Endovascular abdominal aortic aneurysm repair (EVAR) is a well-established procedure, which has long-term mortality rates similar to that of open repair. It has the additional benefit of being less invasive, making it the favoured method of treating abdominal aortic aneurysms in elderly and high-risk patients with multiple co-morbidities. The main disadvantage of EVAR is the higher rate of re-intervention, due to device-related complications, including endoleaks, limb occlusion, stent migration, kinking, and infection. As a result lifelong surveillance is required. In order to avoid missing these complications, intricate knowledge of stent graft design, good-quality diagnostic ultrasound skills, multiplanar reformatting of CT images, and reproducible investigations are important. Most of these complications can be treated via an endovascular approach using cuff extensions, uncovered stents, coils, and liquid embolic agents. Open surgery is reserved for complex complications, where an endovascular approach is not feasible.

Over the past last few decades, cystic fibrosis (CF) has changed from a disease of childhood into a disease of adults. When a chronic infection of the lungs occurs, eradication of the pathogens is almost impossible. In the Institute for Pulmonary Diseases of Vojvodina, we have started the treatment of adult patients with cystic fibrosis in the year of 2010. The aim of the study is to examine the patterns of antimicrobial susceptibility of the pathogens isolated from adult patients with cystic fibosis due to a rational use of antimicrobial therapy. The results are shown for the first six adult patients with cystic fibrosis treated in the Institute, 5 females and 1 male, at the average age of 24.8 years. The following microorganisms were isolated from sputum samples: Pseudomonas aeruginosa 15 (45.5%), Pseudomonas species 11 (33.3%), Escherichia coli 5 (15.2%), Klebsiella pneumoniae 1 (3%), Staphylococcus aureus 1 (3%). The isolated microorganisms showed high susceptibility rates to piperacillin–tazobactam (85.7%) meropenem (81.8%), imipenem (78.8%), cefepime (81.8%), ceftazidime (78.8%), ceftriaxone (72.2%). Susceptibility to ciprofloxacin was 68.7%, and to gentamicin 59.4%. Besides high susceptibility rates to carbapenems, similarly high susceptibility rates of the isolated microorganisms were registered to the third and fourth generation of cephalosporins. The goal of monitoring the resistance of pathogens isolated from the patients with cystic fibrosis and the rational use of antimicrobial therapy is to reduce the number of microorganisms and to maintain the patients’ pulmonary function and decrease an irreversible damage of the pulmonary parenchyma.

Evaluation of Non Contrast Enhanced MRA in patients with PVD Nadeem Shaida, Andrew Priest, Teik Choon See, Andrew Winterbottom, Martin Graves, and David Lomas Department of Radiology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom, Department of Medical Physics, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom, University Department of Radiology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom

Background— Fenestrated endovascular repair of abdominal aortic aneurysms has been proposed as an alternative to open surgery for juxtarenal and pararenal abdominal aortic aneurysms. At present, the evidence base for this procedure is predominantly limited to single-center or single-operator series. The aim of this study was to present nationwide early results of fenestrated endovascular repair in the United Kingdom. Methods and Results— All patients who underwent fenestrated endovascular repair between January 2007 and December 2010 at experienced institutions in the United Kingdom(>10 procedures) were retrospectively studied by use of the GLOBALSTAR database. Site-reported data relating to patient demographics, aneurysm morphology, procedural details, and outcome were recorded. Data from 318 patients were obtained from 14 centers. Primary procedural success was achieved in 99% (316/318); perioperative mortality was 4.1%, and intraoperative target vessel loss was observed in 5 of 889 target vessels (0.6%). The early reintervention (<30 days) rate was 7% (22/318). There were 11 deaths during follow-up; none were aneurysm-related. Survival by Kaplan–Meier analysis was 94% (SE 0.01), 91% (0.02), and 89% (0.02) at 1, 2, and 3 years, respectively. Freedom from target vessel loss was 93% (0.02), 91% (0.02), and 85% (0.06), and freedom from late secondary intervention (>30 days) was 90% (0.02), 86% (0.03), and 70% (0.08) at 1, 2, and 3 years. Conclusions— In this national sample, fenestrated endovascular repair has been performed with a high degree of technical and clinical success. Late survival and target vessel patency are satisfactory. These results support continued use and evaluation of this technique for juxtarenal aneurysms, but illustrate the need for a more robust evidence base.

