Endarterectomy of common femoral artery lesions (CFA) carries favorable longterm results and is currently still considered the gold standard for treating these lesions. Although routine stenting has been considered an option for treating the CFA, it has yielded conflicting results and is currently reserved for a bailout of suboptimal endovascular results. Newer therapies with atherectomy or lithoplasty in conjunction with pharmacologic antiproliferative therapies are promising with less bailout stenting and dissections but randomized trials are needed to confirm their effectiveness and safety.

ensued. Repeat EGD with a duodenoscope revealed a patulous ampulla and large periampullary diverticulum (Figure A). ERCP was performed revealing no choledocholithiasis or stricture; however, an irregularity was found in the distal CBD due to compression from the diverticulum (Figure B). Cytology was obtained from the CBD irregularity which showed benign biliary epithelium. The diagnosis of LS was made and a 10Fr 7cm plastic biliary stent was placed. The patient's bilirubin and alkaline phosphatase quickly improved from a peak of 17.8 mg/dL and 1036 U/L, respectively, to 8.5 mg/dL and 719 U/L within 24 hours of stent placement. Due to recurrent cholangitis requiring multiple ERCPs the patient is awaiting diverticulectomy and cholecystectomy for definitive management. Discussion: LS is characterized by obstructive jaundice due to a periampullary diverticulum. In many patients the diagnosis can be challenging. In this case the presumption of DILI led to a delay in diagnosis. Only in the setting of persistent jaundice and worsening right upper quadrant abdominal pain was the possibility of LS entertained. In hindsight, the patient's initial bacteremia was likely due to cholangitis due to LS. EGD with duodenoscope helped to confirm the diagnosis. Visualization of a periampullary diverticulum via duodenoscope is considered the gold-standard diagnostic modality for LS. Its use should be considered in cases where suspicion for LS is raised.[1768] Figure 1. (1a) Periampullary diverticulum, with solid arrow demarcating the papilla and dashed arrow revealing the large periampullary diverticulum containing smaller internal diverticuli. (1b) ERCP with cholangiogram showing external compression of CBD by the periampullary diverticulum with upstream ductal dilation.

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Fibromuscular dysplasia (FMD) is a rare systemic vascular disease that has been found to present as a renal infarction (RI) in only a handful of cases. We present a case of a 53-year-old Vietnamese patient presenting for sharp, severe left-sided abdominal pain of two-day duration associated with a migraine headache. On presentation, she was afebrile, and her vital signs were stable. Laboratory investigations were significant for mildly elevated leukocytosis but were otherwise normal. CT abdomen and pelvis with contrast revealed a left-sided renal infarct. The patient was then admitted to the hospital and started on therapeutic anticoagulation. A transthoracic echocardiogram was obtained and revealed no vegetation. CT angiography of the abdomen was pursued and was significant for mild beading within the mid-right and left renal arteries, consistent with fibromuscular dysplasia. Our patient was diagnosed with renal infarction in the setting of fibromuscular dysplasia, a combination that has been reported only a few times. Interestingly, our patient also had mild FMD based on imaging, making it even more of an unusual cause of renal infarction. This case highlights the connection between these two diseases and the need for more studies to characterize the association between them.