Mycotic Abdominal Aortic Aneurysms - A Tertiary Centre Experience and Formulation of a Management Protocol.

Background: Mycotic abdominal aorta aneurysm (MAAA) is a rare and life-threatening condition. Because of its rarity, there is a lack of adequately powered studies and consensus on its treatment and follow up. This study aimed to review the outcomes following surgical intervention for MAAA in a single tertiary centre and to formulate a management protocol based on available evidence and expert opinion.

Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children.

Background / Purpose: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2-2.5/1000 in children.

Operative and 1-Year Outcomes of the Custom-Made Fenestrated Anaconda Aortic Stent Graft-A UK Multicenter Study.

Background: Early and 1-year outcomes are presented for fenestrated endovascular aneurysm repair (FEVAR) of complex aortic aneurysmal disease with the custom-made Anaconda fenestrated stent graft in 101 patients.

Methods: Retrospective site-reported data from the first 101 elective cases (2010-2014) from 4 UK centers were studied to evaluate patient demographics, aneurysm morphology, clinical success, and 1-year outcomes in patients undergoing fenestrated aneurysm repair with the custom-made Anaconda device.

Results: 101 fenestrated grafts (median age 76, 85% male) were implanted with a total of 255 fenestrations (196 renal arteries, 48 superior mesenteric artery, and 11 celiac arteries) with 3% mortality, 98.

Are we cross-matching too much blood for elective open abdominal aortic aneurysm repair?

Objectives: This study aims to identify current blood transfusion requirements in elective open abdominal aortic aneurysm repair and to compare this to an existing maximum surgical blood order schedule.

Methods: We retrospectively identified patients who underwent elective open abdominal aortic aneurysm repair over a 40-month period in our institution. Pre-operative number of units cross-matched and the number of units actually transfused were identified.

Arteriovenous fistula formations: key to vascular surgical training.

Purpose: To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations.

Methods: Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved.

Rupture of the Left External Iliac Artery and Right Groin Pseudoaneurysm Formation following Angioplasty in a Patient with Neurofibromatosis Type 1 and Undiagnosed Bilateral Phaeochromocytoma.

Neurofibromatosis type 1 (NF1) is a genetic condition, which affects 1 in every 3000 births. Patients with NF1 are at increased risk of a variety of vascular abnormalities. This report presents the case of a 60-year-old male with NF1 who suffered a left external iliac rupture and a right pseudoaneurysm following angioplasty.

Daycase hernia surgery: a missed training opportunity.

Introduction: Traditionally uncomplicated elective hernia operations were performed by surgical trainees; allowing them to develop key competencies and skills transferable to emergency hernia surgery. Daycase surgical units (DCU) are increasingly accommodating operations that traditionally contributed to operating lists in general elective theatres. We aim to assess whether DCU could help improve training in hernia surgery.

Endovascular management of delayed complete graft thrombosis after endovascular aneurysm repair.

Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult.

Endovascular repair of a primary iliac-cecal fistula presenting with gastrointestinal hemorrhage.

We report a case of an arterio-enteric fistula between an external iliac artery aneurysm and otherwise healthy cecum, presenting with torrential hemorrhage per rectum in an 85-year-old patient. Whilst fistulization to the aorta and common iliac arteries has been reported, to our knowledge no previous cases of primary fistulization between an external iliac aneurysm and normal cecum have been. Successful endovascular exclusion of the aneurysm was undertaken with a Wallgraft covered stent and the patient remains well at 1 year.

Role of micronutrients in activated sludge-based biotreatment of industrial effluents.

Industrial processes often produce wastewaters that resist biological treatment owing to the unfamiliarity of some components to biological systems. Availability of nutrients determines the community structure of the activated sludge and hence the efficiency of the degradation process. Micronutrients influence the bacteria involved in waste degradation and also the species diversity within the sludge.

Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysm.

Purpose: To report the use of autologous thrombin for transcatheter embolization of a traumatic parenchymal splenic pseudoaneurysm.

Case Report: A 15-year-old boy presented with a splenic parenchymal laceration after blunt abdominal trauma. The patient was managed conservatively but developed an intrasplenic pseudoaneurysm (grade III AAST scale) with subcapsular contrast extravasation after 3 weeks.

Autologous thrombin for treatment of pseudoaneurysms.

