Reapplix ApS.

Background and Purpose-We sought to assess the clinical value of regional cerebral saturation (rSO 2 ) obtained by means of the cerebral oximeter INVOS 3100A (Somanetics) in comparison to monitoring of somatosensory evoked potentials (SEP) for the reliable detection of severe cerebral ischemia requiring shunt placement in the individual patient undergoing carotid surgery under general anesthesia. Methods-In 317 patients undergoing reconstructive surgery on the internal carotid artery, simultaneous recordings of SEP and rSO 2 were obtained throughout the operation. Results-All 287 patients with preserved cortical SEP remained neurologically intact. Shunt placement was performed in 27 patients (9%) after flattening of cortical SEP during cross-clamping of the internal carotid artery. A stable rSO 2 value just before cross-clamping and the lowest value after cross-clamping were registered, and the decrease was calculated. A statistically significant (PϽ0.01) decrease of rSO 2 after cross-clamping could be found in patients without (64.9Ϯ8.3% to 60.9Ϯ9.9%) as well as in patients with consecutive loss of cortical SEP (65.8Ϯ9.1% to 56.1Ϯ13.4%).The difference of the decrease of rSO 2 in both groups was highly significant (6.9Ϯ9.0% versus 15.6Ϯ14.0%; PϽ0.001).However, substantial interindividual variability of rSO 2 and derived change of rSO 2 did not allow the definition of a threshold value indicating need of shunt placement. Conclusions-The

Heel raising produced changes in ankle pressure which correlated well with those induced by treadmill exercise. We recommend the use of simple heel raising when a stress test is required to diagnose lower limb arterial insufficiency in the outpatient clinic.

Only 30 per cent of unselected AAAs presenting to a vascular service are entirely suitable for EVAR; most of these patients can safely undergo open AAA repair. These data suggest that increased use of EVAR is only possible by deploying devices in suboptimal morphology, and in treating patients who would not normally be considered for open AAA repair.

SummaryStroke in young adults may be devastating and frequently no cause can be found. However, there is ample literature to suggest an association between cryptogenic stroke in young people and paradoxical embolisation via a venous to arterial circulation shunt (v-aCS), commonly due to patent foramen ovale (PFO). Although paradoxical embolisation is assumed to be a rare event, this review suggests that it is an important or even dominant cause of stroke in young people and that a transcranial Doppler (TCD) technique may be the investigation of choice to identify v-aCS.Appendix I, II on pp. 26-7