The use of minimally invasive endovascular procedures has increased, and as such, the frequency of associated vascular complications has also increased. Regardless of the access site location, rarely, arterial perforation can occur, which can be fatal if not properly managed. Interventionalists should be aware of the risk factors for perforation, commonly perforated vessels, and how different sites of perforation are diagnosed and managed. Rapid recognition and endovascular management reduce the need for open surgical repair, and thus reduce the morbidity and mortality of these complications. This review outlines the presentation, diagnosis, and management of iatrogenic perforations of the subclavian artery, thyrocervical trunk (TT), common carotid artery, superficial femoral artery (SFA), and external iliac artery.

The radial approach to cardiac catheterization and percutaneous coronary interventions has increased in popularity due to the favorable side effect profile relative to the femoral approach. Mediastinal hematoma after radial access cardiac catheterization has scarcely been reported in the literature and, if present, the exact location of the bleed was rarely identified. In this case presentation, we describe an elective transradial coronary angiography resulting in subclavian artery perforation in close proximity to the vertebral artery, with subsequent mediastinal and cervical hematoma formation. This scenario was managed by immediate imaging of the chest after sudden deterioration raised suspicion of an adverse event during wire navigation. Formation of a mediastinal hematoma is the equivalent of retroperitoneal bleed from the femoral approach and requires rapid recognition, interdisciplinary collaboration, and endovascular management.

Topical hemostatic agents are commonly used in a wide variety of surgical procedures to assist in hemostasis. However, the use of these agents is not without risk as many contain biologically active agents derived from human and animal products that have the potential to cause adverse reactions. This case report covers a 44-year-old man with a history of alpha-gal syndrome who was scheduled for an open reduction and internal fixation of a left distal radius fracture. Alphagal syndrome is characterized by an IgE-mediated type 1 hypersensitivity reaction to a mammalian oligosaccharide epitope. Patients with this condition have a history of a past tick bite and subsequent development of an allergic reaction to mammalian protein products, most notably red meat. The patient had concerns about products used during surgery and potential reactions based on his allergy. The intent of this case report is to promote physician awareness of the widespread use of mammalian products in surgical hemostatic agents and potential immunogenic reactions. By increasing awareness of the alpha-gal syndrome, the goal is that medical device companies will actively disclose product components that could potentiate these adverse reactions and continue to develop alternative agents.

The design, installation and operation of offshore high power static (seabed) cables are mature technology areas. However, the key missing component in the power transmission system is the water-column portion of the cable that links the floating facility with the static cable on the seabed, the electrical equivalent of a pipeline riser. When such dynamic power cable enabling technology matures it will allow the removal of power generation equipment from platforms, interconnection between offshore installations, utilization of stranded gas for power generation (GTW -Gas to Wire) and its transmission by subsea power networks to the customer, and the transmission to land of power from offshore deep water renewable energy devices. This paper reviews recent developments in dynamic power cable technology. It discusses the range of configurations and technical requirements required to deliver a fit-for-purpose deep-water product. In particular, mechanical fatigue is addressed together with the need for field specific designs to optimize configurations. Conclusions from the PowerCab JIP recently completed by BPP-Cables are presented. The JIP delivered a prototype 100MW 132kV dynamic AC power cable optimized for extended service life with account taken of the manufacturing and installation issues. The cable has been fatigue tested to verify electrical and mechanical performance in conditions representative of the West of Shetlands.