Supporting habitat restoration in the northern Gulf of Mexico through synthesis of data on multiple and interacting benefits and stressors.

Outcomes of landscape scale restoration and conservation can be maximized when planning is based upon quantitative and decision-relevant information. Existing tools to support data-driven planning are hindered by regionally inconsistent information and a need for advanced methods to analyze data of varying spatial resolution and coverage. We present a synthesis methodology for region-wide derived metrics to characterize natural resource value, ecosystem stress, and social vulnerability to inform implementation of conservation and restoration projects. Our three-part methodology was developed and tested for the Gulf of Mexico in support of the Southeast Conservation Blueprint that was created to advance the Southeast Conservation and Adaptation Strategy. The first step included integration of prioritized natural resource metrics alongside socio-ecological metrics to create a data layer of synthesized natural resource priority across the northern Gulf of Mexico. The second component was calculation of ecosystem stress indices based on ecologically relevant thresholds and a cumulative ecosystem stress layer, in addition to analyzing correlations between individual stressors and their relative importance. The final component was development of a social vulnerability (SoVI) index. Analysis of these metrics illustrate their ability to effectively capture variability at multiple scales in the Gulf of Mexico, including expected spatial correlation of stressors such as road density and non-point source pollution in populated areas and the dominance of sea-level rise as a future stressor along the coast. Significant composite components of social vulnerability for the northern Gulf of Mexico region were identified and include economic status, professional workforce, elderly population, population stability, migrant workforce, and rural population. To demonstrate the utility of the data synthesis approach, we used the developed data layers to evaluate proposed marsh creation projects in southern Louisiana. The synthesized data layers were capable of distinguishing differences at the scale of individual habitat restoration projects, and high-value projects could be aligned with the goals of key funding streams. This pilot application illustrates how restoration programs could use the methodology developed here to maximize benefits from conservation and restoration actions along the northern Gulf of Mexico or other regions globally.

Managing the failing heart: total circulatory assist--a case study.

Congestive heart failure remains one of the leading causes of cardiac death and disability. As pharmacological therapies have advanced, patients are living longer and more productive lives. However, at some point, these interventions begin to fail. Circulatory assist devices have revolutionized the management of patients with end-stage heart disease. These devices successfully bridge patients to cardiac transplantation. The Syncardia Total Artificial Heart provides biventricular support for the failing heart. This case study illustrates the challenges of caring for patients with such a device.

An integrated approach to assess broad-scale condition of coastal wetlands--the Gulf of Mexico Coastal Wetlands pilot survey.

The Environmental Protection Agency (EPA) and U.S. Geological Survey (USGS) initiated a two-year regional pilot survey in 2007 to develop, test, and validate tools and approaches to assess the condition of northern Gulf of Mexico (GOM) coastal wetlands. Sampling sites were selected from estuarine and palustrine wetland areas with herbaceous, forested, and shrub/scrub habitats delineated by the US Fish and Wildlife Service National Wetlands Inventory Status and Trends (NWI S&T) program and contained within northern GOM coastal watersheds. A multi-level, stepwise, iterative survey approach is being applied to multiple wetland classes at 100 probabilistically-selected coastal wetlands sites. Tier 1 provides information at the landscape scale about habitat inventory, land use, and environmental stressors associated with the watershed in which each wetland site is located. Tier 2, a rapid assessment conducted through a combination of office and field work, is based on best professional judgment and on-site evidence. Tier 3, an intensive site assessment, involves on-site collection of vegetation, water, and sediment samples to establish an integrated understanding of current wetland condition and validate methods and findings from Tiers 1 and 2. The results from this survey, along with other similar regional pilots from the Mid-Atlantic, West Coast, and Great Lakes Regions will contribute to a design and implementation approach for the National Wetlands Condition Assessment to be conducted by EPA's Office of Water in 2011.

Global genomic methylation levels in the liver and gonads of the three-spine stickleback (Gasterosteus aculeatus) after exposure to hexabromocyclododecane and 17-beta oestradiol.

Alteration of DNA methylation is a major epigenetic mechanism associated with the effects of nongenotoxic carcinogens. We evaluated the effects of two environmental pollutants, hexabromocyclododecane (HBCD), 17-beta oestradiol (E(2)) as well as 5-aza 2' deoxycytidine (5AdC) on global DNA methylation levels (5-methyl 2' deoxycytidine) in the liver and gonads of the three-spine stickleback (Gasterosteus aculeatus). HBCD at 30 and 300 ng/L of water did not produce statistically significant differences in global genomic methylation in liver of female stickleback. On the other hand, the methylation inhibitor, 5-aza-2'-deoxycytidine, significantly lowered hepatic global methylation levels in these fish by 14% (P<0.05). The naturally occurring oestrogen, 17-beta oestradiol (E(2)) at 100 ng/L also decreased global DNA methylation levels in female liver but this effect was not statistically significant. In contrast, both E(2) and 5AdC caused statistically significant (P<0.001 and P<0.01 respectively) global genomic hypermethylation in the gonads of male sticklebacks although the increase seen in the female gonads was not statistically significant. The male gonad effect though unexplained may potentially be an indirect response to hypomethylation in other tissues (such as the liver) and may have important implications regarding oestrogenic effects in fish. The contrasting effects of HBCD and E(2) on global DNA methylation in stickleback should contribute to the integrated risk assessment of these environmental chemicals.

