The burden of AAA disease has been falling since at least 1991 in NZ, and since 1995 in England and Wales. Although survival appears to be improving, most of the reduction is due to lower disease incidence.

Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.

Ethnic variation in the incidence, mortality and cumulative relative survival from AAA in NZ resembles ethnic inequalities in other health outcomes. This provides additional support for screening on equity grounds.

Over a five-year period 64 Quinton Permcaths were inserted into 51 dialysis patients (age range 17-72 years, mean 52.1 SD 12.83). The duration of catheter use ranged from 5 to 1479 days, mean 315.7 SD 337. The actuarial catheter survival rate at 1 year was 74%, at 2 years 43%, at 3 years 25% and at 4 years 12%. The indications for use were: exhausted peripheral access; CAPD contraindicated; abrupt failure or lack of an arteriovenous fistula; acute renal failure; limited life expectancy; patient insistence; conventional access contraindicated. Only minor complications occurred during insertion: haemorrhage requiring exploration in three patients and a temporary left recurrent laryngeal nerve palsy in one patient. The exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively. Eighteen catheters failed due to infection (range of use 72-1479 days, mean 559 SD 388). Inadequate initial blood flow (less than 150 ml/min) occurred in 10% of dialyses but only six catheters failed due to intractable flow difficulties (range of use 5-49 days, mean 22 SD 17.5). Catheter sepsis was implicated in the death of two patients. One subclavan/innominate vein thrombosis occurred. The Quinton Permcath represents a significant advance providing immediate, durable, and relatively safe access in a variety of difficult circumstances.

Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V-POSSUM) is a risk-adjusted scoring system for predicting 30-day mortality in patients undergoing vascular surgery. It can assess surgical performance by comparing predicted deaths with observed deaths. The aim of this analysis was to assess trends in surgical performance over time using risk-adjusted 30-day mortality as the primary outcome. Major vascular surgery procedures (n = 454) were prospectively scored for V-POSSUM between 1995 and 2006. Procedures were divided into 11 consecutive time bands. Observed and predicted deaths were compared using the logistic regression equation derived for V-POSSUM. The observed death rates decreased over time, as did the predicted number of deaths calculated from the V-POSSUM scores. The overall predicted mortality rate was 17.2% and the rate varied with the 12-month period, with a high of 23.9% and a low of 9.2%. The downward trend in the predicted rate shows that the patient risk factors have changed over time and that the risk of dying has declined by almost 50% (from 21.6 to 11.1%). There was a trend towards improved surgical performance over time, with a drop in the observed to predicted ratios of deaths. Observed and predicted deaths changed over the study periods. There was a trend towards improved performance compared with the risk-adjusted predicted mortality. V-POSSUM is a useful tool in the longitudinal assessment of performance in major vascular surgery.