Brachiocephalic Artery Dissection Following Type A Aortic Dissection Repair

Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with major morbidity and mortality. Arterial dissections, particularly the brachiocephalic artery, can remain as a residual dissection after type A aortic dissection repair. We present a rare case of brachiocephalic artery dissection due to the clamping effect and the management of ATAAD patients. A 47-year-old male known for aortic aneurysm and uncontrolled hypertension presented with high blood pressure, unequal pulses, and a history of chest pain. A thoracic and abdominal aorta angiogram showed aneurysmal dilatation of the aortic root and ascending aorta with a peripheral linear filling defect shortly distal to the aortic root. The patient underwent the Bentall procedure, hemi-arch replacement, and patent ductus arteriosus closure. The brachiocephalic artery was clamped. The angiogram showed right common carotid occlusion. Endovascular intervention was made by balloon-mounted covered stent graft and kissing technique. The patient had a smooth post-procedure period without major events. Iatrogenic brachiocephalic artery dissection can occur during type A aortic dissection repair and is frequently affected by residual dissection. The decision of intervention versus conservative management is based on a patient's general condition.

Phlegmasia Cerulea Dolens Secondary to COVID-19 and May-Thurner Syndrome: A Case Report

Coronavirus disease 2019 (COVID-19) is associated with significant thromboembolic risk. Extensive deep vein thrombosis can infrequently progress to phlegmasia cerulea dolens that carries high morbidity and mortality rates. We report a case of a middle-aged male presenting with phlegmasia cerulea dolens in the context of COVID-19 and underlying May-Thurner syndrome, associated with transiently positive antiphospholipid antibodies.

Lower Extremity Arteriovenous Fistula Mimicking Deep Venous Thrombosis: A Case Report

Deep venous thrombosis (DVT) is the most common cause of unilateral lower limb swelling. Common differential diagnosis includes superficial thrombophlebitis and ruptured Baker's cyst. DVT is one of the most common complications diagnosed following lower extremity orthopedic surgery. However, many less frequent causes are often easily overlooked. Here we present a case of a 65-year-old man with a previous hip replacement who developed left-sided progressive leg swelling for years, which was managed initially with anticoagulation for provoked DVT and with compression stockings for post-thrombotic syndrome with no improvement. There was arterialization and spectral broadening of the venous waveform in the Doppler study. Computed tomography angiogram of the lower limbs showed evidence of arteriovenous fistula (AVF) with opacification of the deep left leg veins. Angioplasty and embolization of the fistula resulted in the resolution of leg swelling. We also discussed similar cases found in the literature. AVF needs to be considered in patients presenting with unilateral leg swelling following lower extremity orthopedic surgery.