Overall the quality of reported data on IIA sacrifice is poor. Buttock claudication and erectile dysfunction occurred frequently after IIA sacrifice. Where both options are technically possible, plugs could be considered preferential to coils, and placed as proximally in the IIA as possible.

Conclusions: These quality indicators will help clinicians to assess the appropriateness of healthcare provided in PAD. The development of evidence-based indicators in PAD is limited by the lack of methodological quality of the research in this disease, the inconclusiveness of the evidence on diagnostic and surgical techniques, and the dynamic nature of the vascular diseases field.

Coral reef aorta is a rare condition characterised by extreme calcific growths affecting the juxta and suprarenal aorta. It can cause symptoms due to visceral ischaemia, lower limb hypoperfusion, and distal embolisation. We present a case of a 61-year-old man with unresponsive hypertension, who was found to have an occluded right renal artery, and an extensive coral reef aorta with a marked pressure gradient across the lesion. Renal hypoperfusion secondary to aortic coral reef aorta was thought to be the cause for his hypertension. Endovascular placement of a balloon expandable uncovered stent resolved his hypertension within one month, with no adverse effects noted at subsequent follow-up. Endovascular treatment of coral reef aorta is technically possible and avoids a major vascular procedure.

A report of a study set up to discover whether patients with healed venous ulcers were receiving adequate investigation after recurrent ulceration.

Peripheral artery aneurysms a r e uncommon and almost always occur in the lower limb. T h e popliteal artery accounts for 55 per cent and the common femoral artery for 42 per cent of aneurysms of the leg'. Aneurysms of t h e profunda femoris artery ( P F A ) a r e estimated t o represent 0.5 per cent of all peripheral artery aneurysms b u t a r e rarely considered as a cause of thigh swelling and are often missed, with subsequent limb loss. A ruptured PFA aneurysm in which the diagnosis had been missed, with potentially catastrophic consequences, is reported. Case reportA 77-year-old man suddenly developed a painful swelling in the left thigh while on holiday abroad. He continued his 2-week vacation and on return to the U K was referred by his general practitioner to hospital where an 8-cm abdominal aortic aneurysm was found on ultrasonography. The patient was concerned that he was scheduled for abdominal operation only to repair the aortic aneurysm and requested a second opinion. The man had had no previous cardiac or cerebrovascular disease and no symptoms of intermittent claudication. He was anaemic, with left upper thigh swelling and bruising over the medial aspect. Bilateral femoral and popliteal artery aneurysms were identified with all peripheral pulses palpable. Routine laboratory investigations revealed a hypochromic microcytic anaemia (haemoglobin level 8.8 g/dl; all other indices were normal). Colour Doppler ultrasonography demonstrated a large aneurysm arising from a connection with the left PFA. Computed tomography of the pelvis and upper thighs confirmed aneurysms of the abdominal aorta and both common iliac arteries. In the upper thigh there was a 20-cm diameter heterogeneous soft tissue mass continuous with the profunda femoris vessel with a clear soft tissue plane between it and the superficial femoral artery on all sections ( Figure I ). This aneurysm was confirmed by arteriography ( Figure 2 ) .Laparotomy revealed a 7-cm aneurysm of the aorta and right common iliac artery, with a 3-cm aneurysm of the left internal iliac artery. A massive aneurysm in the left thigh contained 2 litres of old thrombus and blood clot, and communicated freely with a ruptured aneurysm of the left PFA 8 cm from its origin. After cross-clamping, the aortic and iliac aneurysms were opened and the lumbar arteries under-run with polyglactin sutures. The left external and internal iliac arteries and right external iliac arteries were oversewn with polypropylene, and an 8-mm Dacron ( D u Pont, Stevenage, U K ) tube graft sutured into the origin of the right internal iliac artery. A 22 x 11 mm bifurcation graft was anastomosed end to end to the infrarenal aorta. Both limbs were directed retroperitoneally and anastomosed end to end to the common femoral bifurcation, and the right internal iliac graft was sutured end to side to the right limb of the bifurcation graft. The aneurysm in the left thigh was opened and the feeding PFA ligated proximally and sutured distally. After surgery the patient developed a lymphocele of the ri...