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Purpose: To report a late complication associated with embolization coils used to treat an endoleak after endovascular abdominal aortic aneurysm (AAA) repair., Case Report: A 79-year-old man with a 5.8-cm AAA underwent endovascular repair with an Ancure graft in 1997. A persistent type I endoleak was identified on serial postoperative computed tomographic scans. Three transarterial coil embolization procedures were performed to treat an endoleak from the proximal and right distal attachment sites with outflow by the inferior mesenteric and lumbar arteries. Coil embolization was ultimately successful in sealing the endoleak, and the AAA decreased in size. Four years later, the patient developed an aortoenteric fistula due to erosion of the metallic embolization coils into the duodenum. The endograft was explanted and an extra-anatomical bypass inserted., Conclusions: Coil embolization to treat endoleaks can, on rare occasions, be the cause of aortoenteric fistula. Lifelong follow-up of stent-graft patients is required.

A missile embolus, an extremely rare lesion, presents an unusual and challenging problem for the clinician. A case is discussed in which a patient sustained a gunshot wound of the portal vein, and the bullet entered the portal venous system and then lodged in the superior mesenteric vein. The portal vein injury was repaired. The missile then migrated into the right branch of the portal vein and was not extracted. The patient recovered. This appears to be the first reported case of a missile embolus of the portal venous system.

Traumatic forequarter amputation is a rare and devastating injury in which the arm, scapula, clavicle, and pectoral muscles are avulsed from the body by a tremendous force. The case of a man who survived this injury is presented. Replantation at this level has not been successful: treatment recommended consists of control of hemorrhage, wound debridement, ligation of vessels and nerves, coverage of their exposed stumps with muscle, unless excess contamination is present; electrical or cosmetic prostheses can be fitted later.

A free fall, the unimpeded drop of a body from a known point to a known impaction point, is common in modern society. Death usually results when distance is more than six stories. The following case report describes the circumstances which allowed a young man attempting suicide to survive a 17-storey free fall. Although his impact velocity was estimated to be 72 m.p.h. (uncorrected for air drag), he impacted in a supine position on an automobile trunk lid so that some of the force was dissipated by tires and shock absorbers. Multiple fractures and soft-tissue injuries and a subsequent stress ulcer were successfully treated and the patient has a satisfactory level of physical activity while remaining under psychiatric care 1 year postinjury.

Injection of petroleum distillates is rare. We recently cared for a man with a long history of drug abuse who attempted intravenous injection with gasoline into a right forearm vein in order to "get high." We believe he accomplished an intramuscular and subcutaneous injection of gasoline which resulted in a severe impairment of the right hand and forearm from damage to the right median, ulnar, and radial nerves.

A new technique is described for regional perfusion chemotherapy in the presence of a replaced right hepatic artery. By anastomosis of the replaced right hepatic artery end-to-side to the left hepatic artery, a single implantable pump can be used to perfuse both lobes of the liver. This technique has the advantage of facilitating postoperative follow-up and substantially reducing the cost of the procedure.