Editor's Choice Articles
- A 71 year old male was re-operated on 48 hours after a right carotid endarterectomy (with Dacron patch) for evacuation of a neck haematoma. Meticulous haemostasis, placement of absorbable haemostatic gauze (SIDA-CEL, Sidapharm, Thessaloniki, Greece; estimated absorption time 21–28 days) and drain, was undertaken. Broad spectrum antibiotics were administered for 5 days. Five months later, signs of wound infection and two areas of skin dehiscence appeared with foreign material in one of them. Computed tomography revealed only superficial involvement (red arrow).
- An 86-year-old female presented with a 3-cm saccular aneurysm at the left subclavian artery (LSA) origin, effectively providing only one landing zone for endografting. This was successfully excluded under regional anaesthesia using a thoracic stent-graft (38 × 77 mm TX2, Cook Aortic Intervention) with a heparin-bonded endoprosthesis (10 × 150 mm Viabahn, Gore Medical) deployed in periscope configuration. Both remain patent 8 months later, with LSA aneurysm exclusion and no endoleakage. Such endovascular techniques avoid the morbidity of open bypass surgery and waiting times for a customised/fenestrated device, and provide an alternative for aneurysms of the aortic arch outflow where only single landing zones are available.
- A 59-year-old man developed sudden onset vertigo, diplopia, and vomiting which resolved in < 12 hours. The next day, the same symptoms recurred, this time in association with left arm and leg weakness. There was no history of trauma, but he recalled a bout of violent coughing 2 days earlier. A magnetic resonance imaging brain scan demonstrated an acute left cerebellar infarct with retrograde flow in the distal left vertebral artery. A computed tomography angiogram revealed an extensive left vertebral artery dissection.