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Thrombotic events are known to occur in nephrotic syndrome, as these patients have a hypercoagulable state. Venous thrombosis is well recognized, but arterial thrombosis is rare and is mainly noted in pediatric population. In the present study, we report a case of thrombosis of right brachiocephalic artery, embolic occlusion of right axillary artery, and right middle cerebral artery territory infarction due to thromboembolism in an adult patient with nephrotic syndrome (Minimal change disease). Patient underwent thromboembolectomy in the right axillary artery followed by anticoagulation therapy.

But, the technique gets complex in adults mainly owing to the occurrence of associated abnormalities. As of now, there is no consensus about how to approach such cases. According to some reports, it is recommended that coarctation ought to be treated initially, while in other studies, it is proposed that cardiac lesions must be treated before coarctation repair. [1][2][3] As the patients are subjected to two different surgical techniques, the perioperative morbidity and mortality risks are elevated in the two-staged repair techniques. Moreover, the patients, in the long-term, can show distress as two separate skin incisions are made.In this study, we assessed the surgical procedures carried out on three patients who underwent aortic coarctation Background: Coarctation of aorta and associated cardiac disease is complex medical situation. Both requires correction either simultaneous or in stages. A distinct approach is vital in order to bring down the perioperative mortality and morbidity. Objective:To study the different strategies for simultaneous repair of aortic coarctation and associated cardiac diseases in adult patients. Materials and Methods:We have operated three patients with coarctation associated with other cardiac diseases, who were treated by various surgical approaches. Developments in endovascular technology over the past decade may potentially reduce the morbidity from open surgical repair. However, some cases are unsuitable for endovascular repair, and open surgical techniques continue to play a part in the management of these patients. Coarctation and associated diseases were treated in a single stage by an ascending-to-descending bypass (n = 2). One patient underwent a twostage operation for his treatment.Result: Postoperative recovery of all the three patients was uneventful. Their ICU parameters were within acceptable limits. All the three patients showed negligible gradients of blood pressure between the upper and lower extremities and discharged within 8 to 9 days. They showed postoperative CTscan suggestive of normal functioning graft without any leak or aneurysm. Conclusion:In spite of the progress in the development and popularization of endovascular techniques, surgical intervention is becoming a more preferable option for the treatment of coarctation accompanied by cardiac diseases. Two-stage and single-stage (extra-anatomical bypass) procedures are the alternative techniques that are performed depending upon the experience of the surgeons in the center; however, we prefer the single-stage (simultaneous) technique.

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BACKGROUNDCoronary Artery Bypass Grafting (CABG) is one of the most frequently done cardiac surgical procedures. However, with the advancements in catheter-based interventional procedures, the category of patients taken up for CABG is gradually being restricted to more high-risk group. Additional surgical procedures like Coronary Endarterectomy (CE) are needed for treating such high-risk coronary artery disease to achieve complete revascularisation. Off-pump coronary endarterectomy can be performed safely with morbidity and mortality comparable with those of conventional coronary endarterectomy.