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A quiz is presented on the case of a 21-year woman with cyanotic hands and necrosis of finger tissues which developed after walking in the mountains through the snow.

Colon ischemia following aortic reconstruction is a severe complication with an incidence of 1% to 2% of the operated patients; this infrequent complication will be lethal for nearly half of these patients. Commonly, colon ischemia may be an intraoperative observation or an early postoperative finding. However, in the case presented here, sigmoid rupture and small and large intestine communication was revealed 3 months following repair of the abdominal aorta. A 71-year-old man, following open repair of an abdominal aortic aneurysm, went home on the fifth postoperative day. Four months later, he was admitted to the emergency department of our hospital, because of fever, diarrhea, and abdominal pain for about 5 days. After conservative treatment and improvement in symptoms, the patient was released only to return to hospital with the same symptoms after a month. On this second admission, the symptoms were initially mild and the patient seemed to improve, but suddenly he deteriorated and an exploratory laparotomy was conducted, which revealed a left colon ischemia and a communication between the sigmoid and the small intestine. A left hemicolectomy was performed, along with a temporary colostomy (Hartmann diversion). The patient, 2 years after the initial aortic repair and 10 months following the complete restoration of the large intestine continuity, is well with no further manifestations.

Background: The aim of this study is to document the outcome following endovascular treatment of subacute type B aortic dissection (AD)., Methods: Between October 2000 and June 2014, 40 patients (33 men, mean age 65 [range 35-87] years) with type B AD underwent thoracic endovascular aortic repair (TEVAR) during the subacute phase (defined as 15-90 days from the onset of symptoms). Indications for intervention were acute aortic enlargement, resistant hypertension, and/or intractable pain. The primary outcome was survival. Secondary outcome measures included reinterventions and aortic remodeling (i.e., the fate of the false lumen [FL] post-TEVAR, which was classified as complete, partial, or no thrombosis of the FL)., Results: The intraprocedural technical success was 95% (2 proximal endoleaks). Three patients died within 30 days (7.5%), all 3 from dissection-related causes (retrograde type A AD in 2, ruptured thoracic aorta in 1). Another 11 deaths occurred during follow-up (median 64 months, range 1-167), 3 of which were dissection-related. The 1-, 3-, and 5-year Kaplan-Meier survival probability was 87.5%, 79%, and 71.5%, respectively. With regard to the aortic remodeling, there was complete FL thrombosis in 10 (25%) patients, partial thrombosis in 22 (55%), and patent FL with no thrombosis in 8 (20%) patients. There was no statistically significant association between FL status and survival, or between FL status and initial extent of dissection. However, there was a statistically significant association between FL status and reinterventions, the latter being more frequent in patients with no FL thrombosis., Conclusions: TEVAR for subacute type B AD appears to be associated with acceptable perioperative and long-term results. In contrast to previous reports, there is still a risk for postoperative retrograde type A AD even when patients are treated in the subacute phase when the aorta is less fragile. Aortic remodeling occurs in the majority of patients, but requires frequent aortic reinterventions, an observation that underlines the need for life-long surveillance., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aneurysms of the foot arteries are rare. A case of a true dorsalis pedis artery aneurysm in a 69-year-old man, with no history of local trauma or injury on his foot, is presented. Clinical examination and ultrasonic imaging confirmed the aneurysm. Dorsalis pedis artery aneurysm was resected and an end-to-end anastomosis was performed, without complications. Arterial duplex scan findings, operative procedure, and literature review are presented and discussed., (Copyright © 2016 Elsevier Inc. All rights reserved.)