Several tumour biological variables not included in the seventh edition of the AJCC classification affect overall survival. These require incorporation into prognostic models to ensure a personalized approach to prognostication and treatment.

Endovascular aneurysm repair (EVAR) is an established therapy to prevent rupture in large infrarenal abdominal aortic aneurysms (AAA). As experience with this therapy has grown, treatment of more challenging anatomy has led to the identification of several new procedurally related complications. We report the case of a 67-year-old man with an asymptomatic, large infrarenal AAA with an associated left common iliac artery aneurysm. Endovascular therapy for an aortoiliac aneurysm involved prior coil embolization of his left internal iliac artery to allow conventional EVAR with extension to the external iliac artery of the left graft limb, thus excluding the left iliac aneurysm. He presented 6 weeks postoperatively with onset of left-sided scrotal pain and underwent emergency orchidectomy for ischemic infarction of his left testis. The histology report confirmed that the left testis was necrotic secondary to a thrombus in the testicular artery. To our knowledge, this is the first report of testicular infarction after EVAR.

No abstract

During follow up (mean 4.5 ± 3.1 years, range 1-8), AF progressed to permanent form in 118 ⁄ 256 patients (46.1%), despite active treatment. Overall, 197 ⁄ 335 patients (58.8%) had permanent AF at the end of follow up, either because of unsuccessful cardioversion at baseline (79 patients, 23.6%) or because of AF progression during follow up (118, 35.2%). Only 40 patients (11.9%) were continuously in SR (for mean 2.9 ± 2.2 years, range 1-7) and 98 (29.3%) needed repeated cardioversions (1-8, mean 2.0 ± 1.5 cardioversions per patient) to maintain SR. In multivariate analysis, adjusted for baseline clinical (including AF duration) and echocardiographic characteristics and anti-arrhythmic therapy, each 5-mm increase in LA-APD was associated with an increasing risk of rhythm control failure [HR 1.8, 95%CI:1.2-2.7 and HR 2.9, 95%CI:1.8-4.9 (for LA-APD 46-60 mm), all p < 0.01].An analysis without including patients who were cardioverted pharmacologically, showed broadly similar results where increased LA diameter was significantly related to the risk of cardioversion failure (OR 1.9, 95%CI: 1.4-2.5; p < 0.001). A 5-mm incremental increase in LA-APD was also associated with an increasing risk of cardioversion failure (OR 3.0, 95%CI: 1.5-6.0; p = 0.001; OR 3.2, 95%CI: 1.4-7.3; p = 0.007; and OR 8.5, 95%CI: 2.8-25.9; p < 0.001, respectively).In the present study, LA size was estimated using a 'surrogate measure' (LA-APD), which is commonly used in clinical practice as an estimate of LA size, although it may not accurately represent the true LA dimensions (11). However, we have demonstrated that the risk of cardioversion or rhythm control failure in patients with persistent AF is significantly influenced by the degree of LA-APD dilatation and gradually increases with each 5 mm of LA-APD dilatation.

IAAAs and the associated peri-aortic inflammation and fibrosis can be successfully treated using endovascular abdominal aortic aneurysm repair with concurrent ureteric stenting.