Urinary excretion after transcaval renal penetration of a fragmented Bird's Nest filter.

Permanent inferior vena cava (IVC) filters are used to prevent venous thromboembolic events in select populations of patients. The Bird's Nest filter (BNF; Cook Medical, Bloomington, Ind) is an IVC filter that has been associated with various complications including filter strut fractures, migration, caval wall perforation, visceral perforation, and vascular injury. We report a case of a BNF that eroded transmurally through the IVC into the right kidney parenchyma. The patient underwent operative intervention with removal of the BNF with an uncomplicated postoperative course. In patients with symptoms and local filter perforations, we advocate for safe filter removal when possible to avoid long-term damage.

Importance of technical preparation of intraarterial shunts to prevent iatrogenic arterial injury during urgent procedures.

Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.

Forearm Isosulfan blue injection in the treatment of postoperative lymphatic complications.

Lymphatic leakage is an uncommon but serious complication following vascular procedures. When conservative measures fail, accurate identification and ligation of disrupted lymphatic channels is necessary to avoid recurrence. We report the case of a 52-year-old male with a left forearm lymphocele, which occurred following repair of an interosseous artery pseudoaneurysm. Successful lymphatic identification and ligation was performed using intradermal injection of Isosulphan blue dye at the time of operation.

Temporary femoral artery bifurcation shunting following penetrating trauma.

Penetrating common femoral artery injuries are life-threatening, especially when the femoral bifurcation has been destroyed. In the presence of other associated injuries which preclude immediate definitive vascular reconstruction, temporary arterial shunting may be useful. Presently available shunts, however, are tubular and allow for distal perfusion to only one vessel. We have utilized a modified bifurcated hemodialysis catheter (Mahurkar MAXID; Tyco Healthcare, Mansfield, Mass) to successfully provide simultaneous perfusion from the proximal common femoral artery to both the superficial and deep femoral vessels. Such catheters are readily available in most institutions, can be quickly modified, and are easy use in urgent trauma situations.