This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.

BackgroundSecondary aorto‐enteric fistulae (SAEF) are a rare, complex and life‐threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long‐term management.MethodsThis was a retrospective, observational, multi‐institutional cohort study. Patients who had been treated for SAEF between 2003 and 2020 were identified using a standardized database. Baseline characteristics, presenting features, microbiological, operative, and post‐operative variables were recorded. The primary outcomes were short and mid‐term mortality. Descriptive statistics, binomial regression, Kaplan–Meier and Cox age‐adjusted survival analyses were performed.ResultsAcross 5 tertiary centres, a total of 47 patients treated for SAEF were included, 7 were female and the median (range) age at presentation was 74 years (48–93). In this cohort, 24 (51%) patients were treated with initially with OAR, 15 (32%) with EVAR‐first and 8 (17%) non‐operatively. The 30‐day and 1‐year mortality for all cases that underwent intervention was 21% and 46% respectively. Age‐adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR‐first group compared to the OAR‐first group, HR 0.99 (95% CI 0.94–1.03, P = 0.61).ConclusionIn this study there was no difference in all‐cause mortality in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad‐spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.

Objective Chronic venous insufficiency is a common vascular condition with significant resultant patient morbidity. There has been a shift towards minimally invasive treatment modalities with VenaSeal endovenous ablation among the more recent treatment modalities introduced. Long-term outcome data for this treatment modality is not widely available yet. We aim to report 6-week patient outcomes over a 5-year period from a high-volume tertiary vascular centre. Methods This is a retrospective, single-centre study reporting short-term outcomes following VenaSeal endovenous ablation for symptomatic saphenous incompetence. Patients were followed-up at 6-weeks post-procedurally by telemedicine or in-person clinic appointment without routine venous ultrasound assessment. Results We report outcomes for 235 patients during this study period. All patients tolerated the procedure under local anaesthesia. Average age was 60.5 years (29–82 years) with slight male predominance (55.7%). The majority were New Zealand European (63.8%). Mean body mass index was 28.5 (22.2–41.4). We report a 21% rate of self-limiting phlebitis and 33 minor complication events. These include 15 cases of residual varicose veins, 9 saphenous nerve neuropraxia, 6 cases of puncture-site cellulitis and 3 deep vein thromboses. Patient demographics and primary surgeon did not have a statistically significant outcome on development of complications Conclusion We report that VenaSeal endovenous ablation is a safe and effective method of treatment for symptomatic truncal saphenous vein incompetence. We report safely managing post-operative phlebitis conservatively and find a mixture of clinical and phone clinic follow-up sufficient without requirement for objective duplex ultrasound following the procedure to ensure objective saphenous vein closure.

No abstract

Inferior vena cava (IVC) aneurysms remain rare vascular entities that carry significant morbidity and potential mortality. Given the paucity of literature on this clinical entity, there is no consensus regarding management guidelines, and it is important to continue to add to the current literature body. In this report, we describe the case of a 64-year-old male diagnosed with a type III IVC aneurysm. Here, we describe this clinical presentation and discuss our management of this aneurysm in the context of the wider, yet limited literature body.