In Saccharomyces cerevisiae, the developmentally regulated Soluble N-ethylmaleimide sensitive factor attachment protein receptor (SNARE) protein Spo20p mediates the fusion of vesicles with the prospore membrane, which is required for the formation of spores. Spo20p is subject to both positive and negative regulation by separate sequences in its aminoterminal domain. We report that the positive activity is conferred by a short, amphipathic helix that is sufficient to confer plasma membrane or prospore membrane localization to green fluorescent protein. In vitro, this helix binds to acidic phospholipids, and mutations that reduce or eliminate phospholipid binding in vitro inactivate Spo20p in vivo. Genetic manipulation of phospholipid pools indicates that the likely in vivo ligand of this domain is phosphatidic acid. The inhibitory activity is a nuclear targeting signal, which confers nuclear localization in vegetative cells and in cells entering meiosis. However, as cells initiate spore formation, fusions containing the inhibitory domain exit the nucleus and localize to the nascent prospore membrane. Thus, the SNARE Spo20p is both positively and negatively regulated by control of its intracellular localization.

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We performed an extensive literature search using PubMed and found 274 articles referencing tumor invasion of the carotid, with 31 articles describing carotid reconstruction in the setting of tumor invasion. There were no reports using Artegraft for carotid reconstruction.Results: A 65-year-old man presented with a large left neck mass. Computed tomography angiography (CTA) of the neck demonstrated a complex 9.1-cm  5.9-cm  7.5-cm mass encasing and invading the cervical internal carotid artery (Fig 1). Fine-needle aspiration revealed squamous cell carcinoma. Furthermore, he had an incomplete circle of Willis on CTA and no viable vein conduit on duplex mapping. The patient underwent en bloc resection of the left neck tumor, including a portion of the cervical internal carotid artery, followed by reconstruction with the Artegraft (Fig 2). Brachytherapy catheters were left in place, followed by pectoralis major rotational flap for coverage. At the conclusion of the procedure, there were multiphasic Doppler signals throughout the graft. The procedure was well tolerated, and the patient had an uneventful course with no neurologic sequelae.Conclusions: To our knowledge, this is the first case reported of tumor invasion of the internal carotid reconstructed using Artegraft bovine heterograft as conduit. This novel approach provides an alternative to synthetic conduit when there is an increased concern for infection and need for a durable repair in a patient without suitable autologous conduit.

popliteal artery with medial displacement suggestive of PAES. The patient was taken to the operating room for right popliteal artery exploration via posterior approach. A type III PAES was identified intraoperatively (Fig). The accessory slip of muscle from the medial head of gastrocnemius muscle was divided. A balloon thromboembolectomy was performed through a longitudinal arteriotomy and the artery was patched with bovine pericardium.Results: Postoperatively, the patient recovered well and was neurologically intact with normal pedal pulses. She was seen by obstetrics and underwent fetal heart rate monitoring. She was started on 81-mg aspirin daily and was discharged home on postoperative day 4. She was seen in follow-up by vascular surgery and in consultation with maternal fetal medicine because she was previously cared for by nurse midwives.Conclusions: Nonatheromatous popliteal artery pathology should be considered in young active patients who present with intermittent claudication or acute limb ischemia. The pregnant woman warrants a discussion of safe imaging modalities to establish a diagnosis and anesthesia considerations for surgical repair. Although we know strenuous exercise predisposes patients to symptomatic PAES, pregnancy is a hypercoagulable state and may be an independent risk factor.

Preoperative patient characteristics, intraoperative details, postoperative factors, longterm outcomes, and cost data were reviewed using an Institutional Review Board-approved prospectively collected database. Multivariate analysis was used to determine statistical difference between patients with LOS #2 days and >2 days.Results: Complete 30-day variable and cost data were available for 162 patients with an average follow-up of 12 months. The LOS for 66 patients (41%) was >2 days. Variables determined to be statistically significant predictors of prolonged LOS included aneurysm diameter (P ¼ .007), American Society of Anesthesiologists score (P ¼ .0001), thromboembolectomy (P ¼ .006), and postoperative cardiac (P ¼ .0001) and renal (P ¼ .0001) complications. Specifically, modifiable risk factors that contributed to increased LOS included performance of a concomitant procedure (P ¼ .0001), increased iodinated contrast (P ¼ .027), placement in an intensive care unit (P ¼ .0001), return to the operating room (P ¼ .001), and the use of vasoactive medications (P ¼ .0001). Hospital charges (P ¼ .002) and costs (P ¼ .003) were both significantly higher in patients with prolonged LOS; however, there was no difference in physician charges (P ¼ .124). Increased LOS after EVAR was associated with an increase in 1-month (P ¼ .015), 6-month (P ¼ .020), and 12-month mortality (P ¼ .006).Conclusions: This study highlights several modifiable risk factors leading to increased LOS after EVAR. Further, increased LOS was associated with increased charges, costs, as well as morbidity and mortality after EVAR. This study highlights specific areas of focus for improving quality in vascular surgery.