The influence of raised fibrinogen levels on outcome in stable outpatients with peripheral arterial disease (PAD) has not been consistently investigated. We used data from the Factores de Riesgo y ENfermedad Arterial (FRENA) registry to compare ischemic events, major bleeding, and mortality in stable outpatients with PAD, according to their baseline plasma fibrinogen levels. Of 1363 outpatients with PAD recruited in FRENA, 558 (41%) had fibrinogen levels >450 mg/100 mL. Over 18 months, 43 patients presented with acute myocardial infarction, 37 had an ischemic stroke, 51 underwent limb amputation, 19 had major bleeding, and 90 died. Compared to patients with normal levels, those with raised fibrinogen levels had an over 2-fold higher rate of ischemic stroke (rate ratio [RR]: 2.30; 95% confidence interval [CI]: 1.19-4.59), limb amputation (RR: 2.58; 95% CI: 1.46-4.67), or death (RR: 2.27; 95% CI: 1.49-3.51) and an over 3-fold higher rate of major bleeding (RR: 3.90; 95% CI: 1.45-12.1). On multivariate analysis, patients with raised fibrinogen levels had an increased risk of developing subsequent ischemic events (hazard ratio [HR]: 1.61; 95% CI: 1.11-2.32) and major bleeding (HR: 3.42; 95% CI: 1.22-9.61). Stable outpatients with PAD and raised plasma fibrinogen levels had increased rates of subsequent ischemic events and major bleeding.

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Hepatitis C virus. 16.3% of the patients had detectable levels of Hepatitis C viraemia on ribonucleic acid. 1% of patients were positive for HIV-1. 67 patients underwent groin exploration and drainage of an abscess with 27 also requiring ligation of a femoral pseudoanueysm. No patients underwent reconstruction of the femoral artery following ligation and there were 3 above knee amputations performed during the same inpatient episode. Conclusion-We have noted a significant increase in the number of patients presenting with SSVTI over the period of our study. This has had a significant impact on resources given the LOS and multidisciplinary input required to ensure a safe and timely discharge from hospital when dealing with PWID. All patients in whom a SSVTI is suspected in the groin should undergo a CT angiogram as the imaging modality of choice as this accurately identifies any vascular complications as well as the presence of foreign bodies which may potentially cause a needle stick injury to the surgical team. Ligation of femoral pseudoaneurysms generally does not result in patients requiring amputation, however, they are often claudicants as a result.

WHAT THIS PAPER ADDS The case of a patient with an untoward outcome after repair of his thoraco-abdominal aneurysm is reported. He was treated for an anastomotic pseudoaneurysm and for multiple visceral aneurysms of new onset. Infection was suspected however, it could not be confirmed. Finally, the post-mortem revealed a fibrin associated EpsteineBarr virus positive diffuse large B cell lymphoma, a very rare malignancy involving the aorta. Although infection is common in patients with a bad outcome after aneurysm repair, other diagnoses must be considered. Background: Malignancies involving the aorta are extremely rare. Case report: A 62 year old man with a history of open repair of a thoracic aortic aneurysm developed new visceral aneurysms and an anastomotic pseudoaneurysm. Fludeoxyglucose positron emission tomography/ computed tomography, performed for suspicion of graft infection, found abnormal uptake around the bypass, the visceral aneurysms, and the femoral arteries. The patient was treated by embolisation of the visceral aneurysms and a thoracic endovascular aortic repair. Several bleeding complications occurred, and the patient died. Post-mortem revealed a fibrin associated EpsteineBarr virus positive diffuse large B cell lymphoma. Conclusion: Patients with aortic aneurysms can develop malignancies including fibrin associated lymphoma. Clinical manifestations may be similar to those of an infectious process; timely diagnosis is uncommon.