IntroductionSpontaneous iliac arteriovenous fistulae are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, therefore, is often incidental or delayed.Case presentationWe report a case of a spontaneous ilio-iliac arteriovenous fistula in a 68-year-old Caucasian man detected following presentation with unilateral claudication and congestive cardiac failure. Following computed tomography evaluation, the fistula was successfully treated with a combined endovascular (aorto-uni-iliac device) and open (femoro-femoral crossover) approach.ConclusionEndovascular surgery has revolutionized the management of such fistulae and we report an interesting case of a high-output iliac arteriovenous fistulae successfully treated with a hybrid vascular approach.

Introduction Ankle/brachial indices are inaccurate in the presence of calcification, and physicians may rely on the measurement of digital pressures. As the population continues to age and with the escalation in type 2 diabetes, the importance of, and reliance on, toe pressure measurements will increase. The aim of this study was to assess the reproducibility of toe pressure measurements in a single vascular laboratory. Methods Repeated ankle/brachial indices and toe pressures were measured in 20 patients (10 with known peripheral vascular disease and 10 with aneurysmal or carotid artery disease but no history of PVD), and 10 control patients. Three measurements were made 48 hours apart. All measurements were made by a single vascular technologist. Reproducibility was assessed by the use of the repeatability coefficient and the intraclass correlation coefficient. Results Ankle/brachial indices ranged from 0.36 to 2.4, toe pressures from 18 mmHg to 173 mmHg, and toe/brachial indices from 0.11 to 1.1. The repeatability coefficient showed no significant difference between measurements ( p > 0.1) and the intraclass correlation coefficient estimates showed high agreement between repeated measurements (0.77–0.99). Bland-Altman plots indicated that the observer variability was equally distributed across the range of pressure measurements. Conclusion These results confirm the intraobserver reproducibility of toe pressure measurements; however, further work is required to demonstrate inter-observer reproducibility.

A paradigm shift has occurred towards endovascular management of aortic, iliac and femoral arterial disease. Whilst patient age >75 significantly impacts on complication rates from index open vascular procedures, age does not impact upon complication rates of corresponding endovascular procedures. We, therefore, recommend an endovascular approach be adopted as first line for all patients, regardless of patient age.

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