Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

OBJECTIVE: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). METHODS: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. RESULTS: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). CONCLUSION: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Glomus tumours and genomic imprinting: influence of inheritance along the paternal or maternal line.

Two new families with glomus tumours and two additions to earlier publications are presented. The pattern of inheritance is autosomal dominant. Familial glomus tumours are inherited almost exclusively via the paternal line, a finding inconsistent with autosomal dominant transmission. This can be explained by genomic imprinting. The maternally derived gene is inactivated during female oogenesis and can be reactivated only during spermatogenesis. Two different loci have been assigned, one to a 5 cM region of chromosome 11q13.1 and one to 11q22.3-q23.3. Genomic imprinting has already been found for the distal locus and here we demonstrate that the proximal locus is subject to genomic imprinting too. Genomic imprinting has considerable implications for genetic counselling in families with glomus tumours. In addition to this the sex ratio among affected offspring appears to be influenced by the paternal or maternal origin of the gene of the transmitting father.

Colonic malignancy mimicking an appendiceal mass.

The records of 99 patients admitted for inflammatory appendiceal mass were evaluated. Eight of these patients (8%) had a malignancy of the right colon with, in four cases, secondary inflammation of the appendix. Remnants of inflammation limited to the appendix were present in 64 patients. These two groups were compared to a group of 21 patients treated in the same period for a palpable malignancy of the right colon. In patients older than 50 years absence of pain, symptoms which last more than one week, a painless palpable mass in the right lower abdomen and the presence of anemia indicate (underlying) colonic malignancy. Barium enema of the colon remains the most reliable method for a correct preoperative diagnosis of colonic malignancy and should be done in every patient older than 50 years who presents with an appendiceal mass, as well as in younger patients with a protracted course of the disease.

Carotid body tumor: familial occurrence.

Four patients are presented with a carotid body tumor and three patients who may have had a carotid body tumor, all from one family of 81 members. This confirms the familial incidence of this tumor. A short review of the literature is presented. An autosomal dominant inheritance seems most likely in familial carotid body tumor. Screening family relatives of patients to diagnose a carotid body tumor at an early stage should make surgery easier and reduce the complication rate associated with surgery.