Factors predicting positive CT mesenteric angiography results in lower gastrointestinal haemorrhage prior to consideration of intra-arterial angio-embolisation.

Introduction: Lower gastrointestinal haemorrhage (LGIH) is a challenging phenomenon in a comorbid, elderly population. CT mesenteric angiography (CTMA) allows localisation of the site of haemorrhage, and provides a target for interventional techniques, but the intermittent nature of LGIH makes it challenging to reliably demonstrate extravasation. This study aimed to identify objective factors that may predict scan outcomes.

Endovascular flow-diversion of visceral and renal artery aneurysms using dual-layer braided nitinol carotid stents.

Background: Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs.

Perforating arteries of the thigh: An anatomical and radiological study.

Introduction: We aimed to advance the understanding of the anatomy of the perforating branches of the profunda femoris artery to facilitate the avoidance of iatrogenic injury in surgery around the thigh and ensure safe percutaneous embolisation.

Methods: Dissection was carried out on seven cadavers, examining the relationship of the point of origin of the perforating branches of profunda femoris, relative to lines connecting palpable bony landmarks (lines A and B). These were compared with 16 computed tomography angiograms (CTA).

Endoluminal thoracic aortic repair in the octogenarian and nonagenarian: the New Zealand experience.

Introduction: The aim of this study was to review the New Zealand-wide experience of thoracic endovascular aortic repair to determine effect of age on outcome.

Methods: This was an observational, retrospective analytic study comparing two age groups. The New Zealand Thoracic Aortic Stent (NZTAS) registry was reviewed for patient demographics, indications for repair, risk factors, technical success, complications, length of hospital stay and in-hospital mortality.

Vertebral levels of key landmarks in the neck.

Vertebral levels of key landmarks in the neck are well documented in anatomy texts but are they accurate? This study aimed to investigate the vertebral levels of the hard palate, hyoid bone, thyroid cartilage, cricoid cartilage, and bifurcation of the common carotid artery (CCA) using computed tomography (CT). After excluding patients with distorting pathology, 52 CT scans of the neck from supine adults with a standardized head position (mean age 63 ± 17 years, range 30-94 years; 21 female) were available for analysis by dual consensus reporting. Only the vertebral level of the hard palate (C1) was consistent with contemporary descriptions.

A reappraisal of adult abdominal surface anatomy.

Descriptions of clinically important surface landmarks often vary between and within contemporary anatomical texts. The aim of this study was to investigate the surface anatomy of major abdominal vessels, kidneys, spleen, gastroesophageal junction, and duodenojejunal flexure in living adults using computed tomography (CT). After excluding patients with distorting space-occupying lesions, scoliosis, abnormal lordosis, and obvious visceromegaly, 108 abdominal CT scans of supine adults (mean age 60 years, range 18-97 years; 64 female) at end tidal inspiration were available for analysis by dual consensus reporting.

Anatomical planes: are we teaching accurate surface anatomy?

Anatomical planes used in clinical practice and teaching anatomy are largely derived from cadaver studies. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. The aim of this study was to reassess the accuracy of common anatomical planes in vivo using computed tomographic (CT) imaging.

Association of statin prescription with small abdominal aortic aneurysm progression.

Background: Statins have been suggested to reduce expansion of abdominal aortic aneurysms (AAAs) independent of lipid-lowering effects.

Methods: We assessed the association of statin treatment and serum low-density lipoprotein (LDL) concentrations with small AAA expansion. Six hundred fifty-two patients undergoing surveillance of small AAAs were entered into the study from 5 vascular centers.

Endovascular repair of chronic mesenteric occlusive disease: the role of duplex surveillance.

Background: Chronic occlusive mesenteric ischaemia can be treated surgically or endovascularly. Endovascular techniques as elsewhere in the vascular tree are limited by restenosis. The aim of this study was to determine if duplex ultrasound proven restenosis correlates with recurrence of symptoms.

Comparison of duplex ultrasound with digital subtraction angiography in the assessment of infra-inguinal autologous vein bypass grafts.

Background: Postoperative surveillance of infra-inguinal vein grafts has arisen because of the high incidence of vein graft stenoses, which frequently progress to vein graft occlusion. The use of duplex ultrasound as the primary imaging method for graft surveillance is well established. This study aims to compare the accuracy of duplex ultrasound with the reference standard of digital subtraction angiography in the assessment of infra-inguinal vein grafts.

Informed consent for vascular intervention.

Aim: To audit documentation of the process of informed consent in patients undergoing vascular surgical and radiological procedures.

Method: A retrospective audit of randomly selected elective vascular radiological and surgical admissions was undertaken at Christchurch Hospital (Christchurch, New Zealand) to assess documented evidence of the consent process. Clinic letters, handwritten entries in patient notes, and consent forms were scrutinised and data collated on which medical practitioners took consent, what details of the consent process were documented, and what additional information was made available to patients.

Spectral Doppler characterization of endoleaks following endoluminal abdominal aortic aneurysm repair.

Background: Colour Doppler ultrasound of endoluminal abdominal aortic aneurysm repair is becoming an established imaging technique in identifying endoleak. Management and treatment of endoleak is determined in part by the exact nature of the endoleak, namely its type and whether it has single or multiple vessel inflow and outflow. To date, spectral Doppler waveform analysis has provided some information about the propensity for spontaneous seal of isolated type II endoleaks, rather than assisting in their classification.

Salivary duct intervention.

Interventional sialography can be used to remove stones or delayed strictures from the submandibular or parotid glands. For stone removal, short-tipped, wire retrievable baskets are predominately used. Stones in the intraglandular ducts are almost impossible to remove, while stones proximal to the anatomic genu of either the parotid or submandibular ducts are also difficult to remove.