Background: Endovascular therapy for lower-limb arterial disease is widely performed today. A vast array of sheaths, catheters, wires, balloon types, stents, and tools such as atherectomy, thrombectomy, and lithotripsy devices are now available to achieve the best outcomes in terms of vessel patency and ultimately limb salvage. The use of atherectomy devices, however, has raised some controversies in terms of outcome efficacy, cost effectiveness, and safety profile in various series and studies. Objectively, the types and disease pattern in these studies are also greatly heterogeneous. Methods: Here, we reported three cases which exemplify how these atherectomy devices have served as a valuable tool, especially for patients with complex and heavily calcified lesions. Results: The three cases highlighted scenarios where atherectomy displayed good outcomes, each involving the use of atherectomy devices to treat highly calcified vessels. Conclusions: Despite the concerns with atherectomy devices, we believe that with proper selection, patients will benefit most from their ability to achieve the best outcomes of both vessel patency and limb salvage.

Introduction: Retained surgical items are rare yet serious complications that may occur despite correct instrument and sponge counts. Surgical sponges remain the most frequently retained items, with gauze marker strand retention being an uncommon mechanism. Case presentation: A 69-year-old male with severe mitral regurgitation and triple-vessel coronary artery disease underwent mitral valve replacement with coronary artery bypass grafting. All surgical counts were verified as correct at the conclusion of surgery. Postoperative chest radiography, however, revealed two linear radio-opaque foreign bodies near the left lower sternum. Mediastinal re-exploration identified two radio-opaque strands, measuring 3.0 cm and 2.0 cm, attached to the left lower chest wall near the internal mammary artery stump. These were confirmed to be detached marker strands from Raytec gauzes. The patient’s recovery was uneventful and he was discharged well. Conclusion: This case illustrates that retained gauze fragments can occur despite correct counts due to fragmentation of radiopaque markers. Surgeons and operating room nurses should inspect gauzes for integrity, maintain vigilance when manipulating sponges in confined operative fields, and consider adjunct technologies such as radiofrequency or barcode tracking. In high-risk surgeries, postoperative imaging may be warranted even with accurate counts to ensure patient safety.

GLI1 ‐altered mesenchymal tumors are exceptionally rare mesenchymal tumors, with recent molecular studies implicating GLI1 gene fusion or amplification. We report a 39‐year‐old nonsmoking woman who presented with an incidentally detected right pleural‐based mass. Cross‐sectional imaging identified a paraspinal pleural lesion at the T5–T6 level without intraspinal extension. Video‐assisted thoracoscopic resection revealed a biphasic tumor and next‐generation sequencing confirmed an ACTB‐GLI1 fusion. The diagnosis of GLI1 ‐altered mesenchymal tumor was established. After multidisciplinary discussion, the patient opted for radiologic surveillance instead of adjuvant therapy. She remains disease‐free at 1‐year follow‐up. This case expands the anatomic spectrum of GLI1 ‐altered tumors and underscores the value of molecular testing in distinguishing them from other pleural neoplasms.