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Objective: The following procedures are the 3 main methods of endovascular repair (EVR) of abdominal aortic aneurysms (AAA): aorto-aortic bypass grafting, bifurcated bypass grafting, and aorta uni-iliac grafts. The latter method has the potential disadvantage of requiring an extra anatomic graft (ie, a femorofemoral crossover bypass graft) to maintain contralateral pelvic and limb perfusion. The aim of this study was to assess the complications associated with the femorofemoral crossover bypass graft after aorta uni-iliac EVR of AAA., Method: A prospective review was conducted of the complications attributable to the femorofemoral crossover bypass graft in 136 patients who underwent EVR of AAA with an aorta uni-iliac device., Results: During a median follow-up of 7 months (range, 0 to 36 months), 4 patients had superficial wound infections that required antibiotic treatment and 2 patients had bypass graft infections. Nine hematomas developed: 7 (5%) groin hematomas (6 in patients with Dacron bypass grafts), 1 scrotal hematoma, and 1 perigraft hematoma. One bypass graft thrombus developed., Conclusion: The femorofemoral crossover bypass graft is a safe and a durable component of EVR of AAA with an aorta uni-iliac device. The results are similar to those with bifurcated devices.

Stenosis of the external iliac artery in healthy athletes, although uncommon, has been reported in competition cyclists. A case of a racing cyclist whose chronic vague leg symptoms were incorrectly attributed to L4/5 nerve root irritation is reported. This highlights the importance of clinical vascular testing when assessing ill defined leg pain. The role of trauma as a causative factor in this condition has not been previously documented.

Purpose: The aim of this study was to evaluate the feasibility of endovascular aortic aneurysm repair with use of an aortouniiliac graft secured with self-expanding (Gianturco) stents., Methods: Thirty patients with a median age of 72 years (age range, 52 to 86 years) and aneurysm diameter of 6.0 cm (range, 4.0 to 9.0 cm) were treated with an aortouniiliac endovascular graft. Of these 30 procedures, 28 were carried out electively and two as emergencies for leaking aneurysm. Of the 30 patients, 21 (70%) were considered to be at high risk for open surgery. A modified Gianturco stent, Dacron graft, and Wallstent were used for these procedures., Results: Endovascular repair was successfully carried out in 25 of 30 (83.3%) patients. All these patients were mobile and had resumed a normal diet within 48 hours of the procedure. The overall 30-day mortality rate was two in 30 (6.6%), but it was one in 28 (3.5%) for the elective cases; all deaths occurred in the group at high risk for surgery. Other complications encountered within 30 days of procedure included myocardial infarction in one patient, pneumonia in two patients, homonymous quadrantanopia in one patient, and colonic ischemia in one patient, giving an overall morbidity rate of four in 30 (13.3%). At a median follow-up of 4 months (range, 1 to 13 months), 27 of 30 (90%) patients remain alive and well., Conclusion: Endovascular aortouniiliac repair of abdominal aortic aneurysm with Gianturco stent is feasible in both elective and emergency situations. It appears to be minimally traumatic, and the majority of patients deemed to be at high risk for open surgery can safely undergo endovascular repair. However, data on more patients with longer follow-up is required to determine its role in the management of abdominal aortic aneurysm.

Objectives: To assess the accuracy of Duplex ultrasound in the assessment of aortoiliac disease., Design: Prospective, semi-blind study., Setting: Vascular laboratory and radiology departments, University Hospital., Materials and Methods: Ninety-two patients underwent assessment of the aortoiliac segment by femoral pulse palpation, Duplex ultrasound and biplanar arteriography. Of these 184 aortoiliac segments, 68 were also assessed by intraarterial pressure measurements and 80 by magnetic resonance angiography (MRA)., Main Results: Femoral pulses were abnormal in all 32 occluded aortoiliac segments. Of 152 patent segments, femoral pulse palpation was misleading in 50 (33%). MRA detected all occlusions and had a sensitivity of 71% and specificity of 68% for stenoses, compared to arteriography. Colour flow Duplex misdiagnosed four occlusions as stenoses. Duplex had a sensitivity of 91% and specificity of 93% for stenoses when compared to arteriography. Two stenoses, detected by Duplex and confirmed by pressure gradients, were missed by arteriography., Conclusions: Pressure measurements remain the gold standard for aortoiliac examination, arteriography providing only morphological information. The limitations of femoral pulse palpation should be appreciated. Although MRA was faster, Duplex examination proved slightly more sensitive to stenoses. At present, colour Duplex provides the best non-invasive assessment of aortoiliac disease and could prevent unnecessary arteriograms.

Inflammatory aneurysms of the abdominal aorta (IAA) comprise 10-15% of all aortic aneurysms (AA) but their aetiology and pathogenesis are obscure. Destruction of mural elastin is a prominent feature of IAA, and both increased elastolysis and decreased inhibition of elastolysis have been implicated. In order to study these factors, we have examined the peripheral blood of three groups of patients; 15 with inflammatory aortic aneurysms (IAA), 61 with simple aortic aneurysms (SAA) and 35 with aorto-iliac occlusive disease (OD). In all cases, alpha-1-anti-trypsin (A-1-AT), alpha-2-macroglobulin (A-2-MG), elastase inhibitory activity (E.I.A.), elastase-anti-trypsin complex, C-reactive protein (CRP), caeruloplasmin (CP) and plasma viscosity were measured. Patients with IAA had a significantly higher plasma viscosity (Mann-Whitney, p less than 0.05), E.I.A. (Mann-Whitney, p less than 0.01) and levels of A-1-AT, CRP, CP and elastase/anti-trypsin complex (Mann-Whitney, all p less than 0.05) than patients in the other two groups. There was no difference in the levels of A-2-MG between any of the groups. This study refutes the theory that reduced inhibition of elastase activity predisposes to the formation of SAA. In patients with IAA, raised marker levels indicate ongoing destruction of elastin, and suggest a difference in pathogenesis between IAA and SAA. The study also suggests that IAA are highly active metabolically, as opposed to the more degenerative SAA.