Acute Mesenteric Ischaemia (AMI) is an uncommon vascular emergency where the diagnosis is often difficult and overlooked and delay in diagnosis results in a grave outcome. Although extravascular events like intussusception, volvulus, strangulated hernia and adhesive obstruction in neglected cases can result intestinal gangrene, this contribution will be limited to acute mesenteric ischaemia as a primary event. AMI consists of four pathologic processes (arterial thrombosis, arterial embolism, Non Occlusive Mesenteric Ischaemia (NOMI) and mesenteric venous thrombosis (MVT)) with similar clinical presentation and one potentially fatal pathological endpoint- intestinal gangrene. The clinical setting and the patient's risk profile often give the clue to the etiological process while the presentation is dominated by severe unrelenting abdominal pain out of proportion to the physical findings. The key to the successful management depends on the surgeon's ability to suspect the diagnosis, pursue appropriate investigations and institute aggressive treatment. The mortality remains high due to difficulty and delay in the diagnosis.

The conventional technique of carotid endarterectomy involves approaching the carotid sheath, anterior and medial to the internal jugular vein with division of the facial vein. Mobilisation of the ansa cervicalis and identification of the hypoglossal nerve is usually required. We describe our results of retrojugular approach in a consecutive nonrandomised cohort of 50 carotid endarterectomy patients.

Complications associated with the use of the Swan-Ganz catheters including coiling and knotting of the catheter in the central venous system or in the chambers of the heart, often with disastrous consequences. We report a case of knotting of a Swan-Ganz catheter in the superior vena cava which necessitated surgical removal via the right internal jugular vein.