Surgical and interventional therapy of VAAs can be life-saving treatments for the patient with a low periprocedural morbidity. The success rate, defined as the exclusion of VAA rupture and the absence of abdominal discomfort, in our material was 88.2% after a mean follow-up of 54.6 months.

The MALS is a rare vascular disorder caused by an extrinsic compression of the celiac artery and induces upper abdominal, mostly, postprandial pain. A definite diagnosis of MALS can be achieved by lateral aortography of the visceral aorta and its branches during inspiration and expiration. Open surgical therapy is a safe and reliable procedure with no mortality and low morbidity. As to the local and specific pathology of the celiac trunk after decompression with fixed stricture or stenosis, further vascular procedures are necessary. The long-time follow-up seemed adequate. The laparoscopic approach reduces the procedure of decompression only, something which seemed inadequate for most cases. Endovascular treatment with percutaneous transluminal angioplasty and insertion of a stent does not solve the underlying problem of extrinsic compression of the celiac trunk and often requires open procedures during the long-term course. Due to the low incidence of MALS, no guidelines will do justice to all the patients sufficiently, and the choice of treatment must depend on the specific clinical situation for each patient.

Chlorhexidine-Alcohol Versus Povidone-Iodine for Surgical-Site AntisepsisDarouiche RO, Wall MJ Jr, Itani KMF, et al. N Engl J Med 2010;362:18-26. Conclusion: For clean-contaminated surgery, cleansing of the patient's skin with chlorhexidine-alcohol reduces surgical-site infections compared with cleansing with povidone-iodine.Summary: There are 27 million operative procedures performed annually in the United States (Infect Control Hosp Epidemiol 1999;20:250-78). Surgical-site infections occur in 300,000-500,000 patients in the United States each year (J Am Coll Surg 2008;206:814-9; JAMA 2005;294: 2035-42). There are recommendations by the Centers for Disease Control and Prevention (CDC) to use 2% chlorhexidine preparations for preoperative cleansing of sites for insertion of vascular catheters, but no CDC recommendations have been put forth regarding antiseptics to prevent surgical-site infection in surgical procedures.This study compared the efficacy of povidone-iodine and chlorhexidinealcohol in preventing surgical-site infections in patients with clean-contaminated operations in six university-affiliated hospitals. Patients were randomly assigned to preoperative skin preparation with chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. Surgical-site infection Յ30 days was the primary outcome. Secondary outcomes included individual types of surgicalsite infection.There were 849 patients (440 in the povidone-iodine group and 409 in the chlorhexidine-alcohol group) that qualified for intention to treat analysis. Surgical-site infection rates were lower in the chlorhexidine-alcohol group than the povidone-iodine group (9.5% vs 16.1%; relative risk, 0.59; 95% confidence interval, 0.41-0.85; P ϭ .004). With regard to secondary end points, chlorhexidine-alcohol was more protective against surgical-site infections than povidone-iodine for superficial incisional infections (4.2% vs 8.6%, P ϭ .008) and deep incisional infections (1% vs 3%, P ϭ .05). There was no difference in protection against organ-space infections 4.4% vs 4.5%. There were 813 patients who were in the study for 30 days and were subject to a per protocol analysis. Overall results remain similar. No differences were noted in adverse events in the two study groups.Comment: In the accompanying editorial to this article, Dr Richard Wenzel makes the observation that human beings have approximately 10 13 total cells, with a total number of colonizing microbes per human being of 10 14 . Basically, bacteria have a 10:1 numerical advantage! The study indicates that all infections at a specific anatomic site can be reduced with a relatively inexpensive process. By substituting chlorhexidine-alcohol for povidone-iodine, all we need to treat are 17 surgical patients with cleancontaminated wounds to prevent 1 surgical-site infection. Of course, vascular surgical procedures fall primarily into the clean-wound category rather than clean-contaminated, as studied here. Nevertheless, the weight of the available literature with respect to chlorhexidine-alco...