Common femoral endarterectomy (CFE) remains essential in the endovascular era for treating common femoral artery disease and enabling hybrid revascularization. Despite its widespread use, contemporary data on outcomes and risk factors are limited. This retrospective multicenter study analyzed 150 consecutive CFE procedures performed at 2 Korean centers between January 2017 and February 2024. The primary endpoints were 6-month all-cause mortality and 3-month local complications. Univariate logistic regression was performed to identify potential risk factors. Although CFE is technically straightforward, it has meaningful perioperative risks, particularly in patients with chronic kidney disease, high American Society of Anesthesiologists scores, or chronic limb-threatening ischemia (CLTI). These findings underscore the importance of careful patient selection and perioperative optimization and highlight the need for vigilant postoperative monitoring even for this commonly performed procedure. The cohort included 150 limbs from 132 patients (mean age 72.2 ± 9.8 years; 72.7% male). Clinical presentations included claudication (45.3%), chronic limb-threatening ischemia (CLTI; 36.7%), acute limb ischemia (12.7%), and access-related indications (5.3%). Combined procedures were performed in 86.7% of the patients. The 6-month mortality rate was 6.7% (10/150), and 3-month local complications occurred in 7.3% of patients (11/150). The significant risk factors for mortality according to the univariate analysis included chronic kidney disease (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.13-15.49; P = .037), an American Society of Anesthesiologists score ≥ 4 (OR 7.75; 95% CI 2.02-29.73; P = .005), and CLTI (OR 4.47; 95% CI 1.11-18.08; P = .038). A body mass index > 25 kg/m2 was significantly associated with local complications (OR 4.01, 95% CI 1.15-14.02; P = .031). Subgroup analysis revealed no significant difference in outcomes between isolated CFE (n = 36) and combined CFE (n = 114).

Recreational nitrous oxide (N2O) misuse has increased markedly over the past decade, particularly among adolescents and young adults. Although neurological toxicity is well established, venous and arterial thrombotic events remain underrecognized in cardiovascular practice. A comprehensive review of the literature was performed by searching PubMed/MEDLINE, Embase, and Google Scholar from inception to January 2026, using combinations of "nitrous oxide," "thrombosis," "pulmonary embolism," "deep vein thrombosis," "stroke," "myocardial infarction," "aortic thrombus," and "homocysteine." All case reports, case series, observational studies, and systematic reviews published in English or French reporting thrombotic events temporally associated with recreational N2O use were included. Eighteen studies comprising over 40 individual thrombotic events were identified. Manifestations include deep vein thrombosis, pulmonary embolism, cerebral venous sinus thrombosis, ischemic stroke, acute limb ischemia, myocardial infarction, and aortic thrombi. Patients were predominantly young (median age 24-26 years), predominantly male (approximately 70%), and lacked conventional cardiovascular risk factors. Hyperhomocysteinemia was nearly universal, often despite normal serum vitamin B12 levels. N2O irreversibly inactivates vitamin B12-dependent methionine synthase, resulting in functional cobalamin deficiency and a prothrombotic state through endothelial dysfunction, platelet activation, and impaired fibrinolysis. Failure to identify N2O exposure may lead to diagnostic delay and recurrent events. Management requires site-specific anticoagulation or antiplatelet therapy, prompt parenteral vitamin B12 replacement, and cessation of N2O use supported by addiction care. Increased awareness among vascular specialists is essential for timely diagnosis and prevention of recurrence.

Posterior circulation strokes can present with diverse neurological deficits, some of which challenge conventional localization principles. We report a case of a 74-year-old male with a history of prior right medullary infarct who presented with recurrent symptoms and was found to have a new medullary acute ischemic stroke in the setting of chronic right vertebral artery occlusion. Notably, the patient exhibited ipsilateral limb weakness, a finding attributable to involvement near the pyramidal decussation at the medulla-spinal cord junction. This case underscores the importance of detailed neuroanatomical understanding in vertebrobasilar ischemia and highlights the diagnostic complexity of brainstem strokes.

Surfer's myelopathy is a rare, nontraumatic spinal cord injury affecting novice surfers. Although spinal ischemia is considered the primary mechanism, whether the initial insult is arterial or venous remains controversial. We report a case of surfer's myelopathy with magnetic resonance imaging findings suggestive of venous congestion-radiological features that, to our knowledge, have not been previously described. A previously healthy 23-year-old man developed acute low back pain, progressive lower limb weakness, and bladder and bowel dysfunction after his first surfing experience. Magnetic resonance imaging on admission showed longitudinal T2 hyperintensity from T8/9 to the conus medullaris without abnormalities on diffusion-weighted imaging. On day 2, repeat magnetic resonance imaging again demonstrated no diffusion-weighted imaging changes, whereas the apparent diffusion coefficient map revealed hyperintensity, indicating vasogenic edema. These findings were more consistent with venous rather than arterial ischemia. The patient was treated with antiplatelet and anticoagulation therapy along with rehabilitation and ultimately achieved complete neurological recovery. This case may represent the first description of magnetic resonance imaging findings suggestive of venous congestion in surfer's myelopathy. Apparent diffusion coefficient hyperintensity in the absence of diffusion restriction may reflect reversible venous ischemia. Incorporating diffusion-weighted imaging and apparent diffusion coefficient maps into routine magnetic resonance imaging protocols for suspected surfer's myelopathy could provide valuable insight into pathophysiology and prognosis.

