Dieulafoy's Lesion: A Rare Cause of Gastrointestinal Bleeding after Interrupted Aortic Arch Repair in an Adult.

Survival into adulthood in patients with an interrupted aortic arch (IAA) is exceedingly rare. A recent literature review found 25 reported cases of IAA in adults. We describe the first case of prolonged, occult, postoperative gastrointestinal bleeding as a major complication following IAA surgery.

Rapid Carotid Screening by Duplex: A Prospective Single Centre Assessment.

Objective: A novel carotid quick scan (CQS) protocol was developed to rapidly screen for carotid atherosclerosis greater than 50% stenosis in a vascular outpatient setting. This study assessed accuracy and time saved.

Material & Methods: The CQS was developed by consensus agreement between vascular surgeons and accredited clinical vascular scientists through a modified Delphi technique.

Accelerated Measurement of Carotid Plaque Volume Using Artificial Intelligence Enhanced 3D Ultrasound.

Background: Carotid plaque volume (CPV) can be measured by 3D ultrasound and may be a better predictor of stroke than stenosis, but analysis time limits clinical utility. This study tested the accuracy, reproducibility, and time saved of using an artificial intelligence (AI) derived semiautomatic software to measure CPV ("auto-CPV").

Methods: Three-dimensional (3D) ultrasound images for 121 individuals were analyzed by 2 blinded operators to measure auto-CPV.

Pelvic vein incompetence and chronic pelvic pain: a case-control study.

Objective: To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices.

Design: Case-control study.

Setting: Gynaecology and vascular surgery services in two teaching hospitals in north-west England.

Aneurysm Geometry Analyzed by the Novel Three-Dimensional Tomographic Ultrasound Relates to Abdominal Aortic Aneurysm Growth.

Background: Abdominal aortic aneurysms (AAAs) are increasingly screen-detected and many small aneurysms enter surveillance. Computed tomography identifies characteristics that can predict subsequent AAA growth but ionizing radiation and nephrotoxic contrast disadvantage its use in surveillance. We investigated whether duplex and 3-dimensional tomographic ultrasound identified features associated with AAA growth in patients on AAA surveillance.

Evaluating Potential Autologous Bypass Grafts with Tomographic Three-Dimensional Ultrasound Compared with Standard Color Duplex.

Background: Vein mapping using duplex ultrasound (DUS) is a routine in selecting optimal autologous bypass grafts (aBG) but is time consuming and operator-dependent. Tomographic three-dimensional (3D) ultrasound (tUS), using free-hand electromagnetic tracking, allows cardiac and vascular surgeons to view 3D images of the entire length of the potential bypass graft. This study compares tUS with DUS in the evaluation of potential autologous grafts for coronary and lower limb bypass.

Comparison Between Below Knee Contrast Enhanced Tomographic 3D Ultrasound and CT, MR or Catheter Angiography for Peripheral Artery Imaging.

Objective: Clear imaging of below knee and foot arteries is essential to plan distal reconstructions. Contrast enhanced tomographic 3D ultrasound (CEtUS) is novel and entirely safe with no exposure to ionising radiation or nephrotoxic contrast. In the present study, inter- and intra-observer agreement of CEtUS was calculated, and compared with below knee angiography.

Endovascular Aneurysm Repair Assisted by CO Digital Subtraction Angiography and Intraoperative Contrast-Enhanced Ultrasonography: Single-Center Experience.

Background: Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease are major limitations to endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). We describe our experience combining CO-assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast-induced allergy or nephropathy.

Methods: Observational cohort study using prospectively acquired data on patients undergoing CO-assisted EVAR in single institution.

An Ex Vivo Evaluation of Tomographic 3-D Ultrasound, B-Mode Ultrasound, CT And MR Imaging to Measure Artery Diameter, Length and Wall Volume.

Precise measurement of luminal diameter in arteries is important when planning interventional vascular procedures in patients. Measuring wall volume may be important in detecting early artery disease and in the assessment of treatments to prevent atherosclerosis. An ex vivo phantom using porcine arteries was used to evaluate the accuracy with which (i) B-mode ultrasound, (ii) 3-D tomographic ultrasound (tUS), (iii) computed tomography (CT) and (iv) magnetic resonance imaging (MRI) measured length, diameters and volume.

Comparison of Contrast-Enhanced Tomographic 3-D Ultrasound Against Rotational Angiography Imaging Immediately After Endovascular Aneurysm Repair.

