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Introduction To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation. Method This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome. Results A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome. Conclusions Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.

Of 58,423 patients who had undergone carotid revascularization, 8% had had contralateral carotid occlusion (CCO). Of the patients with CCO, 69% underwent transfemoral carotid artery stenting (TF-CAS) and 31%, carotid endarterectomy (CEA). Before adjustment, the patients with CCO who had undergone TF-CAS showed no differences in the rate of the combined endpoint of in-hospital death, myocardial infarction, or stroke compared with the patients without CCO (2.1% vs 2.3%; P ¼ .33). The patients with CCO who had undergone CEA had experienced a significantly greater rate of the combined adverse outcomes compared with the patients without CCO (3.6% vs 2.0%). The unadjusted rates of the adverse outcomes were significantly greater for the patients with CCO who had undergone CEA than for the patients without CCO who had undergone CEA (3.6% vs 2.1%). After adjustment, CCO was associated with a 71% increase in the odds of an adverse outcome after CEA (P < .001) compared with no increase after TF-CAS (P ¼ .64).Conclusions: CCO remains an important predictor of increased risk for patients undergoing CEA but not for those undergoing TF-CAS.Commentary: I have two issues with their report. First, although the authors stated that patients with CCO who had undergone TF-CAS had had more comorbidities than the patients who had undergone CEA, they did not emphasize that 2283 patients who had required general anesthesia for CAS had been excluded from the study. Would that not mean that potentially higher risk patients were excluded from the CAS arm? Why did the authors not exclude the patients who had undergone CEA under general anesthesia? Second, cardiologists performed 45% of the TF-CAS procedures, vascular surgeons, 23%, and other specialists, the remaining cases. However, vascular surgeons performed only 40% of the CEAs, with "other surgeons" performing 38%, cardiologists, 2%, and others, 20%. Comparing TF-CAS and CEA for patients with CCO would have been more valid if the vast majority of CEAs had been performed by board-certified vascular surgeons and not by "other surgeons," cardiologists, or radiologists (I did not know cardiologists and radiologists were trained to perform CEA).Despite the weaknesses of their report, I tend to agree that CAS might be preferred over CEA in the setting of CCOdbut not TF-CAS. Even before I read the next article, I think most of us would agree that the preferred technique for patients with CCO would be transcarotid artery revascularization (TCAR). I always wondered how flow reversal during TCAR would not cause diminished cerebral blood flow, especially in the setting of CCO; however, the vast majority of patients tolerate it well. I performed TCAR last week in one patient with CCO, with the patient under local anesthesia so I could monitor the patient after we initiated flow reversal.

Introduction Transrenal Endovascular Abdominal Aortic Aneurysm Repair (EVAR) is a novel approach for Infrarenal Abdominal Aortic Aneurysms (AAA) with unfavourable neck anatomy. This study aims to evaluate the long and short-term outcomes of Transrenal EVAR. Method Data of patients who underwent Transrenal EVAR in a single centre over 6 years were collected. Follow up on complications and mortality for 3 years post-procedure were analysed. Results A total of 36 patients were identified with a mean age of 77 years (61–89 years). Neck anatomy 32 (88.9%) cases had a proximal neck &lt; 15mm. 21 (58.3%) had significant neck thrombus and 27(75%) had significant neck calcification. 11 (30.6 %) had an infra-renal neck angulation &gt; 60 0 and 21 cases (58.3%) had an unfavourable shape. Outcome Post-procedure 30-day mortality was 5.6%. 4 developed renal dysfunction. The 3-year mortality was 33.3%, only 2 patients (5.6%) died of the aneurysm related complication. 7 (19.4%) patients developed endoleak. 5 patients (13.9 %) underwent reinterventions in 3 years. Conclusions In view of the acceptable short term and long-term outcomes, trans renal EVAR can be offered for patients with infrarenal AAA with technically challenging neck anatomy but unfit for open repair in centres with adequate expertise.