Ossification of the ligamentum flavum is a pathological condition that can cause progressive myelopathy or severe radiculopathy. Standard surgical management involves direct decompression via posterior resection of the ossification. However, there is a substantial risk of complications, including dural tears and iatrogenic instability. We report a rare case of lumbar ossification of the ligamentum flavum with degenerative spondylolisthesis treated solely by full-endoscopic trans-Kambin's triangle lumbar interbody fusion, aiming for indirect decompression and stabilization, without direct resection of the ossification. A 68-year-old woman had progressive low back pain, bilateral lower extremity radiculopathy, and severe neurogenic claudication, limiting ambulation to 100 m. Imaging revealed Meyerding Grade I L4-L5 spondylolisthesis with dynamic instability and significant canal stenosis due to ossification of the ligamentum flavum, measuring 4.06 mm in maximal thickness. She underwent single-level Kambin's triangle lumbar interbody fusion at L4-L5. Postoperatively, rapid improvement was observed (visual analog scale low back pain: 7→1, leg pain: 8→0; Oswestry Disability Index: 52%→10% at 3 years). Follow-up computed tomography/magnetic resonance imaging demonstrated progressive regression of the ossification, from 4.06 mm to 3.2 mm at 1 year and 1.46 mm at 3 years (64.0%). This case suggests that Kambin's triangle lumbar interbody fusion with indirect decompression is an effective surgical option in lumbar ossification of the ligamentum flavum with segmental instability. The remarkable regression of the ossification suggests that spinal stabilization may suppress pathological mechanical stress, shifting bone remodeling toward resorption, and supports a mechanistic hypothesis. Further prospective studies are warranted to validate this pathophysiological mechanism.

Multiple hereditary exostosis (MHE) is a rare autosomal-dominant disorder marked by multiple osteochondromas arising from the metaphyses of long bones. Parameniscal cysts, often linked to meniscal tears, can also expand and compress nearby vessels, posing a potential vascular risk. We present a 28-year-old male with MHE and a parameniscal cyst causing popliteal artery compression. The patient's intermittent claudication resolved completely following surgical cyst decompression and meniscal repair. This case report highlights the importance of considering vascular compression in patients with MHE who present with lower extremity symptoms.

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis in which inflammation plays a central pathogenic role. Endovascular revascularisation may transiently amplify inflammation due to vascular injury, but successful restoration of perfusion could reduce inflammatory burden over time. This prospective, observational, single-centre pilot study aimed to characterise the temporal dynamics of inflammatory biomarkers during the first three months following endovascular revascularisation of the lower limbs. Consecutive patients with PAD who underwent successful percutaneous femoropopliteal revascularisation at the Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia, between January 2022 and January 2024 were enrolled. Venous blood was obtained one hour before the procedure, one day afterwards, and again approximately three months later. Concentrations of high-sensitivity C-reactive protein (hsCRP), interleukins (IL-6, IL-8, IL-10), and tumour necrosis factor-alpha (TNFα) were measured. Temporal changes in biomarker levels were analysed using Friedman and Wilcoxon signed-rank tests where appropriate. Clinical outcomes were evaluated at three months and one year post-procedure and were further verified through patient telephone interviews. The observed outcomes were worsening of PAD symptoms, newly diagnosed angina pectoris, myocardial infarction, stroke, transient ischaemic attack (TIA), or death. Twenty-eight patients (median age 69 years) completed all blood samplings. IL-6 concentrations increased significantly one day after revascularisation and decreased below preprocedural levels at three months, with significant differences observed across all time points (p < 0.001). IL-10 and TNFα decreased significantly between the postprocedural and three-month measurements (p = 0.012 and p = 0.016, respectively), but not below preprocedural levels. No significant changes were observed in hsCRP or IL-8. Over a median follow-up of 732 days, 9 patients experienced worsening PAD symptoms in the treated limb, 2 developed new-onset PAD symptoms in the contralateral limb, and 1 was newly diagnosed with angina pectoris. No myocardial infarction, stroke, TIA, or death occurred. To conclude, endovascular femoropopliteal revascularisation induces distinct short-term inflammatory responses, with IL-6 showing the most pronounced peri-procedural dynamics. The observed reductions in some inflammatory biomarker levels at three months suggest that restored limb perfusion may modulate systemic inflammation. Larger studies are warranted to clarify the prognostic relevance of these biomarkers.

