These early results of visceral hybrid repair for high-risk patients with complex thoraco-abdominal aortic aneurysms are encouraging, in a group of patients in whom fenestrated/branched stent-grafting is not an option and open surgery hazardous.

SCI following thoracic and thoracoabdominal aortic endovascular intervention is associated with the proportion of aorta covered. The degree of risk varies between different types of procedure and this should be carefully considered in both selection and consenting of patients.

In nonhealing venous ulcers there is a consistently high level of expression of VEGF, at both the gene transcript and protein level. As our previous data demonstrated that angiogenesis is depressed in these poorly healing ulcers, an increase in VEGF production may indicate an increased but ineffectual angiogenic drive. It is also possible that undiscovered inhibitors are released in the ulcer environment.

Research into the healing of venous leg ulcers is increasing as they are a common problem. The wound fluid bathing an ulcer is thought to reflect the wound microenvironment, and the properties of wound fluids have been studied in attempts to find ways to promote healing. After a brief summary of normal wound healing, this article reviews some of the research that has been carried out on venous ulcer wound fluid, with respect to its biochemistry, proteolytic nature, growth factor profile, and effects on cell cultures. Some of the problems and pitfalls inherent in performing and interpreting wound fluid studies are discussed. Finally, a proposal is made for standardizing research on wound fluids that would improve comparisons between different studies.

Fluid exudate from venous ulcers, in particular those that healed slowly, inhibited experimental angiogenesis in this study.

Objectives: Hybrid aortic arch repair procedure was introduced to reduce invasiveness in high-risk patients with aortic arch pathology. The good results are expanding its application, but endoleak, particularly type I, remains its Achilles' heel.Design: We describe our experience with hybrid treatment of aortic arch diseases focussing on techniques and results to avoid type I endoleak.Materials and Methods: A total of 15 high-risk patients with zone 0 -2 aortic arch pathology underwent supra-aortic debranching on ascending aorta and proximal aortic arch reinforcement with a Dacron prosthesis. Metachronously, the procedure was completed with endovascular stent grafting (ESG).Results: Median age was 70 years with a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12.7 Ϯ 6.8. One patient died between aortic debranching and ESG. Mean time between surgical debranching and ESG was 32 Ϯ 27.7 days. No major neurological events occurred. Mean length of the landing zone for ESG was 3.8 Ϯ 0.8 cm. Computed tomography (CT) angiography scan performed soon after operation, and at 3, 6, and 12 months did not show any type I endoleak.Conclusions: Supra-aortic debranching on ascending aorta with proximal aortic arch reinforcement is a useful step to ensure a safe landing zone for ESG, reducing risk early to midterm of endoleak. Longer term follow-up is required to confirm the viability of this technique.

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Background: The aim was to compare duplex imaging, venography, foot volumetry and air plethysmography in patients with healed leg ulcers considered to be caused by venous disease to discover whether duplex scanning alone could confirm a venous aetiology. The importance of isolated reflux in a segment of the deep system below a competent valve was assessed. Methods: A total of 125 patients with 153 healed leg ulcers was examined. An Acuson (Mountain View, California, USA) scanner was used to detect reflux lasting for more than 0·5 s in the deep, superficial and calf perforating veins; the findings were compared with those obtained with ascending venography, foot volumetry and air plethysmography. Results: No. of legs with duplex reflux > 0·5 s (n = 153) Isolated superficial reflux6Superficial reflux with incompetent perforating veins26Isolated incompetent perforating veins8Isolated deep venous reflux11No reflux13 Thirteen legs showed no reflux on duplex imaging, but ten of these had abnormal foot volumetry and 12 had abnormal plethysmography. Venography showed post‐thrombotic change in 26 legs, but there was evidence of deep venous scarring in only six on duplex ultrasonography. Eight of 75 legs with a normal venogram had ‘complete’ (thigh‐to‐calf) deep reflux on duplex imaging. Forty‐five legs showed segmental deep reflux on duplex imaging, of which 29 had associated perforating vein incompetence. Mean half‐refilling times on foot volumetry were 8·46 s for femoral and 5·84 s for popliteal reflux, compared with 3·84 s in the 33 patients who had thigh‐to‐calf reflux (P < 0·05). Conclusion: Absence of reflux in all venous segments on duplex imaging does not exclude a venous aetiology for ulceration. Segmental femoral and popliteal incompetence on duplex imaging is usually associated with other sites of valvular incompetence, but depresses calf function less than thigh‐to‐calf reflux. © 2001 British Journal of Surgery Society Ltd