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To report an unusual case of severe acute aortoiliac stenosis on computed tomography (CT) mimicking large-vessel vasculitis, highlighting a diagnostic pitfall in a patient at risk for aortoiliac disease.

We report the case of a 64-year-old man referred for vascular assessment after abdominal CT showed marked infrarenal aortoiliac narrowing. The findings were correlated with prior ¹⁸F-FDG PET/CT, duplex ultrasonography, clinical findings, laboratory data, and a targeted literature review.

The patient had a history of biopsy-proven cranial giant cell arteritis, diagnosed 4 months earlier after anterior ischemic optic neuropathy, and was receiving tapering glucocorticoid therapy (prednisone 6 mg daily). An abdominal CT performed for preoperative inguinal hernia assessment during a forceful Valsalva maneuver showed extensive, pseudo-occlusive narrowing of the infrarenal aorta and iliac arteries, accompanied by periaortic infiltration. This initially raised suspicion of acute aortitis. However, PET-CT performed 1 month earlier showed no evidence of extracranial vasculitis and demonstrated a mildly dilated infrarenal abdominal aorta measuring 37 mm, consistent with a small aneurysm. The patient denied intermittent claudication, abdominal pain, weight loss, constitutional symptoms, or exposure to sympathomimetic or illicit drugs. Physical examination showed normal symmetric lower-extremity pulses without a vascular bruit, and contemporary duplex ultrasound confirmed a patent infrarenal aorta with preserved flow and no hemodynamically significant stenosis. Multidisciplinary review of the CT acquisition parameters established that the stenotic appearance coincided precisely with the forceful Valsalva maneuver. The overall picture was therefore most consistent with transient, reversible aortoiliac compression caused by increased intra-abdominal pressure during a forceful Valsalva maneuver, possibly accentuated by increased local vascular compliance related to a small abdominal aortic aneurysm.

Valsalva-induced aortoiliac compression is an underrecognized imaging pitfall that can mimic large-vessel vasculitis on CT. Correlation with acquisition conditions, clinical findings, and multimodal imaging is essential to avoid diagnostic anchoring, unnecessary investigations, and inappropriate treatment escalation.

Background: Lower extremity bypass graft occlusion is associated with recurrent ischemic symptoms, potential limb loss, and the need for urgent revascularization. This study evaluated the technical and clinical outcomes of AngioJet™ rheolytic thrombectomy for occluded lower extremity bypass grafts in a single-center retrospective cohort.

Methods: Consecutive patients who underwent AngioJet™ rheolytic thrombectomy as the primary thrombus-removal strategy for occluded lower extremity bypass grafts between January 2014 and December 2024 were retrospectively reviewed. Technical success was defined as restoration of antegrade flow with less than 30% residual stenosis on completion angiography. Clinical outcomes included Rutherford-category improvement, complications, 30-day mortality, major amputation, target lesion revascularization, and primary patency. Follow-up was complete in 38 of 40 surviving patients (95.0%); two patients without complete postdischarge follow-up were censored at last contact. No imputation was performed.

Results: Forty-one patients underwent AngioJet™-assisted thrombectomy during the study period. Technical success was achieved in 38 of 41 procedures (92.7%). Periprocedural complications occurred in 4 patients (9.8%). Thirty-day mortality was 2.4% (1/41), and the 30-day major amputation rate was 4.9% (2/41). Rutherford-category improvement at 30 days was documented in 18 of 41 patients (43.9%), with a reduction in mean Rutherford category from 3.8 ± 1.4 at presentation to 2.1 ± 1.6 at 30 days (P<0.001). Follow-up was available for 38 of 40 surviving patients (95.0%). Primary patency at final follow-up was 63.4% in the
overall cohort (26/41) and 68.4% among technically successful procedures (26/38). Target lesion revascularization was required in 13 patients (31.7%).

Conclusion: In this retrospective single-center series, AngioJet™ rheolytic thrombectomy was technically feasible for selected patients with occluded lower extremity bypass grafts and was associated with acceptable early safety outcomes

To report staged bilateral transcatheter arterialization of the deep veins (TADV) as a last-resort limb-salvage strategy in a patient with bilateral chronic limb-threatening ischemia (CLTI), extensive tissue loss, and no remaining conventional revascularization option.

A patient with bilateral CLTI (Fontaine stage IV, Rutherford category 6) presented with non-healing ischemic wounds of both lower extremities. Following multidisciplinary assessment, further open surgical or conventional endovascular arterial reconstruction was considered unfeasible on either side, leaving bilateral major amputation as the anticipated alternative. Staged bilateral TADV was performed using the LimFlow system. The subsequent treatment pathway combined close clinical and perfusion surveillance with repeated surgical debridement, negative-pressure wound therapy, infection control, and minor forefoot amputation to prepare the wound beds for definitive closure.

