. Clinical examination revealed upper limb claudication, dyspnea on exertion, decreased or absent radial pulses, carotid bruits, and significant blood pressure asymmetry between upper limbs. Laboratory investigations showed an inflammatory syndrome with elevated C-reactive protein and erythrocyte sedimentation rate, as well as inflammatory anemia. The diagnosis was confirmed by multimodal non-invasive vascular imaging, including Doppler ultrasound, computed tomography (CT) angiography, magnetic resonance (MR) angiography, and positron emission tomography (PET) scan, fulfilling the 2022 American College of Rheumatology classification criteria. All patients received high-dose corticosteroid therapy (1 mg/kg/day) followed by progressive tapering. Standard treatment for heart failure was initiated when indicated, and anticoagulation or antiplatelet therapy was prescribed according to the presence of embolic events. Clinical and biological improvement was observed in all patients, with partial neurological recovery and a significant reduction of inflammatory markers. Takayasu arteritis may present with highly polymorphic clinical presentations, including severe cardiovascular and neurovascular complications as initial manifestations in young women without traditional risk factors. Early recognition through multimodal non-invasive vascular imaging is essential to establish the diagnosis promptly and initiate appropriate treatment, thereby reducing the risk of irreversible complications.

Arteriovenous (AV) fistulas, the preferred vascular access for hemodialysis, fail to mature in up to 60% of patients with kidney failure. This high failure rate is often attributed to adverse hemodynamic conditions, yet the exact mechanisms remain poorly understood. This review explores the application of computational fluid dynamics and machine learning to elucidate these mechanisms and predict clinical outcomes. Computational fluid dynamic models have been instrumental in characterizing the complex interplay between AV fistula geometry, such as anastomotic angle and curvature, and hemodynamic parameters, such as wall shear stress and oscillatory shear index. These studies consistently link disturbed flow patterns, including low wall shear stress and high oscillatory shear index, to regions prone to neointimal hyperplasia and stenosis. Concurrently, machine learning models have demonstrated significant promise in predicting AV fistula maturation, stenosis, and failure by leveraging diverse data sources, including clinical characteristics, ultrasound imaging, and acoustic bruit analysis. While powerful, the clinical utility of these computational models is often limited by small, single-center datasets, a lack of external validation, and simplifying assumptions that may not capture true physiological complexity. Future progress depends on integrating these complementary approaches, using larger and more diverse datasets, and validating models prospectively to create generalizable tools that can guide surgical planning and improve AV fistula maturation rates.