The pooled ACS rate was calculated at 8%, but this figure may be >20% with improved awareness and vigilant monitoring. Although no statistically significant association could be found between ACS and death, almost half the patients who developed ACS after endovascular repair of RAAAs were likely to die.

Based on this series, the Anaconda™ stent graft appears to be safe and effective for the endovascular treatment of AAAs. Both the short-term and the mid-term results are satisfactory.

This study provides meta-analytical evidence that the use of an AOB in unstable RAAA patients undergoing endovascular repair may improve the results.

Management of large postfasciotomy wounds and/or skin and soft tissue defects after major vascular trauma to the extremities can be challenging. The External Tissue Extender (Blomqvist; ETE), a skin-stretching device, which consists of silicone tapes and plastic stoppers, approximates wound margins and facilitates delayed primary closure. We describe our experience with the use of ETE in 5 patients (4 males) with a total of 8 wounds (7 postfasciotomy, 1 soft tissue defect) over the past 12 years. The mean patient age was 32 (range 17-61) years. The wounds involved the lower limb in 3 patients and the upper limb in 2, whereas the injured arteries were the popliteal in 3, the axillary in 1, and the brachial in 1. The mean wound length was 24 cm (range 9-37 cm), and the mean number of ETE silicone tapes used per wound was 13 (range 5-19). The median duration of ETE therapy was 7 days (range 4-7). ETE therapy resulted in sufficient wound approximation to allow complete closure with conventional suturing in 7 out of the 8 wounds. Of these, one developed infection that required drainage, debridement, and resuturing. All wounds achieved satisfactory healing status and all limbs had been salvaged. In conclusion, the ETE is a useful, easy-to-use, and simple adjunct that may facilitate delayed primary closure of large postfasciotomy wounds or extensive skin and soft tissue defects following complex vascular trauma to the extremities.

Spontaneous rupture of a non-aneurysmal visceral abdominal aorta is extremely challenging and potentially fatal. Endovascular management using the periscope stent-graft technique to facilitate aortic stent-grafting may offer an attractive bailout option with satisfactory early results.

I ntravenous drug abusers can present with abscesses, cellulitis, or endocarditis.1 The development of a mycotic pseudoaneurysm is less frequently reported. We describe the emergency endovascular management, in a drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, an effort that was complicated by a fatal pulmonary embolism (PE). Case ReportIn October 2010, a 60-year-old man presented with malaise, fever, and a painful mass in the right groin and thigh. The patient had a 20-year history of intravenous drug use and was positive for hepatitis C. On examination, he kept his right hip slightly flexed and was unable to stretch it or walk because of severe discomfort. There was crepitus locally in the thigh, which suggested the presence of gas in the subcutaneous tissues. Although the femoral pulse was palpable, the overlying groin mass was not considered to be particularly pulsatile. As a result, a diagnosis of femoral pseudoaneurysm was considered unlikely. A computed tomogram suggested the presence of a large right iliopsoas abscess extending down the anterolateral and posterior surface of the thigh, with gas inside it. The patient was taken to the operating room and placed under local anesthesia and intravenous sedation; an incision was made in the area of the lateral thigh, where the palpable crepitus was maximal. Gas, pus, and necrotic material were evacuated and samples were sent for culture. Local débridement and washout were performed, and the wound was left open. The patient was admitted to the surgical ward and started on broad-spectrum antibiotics. The plan was to observe him and decide on the need for further and more radical drainage of the psoas abscess after follow-up imaging. Over the next 48 hours, the patient improved, and only low-grade pyrexia was noted. However, on the 3rd day his condition deteriorated again, with further groin pain, hypotension, and tachycardia. His hematocrit level had dropped to 24%, and then to 17%. Ultrasonograms revealed a large pseudoaneurysm of the femoral artery (diameter, 4.5 × 3.5 cm), accompanied by multiple enlarged inguinal lymph nodes and thrombosis of the superficial femoral vein. At this point, an urgent vascular surgical opinion was requested, and the patient was taken for magnetic resonance angiography. This confirmed the diagnosis of pseudoaneurysm, a lesion that originated at the junction of the common femoral and superficial femoral arteries; the profunda femoris was thrombosed. When we reviewed the computed tomograms Case Reports

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