Technical success was achieved in both limbs. After TADV, local perfusion and wound conditions improved progressively. Multiple surgical and wound-care interventions remained necessary. On the right, the wound bed ultimately permitted split-thickness skin grafting; on the left, secondary wound closure was achieved. During the reported follow-up, both limbs were preserved without major amputation, with ongoing wound healing.

Bilateral TADV can provide sufficient perfusion for wound healing and limb preservation in carefully selected patients with no-option CLTI who would otherwise face major amputation. However, technical revascularization is only the first step in a demanding treatment pathway. Success requires sustained interdisciplinary commitment, including endovascular surveillance and reintervention when necessary, repeated surgical wound management, infection control, and specialized nursing care. TADV should therefore remain an important consideration before proceeding to major amputation in patients with exhausted conventional revascularization options.

Arterial pathologies of the external iliac artery (EIA) due to endurance sporting activities are well known. We present a case of surgical repair of an occluded EIA following heavy weighted squats.

A 33 year old male patient presented with left sided intermittend claudication with a pain free walking distance of around 300 m. Not only his daily duties were restricted but he also was not fit enough to perform his profession as a prison guard. Cardiovascular risk factors consist of a 17py smoking history and obesity with a BMI of 31.6 kg/m2. The intermittent claudication started after performing 12 cycles of heavy weighted squats. On examination foot pulses on the left were weaker than on the right. The ankle-brachial-index was 0.75 on the left and 1.2 on the right side. Duplex sonography and CT angiography (CTA) reveald an occluded left EIA and common femoral artery (CFA). Collateralistion was via the internal iliac artery. In the CTA and cardiologically there was no source of embolisation detected. Operative reconstruction was performed with an iliaco – femoral 8 mm Dacron interposition. Histopathological examination was performed.

The postoperative course was uneventful. Histopatholgy showed an old thrombus in the EIA and a thrombus in the CFA with athersclerosis. There was no vasculitis detected, no dissection and no IgG4 associated disease such as retroperitoneal fibrosis. The short-term follow-up was uneventful.

The intermittent claudication started following heavy weighted squats. The patient has two known cardiovascular risk factors. The surgical reconstruction was preferred to an endovascular treatment due to the small diameter of the EIA and its thrombus load and taking into regard the longterm patency in this young patient.

Martorell's ulcer is a very painful form of atypical leg ulcer, which often requires surgical debridement and split skin grafting. Superinfections and the necessary decongestion as well as wound pain are often additional problems.
Treatment attempt of a Martorell's ulcer with fish skin graft in combination with negative pressure wound therapy and compression therapy.

In the case of a histologically confirmed, superinfected Martorell's ulcer, surgical debridement and subsequent split-thickness skin grafting were planned. Due to a reduced general condition and liver cirrhosis caused by alcohol abuse, the patient was not approved for anaesthesia for elective surgery. She was then referred to a wound clinic. In the absence of size regression and persistent pain under optimal conservative therapy, other options for defect coverage such as punch grafts or use of CAMPs (cellular, acellular and matrix-like products), in this case fish skin grafts were discussed. We agreed on using fish skin grafts.

The application of fish skin graft led to a rapid decrease in local pain. The wound showed significant regression in size with epithelialisation from the wound edge. The wound showed a size reduction of >50% within 4 weeks. The patient was able to return to work.
The defect coverage was done in a private practice in an outpatient setting, no form of anesthesia was needed

Treatment of an Martorell’s ulcer with fish skin graft in combination with NPWT was very well tolerated in this case, leading to rapid regression of pain and significant reduction in wound size. This application was a feasible treatment alternative, particularly in a case where a patient was not approved for elective – albeit urgent – surgical defect coverage. This therapeutic approach may represent a valuable alternative in similar clinical situations.

To describe the feasibility and early clinical outcome of a minimally invasive endovascular approach for recanalization of a surgically ligated superficial femoral artery (SFA) in a patient with Rutherford class 3 claudication following previous common femoral artery endarterectomy and profundal patch angioplasty.

A complex endovascular procedure using simultaneous antegrade and retrograde access was performed to cross the surgically ligated SFA. Laser atherectomy was used to recanalize and debulk the occluded arterial segment. Vessel continuity was restored by implantation of a stent-graft, followed by post-dilatation to optimize luminal expansion and flow restoration. Angiographic and clinical follow-up were performed to assess technical success and early outcomes.

