Epiglottic hematoma after carotid endarterectomy with cervical block.

There are few trials assessing the risks and benefits of performing a cervical plexus block (CPB) in urgent carotid endarterectomies (CEA). We describe a case of a patient who underwent urgent CEA under CPB and suffered a complication of postoperative epiglottic hematoma. There were clinical findings that helped to distinguish the hematoma from other, more common postoperative complications. The mainstay of treatment was steroids and observation. Epiglottic hematomas after cervical blocks for CEAs are rare but potentially lethal complications. More research is needed investigating complications related to CPBs performed for CEAs.

A rare complication of testicular infarction after femorofemoral bypass highlighting the importance of surgical technique.

We present an interesting case of a 66-year-old male who had acute testicular infarction following a right common femoral artery to left profunda femoris artery bypass with advanced symptoms of claudication. Angiography in the preoperative period demonstrated the extent of peripheral arterial disease present, revealing a calcified aorta, partially occluded left hypogastric artery, occluded left external iliac, common femoral and superficial femoral arteries and an occluded right hypogastric artery. A bypass was performed without any initial complications and subsequent relief of symptoms of claudication and rest pain. Postoperative scrotal pain and follow-up duplex demonstrated lack of perfusion of the testicle necessitating orchiectomy. This case serves to illustrate the importance of preserving collateral vessels as a technical consideration, as well as presenting a rare potential complication.

The use of an upper extremity hemodialysis access site for stenting of the superior mesenteric artery for chronic mesenteric ischemia.

We report the use of an upper extremity hemodialysis access site to facilitate endovascular treatment of the superior mesenteric artery in the setting of chronic mesenteric ischemia. A 64-year-old woman with end-stage renal disease on hemodialysis presented with worsening symptoms associated with chronic mesenteric ischemia. Her left upper extremity interposition graft within the fistula access site was selected to avoid a hostile aortoiliac system and in consideration of the potential benefits it provided over transfemoral, transbrachial, and transradial sites. The procedure was technically successful without complication. Hemodialysis access sites, such as the interposition graft within the fistula of this patient, are a potential route of upper extremity access for mesenteric interventions in patients with end-stage renal disease on hemodialysis.