Isolated superior mesenteric artery (SMA) dissection is a very rare cause of mesenteric ischemia. A 66-year-old male patient was admitted to our emergency department with severe epigastric pain. He was diagnosed with spontaneous SMA dissection leading to intestinal ischemia. A bypass graft was used to relieve acute ischemia with an initial success. However, this success was not sustained, as the graft failed slowly despite a satisfactory technical appearance, leading to type 3 intestinal failure which could be explained by the competitive flow. In conclusion, bypass grafting may yield short-term bowel viability in the treatment of isolated SMA dissection and acute ischemia; however, grafts may fail without radiologically apparent technical complications possibly due to the competitive flow from the collateralizing circuits.

True profunda femoris artery aneurysm is a very rare. Herein, we present a very rare case of an aneurysm of the profunda femoris medial circumflex branch in a geriatric male patient. Operative management by ligation was safe and effective with no major complications after two years of follow-up.

Is There a Correlation Between Sarcopenia and Aortic Aneurysm Morphometry? Low muscle mass is common in patients with abdominal aortic aneurysm (AAA) and is associated with reduced postoperative survival, 1 frailty, and acute and chronic disease. AAA is due to connective tissue abnormalities influenced by enzymatic activity. Matrix metalloproteinases, which are implicated in this process, have also been shown to affect muscle development. 2 It is unclear, however, if low muscle mass is related to the anatomy and evolution of AAA. It was hypothesised that low muscle mass, measured by total psoas area (TPA), is associated with certain features of aneurysmal disease in the abdominal aorta, which may determine suitability for infrarenal endovascular aneurysm repair. A retrospective study was conducted to investigate whether patients with AAA and low muscle mass have different aortic anatomy compared with patients with AAA and normal muscle mass, and to explore the relationship, if any, between TPA and aortic anatomy.Consecutive patients who underwent pre-operative computed tomography (CT) scans of the abdominal aorta in arterial phase between 1 January 2017 and 31 June 2018 were included. Patients with thoraco-abdominal, saccular, mycotic, isolated iliac, and post-dissection aneurysms were excluded. Also excluded were patients who had undergone previous aortic surgery. Anatomical features of the AAA (maximum AAA diameter, proximal aortic neck diameter, and length), AAA extent (infrarenal, juxtarenal, or

Introduction: Descending aortic complex atheromatous plaques can cause claudication, critical lower limb ischaemia (CLI), and are an independent risk factor for systemic embolization. Current practice involves dealing with most cases using endovascular techniques. However, open repair remains superior in terms of the patency rates and may be the only valid option in a subgroup of patients who are unsuitable for endovascular treatments. Most of the current data investigating open procedures are now historic. The aim of this study is to determine whether it is a feasible option in the current day practice. Patients and methods: Ten years data from 2010 to 2020 were collected retrospectively from the hospital records. Clinic letters, radiologic scans, operative records and discharge letters were reviewed. Death records were reviewed to identify patients who survived. Results: Ten cases were identified. The average age was 55 and the mean BMI was 29.4. The mean hospital stay in days was 12 (range: 4 to 22). The mean follow-up period was 147 days (range: 30 to 360 days). Four of the patients were TASC B, four were TASC C and two were TASC D. Two cases had to return to theatres. One patient had transient post-op AF and another had transient post-op ileus. One patient was readmitted within 30 days of discharge for urosepsis. All cases are alive to date except one case which only survived three years after procedure. Conclusion: AE is a procedure that should be considered in selected cases where endovascular approach is not feasible. There is a trend towards lower mortality than the historic data available in literature. Larger case series or registry data may be required to accurately estimate the current day mortality and morbidity figures.