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Ulnar artery aneurysms are uncommon and have been linked with traumatic injuries to the hand. These aneurysms are most commonly seen in workers who use the hypothenar eminence of their hands as a hammer and can be accompanied by a constellation of symptoms. Both penetrating and blunt trauma have been documented as sources of ulnar artery aneurysms and its subsequent sequela. In this case report, we describe a 45-year-old gentleman who presented with digital ischemia of his 4th and 5th digits and other clinical symptoms of the hypothenar hammer syndrome after performing manual labor. His initial management, method of diagnosis, operative intervention, and peri-operative management are discussed. Ulnar artery aneurysms, while uncommon, can lead to a limb-threatening event. A high index of suspicion for ulnar artery aneurysms must be considered in patients with an antecedent history of acute or repetitive trauma. While there are multiple diagnostic modalities and minimally invasive altern

Embolization following percutaneous intervention is a universal problem occurring in all vascular beds, including the periphery. Embolic filter protection (EFP) is effective in capturing macrodebris following percutaneous peripheral interventions (PPI). Predictors of distal lower extremity embolization appear to be a recent onset of symptoms in patients with total or subtotal occlusion, long, irregular and calcified lesions, degenerative grafts, intraluminal filling defects, and the use of the Silverhawk atherectomy device and mechanical thrombectomy. Filters have their own set of potential problems, and filter retrieval is probably one of the key steps where problems are likely to occur. In this manuscript, we discuss embolization in the lower extremity following PPI, and provide tips on how to avoid problems with embolic filter protection use.

The following special CME section is underwritten through an educational grant from Possis Medical, Inc.

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Background: 12-month major amputation rates in “true limb salvage” (Rutherford class 5-6 with established tissue loss) are reported as > 90% if nonrevascularable and 25% if revascularable. Twenty-four month mortality rates of > 40-50% are reported post amputation and < 50% will ambulate with a prosthesis. The encouraging Laser Angioplasty for Critical Limb Ischemia (LACI) 6-month limb salvage (LS) rate of 93% prompted adoption of excimer laser assisted angioplasty as one of our primary infrapopliteal treatments for “TLS.” Methods: Between October 2001 – October 2003, 62 patients (62 limbs) with Rutherford class 5-6 symptoms presented with severe infrapopliteal disease without single vessel “straight line flow” to the foot. Seventy infrapopliteal arteries (IA) were treated, including posterior tibial 21/70 (30%), peroneal 16/70 (23%), anterior tibial 8/70 (11%), tibioperoneal trunk 14/70 (20%), and multiple 11/70 (16%). Thirty out of 62 (48%) and 22/62 (35%) required supe

The use of bare-metal stents for intracranial vessels is associated with relatively high restenosis rates. We report the first human use of a sirolimus-eluting stent for a symptomatic proximal middle cerebral artery stenosis. This stent was successfully delivered and deployed without complications, with excellent one month angiographic results.

Unfractionated heparin is a widely utilized anticoagulant during peripheral angioplasty procedures (PTA). In contrast to heparin, bivalirudin is a direct thrombin inhibitor with predictable anticoagulation, does not activate platelets, and inhibits both soluble and bound thrombin. The experience with bivalirudin during PTA remains limited. In this single-center prospective study, 48 consecutive patients (60.4% males, mean age 70.0 ± 12.1) received bivalirudin as the primary anticoagulant during PTA (0.75 mg/kg bolus, 1.75 mg/kg/h during the procedure). Thirty-four (70.8%) had claudication and 6 (12.5%) had ulceration. Thrombus was angiographically seen in 3 (6.3%) patients. In-hospital serious procedural complications were limited to 2 (4.2%) (exact 95% confidence interval: (0.5%,14.3%]) patients with major bleeding; none (0.0%) of the other following endpoints occurred: death, limb loss, emergent need for revascularization of the same vessel, embolic strokes, and vascular complication