Objective True superficial femoral artery aneurysms (SFAAs) are rare and traditionally treated by open repair. However, the endovascular approach excluding the aneurysm sac with a covered stent may be an alternative. This study aimed to compare the outcomes of the open and endovascular repair of SFAAs. Methods This is a retrospective, observational, monocentric study. The main endpoints were: technical success, limb salvage and primary patency rate, and hospitalisation time. Results We identified 49 SFAAs in 40 patients; the mean age was 73.3±10.1 years, the mean diameter of SFAAs was 5.41±3.64cm, and 61.2% were symptomatic for ischaemic or compression-related signs. The indication for open repair was given mainly for complex SFAAs involving the distal third of the superficial femoral artery and with an ipsilateral popliteal aneurysm. Among the 36 open-repair patients, 33 underwent ligation and revascularisation via bypass or graft interposition, and 3 patients underwent simple ligation without revascularisation. The endovascular approach was adopted mainly for aneurysms located in the medial third of the SFAA, which underwent covered stenting in 12 patients and coil embolisation in 1 patient. The technical success was 100% in all cases. There were no statistical differences in terms of primary patency and limb salvage rate between groups at two and four years. The mean hospitalisation time was 10±4 and 3±1 days after open and endovascular treatment, respectively. Conclusions The endovascular approach may be a valid alternative for isolating SFAAs offering good results and shorter hospitalisation. Open repair remains a valid approach, particularly in complex aneurysms.

Purpose: True aneurysms of the superficial femoral artery (SFAA) are rare and, the endovascular approach using covered stents has gained more popularity. We report an endovascular alternative using embolization coils for treatment of a ruptured SFAA. Case description: An 88-old male admitted for a ruptured true SFAA (67×52mm in diameter and 70mm in length) presenting with painful mass pulsating in the proximal third of the left thigh. His surgical history consisted of an infrarenal abdominal aneurysm treated by open surgery and an ipsilateral popliteal aneurysm treated with prosthetic bypass by a medial approach; this was revealed to be occluded at the CT scan evaluation. The patient was asymptomatic for limb ischaemia, therefore we decided to perform embolization of the SFA with coils (MReye®Embolization Coil, Cook Medical, Bloomington,USA). Under local anaesthesia, via a 5-Fr sheath and an antegrade approach, coils were deployed first at the distal neck of the SFAA and then to its proximal neck. On the angiogram, complete aneurysm sac thrombosis with no leaks was achieved. At 6-month follow-up, the SFAA remained occluded, and the patient had not developed any sign of limb ischaemia. Conclusion: Coil embolization of SFAA in selected cases represents a feasible and safe endovascular alternative.

During antegrade puncture of the common femoral artery (CFA) the guidewire can head towards the profunda femoris artery (PFA).This is more likely when the angle of the needle puncture is steep or when a puncture is made close to the femoral bifurcation, in the context of a high bifurcation or obesity. 1,2We report our approach using two parallel guidewires in the same sheath to gain access to the superficial femoral artery (SFA) when this occurs.

INTRODUCTION Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection. MATERIALS AND METHODS A retrospective study was conducted over a four-year period. RESULTS Over this period, 13 patients underwent trans-obturator reconstructions (13 external iliac-popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device. CONCLUSION The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.

13th Annual meeting of the European Venous Forum, Thursday 28 June–Saturday 30 June 2012, Florence, Italy A prospective study comparing ultrasonography and angiography for the diagnosis of chronic cerebrospinal venous insufficiency M Simka, T Ludyga, M Kazibudzki, P Latacz and P Janas Euromedic Specialist Clinics, Department of Vascular & Endovascular Surgery, Katowice, Poland Objectives: This study was aimed at testing the diagnostic accuracy of current sonographic criteria of chronic cerebrospinal venous insufficiency (CCSVI). In addition, we tried to identify alternative sonographic parameters associated with impaired outflow in the internal jugular veins. Method: Firstly, the findings of Doppler sonography were compared with the results of reference test: catheter venography. There were assessed 116 internal jugular veins and vertebral veins in 58 patients with associated multiple sclerosis. We evaluated our findings in the context of current sonographic criteria, proposed by Zamboni, and new criteria: by expert panel of the International Society for Neurovascular Disease (ISNVD). Secondly, we assessed 41 different sonographic variables, also those not mentioned in the current criteria (such as flow direction, peak flow velocity, cross-sectional area and diameter of the vein) in 115 patients. These parameters were also compared with venographic findings. Results: We found that although sonographic patterns suggesting outflow abnormalities were very common in multiple sclerosis patients: e.g. at least one positive Zamboni’s criterion was found in 92.2% of the assessed veins, their diagnostic accuracy was limited. For example, positive and negative predictive values of one positive Zamboni’s criteria were 79.4% and 33.3%, and of at least two positive criteria: 81.8% and 21.7%. Accuracy of ISNVD criteria was not much better. Multivariate regression analysis of 41 sonographic parameters revealed some variables that were associated with increased prevalence of venographic abnormalities: no flow detected in all three segments of internal jugular vein in upright position, peak flow velocity in the upper and middle segments in upright position less than 24 cm/second, and in lower segment less than 88 cm/second, peak flow velocity in the upper segment in supine position less than 24 cm/second, and cross-sectional area of the upper segment in the supine position less than 8 mm. However, even using these parameters we were unable to create a reliable set of criteria. Of note, many variables used by the current CCSVI sonographic protocols were not proven to be associated with increased prevalence of venographic pathology, for example: reduced or bidirectional flow in the vertebral veins. Conclusions: Our research is showing a clear gap in the understanding of haemodynamics in this particular venous territory. Consequently, more research is needed to improve diagnostic accuracy of Doppler sonography for the diagnosis of CCSVI. It is also possible that in this territory catheter venography is a tarnished ‘gold standard’ and that some abnormalities (e.g. compression of the vein by adjacent muscles) show only on sonography. Perhaps, a multimodal approach is required to evaluate these veins properly. Role of duplex ultrasound in chronic cerebrospinal venous insufficiency: a single centre experience with 711 patients A Al-Muzaini*, H Safar† and T Sinan‡ *Vascular Imaging Service; Vascular Surgery Service; Interventional Vascular Radiology Department, Mubarak Al-Kabeer