Fat embolism syndrome is a potentially fatal disease process most commonly associated with long-bone and pelvic fractures. Reports describing ultrasound evidence of fat emboli are restricted to echocardiography. We propose a new objective finding on venous duplex ultrasound imaging of the lower extremities as a useful diagnostic criterion by presenting the case reports of two patients with acute long-bone fractures, possibly leading to earlier orthopedic fixation and allocation of resources to those patients at higher risk of fat embolism syndrome. (J Vasc Surg Cases 2016;2:155-7.) 156Naddaf et al

Understanding the Complexities of Kidney Transplantation 6 "triangulation" while using and exchanging dog legs in order to prove its efficiency (Fig. 3). Even if the procedure was effective for vascular anastomosis and organ revascularization, Carrel mis-recognized that transplanted organ allografts were not permanently accepted. Indeed he did not recognize the immunological reaction and the existence of the immune system. Nevertheless, his surgical technique for vascular suturing is still valid and persists today, with several modifications introduced for microsurgery like the eccentric biangulation technique proposed by Cobett in the Sixties (Fig. 4) (Squifflet et al. 1993) 5 .

Soft tissue sarcomas typically present as soft, painless masses on an extremity. Here, we present a patient with metastatic soft tissue sarcomas at his dialysis access site. This association with dialysis access has not been documented previously.A 62-year-old man presented with a nonhealing wound on his left upper extremity after excision of a pseudoaneurysmal arteriovenous fistula. The patient had received a second kidney transplant that was functioning well. Immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. He was induced with thymoglobulin twice.A biopsy was performed showing a high-grade pleomorphic sarcoma. A magnetic resonance image of his left upper extremity showed an 11 × 5.5 × 3 cm mass abutting the biceps and brachialis muscles. Also, we discovered several lesions in the axilla and the left side of the neck, which were suspicious for metastases. A positron emission tomographycomputed tomography scan confirmed a left upper extremity soft tissue mass, with marked fluorodeoxyglucose uptake, in abnormally enlarged axillary, and supraclavicular lymph nodes of the left thorax, consistent with metastases. The patient underwent chemotherapy and radiation therapy.Soft tissue sarcomas are rare. A high index of suspicion is needed to make a diagnosis. This is the first reported case of a soft tissue sarcoma discovered at a dialysis access site. As with all malignancies, early diagnosis is key to patient survival. Thorough physical examinations and increased vigilance by physicians caring for immunosuppressed patients is invaluable.

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Objectives: Penetrating aortic ulcers can be a concerning finding on imaging. They are believed to be the predecessors for intramural hematomas, dissections, and aneurysm degeneration. It is hypothesized that penetrating ulcers of the abdominal aorta (PUAA) and iliac arteries (PUIA), like their thoracic counterparts, signal impending vascular catastrophe.Methods: With the institution of electronic medical records at our health system in 2010, a search for the words "penetrating ulcer" in radiology reports became possible. Fifty-three patients were identified as having a penetrating ulcer of the abdominal aorta (PUAA) on computed tomography angiography during a 10-month period from October 2010 through August 2011, and 34 were identified as having a PUIA. The patients' clinical course was monitored through August 2014. No specific intervention for the ulcers was performed; however, if the patient had additional aortic pathology necessitating intervention, it was performed. Retrospective and prospective review of imaging was performed when possible. Student's t-test and c 2 tests were performed for statistical analysis.