Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.

Background/Objectives: Since thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) are increasingly utilized, examining their outcomes and safety in real-world scenarios is crucial. This study investigated the management and outcomes of TEVAR and EVAR as alternatives to traditional open surgical repair for managing aortic pathologies. Methods: This was a retrospective cohort study. We analyzed the data from 59 consecutive patients who underwent TEVAR or EVAR between 2015 and 2022 at a single tertiary care center. The primary outcome was survival, and secondary outcomes were complications assessment, including re-intervention and occurrence of endoleaks. Results: TEVAR accounted for 47.5% of cases (n = 28), while EVAR comprised 52.5% (n = 31). Patients were mostly 61–70 years old (23.7%) and male (91.5%). Surgery indications differed, with aneurysmal repair being the prevalent indication for EVAR (90.3%, n = 28) and trauma being the main indication for TEVAR (67.9%, n = 19). Regarding the primary outcome, 11 patients (18.6%) died for various reasons; of those, 2 patients (3.4%) were determined to have died from vascular-related issues. Most patients (81.4%, n = 48) did not experience intraoperative complications. The most common intraoperative complications were endoleaks and access failure, each affecting 5.1% (n = 3) of patients. Re-intervention was necessary in 16.9% (n = 10) of cases, with endoleaks being the major indication (60%). Emergency intervention was more frequent in the TEVAR group (p = 0.013), resulting in significantly longer hospitalization (p = 0.012). Conclusions: Despite limitations, our analysis indicates a good safety profile with high success rates and a low incidence of adverse health outcomes and mortality in TEVAR/EVAR procedures. Nevertheless, the results emphasize the ongoing concern of endograft leaks, necessitating re-interventions.

Background: Carotid endarterectomy (CEA) plays a critical role in stroke prevention, but assessing a patient’s preoperative physiological reserve remains challenging. This study aimed to evaluate the impact of sarcopenia and preoperative albumin on postoperative management outcomes and resource utilization in CEA patients with a high prevalence of metabolic comorbidities. Methods: This retrospective cohort study evaluated 67 patients who underwent elective or urgent CEA between January 2015 and June 2025. Sarcopenia was quantified using the Masseter Muscle Index (MMI) derived from routine preoperative head and neck computed tomography (CT) scans. Multivariable regression models were used to assess the relationships between the MMI, serum albumin levels, and surgical outcomes. Results: The cohort had a mean age of 66.8 years and demonstrated a significant metabolic burden, with a high prevalence of diabetes (71.6%) and an average body mass index (BMI) of 28.15 kg/m². Despite this predominantly overweight demographic, the MMI revealed underlying frailty and showed a strong inverse relationship with hospital resource utilization. A one-unit increase in the MMI significantly reduced total hospital length of stay (LOS) by 14.40 days (p = 0.001) and ICU LOS by 6.91 days (p < 0.001). Emergency surgery was the only independent predictor of mortality (OR 16.61, p = 0.047), while neither the MMI nor albumin significantly predicted short-term adverse clinical events. Conclusions: In a patient population where a higher BMI may mask underlying frailty, opportunistic screening for sarcopenia using routine preoperative CT scans provides important prognostic value. In this cohort study, a lower MMI showed an association with prolonged hospital and ICU stays; while it did not independently predict short-term mortality, its potential utility in forecasting resource utilization warrants further investigation in larger, prospective cohorts.

Background: Renal artery aneurysms (RAAs) are uncommon visceral arterial lesions whose management depends on symptoms, patient-specific rupture risk, and arterial anatomy. Markedly high origin renovisceral arteries may further complicate endovascular access and reconstruction. This report describes the management of a symptomatic RAA in a young woman with multifocal aneurysmal disease and unusual renovisceral arterial origins at the 11th and 12th thoracic vertebral levels (T11–T12). Case presentation: A 35-year-old woman presented with intermittent right loin pain. Computed tomography angiography demonstrated multiple right renal artery aneurysms, the largest measuring 1.7 cm, together with a 0.6-cm left renal artery aneurysm and a 0.67-cm superior mesenteric artery aneurysmal dilatation. The celiac trunk, superior mesenteric artery, and both renal arteries originated unusually high at the T11–T12 level. An initial trial of right renal artery stenting through right brachial access was technically difficult. Selective angiography after difficult cannulation demonstrated contrast extravasation from a minute right renal artery perforation. The patient remained hemodynamically stable; heparin was reversed with protamine, and repeat angiography 5 min later demonstrated complete sealing without further extravasation. The procedure was therefore aborted with close inpatient observation. Definitive treatment was achieved by ligation of the right renal artery aneurysmal segment and a retrocaval aorta-to-right renal artery bypass using a reversed great saphenous vein graft. At six months, the graft remained patent with preserved renal perfusion and no recurrence of the presenting symptom. Conclusions: This case demonstrates how extreme renovisceral anatomical variation, multifocal aneurysmal disease, and adverse arterial characteristics can limit the feasibility of endovascular treatment. In selected patients in whom secure endovascular access or renal branch preservation cannot be achieved, open reconstruction remains an effective renal-preserving option. Long-term surveillance is important because of the remaining untreated aneurysmal lesions and the limited duration of follow-up in this report.