Introduction: Carotid endarterectomy (CEA) has proven benefit in stroke prevention. The aim of this study was to determine the long-term benefit of the post-operative colour duplex ultrasound (CDU) in a follow-up programme. Patients and Methods: All patients who underwent CEA for both symptomatic and asymptomatic carotid artery stenosis between the 1st January 2007 and 31st of December 2008 were included. All patients were enrolled in a standard post-operative surveillance programme, which included a CDU within 2 days post operatively, at 6 months and at 2 years. All scans were performed by one of four senior vascular technologists using a linear 9MHz transducer and grading based on velocities according to international guidelines. Results: A total of 167 (102 male) patients with a mean (±SD) age of 69.5±8.06 years were included. There was no age difference based on gender. 130 (77.8%) completed their full 2-year follow-up programme. 76 patients had right-sided CEA and 91 left-sided. 101 had a widely patent ICA post-CEA, with appearance of residual stenosis (expressed as %) in 23 (50–69%), 3 (70–80%) and 3 occluded. At 6 months this proportion changed to 88, 23, 5, 3 patients and at 2 years 85, 37, 4, 4 patients respectively. No re-stenosis patient became symptomatic or had re-intervention. Therefore, in 105 patients the carotid appearance immediately post-operatively and at 2 years did not change. Contralaterally, 64 had a stable carotid plaque, 5 showed progression, while 23 improved. Conclusion: Carotid Duplex Ultrasound performed immediately post-operatively predicts the outcome at 2 years.

Introduction . Maximum diameter of an abdominal aortic aneurysm (AAA) is the main indication for surgery. This study compared colour duplex ultrasound (CDU) and computed tomography (CT) in assessing AAA diameter. Patients and Methods . Patients were included if they had both scans performed within 90 days. Pearson’s correlation coefficient, paired t -test, and limits of agreement (LOA) were calculated for the whole group. Subgroup analysis of small (<5.0 cm), medium (5.0–6.5 cm), and large (>6.5 cm) aneurysms was performed. A P value of <0.05 was considered statistically significant. Results . 389 patients were included, giving 130 pairs of tests for comparison. Excellent correlation was in the whole group ( r = 0.95) and in the subgroups ( r = 0.94; 0.69; 0.96, resp.). Small LOA between the two imaging modalities was found in all subgroups. Conclusion . Small aneurysms can be accurately measured using CDU. CDU is preferable for small AAAs, but cannot supplant CT for planning aortic intervention.

Introduction: The advent of effective endovascular techniques has revolutionized the treatment of iliac occlusive disease. Long-segment iliac occlusions remain technically difficult to treat, particularly in the presence of femoral disease. Iliac endarterectomy is an established procedure for the treatment of iliac occlusive disease, but it has been suggested that in the era of effective endovascular intervention, its role is limited. Methods: A review of all patients who had eversion endarterectomy of the external iliac artery from a single institution between 2000 and 2008. Results: Twenty-one patients (18 male) underwent eversion external iliac endarterectomy, 15 for external iliac and 6 for iliofemoral disease. Mean age was 64.7 years (range: 46-78 years) and the modal American Society of Anaesthesiologists (ASA) grade was 3. The indications were critical ischemia (n = 16) and disabling claudication (n = 5). Twelve had adjunctive procedures. The mean follow-up was 25.3 months (range: 1-59 months). There were no technical failures. Seventeen patients had significant improvement in symptoms and three had moderate improvement. The cumulative primary patency at 1 year was 81%. One patient had no improvement (because of infrainguinal occlusive disease), and subsequently required femoro-popliteal bypass. There was no systemic morbidity within 30 days. There was 1 in-hospital death from sudden cardiac arrest (47 days postoperatively). Six patients died during follow-up (from unrelated illness). Conclusion: Eversion external iliac endarterectomy is an effective means of treating iliofemoral occlusive disease with excellent short-term outcomes and a low complication rate in a cohort with high levels of comorbidity.

BACKGROUND:Endovascular technology has revolutionised the management of abdominal aortic aneurysmal disease but the less frequent occurrence of pathology in the thoracic aorta has meant that evidence demonstrating the primacy of endovascular treatment strategies in this portion of the vessel is less convincing. Herein we summarise the best available evidence to date.METHODS:A comprehensive search of the surgical and radiological literature using the search term 'endovascular thoracic aorta' was conducted.FINDINGS AND CONCLUSIONS:The vast majority of patients treated by thoracic aortic stent grafting have had their treatment outside the context of a randomised trial. While it would seem that endovascular repair is the treatment of choice for the thoracic aorta, the present evidence is based on single centre case series and is anecdotal at best.

