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Of the many hypothesized predictors of WOC, ISS was the only tangible independent predictor of WOC. We observed an apparent disconnect between the patient's wishes via living wills or advanced directives "in a terminal condition" and fulfillment during EOL decision-making that speaks to the complex nature of EOL decisions and further supports the need for a multidisciplinary approach.

A case of splenic arteriovenous fistula leading to portal hypertension and ascites is presented. The recognition of this vascular lesion is important. When portal hypertension is secondary to a splenic arteriovenous fistula, the complications of portal hypertension can be avoided by the resection of the lesion. The diagnosis can be suspected by clinical findings and confirmed by angiographic delineation of the fistula. Surgical resection of splenic arteriovenous fistulae must include the fistula and all dilated venous tributaries to prevent thrombosis and recurrent portal hypertension.

Carotid pseudoaneurysm is an uncommon but serious complication of carotid endarterectomy. A case is presented in which the lesion occurred four weeks after combined aortocoronary bypass and carotid endarterectomy without patch angioplasty. The English surgical literature concerning this lesion is reviewed and reported. Case ReportA seventy-one-year-old diabetic white male presented to Riverside Methodist Hospitals on August 5, 1985, with claudication. A loud left carotid bruit was appreciated. Arteriography demonstrated greater than 90 % stenosis of the left internal carotid artery (ICA) at its origin (Figures 1, 2) . The vessel was not aneurysmal. The right vertebral artery was occluded, but the carotid system was normal. Aortoiliac occlusive disease, including bilateral superficial femoral artery occlusions with good runoff, was demonstrated. Cardiac catheterization was performed after resting electrocardiography had demonstrated a remote inferior wall myocardial infarction, along with nonspecific ST changes. This showed a large circumflex lesion, nondominant RCA, and 60% LAD lesion. In view of his previous silent infarction he was judged a candidate for aortocoronary bypass and left carotid endarterectomy to precede repair of his aortoiliac and lower extremity disease.On August 12, 1985, the patient underwent left carotid endarterectomy followed by aortocoronary bypass. Findings included excellent left ICA backflow, although there was severe stenosis rather high in the internal carotid that prevented placement of a shunt distally. The at Monash University on June 22, 2015 ves.sagepub.com Downloaded from

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