Thomas Bernik

A novel method for the treatment of dysphagia lusoria due to aberrant right subclavian artery

Dysphagia lusoria occurs secondary to an aberrant right subclavian artery coursing posterior to the oesophagus. Open ligation and transposition to the right carotid artery via a right supraclavicular approach has been described as a minimally invasive method. However, approaching the origin of the aberrant right subclavian artery through this incision can be extremely challenging. A persistent aberrant right subclavian artery stump may account for postoperative residual dysphagia. This article describes a safe, effective and reproducible surgical approach to dysphagia lusoria due to a non-aneurysmal aberrant right subclavian artery.

Endovascular stent graft repair of thoracic aortic mural thrombus in a patient with polycythemia vera: A word of caution

Thoracic aortic mural thrombus (TAMT) is a rare pathology and potential source of cerebral, visceral, and peripheral emboli. We present a 62-year-old male in a hypercoagulable state due to primary polycythemia vera (PV) developed TAMT and catastrophic thromboembolisms despite aggressive medical and surgical management. The outcomes and adverse events of endovascular exclusion of TAMT in the presence of PV are unknown. We would recommend proceeding with extreme caution when performing endovascular exclusion of TAMT, as PV may be a prohibitive risk.

Case report: Hybrid endovascular and open surgical approach to a chronic, traumatic arteriovenous fistula.

Highlights • Chronic traumatic AVF leads to significant morbidity when allowed to progress.• Traumatic AVF may be approached with endovascaular, open, and hybrid techniques.• We describe a traumatic AVF which was left to progress for over 30 years.• Our staged, hybrid approach decreased venous hypertension and bleeding during surgery.

Ulnar artery aneurysm and hypothenar hammer syndrome

A 48-year-old healthy man with no underlying medical history, who worked as a butcher for 20 years, presented with pain in his right wrist and a pulsatile mass with numbness and coolness in his fifth finger. There was good perfusion to the hand and fingertips except for a pale, mildly tender right fifth finger. Allen test result was normal. A pulsatile 1.8-cm mass was noted in the distal ulnar artery at the wrist. Duplex ultrasound documented an ulnar aneurysm with patent inflow and outflow and minimal thrombus. The radial artery as well as the palmar arch was widely patent. Preoperatively, the fifth finger ischemia reversed and did not necessitate thrombolysis. After exposure and mobilization (A and B), primary resection and end-to-end anastomosis were performed. The patient maintained excellent perfusion to the hand and good healing with no further complications. The patient consented to the publication of his case. Ulnar artery aneurysms are a vascular anomaly related to vascular overuse syndrome, a condition known as hypothenar hammer syndrome (HHS). Repetitive striking of the palmar portion of the ulnar artery has been known to cause HHS. This motion is usually associated with sports or occupations that require the constant striking of the heel of the hand. HHS was initially described by Von Rosen in 1934 and named by Conn in 1970. With as few as 150 reported cases, ulnar artery aneurysms are clearly infrequent. In 1972, the reported prevalence rate in a population of workers in mechanical workshops was 14%. In 2006, a large cohort study revealed the incidence rate for HHS to be 1.6%. Symptoms of HHS include ischemia and pain in the digits. Methods of intervention include resection and anastomosis, with resection being preferred. Our case demonstrates the associated occupational trauma in a butcher as the main cause of ulnar aneurysm formation and microembolization. Despite its rarity, physicians should consider HHS as a potential cause of ischemia and pain in the hand and fingers.

Dropped Bifurcation Technique for Femoral Endarterectomy

Femoral endarterectomy is an established procedure with excellent outcomes. Variations in performing this operation generally reflect the extension of pathology into the superficial and deep femoral arteries. For these instances, we developed a technique not previously described that enables continued flow to the superficial and deep femoral arteries and facilitates patch placement.

Bilateral giant extracranial carotid artery aneurysms.

Extracranial carotid artery aneurysms (ECAAs) are rare and extremely challenging disease entities. Untreated ECAAs can lead to serious neurologic sequelae, primarily from thromboembolism. Because of the high incidence of major neurologic complications, surgical intervention is warranted in most cases. We report a 63-year-old woman with voice fatigue and difficulty swallowing. Upon work-up, we discovered bilateral giant ECAAs and treated them with a combination of aneurysmectomy, primary anastomosis, and an interposition polytetrafluoroethylene graft. Unique features of the aneurysms include their unprecedented size and bilaterality, which is exceedingly rare.