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 (CFD) and machine learning (ML) to elucidate these mechanisms and predict clinical outcomes. CFD 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 (WSS) and oscillatory shear index (OSI). These studies consistently link disturbed flow patterns, including low WSS and high OSI, to regions prone to neointimal hyperplasia and stenosis. Concurrently, ML 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, utilizing larger and more diverse datasets, and validating models prospectively to create generalizable tools that can guide surgical planning and improve AV fistula maturation rates.

Takayasu arteritis is a chronic large-vessel vasculitis affecting the aorta and its major branches, most commonly in young women. Neurological involvement is well recognized but typically manifests as ischemic stroke due to arterial stenosis or occlusion. Intracerebral hemorrhage as the initial presentation of Takayasu arteritis is rare and is usually related to severe secondary hypertension or extensive vascular disease. We describe a 27-year-old woman who presented with acute left-sided hemiplegia and facial asymmetry and was found to have a right gangliocapsular intracerebral hemorrhage. She had a background of poorly controlled hypertension and chronic kidney disease without a prior diagnosis of vasculitis. Clinical examination revealed multiple peripheral vascular bruits, prompting further evaluation. CT pan-aortography demonstrated multiple saccular aneurysms involving the infrarenal abdominal aorta and bilateral common iliac arteries, consistent with Numano type IV Takayasu arteritis. The patient underwent surgical intervention followed by immunosuppressive therapy, with stable neurological and clinical status at the three-month follow-up. This highlights the importance of a careful bedside examination during patient examination in order to potentially save a patient's life from an underlying illness.

Median arcuate ligament syndrome (MALS) is an uncommon condition where the median arcuate ligament compresses the celiac artery, leading to reduced blood flow. It commonly presents with upper abdominal pain after eating, unintentional weight loss, and an audible abdominal bruit. Since MALS is a diagnosis of exclusion, early identification and timely intervention are crucial in enhancing the patient's quality of life. A 43-year-old female presented with chronic postprandial epigastric pain, weight loss, and intermittent nausea for 3 months. The pain was described as dull and worsened after meals. MALS is a rare vascular compression syndrome that mimics other gastrointestinal disorders, often causing delayed diagnosis. Imaging techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography aid in diagnosis. Surgical decompression, primarily via laparoscopic median arcuate ligament release, is the preferred treatment and has shown significant symptom relief. MALS is a rare but treatable cause of chronic abdominal pain. A multidisciplinary approach and timely intervention are crucial for optimal patient outcomes.

We present this rare case of bilateral renal artery involvement due to Behçet's disease (BD) vasculitis to attract the attention of clinicians. BD is a chronic autoimmune vasculitis affecting multiple organ systems. BD causes recurrent oral and genital aphthous ulcers, uveitis, papulopustular lesions, gastrointestinal ulcers, neurologic disease, vasculitis, and arthritis. We report the case of a 56-year-old male patient with 20 years of BD who developed renal artery thrombosis, diagnosed with acute renal failure, hypertension, abdominal bruit, and thoracoabdominal computed tomography angiography images showing bilateral renal artery thrombosis. Our patient was treated with steroids, colchicine, clopidogrel, antihypertensives, and infliximab infusions with clinical and laboratory improvement. Due to active inflammation, radiologic intervention was delayed until remission. We present this case of rare bilateral renal artery vasculitis to the attention of clinicians who take care of BD patients every day.

Pneumocephalus is defined as the presence of intracranial air and is a rare but potentially significant complication following ventriculoperitoneal (VP) shunt placement. Delayed presentations are uncommon and remain poorly described in the literature. The report demonstrates the case of a 74-year-old male patient who developed delayed spontaneous intraventricular pneumocephalus 10 months after VP shunt insertion in September 2022 using a high-pressure fixed valve for obstructive hydrocephalus secondary to a tectal plate lesion. The patient presented in July 2023 with posture-dependent frontal headache, tinnitus, and bruit hydroaérique, without fever, infection, or neurological deterioration. Computed tomography revealed intraventricular air and a small air focus adjacent to the mastoid tegmen, suggestive of an occult skull base defect. The presumed mechanism involved sustained negative intracranial pressure related to the siphon effect of the shunt system, facilitating air entry through a pre-existing osteodural defect. Given the patient's clinical stability and absence of infection or shunt malfunction, a conservative management strategy was adopted. Complete clinical and radiological resolution was observed within two weeks, with no recurrence during 12 months of follow-up. This case highlights a rare delayed complication of VP shunting and demonstrates that conservative management may be a safe and effective option in carefully selected, clinically stable patients, after exclusion of infection and shunt dysfunction. It contributes to the limited existing literature on non-invasive treatment strategies for delayed pneumocephalus.

Posttraumatic carotid-cavernous fistulas (CCFs) are rare but potentially sight-threatening vascular lesions, most commonly associated with high-energy craniofacial trauma. Direct high-flow CCFs following penetrating orbital injury are exceptionally uncommon and may present with delayed or misleading clinical features. This report describes the case of a 35-year-old homeless man who presented with a two-month history of progressive left orbital symptoms after a knife-inflicted injury. Initial treatment targeted a presumed infectious process; however, persistent proptosis, ocular pain, mydriasis, complete visual loss, and ophthalmoplegia prompted further evaluation. CT angiography, performed due to a contraindication to MRI, demonstrated a direct high-flow left CCF with marked dilation of the cavernous sinus and superior ophthalmic vein. Digital subtraction angiography confirmed a Barrow type A CCF. The patient underwent staged endovascular therapy. Initial transarterial coil embolization achieved approximately 80% occlusion, with partial improvement in proptosis but persistent visual impairment. Follow-up angiography revealed residual shunting, leading to a second-stage covered stent angioplasty. Despite this, residual flow persisted, and a third endovascular procedure was planned. The third-stage intervention was canceled because of inadequate social support, and the patient was discharged prematurely and lost to follow-up. CCFs are rare entities but should be strongly suspected in cases of penetrating ocular trauma associated with proptosis, chemosis, and orbital bruits. One of the most important determinants of visual prognosis is timely diagnosis and prompt management of these lesions. In the present case, the patient's social vulnerability contributed to delayed recognition and treatment, resulting in complete loss of vision. Furthermore, the patient's social circumstances directly limited completion of the planned therapeutic strategy. Thus, social vulnerability emerged as a key determinant of prognosis, influencing both clinical outcomes and access to definitive care.

Arteriovenous grafts remain crucial for hemodialysis access despite the risk of perigraft seromas (PSs)-sterile fluid collections causing graft compression, thrombosis, and dysfunction. Current treatments (surgical drainage and compression therapy) show high recurrence rates. We describe a novel occlusion-reopening technique for refractory PSs in 5 patients receiving hemodialysis (mean age, 62.6 years) with expanded polytetrafluoroethylene AVGs. All seromas developed at arterial anastomoses (1-43 days after placement) and recurred after conventional therapies. Our protocol involved (1) intentional graft occlusion via manual compression to induce thrombosis, (2) complete surgical seroma evacuation with pseudocapsule preservation, and (3) percutaneous transluminal angioplasty using 6-mm balloons for graft reopening (see Fig 1 for details). Technical success was achieved in all cases, with immediate restoration of thrill/bruit and mean post-percutaneous transluminal angioplasty flow of 1320 mL/min. No seroma recurrences occurred during follow-up, and all AVGs remained functional. The occlusion-reopening technique addresses PS pathophysiology by eliminating fluid production through temporary thrombosis while preserving graft architecture. This approach demonstrates 100% efficacy in our series for recurrent PSs unresponsive to standard therapies, offering a reproducible solution with durable outcomes.