Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

Numerical methods can be used to determine patient-specific drag forces which may help determine the likelihood of stent-graft migration. Anterior-posterior neck angulation appears to be the greatest determinant of drag force magnitude. Graft dislodgement may occur anteriorally as well as caudally.

Despite its low positive predictive value, we found DU to be a sensitive test for the detection of clinically significant endoleaks. Given concerns about cumulative radiation exposure and cost, and the surprisingly low sensitivity of CTA for endoleak detection in this series, selective CTA based on DU surveillance may be a more appropriate long-term strategy.

TriVex is a safe and effective method for excision of varicosities and compares well, after a learning curve, with conventional surgery in regard to complications and recurrence. It has the advantage of a trend toward reduced operating time in extensive varicosities, and significantly fewer incisions, although there was no perceived difference in cosmesis during follow-up.

The results of this study on the intermediate-term outcome of angioplasty suggest that angioplasty, when used preferentially for critical ischemia, in anatomically suitable patients provides very acceptable limb salvage and survival despite a relatively high restenosis rate.

Recently, symptomatic carotid stenosis patients have had higher platelet counts (potentially reflecting increased platelet production, mobilization or reduced clearance) and platelet activation status than asymptomatic patients. MES were more frequently detected in early symptomatic than asymptomatic patients, but the differences between late symptomatic and asymptomatic groups were not significant. Increased lymphocyte-platelet complex formation in recently symptomatic vs. asymptomatic MES-negative patients indicates enhanced platelet activation in this early symptomatic subgroup. Platelet biomarkers, in combination with TCD, have the potential to aid risk-stratification in asymptomatic and symptomatic carotid stenosis patients.

Introduction A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability. Methods Patients who underwent EVAR with CIAA were identified in two teaching hospitals. Bell-bottom technique (iliac limb ≥ 20mm) (BBT) or internal iliac artery embolization and limb extension to the external iliac artery (IIE+EE) were used. Outcome between these two approaches are compared. Results One hundred and eighty five patients were identified. . Indication for EVAR included asymptomatic AAA (n=157), symptomatic or ruptured aneurysm (n=19), and common iliac artery aneurysm (n=9). Mean AAA diameter was 59 mm. A total of 260 large CIAAs were treated. One hundred and sixty six CIAA limbs were treated with BBT, 94 limbs underwent IIE+EE. Total reintervention rates were similar for BBT (n=19, 11%) and IIE+EE (n=18, 19.1%) (p=0.149). Similar rates of reintervention for type 1b or 3 endoleak are reported, BBT (n=7, 4%) versus IIE+EE (n=4, 4%) (p=1.0). There was no significant difference in limb patency rates. Thirty-day mortality was 1%. Median follow-up was 22 months. While there was no significant difference in complications between the two groups the combined incidence of perioperative complications and reinterventions was higher in the IIE+EE group (49% versus 22%, p-0.002). Conclusion The combined incidence of perioperative complications and reinterventions is significantly higher in the IIE+EE when compared with the BB technique. Therefore, when feasible, BB is desirable..

patients with inflammatory aortic aneurysms fare worse than patients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an anterolateral aortotomy and minimal dissection of adherent structures offers excellent results in dealing with this difficult group of patients.