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The balloon-tipped embolectomy catheter is widely utilized in the treatment of arterial thromboemboli, significantly improving mortality and limb salvage rates. However, early and late complications related to catheter-tip injury and balloon trauma continue to occur and compromise the results of surgical intervention. Myointimal hyperplasia is an example of an unusual late complication induced by balloon-related arterial wall trauma. Myointimal hyperplasia is a commonly recognized healing response of the arterial wall to endothelial injury but is rarely reported after balloon-catheter thromboembolectomy. The extensive nature of the injury increases the incidence of limb loss. The pathophysiologic nature of this process is reviewed, and pertinent structural details such as intimal thickening and disruption of the internal elastic lamina are presented. The pathogenesis of myointimal hyperplasia suggests guidelines for catheter use during embolectomy that may further reduce the incidence of this unusual complication.

The case history of a 30-year-old male kidney transplant patient who developed cutaneous protothecosis is presented. The lesions, initially located over the forearm and around the site of previous AV shunt, consisted of maculopapular areas which opened spontaneously and drained purulent sanguineous material. Culutre of drainage grew Prototheca wickerhamii. Other virulent organisms, ie. Klebsiella pneumoniae and Pseudomonas aeruginosa, were also grown. The patient died of Klebsiella septicemia and shock. Protothecosis is an uncommon algal infection in man. This is the first report of the disease among recipients of a renal transplant.

We have described a case of migration of a Kim-Ray Greenfield umbrella from the inferior vena cava to the heart for unknown reason. The umbrella was surgically removed and the patient recovered fully. This complication has not been previously reported. Despite this complication, we believe that the Kim-Ray Greenfield umbrella, when placed with particular attention to technique, effectively prevents pulmonary emboli and offers minimal associated morbidity.