Background:Painful vertebral hemangiomas are often inadequately managed medically. We evaluated the outcome of percutaneous vertebroplasty (PVP) in the treatment of painful vertebral hemangiomas refractory to medical management.Materials and Methods:14 patients (four thoracic and ten lumbar vertebra) with painful vertebral hemangiomas presenting with severe back pain for more than 6 months not responding to medical therapy were treated by vertebroplasty. Cross sectional imaging of the spine with magnetic resonance was done. Blood investigations were done to exclude coagulopathy excluded. PVP was performed under local anesthesia.Results:The pain intensity numeric rating scale (PI-NRS-11) of these patients was in the range of 7-10 (Severe Pain). After vertebroplasty 8 patients were completely free of pain (PI NRS Score 0) while 6 were significantly relieved (PI-NRS Score 1-3). No complications were observed. Two patients with associated radicular pain had good pain relief following PVP. No recurrence was found during 36 months of postoperative followup.Conclusion:PVP is a safe and effective procedure in patients with painful vertebral hemangiomas refractory to medical management.

Introduction Popliteal artery occlusion is common in elderly, smokers, and patients with diabetes, with globally rising incidence. Angioplasty and stenting are common treatment options available to manage lower limb occlusive diseases. As popliteal artery experiences high biomechanical stress, Supera stent is designed to reduce the risk of stent fractures and for better patency across the knee joint. Aim & Objectives The aim of this study is to evaluate the Supera stent in the management of popliteal artery occlusive disease. The objectives of this study are (1) to evaluate the efficacy of Supera stent in the management of popliteal artery occlusive disease and (2) to prove it as a relatively safe to use option. Material & Methods Patients who underwent stent implantation in popliteal artery were analyzed with regular/serial follow-up. Critical limb ischemia and intermittent claudication patients were included. Medical records, radiographs, and procedural data were examined. The patients were classified according to Trans-Atlantic Inter Society Consensus II criteria. The femoropopliteal lesions which were classified into TASC B and C categories were included in the study. Stents of 5 mm and 5.5 mm diameter and with various lengths were used to treat all the patients. Results A total number of patients with tissue loss and rest pain analyzed were eighty-six and all of them were treated by implanting stents in popliteal artery. In 71.4% of cases, the lesions were found in the proximal segment of the artery. In nearly 95% of cases, technical success was achieved with the use of single stent. The primary and assisted primary patency rates at 24 months were found to be 86.04% and 95.34%, respectively. Notwithstanding the stent placement at a region of high biomechanical stress, there was no case of stent fracture. The limb salvage rate was 100%. The patients who died due to unrelated causes within 90 days of procedure were two. Conclusion The present study demonstrated that Supera stent is a safe and effective procedure for treating claudication and limb ischemia due to popliteal artery disease.

position, and were subjected to DRE. TRUS with a color Doppler for the detection of prostatic lesion using G. E. LOGIQ 5 PRO ultrasound color Doppler machine ). Later, a TRUS-guided biopsy was performed using an 18G biopsy gun to confirm the radiological diagnosis. Results: Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, New York, USA). A Chi-square test and a "t-" test of independent samples were used to compare the data. P < 0.05 indicated a significant association. Diagnostic efficacy was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy. The age of patients ranged from 51 to 77 years. The mean age of patients was 63.80 ± 6.76 years. A majority of the patients were <65 years of age (65%); on DRE, a total of 17 (42.5%) patients had induration while 23 (57.5%) had nodular lesions. PSA values ranged from 5.8 to 9.8 ng/ml. Exactly half of the patients had PSA <8 ng/ml; histopathologically, 13 (32.5%) cases were malignant. On TRUS evaluation, a total of 10 (25%) cases were malignant. TRUS findings combined with color Doppler vascularity findings diagnosed malignancy in 15 (37.5%) cases. Conclusion: The findings of the present study showed that TRUS with color Doppler flowmetry can play an important role in the detection of prostate malignancy, with high sensitivity as well as specificity. The high NPV, as observed in the present study, could avoid unnecessary diagnostic invasive intervention. In the present study, TRUS diagnosis established 30 (75%) cases as benign and 10 (25%) cases as malignant, showing the rate of cancer detection to be close to that diagnosed through histopathology. Among different TRUS characteristics, irregular shape, heterogeneous echotexture, loss of differentiation between the peripheral and internal zones, increased mean prostate weight, and capsular invasion were found to be significantly associated with malignancy.

Giant serpentine aneurysm (GSA) with rare aortic and supra-aortic vascular anomaly is technically difficult to treat. Often such patients suffer without treatment. We have treated a patient by a different approach which is not regularly followed. This case has many developmental anomalies with complicated anatomy, and it is a challenge to the treating interventionist. AbstractKeywords ► serpentine aneurysm ► embolization ► direct carotid puncture

possible to perform CAS through a CFA approach. These cases were treated with a trans-brachial arterial approach in four cases and direct carotid puncture (DCP) in two cases. Trans-brachial Arterial ApproachFour cases of CAS were done through a trans-brachial approach. These patients presented with (1) coarctation of aorta, (2) post-aorto bi-femoral graft in one patient each, and (3) aorto-iliac disease in two patients.A 54-year-old man presented with transient ischemic attack (TIA) in right internal carotid artery (ICA) territory with severe, uncontrolled hypertension on two antihypertensives. CT scan and carotid artery Doppler studies were done. Computed tomography (CT) scan was normal, and carotid arterial Doppler showed approximately 90% stenosis of the right ICA origin. The patient was posted for digital subtraction angiogram (DSA) of the carotid and cerebral vessels via a CFA route. However, the diagnostic catheter could not be progressed beyond the thoracic aorta. Hence, the patient was further investigated by CT angiogram of the entire aorta and carotid vessels. CT angiogram showed severe coarctation of aorta and high grade stenosis of right ICA origin. Hence we planned a trans-brachial arterial CAS with distal embolic protection.