A spontaneous coronary arterial dissection associated with a calcineurin inhibitor

Spontaneous Coronary Artery Dissection in a Transplanted Heart

We report the case of a 37-year-old man who presented with shortness of breath 1 year post heart transplantation. He was receiving tacrolimus, methylprednisolone, and mycophenolate. An angiogram showed spontaneous coronary artery dissection involving the left anterior descending artery. Percutaneous coronary intervention was performed successfully, with stent placement and return of flow. (Level of Difficulty: Advanced.).

Giant brachial artery aneurysm as a rare complication of a dialysis shunt

Our patient exhibited a large tumor on his right upper arm where his former dialysis access site had been. X-ray, Doppler ultrasound, and magnetic resonance imaging scan could not fully reveal the nature of that tumor. Eventually, a surgical approach showed a giant aneurysm of the inflowing brachial artery to a partially obliterated arteriovenous fistula. This case highlights the importance of ongoing care for patients with arteriovenous shunts. Even arteriovenous fistulas, that are obliterated or no longer in use, can, especially when immunosuppressant therapy and other vascular risk factors are added to the overall cardiovascular risk, transform and endanger the health of our patients.

Axillary Artery Dissection After Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Case Report

A 52-year-old man with end-stage renal disease underwent ultrasound-guided infraclavicular brachial plexus block for revision of an arteriovenous fistula. On postoperative day 2, the patient developed pain and loss of motor function in the surgical extremity. A computed tomography angiogram revealed complete dissection of the axillary artery. The dissection was emergently treated with a bypass graft, resulting in complete resolution of paralysis and pain. Sensory deficits resolved over the next 3 days. Smoking, hypertension, diabetes mellitus, and chronic intake of a calcineurin inhibitor might have predisposed the patient to iatrogenic arterial dissection.