BTA angioplasty for pedal and plantar arterial occlusive disease is technically feasible. It has good medium-term clinical outcome and limb salvage in a group of patients with poor surgical options.

Pre- and post-operative assessments are presented in 17 adult patients who have been treated with craniovertebral decompression for hindbrain herniation, 11 of whom had syringomyelia. Objective improvement in the size of the syrinx was seen in all 11 cases; contrary to expectation the hindbrain more frequently moved downwards than upwards after decompression of the tonsils and creation of an artificial cisterna magna. A method is reported for the quantitative assessment of hindbrain migration using magnetic resonance imaging (MRI). The degree of 'slump', further downward displacement of the hindbrain, was compared with the clinical outcome and the MRI appearances. Slump was more common than expected, although the severity was not usually great enough to produce symptoms. Slump was less marked where the artificial cisterna magna was generous (p less than 0.02). This quantitative method may be useful in assessing patients with unexplained post-operative symptoms and in comparing different surgical techniques.

We present a patient with Ehlers-Danlos syndrome type IV (EDS IV) with a carotid dissecting pseudoaneurysm causing severe carotid stenosis. This lesion was treated endovascularly. Unfortunately, the patient died of remote vascular catastrophes (intracranial hemorrhage and abdominal aortic rupture). This unique case illustrates the perils of endovascular treatment of EDS IV patients and the need for preoperative screening for concomitant lesions. It also shows that a dissecting pseudoaneurysm can feasibly be treated with a covered stent and that closure is effective using Angioseal in patients with EDS IV.

Pseudoaneurysms due to musculoskeletal trauma are rare and comprise less than 2% of all pseudoaneurysms. We report a case of axillary pseudoaneurysm following anterior dislocation of the shoulder. The patient was successfully treated by endovascular intervention.

Background: Establishing a diagnosis of giant cell arteritis, or indeed ruling it out, may be difficult. We describe an evaluation of temporal artery colour duplex ultrasound as first line investigation in patients with suspected giant cell arteritis. Methods: A retrospective cohort study of all patients undergoing colour duplex ultrasound for suspected giant cell arteritis between January 2005 and January 2014 was undertaken at a teaching hospital. A minimum clinical follow-up of three months was required. Patients were classified on the basis of ultrasound reports, using described features such as a halo sign or arterial wall thickening and clinical diagnosis of giant cell arteritis after at least 3 months follow-up, determined by the treating physician. The relationship of colour duplex ultrasound to a final clinical diagnosis of giant cell arteritis was analysed. Results: A total of 87 patients underwent colour duplex ultrasound: 36 (41%) had clinically confirmed giant cell arteritis at 3-month follow-up. The positive predictive value of colour duplex ultrasound for a clinical diagnosis at 3 months was 97% (95% confidence interval (CI) 93 to 99%) and negative predictive value 88% (95% CI 76 to 95%). Sensitivity was 81% (95% CI 64 to 92%) and specificity 98% (95% CI 90 to 100%). Conclusions: A high positive and negative predictive value of arteritis on colour duplex ultrasound indicates that temporal artery biopsy may be unnecessary in suspected giant cell arteritis, particularly where clinical suspicion of giant cell arteritis is high or low. Keywords 269clinical providers and archived paper medical records as necessary. For the purposes of this study, a clinical diagnosis of GCA made by a consultant rheumatologist, alone or in collaboration with other specialists, after a minimum of 3 months of follow-up, served as the reference or 'gold' standard for a diagnosis of GCA. The American College of Rheumatology (ACR) criteria for GCA were also used to classify all cases for comparison. 4 CDUS was performed on all patients. Examinations were performed by one of two consultant radiologists experienced in vascular ultrasound. Radiologists were not blinded to the suspicion of GCA or clinical data including laboratory test results. Studies were performed using a high-resolution multi-D linear array transducer VFX 13-5 MHz with a Doppler frequency above 6.5 MHz (Hitachi HA700, Hitachi Medical Systems). This probe gives a high frequency range up to 13 MHz and is designed for high resolution imaging of superficial structures. Each patient was examined using standard settings (frequencies of 13.0 MHz for B-mode and 9.0 MHz for colour-mode scanning).Ultrasound examination of the temporal arteries included longitudinal and transverse views of the common superficial temporal arteries and the frontal and parietal branches on both sides as completely as possible (dynamic range 45-50 dB, wall filter low or general, pulse repetition frequency 2250 Hz). The temporal and common carotid artery wall thicknesses on both s...