True femoral aneurysms are a rare but important cause of groin swelling. We report a 79 year-old male, presenting with intermittent claudication and leg oedema after 25 years of a growing left groin swelling. On examination the mass was 14.5 cm in diameter and pulsatile with an audible bruit. Distal pulses were absent. Perfusion was restored by interposition of a PTFE graft between CFA and PFA. This case presents the largest reported true common femoral aneurysm. Conventional open repair is recommended when diameter exceeds 2.5 cm. Although endovascular techniques are evolving, they were not possible in this case.

We present a rare case of a Hepatic Artery Aneurysm (HAA) of the right hepatic artery in a 59-year-old man presenting with acute painless obstructive jaundice. Computed Tomography (CT) and mesenteric angiographic images are presented. HAAs, presenting with painless obstructive jaundice often have a poor prognosis and should be considered as a rare cause in unexplained cases of obstructive jaundice.

Introduction Non-invasive venography to cover the entire neck and thoracic central venous system in one examination is challenging. MR venography is ideal for coverage but the technique is difficult as the majority of contrast media are extracellular agents that rapidly leave the vascular pool. Time resolved serial acquisition methods have improved but image quality may be suboptimal and they are effectively limited to one body region . This could be overcome using a blood pool agent such as gadofosveset trisodium (Vasovist® , Schering) which can be imaged using both a conventional first pass (FP) technique and then repeatedly in the “steady state” after the redistribution of the agent throughout the vascular system[1,2,3]. The aim of this work was to evaluate the diagnostic performance of the steady-state (SS) images against the conventional first pass time resolved technique for MR venography of the central and upper throracic major veins. Methods A prospective ethically approved and Clinical Trial Authorised (2007-002730-11) open-label feasibility study was undertaken from August 2008. Expected final sample size is 30 patients. Patients over 18 years old who have been routinely referred for MRV of central veins were recruited. Informed consent was obtained from all participants. Intravenous Vasovist® 0.12ml/kg body weight (maximum 10mls) is given at 0.8ml/s followed by a saline flush of 20ml at 2ml/s. FP and SS imaging were performed using a 1.5T GE MRI system with an 8 channel cardiac receive array. FP parameters: FOV 40x40cm; slices 42x2.6mm; matrix 418x256x0.75NEX; flip angle 30°;ASSET factor 2; temporal resolution 10sec, 30 phases acquired. SS parameters: FOV 40x40cm; slices 64 x1.6mm;matrix 512x512x2.0 NEX interpolated to 1024 x1024; flip angle 30°; acquisition time 4.25min. Each set of images were assessed independently in randomised fashion. FP images were used as the reference standard for correct diagnosis. Nine venous segments were assessed – superior vena cava (SVC), left and right branches of brachiocephalic, subclavian, internal jugular, and axillary veins. Four parameters were evaluated: 1. image quality in terms of vessel conspicuity using a five-point scale (excellent, good, moderate, poor, very poor); 2. presence of artefacts using a three-point scale (none, mild, major); 3. presence of stenosis using a six-point scale (no: 0%, mild: 1-30%, mild to moderate: 31-50%, moderate: 51-75%, severe: 76-99%, total occlusion); 4. presence of thrombosis using a three-point scale (no, partial, complete). Images were scored by consensus among 3 experienced consultant radiologists.

Sclerosing mesenteritis is characterized by non-specific inflammation of the mesenteric fat associated with variable amount of fibrosis. The aetiology is unclear; the pathogenesis is obscure, and even its nomenclature remains variable. It is a rare condition with imaging features that can be mistaken either for a mesenteric neoplasm or for a wide variety of non-neoplastic inflammatory conditions. Knowledge of the imaging features of this condition may prevent unwarranted aggressive therapy. This review discusses the pathogenesis, clinical manifestations of this condition, as well as illustrating the characteristic computed tomography (CT) features of sclerosing mesenteritis. A rational approach to the differential diagnosis is discussed.