Femoral pseudoaneurysms arise in up to 2% of patients after femoral cannulation for cardiac catheterisation. We used autologous thrombin for percutaneous obliteration of pseudoaneurysms occurring after catheterisation. We prepared autologous thrombin isolates from blood of ten patients with femoral pseudoaneurysms, and injected this solution into the pseudoaneurysms with duplex imaging guidance.

Paradoxical embolus: an unusual indication for upper limb amputation.

Paradoxical emboli occur when venous embolic material passes into the arterial circulation (via a right-to-left cardiac shunt). The association of paradoxical emboli and arterial ischaemia has been described previously, especially with respect to cerebral infarcts. We describe a case in which double paradoxical emboli following a long haul flight, resulted in emergency amputation of an upper limb.

Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures.

Approximately 14%-20% of patients with critical lower limb ischemia are unsuited for distal arterial reconstruction and face major distal amputation. Distal venous arterialization is a unique procedure in which the venous bed is used as an alternative conduit for perfusion of peripheral tissues. Eighteen patients with stage IV Fontaine critical lower limb ischemia underwent venous arterialization.

Municipal wastewater sludge dewaterability and the presence of microbial extracellular polymer.

Dewatering of sewage sludge is an essential and costly part of the wastewater treatment process. The presence of microbial extracellular polymer (ECP) is important for sludge flocculation, but ECP has also been shown to have a detrimental effect on the dewaterability of certain sludge types. This paper investigates the relationship between sludge dewaterability and the level of ECP present in a range of sludges obtained from 8 full-scale municipal treatment works in the UK.

The effects of media size on the performance of biological aerated filters.

Biological aerated filters (BAFs) are an attractive process option, particularly when low land usage is required. They can combine BOD, solids and ammoniacal nitrogen removal and can be utilised at both secondary and tertiary stages of wastewater treatment. Media selection is critical in the design and operation of BAFs to achieve effluent quality requirements.

Changes in the levels of soluble adhesion molecules and coagulation factors in patients with deep vein thrombosis.

Current biochemical markers of thrombosis, such as d-dimer, are of little value in demonstrating the presence of thrombus postoperatively, as their levels are elevated by surgery. Thrombosis involves adhesive interactions between the endothelium, platelets and leukocytes. The aim of the study was to determine which of a panel of haemostatic and adhesion factors are altered by the presence of thrombus, but not by surgery.

A model of in vivo human venous thrombosis that confirms changes in the release of specific soluble cell adhesion molecules in experimental venous thrombogenesis.

Purpose: The mechanisms of venous thrombogenesis have been studied by using animal models and cells in culture. The results from these systems may not, however, be relevant to the human condition. The aim of this study was to develop a method by which thrombus could be safely produced in a human vein in vivo.

Biopolymers in wastewater treatment.

Studies investigating the formation and manipulation of biopolymers produced by the heterogeneous microbial cultures found in wastewater treatment are not advancing at a fast rate, reflecting the inherent complexity of the systems involved. Adjustment of the nutrients present within the treatment process currently appears to offer more potential than bioaugmentation with genetically modified organisms for improving certain aspects, such as sludge settling properties and chlorinated organic pollutant removal. An area likely to be of increasing importance in the future is the role of the microbial biopolymer in retaining water within the sludge matrix.

Prospective randomized trial of woven versus collagen-impregnated knitted prosthetic Dacron grafts in aortoiliac surgery.

Background: Despite the theoretical advantages of coating knitted grafts with a material designed to reduce blood loss, their performance has not been directly compared with woven grafts in a prospective randomized trial. The aim of this study was to compare the graft handling qualities and operative blood loss of the two types of arterial prosthesis, as well as complication rate and patient survival at 1 year.

Methods: A total of 267 consecutive patients having surgery for occlusive or aneurysmal disease of the aortoiliac arteries were randomized to receive woven (141 patients) or knitted collagen-impregnated Dacron (126 patients) grafts.

The role of the monocyte in the generation and dissolution of arterial and venous thrombi.

Monocyte infiltration into forming thrombus has been demonstrated in experimental models of venous thrombosis developed in our laboratories. These cells produce and release plasminogen activators as the thrombus organises and resolves. Monocytes are also capable of assembling and releasing procoagulant factors and the evidence for their importance in thrombogenesis is reviewed.