Introduction: Sympathectomy is used principally in patients of inoperable peripheral vascular disease, small vessel disease, and vasospastic disease. It is useful to alleviate symptoms of rest pain and as an adjunct to heal ischemic ulcers. Aim and Objective: This is a clinical study to evaluate the role of sympathectomy in postvascular surgical patients with persistent pain in distal limb (causalgia) with or without ischemic ulcers on the foot or hand. Materials and Methods: This study was performed between February 2015 and February 2020. We did 823 arterial surgical interventions including embolectomies, endarterectomy with patch arterioplasty, and interposition grafting in upper or lower limb vessels. These patients were diagnosed on clinical bases and with investigational modalities such as arterial Doppler study and computed tomography angiography. All these patients had chronic vascular obstruction. Out of them, we selected 54 patients having persistent pain distal limb (causalgia) not relieved by medications. Besides causalgia, 24 patients had ischemic ulcers either on foot or hand. Postoperative arterial Doppler study was satisfactory in these patients. Their complaint persisted for 3–4 months in spite of all medications. Chemical sympathectomy was tried in 21 patients but was ineffective. We did thoracic sympathectomy in 28 patients and lumbar sympathectomy in 26 patients on side affected. Observation and Results: There were 46 males and 8 females. Majority of these patients were in active phase of life with a mean age of 35 (±2). Pain was relieved in all patients. Ischemic ulcers present in 24 patients also healed within 3–6 weeks. Conclusion: Although no clear guidance exists for the role of sympathectomy in postsurgical patients, we observe it is a boon for postvascular surgical patients with persistent pain and small ischemic ulcers.

Variations in the branching pattern of femoral and profunda femoris arteries have clinical implications while performing various diagnostic imaging procedures as well as during surgeries that are performed in the femoral triangle. Awareness about these variations aid surgeons during preoperative clinical evaluation for surgical and interventional revascularization of the ileo-femoral and femoro-popliteal segments, in open canulation of femoral artery for cardiopulmonary bypass, in radiological interventions for A-V malformations, and in salvage operations for traumatic limb ischemia. Here we report an aberrant configuration of profunda femoris artery which presented as a case of arterial occlusive disease of lower limb. On surgical exploration, Profunda femoris artery was found originating on the medial aspect of left common femoral artery high up in the inguinal region as compared to its usual lower and lateral origin. There was atheromatous occlusion of superficial femoral artery from its origin upto distal femoral metaphysis. In case of occlusion of the superficial femoral artery, the profunda femoris artery forms an effective collateral bed between the ileo-femoral segment and the popliteal artery and its branches. The clinical implications associated with these variations in therapeutic and diagnostic interventions is been discussed along with relevant literature review. Further study is necessary to identify aberrant configuration of femoral vessels as a cause of arterial occlusive disease in the lower limbs.

Recently we operated a case of large patent ductus arteriosus (PDA). On clinical examination and radiological investigation patient has features of rare Crouzon's syndrome. Familial affection are usually mother and her daughter but in this case father and not mother affected. Being a rare anomaly and has association with cardiac anomaly and familial tendency, we feel it is worth to report this patient.