Annals of vascular surgery
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Case Reports
Distal aortic arch replacement for aneurysmal disease: the value of preparatory carotid subclavian reconstruction.
Between November 2000 and January 2002, two patients with aneurysms that involved the distal part of the aortic arch including the left subclavian artery were treated at our institution. Patient 1 had an aneurysm of 5.8 cm extending to the proximal descending aorta. Patient 2 had a 6.8 cm type II thoracoabdominal aneurysm extending proximal to the aortic bifurcation. ⋯ Both patients remain alive and well at the time of last follow-up (7 to 20 months). Carotid subclavian reconstruction in preparation for distal aortic arch replacement facilitates the performance of the proximal anastomosis and attempts to maintain flow through the left vertebral system during aortic cross-clamping. This may reduce the risk of stroke during distal aortic arch replacement.
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Stingray envenomations usually result in minor injuries with localized symptoms. In some cases the injury incurred is more serious, resulting in significant morbidity if not adequately treated. ⋯ Stingray venom is known to have necrosing properties in human tissues and in this case this led to graft failure requiring surgical repair. This case emphasizes the insidious nature of stingray venom and the necessity of extensive surgical debridement for more significant envenomations.