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Due to the extensive collateral arterial network, symptomatic chronic mesenteric ischemia is a relatively uncommon condition and is associated with severe atherosclerotic disease of all major visceral arteries. Open surgical repair has been commonly used to restore blood supply to the visceral arteries, and the "roof-top" approach has been advocated as an alternative technique to traditional midline incision, mainly because of the great exposure of the suprarenal aorta that it offers. Roof-top approach, in other words, bilateral subcostal incision, is a totally abdominal approach to the suprarenal aorta, and as the title says, it is like a roof-top on the abdominal wall. We present a case of a female patient with intestinal angina that was deemed unsuitable for endovascular repair (ER) and was treated with open surgical repair utilizing the "roof-top" approach., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Seretis et al.)

Fistula formation between the urinary tract and the arterial system is very rare, and usually involves the ureter and the adjacent iliac vessels. Communication of the ureter with the aorta has been described a few times worldwide, and most of them had a fatal outcome. In our case, a 79-year-old man had a history of total cystectomy for malignancy and diversion of both ureters to a single site in the right hypogastrium with the left one crossing over the aorta. He was admitted elsewhere several times for intermittent hematuria, and four months ago the diagnosis of communication of the left ureter with a mycotic aortic pseudoaneurysm was made. He was then referred to an interventional radiologist who sealed the communication. He was admitted to our hospital four months later in a state of hypovolemic shock and massive hematuria. In lack of information, it seemed to us that he had been treated with endovascular aneurysm repair (EVAR) for uretero-aortic communication, and was experiencing a regression because of endoleak formation. We attempted to treat him as type I endoleak with a proximal extension, and upon failure, with distal extensions, but finally we had to 'build' the entire previous graft from the inside to achieve hemodynamic stability. Our patient remained stable, without endoleak on the post-intervention computed tomography angiography (CTA). Post-operatively, we discovered that the initial operation was the formation of a bifurcated graft with multiple bare stents and coil embolization through them. This was done in an attempt to avoid material infection by the mycotic aneurysm. This is an example of a case where 'things got rough' in a lack of information on patients' medical records. Maybe the time has come to adopt the concept of implanting microchips into humans which would enable doctors to access their medical records. This will only serve as a tool for the benefit of the suffering patients, especially when we are dealing with life-threatening situations with no time to be lost., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Seretis et al.)

A complete configuration of the circle of Willis is not always present, and anatomical variations are observed often. The fetal posterior cerebral artery has been described in cases where the embryonic posterior communicating artery has failed to regress, something that may happen on the right side, the left side, or bilaterally. We describe a case of a male patient with bilateral posterior cerebral arteries with direct communication with the internal carotid artery on both sides who presented with symptoms of stroke allocated to both posterior and middle cerebral artery areas. In our knowledge, although there are several reported cases of occipital infarction from internal carotid artery disease, this is the first case of simultaneous infarction in the territories of the posterior cerebral and middle cerebral arteries due to internal carotid artery disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Seretis et al.)