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Renal artery aneurysm (RAA) and renal arteriovenous fistula are rare vascular pathologies with reported incidences of 0.3% to 1.0% and 0.04% in the general population, respectively. We describe a 61-year-old Caucasian man who presented to the hospital with symptoms of right flank pain. Imaging demonstrated a right RAA with concurrent hilar RAA and renal arteriovenous fistula. He ultimately underwent an open right nephrectomy, ligation of the fistula, and bovine patch repair of the aortic defect.

Arteriovenous fistulas are known to be one of the most enduring and safe hemodialysis access modalities. However, access preservation can be challenging in the setting of degeneration, including the development of complex pseudoaneurysms. Prolonged compression or thrombin injection can risk thrombosis of the fistula, and covered stent use can predispose the access to infection and other stent complications. We present a case in which endovascular balloon occlusion was used to facilitate the use of ultrasound-guided thrombin injection to resolve a dialysis access pseudoaneurysm by transiently reducing flow and preventing thromboembolism. This method is a safe, effective, and minimally invasive technique that should be considered for salvage of autogenous access compromised by pseudoaneurysm development.

The coronavirus disease 2019 pandemic has had an impact on system processes, with airway management being significantly affected. A 37-year-old woman diagnosed with stroke was found to have a filling defect at the origin of the right internal carotid artery. She was taken to the operating room urgently for carotid endarterectomy. The procedure was uneventful; however, anaphylaxis developed on extubation, subsequently attributed to sugammadex. Institutional policies and limited resources resulted in delayed reintubation. Fortunately, she did not have lasting deficits, but this highlights the potential of current policies to lead to complications and the need to improve policies to minimize harm.