While endovascular aortic aneurysm repair (EVAR) has significantly reduced the morbidity associated with open surgery, efforts continue to minimise the surgical insult to the patient. We report our experience of percutaneous EVAR.

INTRODUCTION:The incidence of neurological injury following carotid angioplasty and stenting is of great interest to those advocating it as an alternative to endarterectomy in the management of critical carotid stenosis. A significant inter-observer variation exists in determining the presence or absence of a neurological deficit following the procedure objective imaging would be advantageous. In this study, we sought to assess diffusion weighted MRI as a diagnostic tool in evaluating the incidence of neurological injury following carotid angioplasty and stenting (CAS).PATIENTS AND METHODS:The first 110 cases of CAS in our unit were included in this series. The procedure was abandoned in three patients. Patients underwent intracranial and extracranial MR angiography, together with diffusion-weighted MRI (DWI) prior to and following CAS and had a formal neurological assessment in the intensive care unit after the procedure.RESULTS:One hundred and ten Procedures were attempted in 98 patients. Twenty-eight percent were asymptomatic. Following CAS, 7.2% of patients had a positive neurological exam (two major strokes with one fatality) and 21% had positive DWI scans, equating to a sensitivity of 86% and a specificity of 85% for DWI in detecting cerebral infarction following CAS. The positive predictive value of the test was 0.3 and negative predictive value 0.99. The major stroke and death rate was 1.8%. While the use of a cerebral protection device appeared to significantly reduce the incidence of cerebral infarction (5% vs. 25%, p = 0.031) this may be a reflection of the learning curve encountered during the study.CONCLUSION:The incidence of subclinical DWI detected neurological injury was significantly higher than clinical neurological deficit following CAS. Conventional methods of neurological assessment of patients undergoing CAS may be too crude to detect subtle changes and more sensitive tests of cerebral function are required to establish whether these subclinical lesions are relevant.

BACKGROUND:While aneurysm neck length, angulation and width have all been previously assessed in endovascular abdominal aortic aneurysm repair (EVAR), aneurysm neck shape has not been considered.AIMS:To analyse the influence of aneurysm neck morphology on outcome following EVAR.METHODS:Aneurysm neck morphology in 70 patients undergoing EVAR from April 2001 to May 2004 was determined using pre-operative CT scans and graft plans. Necks were classified as flared, parallel, irregular, conical, barrel or hourglass. End-points were death,Type I endoleak and graft migration.RESULTS:Forty-six per cent of necks were flared, 34% parallel, 9% irregular, 6% conical, 3% barrel and 3% hourglass. Mean follow-up was 20.2 months (range 4-35). There was one Type I endoleak and one graft migration. There were no aneurysm related deaths.CONCLUSIONS:Assessment of aneurysm neck morphology should be part of the routine preoperative workup for EVAR. A classification system of AAA necks is suggested to facilitate this.

Introduction. Chemoradiotherapy improves survival for some cancer patients. Methods of enhancing treatment response would further enhance survival rates. The effect of the addition of an antiangiogenic agent to a chemoradiotherapy regime has not previously been examined.Materials and methods. C57B16 mice were inoculated with 1 X 106 Lewis lung carcinoma cells into the flank and randomized to 1 of 10 treatment groups when tumor volume approached 1000 mm(3). Animals received combinations of standard doses of intraperitoneal cisplatin, 5-fluorouracil, and the antiangiogenic agent genistein, together with 10 or 20 Gy of external beam radiotherapy. Animals were sacrificed at day 6 when tumor volume, microvessel density, and serum VEGF were determined.Results. Mean (SEM) tumor volume in the chemoradiotherapy group was 762 (212) mm(3) versus 565 (79) mm(3) in the chemoradiotherapy plus genistein group (P = 0.04, unpaired t-test). The addition of genistein produced a significant reduction in tumor microvessel density (P = 0.01) as well as serum VEGF levels (P < 0.05) compared to those animals receiving chemoradiation alone.Conclusion. This study provides proof of principle that chemoradiation can be enhanced by the addition of an antiangiogenic agent to the regime and suggests that further examination of such regimes is warranted. (C) 2004 Elsevier Inc. All rights reserved.