Marfan syndrome is an autosomally inherited disorder affecting the synthesis of connective tissues. Vascular manifestations of Marfan syndrome include aneurysmal dilatation of the aortic root, aortic dissection, and rupture. Peripheral aneurysms are mostly reported in the iliac, femoral, and subclavian arteries. We report a Marfan patient with a ruptured axillary artery aneurysm and a large left internal mammary artery aneurysm. The axillary aneurysm was successfully excluded using covered stent grafts, and the left internal mammary artery aneurysm was effectively coiled. Duplex ultrasound imaging at 4 months and computed tomography at 9 months demonstrated complete thrombosis and exclusion of both aneurysms with patent subclavian-axillary stent grafts.

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Small bowel lipomas, which can cause intussusception and gastrointestinal bleeding, can be managed with laparoscopic resection when diagnosed preoperatively.

Rest pain, tissue loss, and gangrene are manifestations of critical limb ischemia caused by peripheral arterial disease and define a patient subgroup at highest risk for major limb amputation. Patients with nonhealing lower extremity wounds should be screened for the risk factors for peripheral arterial disease and offered noninvasive vascular testing. The diagnosis of critical limb ischemia mandates prompt institution of medical and surgical management to achieve the best chance of limb salvage. Surgical intervention has evolved from primary amputation to open bypass to the present era of endovascular therapy. The goals of surgical bypass and endovascular therapy are to improve perfusion sufficiently to permit healing. Despite poorer patency rates and the more frequent need for reintervention, endovascular therapy has been shown in multiple retrospective studies to achieve limb salvage similar to open bypass. Only one large, prospective, randomized controlled trial exists comparing open bypass with endovascular therapy: The Bypass versus Angioplasty in Severe Limb Ischemia of the Leg (BASIL) trial. Close clinical surveillance and serial monitoring of limb perfusion by means of noninvasive arterial studies are needed to determine the need for further vascular intervention. Limb salvage patients suffer from multiple comorbidities and benefit from a multidisciplinary, team approach to care.