Growing evidence has supported the potential method of umbilical cord mesenchymal stem cell (UCMSC) therapy for diabetic foot and lower extremity peripheral artery disease (PAD), but their results are not consistent. Thus, the authors conducted the first meta-analysis concerning the safety and efficacy of UCMSC treatment in diabetic foot patients. 8 English and Chinese databases were searched to identify randomized controlled trials regarding UCMSC therapy in diabetic foot patients. Two independent investigators carried out literature inclusion, data extraction, and quality assessment. Meta-analysis was performed using ReviewManager 5.4.1., 6 RCT studies involving 380 patients were included. Primary endpoints included ulcer healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), and intermittent claudication. Compared with conventional treatment, patients who accepted UCMSC therapy had a better ulcer healing rate (Odds Ratio (OR) = 2.88 [1.20-6.91]), TcPO2 (standardized mean difference (SMD) = 1.39, [0.01-2.77]), and ABI improvement (SMD=1.22 [0.30-2.13]). Moreover, they also experienced significantly better improvements in pain amelioration, skin temperature, and ulcer area reduction. Whereas, intermittent claudication cannot be ameliorated by UCMSC therapy (SMD=0.83 [-0.45-2.10]). Additionally, neovascularization, examined by angiography, was significantly promoted after UCMSC administration. Moreover, two studies recorded adverse events during follow-up, which were considered to be transient, minor, and regional. The present meta-analysis validated that UCMSC treatment enhances diabetic foot ulcer healing and circulation recovery, and has a promising safety profile, though limited by incomplete reporting. Larger-sample multicenter randomized controlled trials and longer-term follow-up are urgently needed to further explore the safety and efficacy of UCMSC treatment in diabetic foot patients. The meta-analysis was prospectively registered on PROSPERO.

Intraneural ganglion cysts are rare, benign mucinous cysts that arise within the epineurium of peripheral nerves. They most commonly involve the peroneal nerve, whereas involvement of the tibial nerve is exceptionally rare. Patients typically present with neurological deficits involving motor and sensory function of the affected nerve. We present a case of an intraneural ganglion cyst of the tibial nerve manifesting primarily with atypical, vascular compression-like symptoms of intermittent claudication. A 43-year-old patient was referred to our department with a 1-year history of exertional, cramp-like pain in the left calf. The pain occurred consistently within minutes of walking or running and subsided with rest, mimicking intermittent claudication. Duplex sonography and subsequent magnetic resonance imaging revealed an intraneural ganglion cyst of the tibial nerve originating from the superior tibiofibular joint, showing compression of the popliteal artery. On magnetic resonance imaging, compression of the popliteal artery to less than a third of its physiological diameter was demonstrated. Definitive surgical management involved decompression of the intraneural cyst and disconnection of the articular branch. Postoperatively, the patient's intermittent claudication symptoms ceased. Intraneural ganglion cysts of the lower extremity represent a rare cause of neurological symptoms. This case report showed that they can also compress adjacent vascular structures, thereby mimicking intermittent claudication. These atypical symptoms can lead to an initial suspicion of a vascular etiology and hence pose a risk for misdiagnosis. Decompression of the ganglion and addressing the articular branch are essential steps to prevent recurrence and provide definitive symptom relief.

The aggressive wire recanalization in calcified atheroma and dilatation (ARCADIA) technique has been reported as a promising strategy for endovascular treatment (EVT) of severely calcified plaques in the common femoral artery (CFA). Although the technique is usually implemented via the contralateral CFA, establishing the contralateral approach system can be challenging at times. A 72-year-old man was admitted for the treatment of intermittent claudication in his right lower extremity. The patient had previously undergone EVT for a severely calcified iliac bifurcation with 2 covered stents in a kissing configuration. Subtotal occlusion due to a severely calcified plaque in the right CFA remained. We performed EVT using a trans-ankle intervention (TAI) strategy for this complex pathological entity. First, we punctured the right dorsalis pedis artery under extravascular ultrasound guidance and inserted a guiding sheath into the distal part of the target lesion. The first guidewire was passed through the subtotal occlusion. Parallel guidewire manipulation with a second guidewire using a dual-lumen catheter was performed and successfully passed into the intraluminal space of the external iliac artery. After lesion preparation with optimal balloon dilation via both guidewire routes, the procedure was successfully finalized using drug-coated balloon dilation. The novelty of our case lies in the application of TAI using the ARCADIA technique. As the TAI strategy provides a variety of benefits in overcoming several challenging issues in implementing the ARCADIA technique, it is thought to be an optimal option for achieving better outcomes with the ARCADIA technique.