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We present three novel techniques for creation of (1) a steerable sheath, (2) a 4F snare device, and (3) dual anterograde and retrograde double-wire percutaneous transluminal angioplasty access technique using a single femoral puncture. These techniques were conceived and bench-tested in our institution, allowing the utilization of inexpensive equipment for complicated endovascular procedures. They offer (1) controlled navigation, no-touch vessel cannulation and cannulation of angulated vessels, contralateral limb of stent grafts, fenestrations, and branches; (2) a low-profile (4F external diameter) modifiable snare with the ability to expand to the size of an entire aneurysm and the ability to undo the snare in case of blockage with other endovascular material; and (3) in situ sheath inversion for concomitant anterograde and retrograde percutaneous angioplasty with a single femoral puncture.

High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval.Clinical caseA male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2–L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively.ConclusionComplex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.

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We present the case of an acute or chronic ischaemia of the upper limb due to extrinsic compression and thrombotic occlusion of the left subclavian artery successfully bypassed with a subclavian to axillary artery venous auto-graft.