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Introduction: Spontaneous aortic thrombosis causing distal embolization and acute limb ischemia is an ominous medical condition with a poor prognosis. Herein are reported the clinical courses of two women who presented with severe lower extremity ischemia caused by distal embolization of spontaneous aortic thrombus without obvious antecedent arterial disease. This unusual diagnosis should be expected in patients presenting with persistent lower extremity pain and numbness even in the absence of overt physical findings. Case 1: A 42 year-old woman with mild hyperlipidemia complained of left leg numbness and weakness. She was treated with analgesia but her symptoms worsened. Lower extremity ultrasound revealed a significant infra-inguinal perfusion defect; computed tomography revealed mural thrombus in a normal aorta along with extensive thrombotic occlusion of the left popliteal and tibial arteries. Attempts at endovascular recanalization were unsuccessful; the patient underwent successful left popliteal-to-plantar artery bypass with autologous vein. Case 2: A 57 year-old woman without medical history presented to a local Emergency Room with a five-day history of numbness in the right lower extremity. Computed tomographic angiography revealed complete infrarenal aortic occlusion in a 3 cm diameter area of mild aortic ectasia along with iliac and distal right infrainguinal thromboembolism. The patient was treated with aortobifemoral bypass grafting with right leg fasciotomy, which restored perfusion and function. Conclusion: Spontaneous aortic thrombosis causing distal embolization and acute limb ischemia is an ominous medical condition with a poor prognosis. Episodes of embolization may be intermittent and asymptomatic such that, when symptoms finally occur, the distal thrombus is often chronic and inaccessible. The diagnosis should be suspected in patients with unexplained lower extremity symptoms and pulse deficits; it can be readily established with computed tomography.

green (ICG) has shown promising results. In this pilot study, ICG NIR fluorescence imaging was performed to quantify changes in foot perfusion following revascularization.Methods: ICG NIR fluorescence imaging was performed pre-and postrevascularization. After intravenous bolus injection of 0.1 mg/kg ICG, the camera registered the fluorescence intensity over time on the dorsum of both feet for 15 minutes using the Quest Spectrum Platform. Time-intensity curves were plotted for 3 regions of interest (ROIs): (1) the dorsum of the foot; (2) the forefoot; and (3) the hallux. The time-intensity curves were normalized for maximum fluorescence intensity. Derived parameters were the maximum slope, the area under the curve (AUC) for the

publicly insured. PADLI had higher one-year ostomy closure rates (83.3% vs. 64.7%, p<0.01;); p<0.01) and shorter time-to-closure (median 82 days ; p<0.01) relative to HP. PADLI resulted in increased unplanned readmissions (HR¼2.88 ]; p<0.01), and fewer complications upon stoma closure (OR 0.62 [95%CI 0.49-0.78]; p<0.01) but not during the index admission (OR¼1.17 [95%CI 0.96-1.44]; p¼0.12).CONCLUSION: Most patients undergo HP for acute diverticulitis in the U.S. Those who undergo PADLI are more likely to undergo ostomy reversal and experience fewer postoperative complications upon stoma reversal. In agreement with national guidelines, these data support increasing the utilization of PADLI in appropriate cases of acute diverticulitis requiring operative treatment.