Symptomatic long occlusive lesions of the SFA treated percutaneously with the Hemobahn stent-graft achieved good outcomes initially with a low complication rate. Primary and secondary patencies were similar to those reported for open synthetic femoropopliteal bypass procedures.

CFDU can be utilized to accurately diagnose unusual lesions, such as AVFs involving the vertebral artery. The technique is also useful in planning treatment and monitoring the durability of stent-grafts implanted to obliterate this type of defect.

We describe a case of vocal cord palsy leading to respiratory obstruction during carotid endarterectomy under cervical plexus block in a patient who had preexisting contralateral vocal cord paralysis subsequent to a previous thyroidectomy. The patient required immediate tracheal intubation and subsequent tracheostomy to maintain the airway postoperatively. Care must be given to avoid contralateral vocal cord paralysis in the presence of a preexisting vocal cord palsy.

A 62-year-old woman was found incidentally to have a right carotid body tumour (CBT) during investigation for a transient ischemic attack. Computed tomography angiography confirmed a tumour measuring 1.5 ¥ 3 cm splaying the carotid bifurcation (see Fig. 1). The patient underwent preoperative embolization, with penetration of the tumour bed, 2 days before surgical resection (see Figs 2,3). After initial neck dissection, a lymph node was removed. Frozen section revealed the node to be benign. The tumour was successfully resected off the internal carotid artery (ICA) with ease. The patient made an uneventful recovery. Post-operative histology revealed the lymph node to contain metastatic deposits and as such the patient was confirmed as having metastatic malignant paraganglioma. Staging investigations showed no further evidence of metastatic disease. The patient underwent adjuvant radiotherapy. She experienced hoarse voice, dysphagia, radiation dermatitis, skin erosion and reduced hearing as a consequence.Our understanding of the behaviour and management of CBTs continues to grow, albeit at a slow rate given the relative uncommonness of these lesions. It is generally agreed upon that surgical treatment is the optimal management of these tumours in order to prevent long-term neurological sequelae that accompany tumour growth keeping in mind the not insignificant complications and difficulties encountered with these operations.The case described did not sustain residual post-operative neurological/nerve-related deficits; however, a multicentre review has shown significant post-operative morbidity of 35% and mortality of 1% -the risks being higher for larger tumours. 1 As a result, the concept of radiation therapy as an effective alternative to surgery has been explored and a series of 121 paragangliomas in a single institution managed with radiation therapy demonstrated a local control rate of 94% at 10 years. 2 Conclusive evidence required to publish a significant result is currently lacking because of the infrequency with which these lesions are encountered; however, it may not be entirely unreasonable to consider this option in elderly patients, those with significant co-morbidities and 'surgically unresectable' tumours. 3 Radiation is not without risks however, and this patient who received it post excision reported hoarse voice, dysphagia, radiation dermatitis, skin erosion and reduced hearing as a consequence.Preoperative embolization remains controversial, and despite the available literature a general consensus is not agreed upon. It remains a useful adjuvant option in large tumours (greater than or equal to 3 cm) and where the tumour is adherent and partially or completely surrounds the carotid vessels (as is the case with Shamblin classification I and II). 4-6 This procedure is not without risk, Fig. 1. Computed tomography angiogram demonstrating an enhancing mass lesion in the carotid bifurcation splaying the right external carotid artery and internal carotid artery. The lesion is 3 cm in craniocaudal dimen...

Symptomatic long occlusive lesions of the SFA treated percutaneously with the Hemobahn stent-graft achieved good outcomes initially with a low complication rate. Primary and secondary patencies were similar to those reported for open synthetic femoropopliteal bypass procedures.