These risk factors can be easily determined on admission and may be used to help improve patient selection for surgical intervention. The current operative mortality rate for ruptured abdominal aortic aneurysm remains high, and in some cases health care resources are used in a nonproductive fashion. Restricted patient selection and allocation of scarce resources will bring advantages to both the patient and the community.

The accuracy of duplex studies compared with angiography in the assessment of extracranial vascular disease depends on the method of angiographic determination of carotid stenosis. Vascular laboratories should validate the duplex criteria they use against a standard method of angiographic assessment of carotid artery stenosis, with special reference to the recently reported studies noting the significance of a stenosis greater than 70% in patients with symptoms.

Dispersal and gene flow are important processes affecting the evolutionary potential of wild populations. Assessing the importance of such patterns is thus critical, especially in contexts where environmental attributes may enhance or restrict the movements of individuals across patchy habitats. A landscape genetics approach is effective in that respect as it combines spatial and genetic data to identify landscape features that play a role in shaping genetic structure. The primary objective of our research was to characterize the determinants of population genetic structure in the eastern chipmunk (Tamias striatus) over a large heterogeneous study area in southern Quebec and Ontario, Canada. We genotyped 572 individuals using 7 microsatellites loci and found an average F(ST) of 0.127 +/- 0.035 among our 7 sampling sites. We found evidence that major rivers act as important barriers to gene flow at a large scale. We also detected a signal of male-biased gene flow at all scales considered. Our findings highlight the importance of simultaneously taking into account landscape elements and geographic distance, considering the scale at which determinants of genetic structure may act and using the appropriate measures to detect sex-biased dispersal based on the characteristics of the sampling design.

Primary aorto‐appendiceal fistula has been reported only once previously. A further case is presented in which bleeding. per rectum. occurred in association with rupture of an aorto‐iliac aneurysm adherent to an acutely inflamed appendix. Postoperatively the patient had several complications including permanent asynimetrical L, paraplegia and delayed presentation of an intramedullary abscess of the femur which grew Bacteroirdes fiqilis organisms. These complications highlight the high morbidity associated with nortocolic fistulae.

Background Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision‐making about vascular surgery in the resource constrained COVID‐19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. Methods The COVID‐19 Vascular Service in Australia (COVER‐AU) prospective cohort study evaluates 30‐day and six‐month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March–July 2020. The primary outcome was mortality, with secondary outcomes procedure‐related outcomes and hospital utilization. Frailty was assessed using the nine‐point visual Clinical Frailty Score, scores of 5 or more considered frail. Results Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% ( n = 20) and 5.9% ( n = 35) respectively with no significant difference between frail and non‐frail patients (OR 1.68, 95%CI 0.79–3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non‐frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non‐frail patients, after adjustment (OR 2.01; 95% CI 1.17–3.78), driven by a high rate of amputation during the period of reduced surgical activity. Conclusion Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.

An aberrant right subclavian artery arising distal to the origin of the left subclavian artery is the most common anomaly of the aortic arch. Degenerative diseases of aberrant subclavian arteries including aneurysms and occlusive disease have been reported previously. We believe that this case is the first reported case of fibromuscular hyperplasia affecting an aberrant subclavian artery. A 25-year-old woman admitted with a history consistent with neurogenic thoracic outlet syndrome was found to have a reduced pulse and blood pressure on the ipsilateral side caused by fibromuscular hyperplasia of an aberrant subclavian artery. A carotid-subclavian bypass via a supraclavicular incision was performed at the same time as thoracic outlet decompression. Histologic examination confirmed the presence of fibromuscular hyperplasia in the aberrant subclavian artery. This case is discussed with reference to the available literature.

The accuracy of four non‐invasive methods used in the evaluation of the extracranial carotid arterial system are presented. Three of the methods were flow dependent whilst the fourth was an ultrasonic imaging system. A consecutive series of 67 patients, (134 carotid arteries), having carotid angiography were investigated by means of carotid phonoangiography (CPA), oculoplethysmography (OPG), supra orbital Doppler (SOD) and B mode ultrasound scanning. The sensitivity of the B mode ultrasound was 81% with the OPG, CPA and Doppler method yielding sensitivites of 51%, 56% and 63% respectively. The specificity of both the OPG 95% and the Doppler 90% wqs high. The combined use of both B Mode ultrasound and OPG or Doppler will provide an improved overall accuracy in the assessment of extra cranial carotid stenosis.