Introduction Creation of arteriovenous fistulas (AVF) for providing vascular access in patients dependent on hemodialysis is a very frequent type of surgery. One of the common complications of such a fistula is the formation of an aneurysm or a pseudoaneurysm and the risk of impending rupture. These are a few of the reasons why such surgically created AVF have to be taken down surgically. Some of these may be taken down for cosmetic reasons electively while some present in an emergency due to rupture of the aneurysm itself. Aim This is a retrospective study of 26 patients who underwent AVF takedown at our center over a period of 4 years. Material and methods We intended to study the patient profile, the surgery that they underwent and the post-operative course of these patients. Results We found that aneurysm formation was the most common reason for a takedown, although we did see a good percentage of patients who presented to us with a ruptured AVF aneurysm. Our procedure was a ligation of the aneurysm with resection of the aneurysmal segment and maintaining arterial continuity. No attempt to preserve the fistula was made in any of these cases. Conclusions This article gives a brief overview of our experience in AVF takedown.

Coronary cameral fistula is a rare entity characterized by an abnormal communication between coronary artery and a cardiac chamber. It is congenital and asymptomatic in the majority of patients. A 29-year-old male patient presented with fever and dyspnea for eight months. A coronary cameral fistula arising from the right coronary artery to the right atrium complicating with aortic valve endocarditis was detected on computed tomography angiography. The rarity of the condition and the nuanced complication led to very individualized course of treatment which was optimal for this patient.

Background:The term pelvic-ureteric obstruction denotes a restriction of flow of urine from the renal pelvis to the ureter which if left uncorrected will lead to progressive renal deterioration. Today majority of the cases are identified and diagnosed in the perinatal period (1,9). To a lesser degree it is also seen in childhood and adolescence period. However not all the cases of PUJ obstruction require surgery Aim: A retrospective analysis of antenatally detected cases of hydronephrosis was done to elucidate the postnatal outcome and management on a prolonged follow up. Materials and Method:From about 5000 antenatal ultrasound scans carried out at our institute annually from NOVEMBER 2011 to JANUARY 2014, total 49 cases were suggestive of hydronephrosis;34 out of these 49(70%) were diagnosed as Pelvi-ureteric junction obstruction. Setting and Design:A retrospective study of patients with hydronephrosis detected on antenatal ultrasound scan from NOVEMBER 2011 to JANUARY 2014.Results: 9 out of 34 babies (25%) detected to have Pelvi-ureteric junction obstruction on antenatal ultrasound were transient obstructions. Out of the remaining 25 cases,7(28%) did well on observation alone and did not require surgery while the rest 18 (72%) required surgical intervention. Conclusion:Conservative management of Pelvi-ureteric junction obstruction is a safe procedure, provided diligent follow up is maintained and surgical intervention is done in case of deterioration of renal function or presence symptoms or both. Satistics and analysis:The study was subjected to bi-variable analysis with two test preparation and was statistically significant while p<0.05.

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Acquired tracheo-esophageal fistulas (TEFs) are challenging. The most common causes are prolonged intubation, malignancy, and trauma whereas granulomatous infections like tuberculosis are rare. Endoscopic intervention with esophageal or tracheal stenting or clipping is of unproven benefit in the management of such lesions, where surgical repair is almost invariably required. We report a case of a 32-year-old man, with a case of multidrug-resistant pulmonary tuberculosis. He had no history of malignancy or trauma. The patient developed spontaneous TEF probably due to mediastinal lymph node necrosis. Multiple attempts were made using staplers, clips, and atrial septal defect (ASD) device closure but were unsuccessful. The nuanced complication leads to very individualized course of treatment which was optimal for this patient.