Background Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra‐anatomical bypass. Long‐term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in‐situ arterial reconstruction using cryopreserved allograft as a conduit. Methods The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). Results There were three peri‐operative mortalities (23%) with all three mortalities related to graft re‐infection and post‐implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re‐infection or aneurysmal degeneration. Conclusion Patients that survived the peri‐operative period demonstrated acceptable medium‐term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide‐spread use in our state remains inadequate supply of banked cryopreserved tissue.

Background Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision‐making about vascular surgery in the resource constrained COVID‐19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. Methods The COVID‐19 Vascular Service in Australia (COVER‐AU) prospective cohort study evaluates 30‐day and six‐month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March–July 2020. The primary outcome was mortality, with secondary outcomes procedure‐related outcomes and hospital utilization. Frailty was assessed using the nine‐point visual Clinical Frailty Score, scores of 5 or more considered frail. Results Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% ( n = 20) and 5.9% ( n = 35) respectively with no significant difference between frail and non‐frail patients (OR 1.68, 95%CI 0.79–3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non‐frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non‐frail patients, after adjustment (OR 2.01; 95% CI 1.17–3.78), driven by a high rate of amputation during the period of reduced surgical activity. Conclusion Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.

titles with an asterisk were judged for the RACS/?? Research Prize for Trainees.Objective: To report the early human results of H.E.L.P. technology in the prevention of major limb amputation. In the short-term, the aim was to pressure dilate collateral channels and in the long-term to stimulate remodelling and new collateral pathways by increasing endothelial shear stress. Methods: A pilot study consisted of the ischaemic limbs of 15 patients with critical limb ischaemia. These patients had no other option but major amputation as determined by at least two vascular surgeons. The limbs were connected to a commercially available cardiac pump via an access system. The limbs were hyperperfused pancycle at 2-3 times the mean arterial pressure (MAP). This was performed intermittently in sessions of 24-36 hours. The major endpoint was avoidance of major amputation. Results: Given adequate arterial access, 29 of 30 connections developed flows 4-8 times the MAP. There was a progressive decrease in peripheral resistance. All patients developed a pain-free, warm foot or hand whilst on the pump in the short-term. In the longer term, a mean of 10.4 months (range 1-29 months) 50% had avoided major amputation. Pain scores changed from 0.9 ± 0.1 to 1.1 ± 1.3 under the visual analogue scale (V.A.S). The ankle brachial index (A.B.I) changed from 0.06 ± 0.09 to 0.57 ± 0.33, p < 0.05 (t test). Conclusions: The collateral circulation of ischaemic limbs can be augmented and regulated via connection to an extracorporeal cardiac pump. The technique is similar to haemodialysis. Major amputation can be avoided in selective cases. Improvements in the technology are continuing.

A survey to determine the prevalence and nature of behaviour problems (adjustment difficulties) in State primary school children in the South Coast Region of Queensland, was conducted using a personally abbreviated form of the Achenbach and Edelbrock (1986) Child Behaviour Checklist - Teacher Report Form (CBCL-TRF). The subjects of this study were 494 children (407 boys and 87 girls) aged between 6 and 13 years, who were nominated by teachers from a random selection of 30 schools in the Region. Teachers were asked to complete the checklists on children whose behaviour had caused them concern within the last two months. Results indicated that 3% (494) of the children in these schools were reported to have a behaviour problem as perceived by teachers, and 23% (370) were determined to have a behaviour problem in the clinical range of functioning, according to the CBCL-TRF. Specific types of problems were identified in each of the age and gender groups, but aggression was perceived to be the most frequent problem across age and gender. Behaviour problems were also shown to be associated with poor academic performance. Overall this study provides useful information, in the form of general prevalence estimates, on which to base a regional adjustment policy.

Background: Acute limb ischaemia (ALI) is a limb and life-threatening condition with significant morbidity. There are currently no consensus recommendations for the investigative practices to determine the aetiology of ALI presenting without a known aetiology. We undertook a detailed analysis of all investigations performed to identify an underlying precipitant in those with unexplained ALI and formulated a suggested diagnostic algorithm for the evaluation of unexplained ALI. Methods: ALI cases presenting to a tertiary referral centre over a 3-year period were reviewed, and known aetiologies, and investigations undertaken to determine the underlying aetiology of unexplained ALI were obtained. Results: Unexplained ALI was found in 27 of 222 patients (12%), of which 21 (78%) had a cause for ALI established after further investigations. Six patients had no cause identified despite extensive work-up. Most patients with unexplained ALI had a cardioembolic source identified as the underlying cause (62%), and this included atrial fibrillation, infective endocarditis, cardiac myxoma and intra-cardiac thrombus. Other causes of unexplained ALI were detected by computed tomography (CT) imaging and included newly diagnosed significant atherosclerotic disease (19%), embolism from isolated proximal large vessel thrombus (10%) and metastatic malignancy (10%). There were no cases attributed to inherited thrombophilias, myeloproliferative neoplasms or anti-phospholipid syndrome. Conclusion: Among patients with unexplained ALI, the majority had a cardioembolic source highlighting the importance of comprehensive cardiac investigations. A subset of patients had alternative causes identified on CT imaging. These data support the use of a collaborative and integrative diagnostic algorithm in the evaluation of unexplained ALI. 1 Cardiac mass 1 Combined recent vascular intervention and trauma 1