A novel endovascular technique in the management of a large internal iliac artery aneurysm associated with an arteriovenous fistula.

PURPOSE: To describe a novel endovascular technique in the management of a complex arteriovenous fistula between a large internal iliac artery aneurysm and the adjacent iliac vein in a 76-year old patient with previous aortobifemoral bypass graft with an occluded proximal common iliac artery. CASE REPORT: Due to the high risk of open surgery in this case, endovascular treatment with simultaneous venous and arterial access was performed, with implantation of 2 stent grafts in the iliac vein to cover the fistulous communication and embolisation of the native external iliac artery (inflow). CONCLUSION: The endovascular technique described enables thrombosis of the large internal iliac aneurysm and treatment of the arteriovenous fistula without exposing the patient to the high morbidity and mortality associated with open surgery.

Static sac size with a type II endoleak post-endovascular abdominal aortic aneurysm repair: surveillance or embolization?

A best evidence topic was written according to a structured protocol. The question addressed was whether embolization is superior to surveillance for a type II endoleak associated with a static sac size post-endovascular abdominal aortic aneurysm repair (EVAR). Four hundred and sixty-one papers were identified, of which 10 papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, and relevant outcomes and results are tabulated. A review of the available literature suggests that most type II endoleaks are innocuous and will seal spontaneously during the long-term follow-up, even when they persist for more than 6 months. An analysis of the large European Collaborators on Stent-Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry that includes prospective data on 2463 patients from 87 European hospitals showed that type II endoleaks were not associated with an increased risk of rupture; this correlates well with the large single-centre studies included in this review. Based on the available evidence, we conclude that the management of most isolated type II endoleaks should be conservative-with close radiological follow-up--even when persistent, with intervention restricted to theoese associated with sac enlargement >5 mm over a 6-month period or >10 mm when compared with pre-EVAR diameter.

Does the protocol for suspected renal colic lead to unnecessary radiation exposure of young female patients?

Unenhanced multidetector computed tomography (CT KUB) is now firmly established as the best imaging method in the evaluation of suspected acute renal colic, and is replacing intravenous urography at an increasing number of hospitals. The female patient presenting at the emergency department with suspected acute renal colic presents a particular diagnostic problem, as the positive rate for stone disease in female patients is considerably lower compared with male patients. The indiscriminate use of suspected renal colic protocol and CT KUB in all female patients with flank pain should be avoided.