Jugular Venous Aneurysm.

Jugular venous aneurysms are uncommon and can involve the internal, external, and anterior jugular veins. These aneurysms may be congenital or acquired secondary to malignancy, inflammation, trauma or arteriovenous fistulas. Treatment strategies are not clearly defined and involve either surveillance of asymptomatic aneurysms or resection, excision, and ligation of the aneurysmal vein. In this case series, we discuss the presentation, diagnostics, treatments and outcomes in 3 patients with jugular venous aneurysms.

Activities of daily living is a critical factor in predicting outcome after carotid endarterectomy in asymptomatic patients.

BACKGROUND AND PURPOSE: Ability to perform basic daily activity represented by functional status (FNS) before surgery can be assessed in the clinic for determining health status of the patient. We sought to study the effect of FNS on postoperative outcomes after carotid endarterectomy (CEA) in a national data set. METHODS: National Surgical Quality Improvement Project is a national data set, which includes data from >300 hospitals. Patients who underwent CEA were identified by Current Procedural Terminology code and divided into 3 categories based on FNS: independent, partially dependent, and dependent. Thirty-day postoperative stroke, death, and other postoperative complications were identified as the study end point. We used multivariate logistic regression to estimate odds ratio for outcomes while controlling for sex, race, diabetes mellitus, cardiovascular disease, smoking, and other confounders. RESULTS: Of 19 748 CEAs, 19 348 (97.97%) were functionally independent, 377 (1.99%) were functionally partially dependent, and 23 (0.12%) were functionallydependent. In functionally independent group, there were 196 (1.01%) strokes, 84 (0.43%) deaths, and 1416 (7.17%) other complications, whereas in the functionally partially dependent group, there were 14 (3.71%) strokes, 10 (2.65%) deaths, and 80 (21.22%) other complications. In multivariable risk-adjusted model, using functionally independent as reference, functionally partially dependent was associated with death (odds ratio, 3.3; 95% confidence interval, 1.6-6.8; P<0.001), stroke (odds ratio, 3; 95% confidence interval, 1.7-5.4; P<0.001), and other complications (odds ratio, 2.5; 95% confidence interval, 1.9-3.2; P<0.001). CONCLUSIONS: In this national data set, patient's inability to perform basic activities of independent living is associated with adverse postoperative outcomes after CEA. Hence, FNS should be vigilantly assessed in clinic for risk stratification along with other objective factors for gauging risk of adverse outcomes after CEA.

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation.

Vascular injury as a result of total hip arthroplasty (THA) represents an uncommon complication. Although these injuries typically present acutely, delayed presentation has been reported. In this case, a 70-year-old female presented with groin pain and medial thigh numbness 15 years after a left THA. After initially being misdiagnosed, repeat imaging revealed a large external iliac pseudoaneurysm as a result of a transacetabular screw penetrating the medial acetabular wall. The patient underwent staged endovascular exclusion of the pseudoaneurysm, percutaneous drainage, and revision THA. She had resolution of her symptoms. To our knowledge, this is the only reported case of a late vascular injury related to an aseptic THA with well-fixed components. Staged treatment with endovascular exclusion and revision THA is a viable approach.