Background Major upper-limb amputations are performed for various nontraumatic causes such as limb ischemia, malignancy, and infections. These procedures have significant psychosocial and functional impacts on patients, often leading to long-term disability and reduced quality of life. Understanding the interplay between the risk factors and disease progression is essential for improving preventive and therapeutic strategies. Limited data exist correlating clinical profile and surgical outcomes in nontraumatic major upper-limb amputations. This study aims to evaluate these factors in patients undergoing nontraumatic major upper-limb amputation at a tertiary care center. This study descriptively analyzes the demographic details, clinical presentation, risk factors, and surgical outcomes of patients undergoing major upper-limb amputation for nontraumatic indications. Methodology A retrospective observational study was conducted over a two-year period (August 2023 to August 2025) in the Department of General Surgery at a tertiary care center. In total, 23 patients who underwent major upper-limb amputation for nontraumatic causes were included. Data were collected from hospital records with respect to demographic details, comorbidities, Doppler and CT angiography findings, indications and level of amputation, and postoperative outcomes, including duration of hospital stay, revision amputation, surgical site infection, intensive care unit admission, readmission, and mortality. Results Among the 23 patients, 78.9% were middle-aged, and 69.6% were male. The left upper limb was involved in 73.9% of cases. Diabetes mellitus was present in 60.9% of patients, hypertension in 39.1%, and 65.2% were smokers. Anemia was observed in 69.5%, and hypoalbuminemia in 39%. Brachial artery involvement was noted in 30% of cases. Limb ischemia was the most common indication (78%), followed by necrotizing fasciitis (17.4%). Above-elbow amputation was performed in 91.3% of patients. Revision amputation was required in 8.6% of cases. Hospital readmission occurred in 4.3%, and one (4.3%) case of mortality was recorded. The mean hospital stay was 8.7 days. Conclusions Vascular insufficiency was noted to be the leading cause of nontraumatic major upper-limb amputation. While limited by a small sample size, these findings provide a descriptive profile with respect to nontraumatic major upper-limb amputations. Early diagnosis and aggressive management of vascular and infectious etiologies may improve limb salvage rates and reduce morbidity and mortality.

Spontaneous middle cerebral artery (MCA) dissection is a rare cause of ischemic stroke. Due to the lack of established guidelines, management strategies, ranging from conservative medical therapy to endovascular reconstruction, remain controversial. In Case 1, a 53-year-old woman presented with acute left upper limb paresis. Imaging revealed an infarct in the right MCA territory and angiographic features of dissection. She was treated conservatively with dual antiplatelet therapy. Her symptoms resolved, and follow-up imaging at 10 weeks demonstrated spontaneous angiographic healing of the vessel. In contrast, Case 2 involved a 72-year-old man who presented with right upper limb weakness due to left MCA dissection. Initial conservative management with antiplatelet therapy was insufficient; the patient experienced neurological deterioration with expanding infarction on day 5. Emergent endovascular reconstruction using a Wingspan stent (Stryker Neurovascular, Fremont, CA, USA) was performed. The procedure successfully stabilized the dissection, improved distal perfusion, and halted further neurological decline. These two cases suggest that conservative management may be reasonable in selected clinically stable patients with spontaneous unruptured ischemic MCA dissection, whereas rescue endovascular stenting may be considered in patients with neurological worsening and imaging progression despite medical therapy. Because this report includes only two cases, these observations should be interpreted cautiously.

Acute limb ischemia (ALI) is a medical emergency that can be due to prolonged tourniquet application, peripheral arterial disease, arterial embolization, and/or arterial thrombosis. To prevent associated morbidity and mortality, ischemia time should be minimized by urgent or emergent revascularization. However, revascularization can lead to ischemia-reperfusion injury (IRI), a devastating complication that can cause limb loss, multi-organ failure, and/or death. Currently, management of IRI largely relies on preventative measures and supportive care. In Part 2 of this two-part review article, we will briefly review the pathophysiology of IRI discussed in Part 1, and then discuss contemporary interventions to perfuse an acutely ischemic limb, clinical strategies that have been used to reduce and/or prevent IRI, and lastly, randomized controlled trials that have investigated pharmacological interventions to neutralize or mitigate IRI toxicity.