Objective To assess whether screening for abdominal aortic aneurysms in men reduces mortality. Design Population based randomised controlled trial of ultrasound screening, with intention to treat analysis of age standardised mortality. Setting Community based screening programme in Western Australia. Participants 41 000 men aged 65-83 years randomised to intervention and control groups. Intervention Invitation to ultrasound screening. Main outcome measure Deaths from abdominal aortic aneurysm in the five years after the start of screening. Results The corrected response to invitation to screening was 70%. The crude prevalence was 7.2% for aortic diameter ≥ 30 mm and 0.5% for diameter ≥ 55 mm. Twice as many men in the intervention group than in the control group underwent elective surgery for abdominal aortic aneurysm (107 v 54, P = 0.002, 2 test). Between scheduled screening and the end of follow up 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm, yielding a mortality ratio of 0.61 (95% confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.19 (0.04 to 0.89). Conclusions At a whole population level screening for abdominal aortic aneurysms was not effective in men aged 65-83 years and did not reduce overall death rates. The success of screening depends on choice of target age group and the exclusion of ineligible men. It is also important to assess the current rate of elective surgery for abdominal aortic aneurysm as in some communities this may already approach a level that reduces the potential benefit of population based screening.

Objective To assess whether screening for abdominal aortic aneurysms in men reduces mortality. Design Population based randomised controlled trial of ultrasound screening, with intention to treat analysis of age standardised mortality. Setting Community based screening programme in Western Australia. Participants 41 000 men aged 65-83 years randomised to intervention and control groups. Intervention Invitation to ultrasound screening. Main outcome measure Deaths from abdominal aortic aneurysm in the five years after the start of screening. Results The corrected response to invitation to screening was 70%. The crude prevalence was 7.2% for aortic diameter ≥ 30 mm and 0.5% for diameter ≥ 55 mm. Twice as many men in the intervention group than in the control group underwent elective surgery for abdominal aortic aneurysm (107 v 54, P = 0.002, 2 test). Between scheduled screening and the end of follow up 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm, yielding a mortality ratio of 0.61 (95% confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.19 (0.04 to 0.89). Conclusions At a whole population level screening for abdominal aortic aneurysms was not effective in men aged 65-83 years and did not reduce overall death rates. The success of screening depends on choice of target age group and the exclusion of ineligible men. It is also important to assess the current rate of elective surgery for abdominal aortic aneurysm as in some communities this may already approach a level that reduces the potential benefit of population based screening.

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One of the principal reasons for failure of endovascular aneurysm repair (EVAR) is the occurrence of endoleaks, which regardless of size or type can transmit systemic pressure to the aneurysm sac. There is little debate that type I endoleaks (poor proximal or distal sealing) are associated with continued risk of aneurysm rupture and require treatment. Similarly, with type III endoleak, there is agreement that the defect in the device needs to be addressed; however, what to do with type II endoleaks and their effect on long-term outcome are not so clear. Aneurysm sac change is a primary parameter for determining the presence of an endoleak and assessing its impact. While diameter measurement has been the most commonly used method for determining sac changes, volume measurement has now been proven superior for monitoring structural changes in the 3-dimensional sac. Determining the source of an endoleak and the direction of flow are necessary for proper classification; however, while computed tomographic angiography has high sensitivity and specificity for detecting endoleaks, it is limited in its ability to show the direction of flow. Contrast-enhanced duplex ultrasound, on the other hand, is better able to quantify flow and characterize endoleaks. Flow is evidence of pressure, and increasing intrasac pressure increases wall tension, thus inducing progressive aneurysm expansion until rupture. Hence, determining intrasac pressure is becoming a vital component of endoleak assessment. All endoleaks can create systemic pressure inside the aneurysm sac, and there are a variety of intrasac pressure transducers being evaluated to assess this effect. A clinical pathway for patients with suspected type II endoleaks is based on a combination of imaging and pressure measurements. Imaging alone requires at least two interval examinations to determine the trend, while pressure measurements give immediate reassurance or an indication to intervene. Although still under development, pressure measurement is destined for general use and will provide a scientific basis for the management of type II endoleaks.

Background and Purpose-Octogenarians were not included in the major trials of carotid endarterectomy. Concern has been expressed about the role of carotid endarterectomy in this age group. This concern is based in part on uncertainty about the long-term survival of elderly patients after carotid endarterectomy. The aim of the present study was to assess relative survival in those patients Ն80 years of age undergoing carotid endarterectomy. Methods-A population-based record linkage study of all patients who underwent carotid endarterectomy from 1988 to 1998 in Western Australia was undertaken. Long-term relative survival after carotid endarterectomy was assessed against age-and sex-matched controls. Results-During the period 1988 to 1998, 1796 (1306 male, 490 female) cases were identified. There were 151 patients Ն80 years of age. The cumulative survival at 5 years was 64.9% for those Ն80 years of age compared with 80.1% for those Ͻ80 years of age. Relative survival at 5 years was 118% (95% CI, 102 to 134) for those Ն80 years of age compared with 94.7% (95% CI, 92 to 97) for those Ͻ80 years of age. Conclusions-Long-term relative survival after carotid endarterectomy in patients Ն80 years of age was better than that of an age-matched population. ver the last decade, reports from the 2 major randomized clinical trials of carotid endarterectomy (CEA) have provided the scientific basis for the management of symptomatic carotid artery stenosis. 1,2 Because patients, institutions, and surgeons participating in these trials were carefully selected, it is not surprising that the surgical results were outstanding. Surgeons working with variable levels of individual skill and a more complex and aging case mix have endeavored to emulate these results ever since their publication.One increasingly important group of patients excluded from the major trials are those Ն80 years of age. 3 Recent reanalysis of outcome in these trials based on age showed that patients Ն75 years of age obtained more benefit from CEA than younger patients. 4,5 The reason is that older patients have the highest risk of ischemic stroke if treated medically and the lowest surgical risk. 5 Whether this finding also applies to patients Ն80 years of age cannot be readily answered from the trial data.There are reports that the elderly, including octogenarians, can undergo CEA safely. 6 Despite cogent arguments 3 that most octogenarians would probably live long enough to benefit from CEA, there are few studies of long-term survival in the very elderly after CEA. The present study used data from the Western Australia Data Linkage System to measure the long-term survival of patients undergoing CEA to assess relative survival in the very elderly. Patients and MethodsThe Western Australia Data Linkage System has been described elsewhere. 7 All patients who had CEA during the period 1988 to 1998 were selected by use of the International Classification of Diseases, Clinical Modifications (ninth revision) procedure code 38.12. Details of presenting symptoms and sev...

Hookwire localization using ultrasound guidance is an invaluable tool in directing the surgeon intraoperatively when excising deep intramuscular haemangiomas.

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Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images.