Totally percutaneous aortic aneurysm repair is technically feasible in most cases, with no effect on the luminal diameter of the accessed femoral artery. Complications occur more often in morbidly obese patients and with sheaths larger than 20F. These complications can be minimized with meticulous technique and good patient selection. The capability for expeditious open femoral arterial repair is mandatory with this approach.

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In the trauma setting, penetrating vascular injuries secondary to gunshot wounds need to be addressed promptly and carefully. By identifying the entry and exit sites, the pathway of injury can usually be determined. Vessel injury is typically related to direct vascular trauma or secondary blast injury. On rare occasions, the involved vessels can serve as conduits, transporting projectiles to various locations remote from the entry wounds. The cases described demonstrate different manifestations of bullet embolism within the arterial and venous systems. We provide a literature review and we discuss therapeutic options available in these unique scenarios.

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Arteriopathy associated with human immunodeficiency virus infection and clinical acquired immunodeficiency syndrome is well-documented. The pathophysiology of this arteriopathy may vary in different vascular beds. Although arteriopathy of central nervous system (CNS) circulation has been recognized in pediatric patients since the late 1980s, there are no reported cases of CNS arteriopathy in adults. We present the first reported case of adult CNS arteriopathy in a human immunodeficiency virus-positive patient who succumbed to complications secondary to diffuse aneurysmal disease of the Circle of Willis.

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