Arterial venous (AV) fistula is the first choice of vascular access to perform hemodialysis in the vast majority of suitable patients followed by arteriovenous grafts (AVG). An iatrogenic fistula can occur when a second vein adjacent to the graft is punctured and the needle traverses the vein. In normal circumstances, this has no clinical repercussions and does not need correction, and in prior reports, it has helped to maintain the patency of partially occluded grafts but rarely can lead to thrombosis of the graft due to reduced flow and pressure in the graft lumen. We report here what we believe is a unique approach to perform thrombectomy of an occluded graft in a 71-year-old patient on hemodialysis to avoid placement of tunneled hemodialysis catheters and complications associated with catheters. When the outflow of basilic vein in this patient was thrombosed and could not be traversed, we successfully used an iatrogenic fistula as main outflow vein for the graft and created an alternative vein for drainage thus avoiding placement of a tunneled catheter for hemodialysis.

In young adults, spontaneous craniocervical arterial dissections (sCAD), which involve the major arteries of the head and neck, are associated with an increased risk of stroke. sCAD occurs in the absence of major trauma as seen in traumatic craniocervical artery dissection. It may affect unilateral or bilateral carotid or vertebral arteries. Cases of spontaneous bilateral carotid and vertebral artery dissections occurring simultaneously are extremely rare. We present a case of a 49-year-old female with no history of arteriopathy who presented with aphasia and right upper extremity weakness and was found to have dissections in bilateral extracranial and intracranial carotid arteries, as well as the bilateral vertebral arteries. She had symptomatic improvement with antithrombotic therapy and aggressive outpatient rehabilitation.

Sphingobacterium spritivorum (SS) is a ubiquitous gram-negative organism and an uncommon cause of infection in humans. To our knowledge, there are no reported cases of this bacterium causing spontaneous bacterial peritonitis (SBP) in patients with cirrhosis. In this report, we discuss a case of a male patient in his late 60s who presented with severe sepsis from methicillin-resistant staphylococcus aureus (MRSA) , in whom SS was subsequently identified via ascitic fluid culture. This unusual organism is known to have an innate resistance to multiple antibiotics and can cause life-threatening sepsis in cases of delayed or missed diagnosis. Clinicians should not be weighed down by anchoring bias and look for alternative, uncommon gram-negative organisms in cases of progressive sepsis in patients with ascites.

The type of hemodialysis access and its preservation impact the quality of life and survival of patients undergoing hemodialysis. Vascular access complications are among the top causes of morbidity, hospitalization, and catheter use, with significant economic burden. Poor maturation and stenosis continue to be key impediments to upper arm arteriovenous fistula feasibility. Cephalic arch is a common location for vascular access dysfunction due to its distinctive anatomy, complex valves, and biochemical alterations attributable to renal failure. Understanding cephalic arch stenosis is critical due to its high prevalence and treatment failure. The appropriate management option is highly debatable and mostly dependent on patient characteristics and interventionist’s preference. Current options include, percutaneous transluminal balloon angioplasty, stent grafts, bare metal stents, cutting balloon angioplasty, endovascular banding, and surgical procedures. This article discusses the etiologies of cephalic arch stenosis as well as currents trends in management including endovascular and surgical options.

Primary cardiac tumors are rare; however, atrial myxoma is one of the most common benign cardiac tumors. Myxomas may arise from any of the cardiac chambers but have a predilection for the left atrium. Its manifestations may mimic left heart failure or pulmonary hypertension either by causing blood flow obstruction or by mitral regurgitation. Patients can also present with thromboembolic features. Often, the diagnosis may be missed or delayed due to subclinical cardiac manifestations. Prompt diagnosis and surgical resection is necessary for favorable prognosis. Often, mitral valve replacement may be needed. We report a rare case of rapidly growing atrial myxoma in a 39-year-old female who presented with progressively worsening shortness of breath and cough with a previously normal echocardiogram 8 months prior. Her symptoms resolved after surgical resection and mitral valve replacement.