This proof of principle study assesses the utility of contrast-enhance ultrasound (CEUS) and contrast-enhanced tomographic 3-D ultrasound (CEtUS), as an intra-procedural imaging tool after endovascular-aneurysm repair (EVAR), compared with rotational angiography. A total of 20 consecutive patients undergoing infra-renal EVAR underwent immediate post-deployment rotational angiography, followed by CEUS and CEtUS scans. Outcomes were presence of endoleak, renal artery patency and endograft deformity.

Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy.

Objective: The aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy.

Methods: A retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter.

Three-dimensional contrast-enhanced ultrasound improves endoleak detection and classification after endovascular aneurysm repair.

Background: Three-dimensional contrast-enhanced ultrasound (3D-CEUS) is a novel technology allowing surgeons to view duplex ultrasound images in three dimensions with ultrasound contrast highlighting blood flow in endoleaks after endovascular aneurysm repair (EVAR). It potentially reduces the need for computed tomography angiography (CTA) and catheter angiography. This study compares 3D-CEUS with both CTA and the final vascular multidisciplinary team (MDT) diagnosis using all available imaging.

Reintervention following endovascular abdominal aneurysm repair is uncommon after five-years: results of greater than a decade follow-up.

Background: Endovascular aneurysm repair offers improved perioperative morbidity and mortality compared to open repair, counterbalanced by a higher incidence of graft-related complications and re-interventions. Randomized studies comparing EVAR to open repair are yet to report greater than ten-year outcomes. This study reports the outcomes of patients who underwent EVAR greater than ten years ago.

Management of novel oral anticoagulants in emergency and trauma surgery.

Background: The compelling safety, efficacy and predictable effect of novel oral anticoagulants (NOACs) is driving a rapid expansion in their therapeutic indications. Management of the increasing number of patients on those new agents in the setting of emergency or trauma surgery can be challenging and the absence of specific reversal agents has been a matter of concern. This review summarises the key principles that underpin the management of those patients with a particular emphasis on the recent development of specific antidotes.

The early management of DVT in the North West of England: A nation-wide problem?

Background: Despite NICE guidelines, the early management of deep vein thrombosis (DVT) in UK hospitals varies widely. We investigated the variation in clinical pathways used in NHS hospitals in North West England.

Methods: A detailed questionnaire was sent to seventeen University or District General hospitals with an Accident and Emergency department.

Periodontal disease and late-onset aortic prosthetic vascular graft infection.

Prosthetic vascular graft infection (PVGI) is a rare but significant complication of arterial reconstructive surgery. Although the relative risk is low, the clinical consequences can be catastrophic. Microbiological data on causative bacteria are limited.

Use of three-dimensional contrast-enhanced duplex ultrasound imaging during endovascular aneurysm repair.

Background: Iodinated contrast during endovascular aneurysm repair (EVAR) is used with caution in patients with chronic kidney disease. Contrast-enhanced ultrasound (CEUS) imaging using nonnephrotoxic sulphur hexafluoride microbubble contrast is a novel imaging modality that accurately identifies and characterizes endoleaks during EVAR follow-up. We report our initial experience of using three-dimensional (3D) CEUS imaging intraoperatively as completion imaging after endograft deployment.

Transcranial Doppler ultrasound: a review of the physical principles and major applications in critical care.

Transcranial Doppler (TCD) is a noninvasive ultrasound (US) study used to measure cerebral blood flow velocity (CBF-V) in the major intracranial arteries. It involves use of low-frequency (≤2 MHz) US waves to insonate the basal cerebral arteries through relatively thin bone windows. TCD allows dynamic monitoring of CBF-V and vessel pulsatility, with a high temporal resolution.

Non-surgical management of superior mesenteric artery thrombosis using spinal cord stimulation.

We report the use of a spinal cord stimulator (SCS) for non-surgical management of superior mesenteric artery thrombosis. A 59-year-old woman with polycythaemia rubra vera presented with extensive superior mesenteric artery thrombosis not amenable to surgical or endovascular revascularisation. A SCS was implanted for analgesia thereby allowing enteral feeding to be tolerated during the acute period.

Type B aortic dissection after standard endovascular repair of abdominal aortic aneurysm.

Dissection of the aorta is a rare yet potentially serious complication following endovascular abdominal aortic aneurysm (EVAR). These can lead to visceral branch hypoperfusion, compromise of aneurysm exclusion, arterial dilation or rupture. Intimal injury and dissection in the context of EVAR may be associated with a number of risk factors that include adverse infrarenal neck morphology, device oversizing, barbed fixation and wire manipulation in the proximal aorta.