The role of the chimney technique in the management of complex abdominal aortic aneurysms is still unclear. This technique has relatively good results, considering the anatomic limitations of the aortic neck. However, long-term endograft durability and proximal fixation remains a significant concern. Thus, there is a reasonable hesitation to embrace the method for widespread use in the absence of long-term data.

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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.

Percutaneous metallic biliary stenting provides good palliation of malignant jaundice. Partial liver drainage achieved results as good as those after complete liver drainage. A serum bilirubin level of less than 4 mg/dl after stenting is the most important independent predictor of survival, while increasing age and Bismuth IV lesions represent dismal prognostic factors.

Purpose:To evaluate the usefulness of a time-efficient MRI method for the quantitative determination of tissue iron in the liver and heart of ␤-thalassemic patients using spinspin relaxation rate, R2, measurements. Materials and Methods:Images were obtained at 1.5 T from aqueous Gd-DTPA solutions (0.106 -8 mM) and from the liver and heart of 46 ␤-thalassemic patients and 10 controls. The imaging sequence used was a respiratorytriggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spinecho (SE) pulse sequence (TR ϭ 2000 msec, TE min ϭ 5 msec, echo spacing (ES) ϭ 5 msec, matrix ϭ 192 ϫ 256, slice thickness ϭ 10 mm). Liver iron concentration (LIC) measurements were obtained for 22 patients through biopsy specimens excised from the relevant liver segment. Biopsy specimens were also evaluated regarding iron grade and fibrosis. Serum ferritin (SF) measurements were obtained in all patients.Results: A statistically significant difference was found between patients and healthy controls in mean liver (P Ͻ 0.004) and myocardium (P Ͻ 0.004) R2 values. The R2 values correlated well with Gd DTPA concentration (r ϭ 0.996, P Ͻ 0.0001) and LIC (r ϭ 0.874, P Ͻ 0.0001). A less significant relationship (r ϭ 0.791, P Ͻ 0.0001) was found between LIC measurements and SF levels. R2 measurements appear to be significantly affected (P ϭ 0.04) by different degrees of hepatic fibrosis. The patients' liver R2 values did not correlate with myocardial R2 values (r ϭ 0.038, P Ͻ 0.21). Conclusion:Tissue iron deposition in ␤-thalassemic patients may be adequately quantified using R2 measurements obtained with a 16-echo MRI sequence with short ES (5 msec), even in patients with a relatively increased iron burden.