These guidelines refer to the management of elective infra-renal AAA onlye for cases that are amenable to treatment by a standard, commercially available endograft, or by open repair utilising an infra-renal aortic clamp placement. Cases that will require the use of branched/ fenestrated endografts, a suprarenal aortic clamp, suprarenal aneurysms and thoraco-abdominal aneurysms should be referred to units specialising in the treatment of these more complex, higher-risk cases.

Favourable and adverse anatomy patients can be successfully treated using the Nellix sac-anchoring endoprosthesis. Early results are promising but longer-term studies are needed.

This study provides Class III evidence that any difference between the effects of CAS and CEA on cognition at 6 months after revascularization is small.

Abstracts Gregory L. Moneta, MD, Section Editor Atherosclerotic Plaque Composition and Occurrence of Restenosis After Carotid EndarterectomyHellings WE, Moll FL, De Vries JP, et al. JAMA 2008;299:547-54. Conclusion: Lipid-rich inflammatory plaques are associated with a reduced risk of restenosis after carotid endarterectomy.Summary: Both clinical and angiographic criteria have been used to try to determine the risk of restenosis after a vascular intervention. The authors of this study evaluated the composition of the atherosclerotic plaque at the intervention site in terms of plaque features that may be related to carotid restenosis after carotid endarterectomy. There were 500 patients prospectively followed up between April 1, 2002, and March 14, 2006. Patients were assessed for carotid artery restenosis as measured by duplex ultrasound imaging 1 year after intervention. A Ͼ50% stenosis was defined as a peak systolic velocity of Ͼ125 cm/s and a Ͼ70% stenosis was defined as a peak systolic velocity of Ͼ230 cm/s. Carotid restenosis after carotid endarterectomy was determined with predefined histologic plaque characteristics. These included macrophage and smooth muscle cell infiltration, collagen, calcification, interplaque hemorrhage, luminal thrombus, and lipid core size. Comparisons were determined using multivariate logistic regression analysis and were adjusted for clinical characteristics.At 1 year, 85 patients (17%) had developed Ն50% carotid restenosis, and 40 (8%) developed Ն70% restenosis. Histologic examination of the plaque revealed that increased macrophage infiltration (n ϭ 286) had a lower risk of Ն50% restenosis than plaques with no or minor macrophage infiltration (n ϭ 215; 11.5% vs 24.3%; adjusted odds ratio [OR], 0.43; 95% confidence interval [CI], 0.26-0.72). Patients with higher macrophage infiltration also had a lower risk of developing Ն70% restenosis (4.5% vs 12.6%; adjusted OR, 0.36; 95% CI, 0.17-0.74). The 177 patients whose plaque had a lipid core that was Ͼ40% of plaque volume also had a lower risk of Ն50% restenosis than the 94 patients with a lipid core size of Ͻ10% (11.3% vs 25.5%; adjusted OR, 0.40; 95% CI, 0.19-0.81). A large lipid core also had a lower risk of developing Ն70% restenosis (5.6% vs 14.9%; adjusted OR, 0.42; 95% CI, 0.17-1.04).Comment: Many of the findings of this study are unexpected. Plaque characteristics of inflammation and higher lipid content, commonly thought to be associated with more dangerous plaques were, in this study, associated with lower rates of restenosis after carotid endarterectomy. Their other findings also seem in opposition to previous studies or prevailing opinion. For example, an incidence of 21% of Ͼ50% restenosis with Dacron patch angioplasty at 1 year is higher than usually reported. Also, vein and Dacron patches are not generally regarded as having much difference in their ability to prevent restenosis after carotid endarterectomy, but this study found vein patches were more much effective in preventing restenosis than Dacron patches. The...

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