Combined Endovascular/Surgical Management of a Ruptured Para-Anastomotic Aneurysm of the Left Common Iliac Artery#

A 75-year old man presented with signs and symptoms of acute abdomen and a clinical picture of hypovolemic shock. An emergency CT scan revealed a ruptured para-anastomotic left common iliac artery aneurysm. The patient had undergone an elective abdominal aortic aneurysm repair operation and placement of an aortoiliac bifurcated graft 10 years before. Para-anastomotic aneurysms had developed in all 3 (aortic and the 2 iliac) anastomosis. As the patient was highrisk, a combined endovascular/surgical approach was undertaken. The patient was discharged 4 days later

Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

<p>Abstract</p> <p>Background</p> <p>The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1^stJanuary 2009 and 31st December 2010.</p> <p>Results</p> <p>Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention.</p> <p>Conclusions</p> <p>The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.</p

Future priorities for a climate-friendly transport:A European strategic research agenda toward 2030

Research is a key factor for a successful reduction in greenhouse gas (GHG) emissions from transport. This article summarizes the main results of REACT, a project cofinanced by the European Commission, which aimed to develop a European Strategic Research Agenda for low GHG transport. A literature review and a multistage expert consultation process were used to map technological and nontechnological research areas and evaluate them according to different criteria (i.e., GHG emissions reduction, cost-efficiency, feasibility, time frame of research stages). We consulted the research agendas of the European Technologies Platforms on transport and current EU research programs. Expert opinions were collected through web forms, interviews, and participation in structured workshops. The REACT Research Agenda identified the following research priorities for a more climate-friendly transport system by 2030: (a) in the short term, cost-effective solutions consist of (1) more efficient, lighter vehicles with advanced internal combustion engines, (2) reducing road transport demand and (3) fostering GHG emission legislation; (b) in the medium/long term, the focus shifts toward (1) electric vehicles and hydrogen, (2) Intelligent Transport Systems, and (3) spatial planning and economic and social measures to reduce transport demand. In addition, one of the main findings identified strong links between technology research and planning, social sciences, and economy.</p

Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair

Background: Despite the intuitive advantages of endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (AAAs), uncertainty remains about the optimal management in the absence of convincing high-quality evidence. Our objective was to undertake a comprehensive literature review and perform a meta-analysis of outcome data of treatment modalities for ruptured AAAs. Methods: Systematic searches were conducted of electronic information sources to identify studies comparing perioperative outcomes of EVAR and open repair for AAA rupture. Summary estimates of odds ratios (ORs) or standardized mean difference and 95% confidence intervals (CIs) were obtained with a random-effects model. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time. Results: We selected 41 studies for analysis. The entire meta-analysis population comprised 59,941 patients (8201 EVAR patients and 51,740 open repair patients). EVAR was associated with a significantly lower incidence of in-hospital mortality (OR, 0.56; 95% CI, 0.50-0.64; P &lt; .01; meta-analysis of risk-adjusted observational studies and randomized controlled trials: OR, 0.58; 95% CI, 0.46-0.73; P &lt; .01). EVAR patients had a significantly decreased risk of developing respiratory complications (OR, 0.59; 95% CI, 0.49-0.69; P &lt; .01) and acute renal failure (OR, 0.65; 95% CI, 0.55-0.78; P &lt; .01) and a trend toward a reduced incidence of cardiac complications (OR, -0.02; 95% CI, -0.03 to 0.00; P = .05) and mesenteric ischemia (OR, 0.66; 95% CI, 0.44-1.00; P = .05). Patients treated with EVAR had significantly less requirements of intraoperative blood transfusion (standardized mean difference, -0.88; 95% CI, -1.06 to -0.70; P &lt; .01). Random-effects meta-regression revealed no statistical evidence for an association between death and year of publication (P = .19). Conclusions: Our analysis provides evidence to motivate the adoption of an EVAR-first policy in a nonelective setting and the establishment of standardized protocols for the management ruptured AAAs

Future priorities for a climate-friendly transport: A European strategic research agenda toward 2030

Research is a key factor for a successful reduction in greenhouse gas (GHG) emissions from transport. This article summarizes the main results of REACT, a project cofinanced by the European Commission, which aimed to develop a European Strategic Research Agenda for low GHG transport. A literature review and a multistage expert consultation process were used to map technological and nontechnological research areas and evaluate them according to different criteria (i.e., GHG emissions reduction, cost-efficiency, feasibility, time frame of research stages). We consulted the research agendas of the European Technologies Platforms on transport and current EU research programs. Expert opinions were collected through web forms, interviews, and participation in structured workshops. The REACT Research Agenda identified the following research priorities for a more climate-friendly transport system by 2030: (a) in the short term, cost-effective solutions consist of (1) more efficient, lighter vehicles with advanced internal combustion engines, (2) reducing road transport demand and (3) fostering GHG emission legislation; (b) in the medium/long term, the focus shifts toward (1) electric vehicles and hydrogen, (2) Intelligent Transport Systems, and (3) spatial planning and economic and social measures to reduce transport demand. In addition, one of the main findings identified strong links between technology research and planning, social sciences, and economy

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable