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.

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.

The study assessed radiation exposure during EVAR. Two types of patient dose were estimated: effective dose (ED), which allows estimation of radiation risk to the EVAR patient population; and Peak Skin Dose (PSD), which allows us assess the potential for an individual patient to receive a radiation skin injury. An ancillary aim was to examine dose optimization in EVAR procedures. Based on 111 EVAR cases we estimated average ED as 12.4 mSv. Cumulative patient dose in our centre was lower than other studies because the follow up of EVAR patients is based on ultrasound rather than CT. PSD calculated using a published conversion formula closely matched measurements with calibrated gafchromic film. 99% of patients had an estimated PSD of < 2Gy. Results indicate that skin injuries are possible, but very unlikely in EVAR procedures at our centre. EVAR is a high dose procedure and emphasis on dose optimisation is important. We broke the EVAR procedure into 15 steps and, in a phantom study, showed how skin dose changes as procedure steps are varied. The resulting dose matrix has the potential to be used as an educational tool to promote dose optimization.

Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.

The role of endovascular techniques in the treatment of TAAA continues to evolve. Hybrid and complete endovascular repairs do not replace conventional repair, but provide an alternative for high-risk patients who might otherwise be denied treatment.

incidence to be understated. In this ongoing study we compared the incidence of arrhythmias using two different monitoring devices.Methods: Patients with sinus rhythm were monitored with a 72-hour Holter electrocardiography device (Holter-ECG) (N ϭ 350), and combined with a subcutaneously implanted cardiac loop recorder (Reveal XT®) (N ϭ 20), the latter starting one month prior to surgery, until it was explanted one month post-surgery. New-onset arrhythmias were noted. Thirty-day postoperative events, defined as MI, stroke, and cardiac death, were noted.Results: New-onset perioperative arrhythmias were recorded in 45 (13%) and 8 (40%) patients with Holter-ECG and Reveal respectively. In patients with perioperative arrhythmias, cardiovascular events occurred more frequently (OR 3.0, 95% CI 1.4-6.4). Using the Reveal device 4 additional patients were identified who experienced perioperative cardiovascular events. The incidence of cardiovascular events with Holter and Reveal monitoring was 11/45 (24%) and 4/8 (50%) respectively.Conclusions: Vascular surgery patients may develop paroxysmal arrhythmias outside the recording window of the 72-hour Holter ECG and are generally asymptomatic. Continuous implanted cardiac monitors can detect these paroxysmal episodes of arrhythmias, which in turn could have important therapeutic consequences.

This article presents the design and architecture of a health information system that takes into account various requirements posed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The recommendations made, primarily address Health Care Provider and Health Plans' needs. It introduces the reader to common HIPAA terminology, then picks a specific enterprise technology stack, i.e. Java Enterprise Edition (J2EE) and delves into some of its relevant artifacts. The article makes recommendations for tools, techniques and design guidelines to facilitate the architecture of a HIPAA compatible information system. We focus primarily on Health-care Providers and a subset of Health Plans. These entities have one thing in common: they process or store health information, hence they fall under HIPAA's purview. The architecture model that we are proposing will attempt to present a unified security model (e.g. security in client, application and database layers).

Hybrid techniques allow for the treatment of pathology that would otherwise not be amenable to surgery.