Urgent aggressive BMT after index-event is associated with a significant reduction in the risk of early NR in CEA candidates. The early risk of recurrent stroke in patients with symptomatic significant carotid stenosis is dramatically reduced after urgent aggressive BMT in specialised stroke clinics.

Introduction: Is it possible by pharmacological methods to attenuate the expansion rate of abdominal aortic aneurysms?Method: An Internet-based systematic literature search was performed to identify published reports on pharmacological methods to influence aneurysmal expansion rate.Results: Of an original 450 articles, 22 remained to review: they included 15 cohort studies with 12,321 patients and seven randomised clinical trials (RCTs) with 1546 patients. Most studies are performed without a pre-study sample size calculation. There is no consistent pattern of pharmacological influence on expansion rate, but statins, non-steroidal anti-inflammatory drugs (NSAIDs) and macrolides should be further evaluated.Conclusion: Properly designed RCTs are needed before conclusions can be drawn on the possibility to pharmacologically attenuate aneurysmal expansion and prevent rupture.

The Hb-PTFE graft significantly reduced the overall risk of primary graft failure by 37%. Risk reduction was 50% in femoro-poplitaeal bypass cases and in cases with critical ischaemia.

In this study there was no difference in primary graft patency between Hb-PTFE and standard PTFE grafts. Patients receiving Hb-PTFE grafts for critical limb ischaemia were more likely to have a patent graft at 5 years than those with standard PTFE grafts.

This paper presents validity evidence for a newly developed, procedure specific assessment tool, Open Aortic Aneurysm Repair Assessment of Technical Expertise (OPERATE), assessing important technical steps of open abdominal aortic aneurysm repair on a simulator, including a credible pass/fail score. The OPERATE can be used to provide structured feedback during simulation based training and to ensure basic open technical skills before supervised training on patients. Objective: The aims of this study were to develop a procedure specific assessment tool for open abdominal aortic aneurysm (AAA) repair, gather validity evidence for the tool and establish a pass/fail standard. Methods: Validity was studied based on the contemporary framework by Messick. Three vascular surgeons experienced in open AAA repair and an expert in assessment and validation within medical education developed the OPEn aortic aneurysm Repair Assessment of Technical Expertise (OPERATE) tool. Vascular surgeons with varying experiences performed open AAA repair in a standardised simulation based setting.All procedures were video recorded with the faces anonymised and scored independently by three experts in a mutual blinded setup. The Angoff standard setting method was used to establish a credible pass/fail score. Results: Sixteen novices and nine experienced open vascular surgeons were enrolled. The OPERATE tool achieved high internal consistency (Cronbach's alpha .92) and inter-rater reliability (Cronbach's alpha .95) and was able to differentiate novices and experienced surgeons with mean scores (higher score is better) of 13.4 AE 12 and 25.6 AE 6, respectively (p ¼ .01). The pass/fail score was set high (27.7). One novice passed the test while six experienced surgeons failed. Conclusion: Validity evidence was established for the newly developed OPERATE tool and was able to differentiate between novices and experienced surgeons providing a good argument that this tool can be used for both formative and summative assessment in a simulation based environment. The high pass/fail score emphasises the need for novices to train in a simulation based environment up to a certain level of competency before apprenticeship training in the clinical environment under the tutelage of a supervisor. Familiarisation with the simulation equipment must be ensured before performance is assessed as reflected by the low scores in the experienced group's first attempt.