We present a rare case of fistulation from the duodenum into the prosthesis site of an aortic Y graft removed 8 months previously owing to infection. We have verified the topographical and anatomical location of the fistulation by fistula filling and CT and MR examination. To our knowledge such a postoperative complication has not been previously documented. In evaluating and comparing our observation we discuss their significance for topographical associations and prognosis and as an indication for surgical intervention.

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Aortic aneurysms can be visualised in the transverse, sagittal and coronary planes using magnetic resonance (MR) thereby enabling their cranio-caudal distension as well as their breadth and depth to be accurately determined. The important question concerning the vessel exits of the main branches of the aorta and their involvement in the aneurysm can be reliably answered. In the case of dissecting aortic aneurysms, the two lumina as well as the dissected vessel wall can be seen in the image. By choosing suitable recording parameters it is possible to differentiate between flowing blood and a thrombus attached to the vessel wall. The thrombus is recognisable from the decrease it causes in the signal intensity of the T2-selected image, whereas flowing blood emits a stronger signal in the T2-selected image than in the T1-selected image. An indication of the flow behaviour and flow rate of blood can be obtained from the differences in the signal intensity distribution in the vessel lumen.

Valvulotomy for in situ vein bypass is commonly performed with a valvulotome. Although the procedure can be controlled through an angioscope, the dangers of intimal damage and valve remnants remain. An experimental study was designed to evaluate angioscopic laser valvulotomy compared with standard mechanical valvulotomy (n = 16). Two different laser probes, a bare 400-microns fibre (n = 20) and a 2-mm hot-tip (n = 26) were tested. Results were investigated by histology and scanning electron microscopy. Hot-tip laser valvulotomy achieved significantly better results than the 400-microns fibre. The Insitucat valvulotome yielded the worst results, with valve remnants in all cases and an 88 per cent rate of intimal damage. It is concluded that laser valvulotomy can be performed simply and safely with a very low incidence of valve remnants and intimal damage.