Technical success was achieved with complete restoration of inline SFA flow and an excellent angiographic result. No device-related or procedural complications occurred. The patient experienced early symptomatic improvement, including resolution of claudication and a marked increase in pain-free walking distance. Duplex ultrasound at three-month follow-up demonstrated sustained patency without evidence of restenosis

Laser-assisted endovascular recanalization combined with stent-graft reconstruction is a feasible and safe treatment option for selected patients with surgically ligated SFA occlusions. This minimally invasive strategy may reduce the morbidity associated with surgical bypass while providing durable short-term revascularization. Further studies are warranted to evaluate long-term outcomes and define its role in complex post-surgical peripheral arterial disease

Endovenous laser ablation (evla) combined with phlebectomy is an established treatment for lower-limb varicose veins. However, phlebectomy requires additional skin incisions and may increase postoperative discomfort and procedural complexity. Total endovenous laser ablation (total evla) is a catheter-based approach aiming to treat both saphenous trunk reflux and varicose tributaries in a single all-endovascular procedure. This study aims to compare early outcomes of total evla with conventional evla combined with phlebectomy.

We performed a single-centre retrospective comparative analysis of consecutive patients treated for symptomatic superficial venous insufficiency. Between August 2025 and June 2026, patients undergoing total evla were compared with patients treated by evla - phlebectomy. All procedures were performed under ultrasound guidance using the same 1940 nm diode laser and Oesch type 3 phlebectomy hooks. Follow-up was performed at day 1, 7 and 30. Demographic data, ceap classification, technical success, procedure time, postoperative pain, complications and need for secondary treatment were analysed.

A total of 96 patients were included (45 total evla and 51 evla - phlebectomy). Age was comparable between groups, with mean CEAP stages of 3.6 and 3.1, respectively. Technical success was achieved in 100% of cases at 1-month follow-up in both groups. Mean procedure time was 21% shorter in the total evla group (77 vs 97 minutes). Postoperative pain was low in both groups and significantly lower after total evla (0.67 vs 1.80 on a 0-10 scale). Minor complications (transient dysesthesia, hyperpigmentation) occurred in 6.7% of total evla and 3.9% of evla-phlebectomy patients. No major complications (venous thromboembolism, severe bleeding or infection) occurred in the total evla group, compared with two cases (3.9%) after evla-phlebectomy.

Total evla appears to be a feasible and safe alternative to conventional evla combined with phlebectomy for superficial venous insufficiency. Early results suggest comparable technical success with potential advantages regarding invasiveness, postoperative comfort and procedural efficiency. A non-statistically significant reduction in major complications was observed. These findings are consistent with the recently published totem trial ( Palombi et al, Journal of Vascular Surgery, 2026).

Diabetic Foot Syndrome (DFS) remains a major clinical challenge, frequently leading to chronic wounds, severe neuropathy, impaired microcirculation, and severe pain. This condition deteriorates especially when all reconstructive therapy options are exhausted. Until recently, there were no highly successful therapies available to directly improve microcirculation. This study presents the primary clinical outcomes of the first 10 consecutive patients treated with transcutaneous carbon dioxide (CO2) therapy at the first hospital and by the first certified physician utilizing this innovative therapeutic modality across Switzerland, Austria, and Germany.

A prospective cohort of 10 patients presenting with complex Diabetic Foot Syndrome - with or without active ulcerations, and with or without peripheral neuropathy - underwent a structured course of transcutaneous CO₂ therapy using the specialized transcutaneous CO2 system. The clinical protocol utilized custom, detachable therapy sleeves that seal around the affected limbs to deliver precise, regulated doses of medical-grade CO₂ gas directly into the subcutaneous tissue. Treatment efficacy was quantified via tissue microcirculation parameters, rate of wound epithelialization, standardized neurological pain scores, and objective mapping of numbness.

Clinical evaluations demonstrated exceptional therapeutic responses across all 10 monitored cases. Patients with active ulcerations exhibited an accelerated wound healing trajectory with a notable reduction in total wound surface area. Neurological evaluations revealed a substantial mitigation of both chronic pain and objective numbness (timberlness). Angiological examinations confirmed marked improvements in localized microcirculation parameters and VAS pain scale overall pain relief.

Transcutaneous CO₂ therapy via the transcutaneous CO2 system represents a clinically potent, minimally invasive and risk free intervention that significantly accelerates wound healing, restores microvascular circulation, and relieves neuropathic symptoms in patients suffering from Diabetic Foot Syndrome. As the pioneering certified clinical site in West Europe (DACH countries), our findings confirm that this modality provides excellent clinical success.