Intercalibration exercise using a stickleback endocrine disrupter screening assay.

The Organisation for Economic Cooperation and Development (OECD) is currently validating a short-term fish screening protocol for endocrine disrupters (estrogens, androgens, and their antagonists and aromatase inhibitors), using three core species: fathead minnow, Japanese medaka, and zebrafish. The main endpoints proposed for the first phase of validation of the screen are vitellogenin (VTG) concentration, gross morphology (secondary sexual characteristics and gonado-somatic index), and gonadal histopathology. A similar protocol is concurrently being developed in the United Kingdom using the three-spined stickleback, with identical endpoints to those for the core species and, in addition, a unique androgen-specific endpoint in the form of spiggin (glue protein) induction. To assess the suitability of this species for inclusion in the OECD protocol alongside the core species, an intercalibration was conducted using 17beta-estradiol (a natural estrogen) and trenbolone (a synthetic androgen), thus mimicking a previous intercalibration with the core species. All three participating laboratories detected statistically significant increases in VTG in males after 14 d exposure to nominal concentrations of 100 ng/L 17beta-estradiol and statistically significant increases in spiggin in females after 14 d exposure to nominal concentrations of 5,000 ng/L trenbolone. The stickleback screen is reliable, possessing both relevant and reproducible endpoints for the detection of potent estrogens and androgens. Further work is underway to assess the relevance and suitability of the screen for weakly acting estrogens, anti-androgens, and aromatase inhibitors.

A brief history of the British Neuroscience Association.

As the British Neuroscience Association commemorates 50 years of existence in 2018, this article recalls its founding as a discussion group, its establishment as the Brain Research Association, its transition to a professional society encompassing all aspects of neuroscience research, both clinical and non-clinical, and its re-branding as the British Neuroscience Association in the late 1990s. Neuroscience as a branch of life science has expanded hugely in the last 25 years and the British Neuroscience Association has adapted, frequently working with partner societies, to serve as an interdisciplinary hub for professionals working in this exciting and crucial field. The authors have attempted to highlight some key events in the Association's history and acknowledge the contributions made by many people over half a century.

Development and application of long-term sublethal whole sediment tests with Arenicola marina and Corophium volutator using Ivermectin as the test compound.

Short-term whole sediment tests using the amphipod Corophium volutator and the polychaete Arenicola marina are now routinely used in Europe to assess the acute toxicity of marine sediments. However, there is still a need to develop longer-term assays which measure effects on sublethal endpoints that are more relevant to predicting impacts at the population level. The effect of increasing exposure times and measuring additional endpoints such as growth, on the sensitivity of these assays was investigated. The test compound used was the chemotherapeutant Ivermectin (IVM), used in aquaculture to treat sea lice infestations. IVM was found to be acutely toxic to both test organisms. Extending the lugworm test to 100 days increased sensitivity of survival by a factor of three; a significant reduction in casting rate was observed at concentrations an order of magnitude lower. This assay shows potential for detecting the sublethal effects of low concentrations of sediment contaminants. Increasing the exposure time did not seem to affect the sensitivity of the amphipod, but further method development is required.

Prevalence of peripheral arterial disease: persistence of excess risk in former smokers.

OBJECTIVE: To determine the age-standardised prevalence of peripheral arterial disease (PAD) and associated risk factors, particularly smoking. DESIGN: Cross-sectional survey of a randomly selected population. SETTING: Metropolitan area of Perth, Western Australia. PARTICIPANTS: Men aged between 65-83 years. RESULTS: The adjusted response traction was 77.2%. Of 4,470 men assessed, 744 were identified as having PAD by the Edinburgh Claudication Questionnaire and/ or the ankle-brachial index of systolic blood pressure, yielding an age-standardised prevalence of PAD of 15.6% (95% confidence intervals (CI): 14.5%: 16.6%). The main risk factors identified in univariate analyses were increasing age, smoking-current (OR = 3.9, 95% CI 2.9-5.1) or former (OR = 2.0, 95% CI 1.6-2.4), physical inactivity (OR = 1.4, 95% CI 1.2-1.7), a history of angina (OR = 2.2, 95% Cl 1.8-2.7) and diabetes mellitus (OR = 2.1, 95% Cl 1.7-2.6). The multivariate analysis showed that the highest relative risk associated with PAD was current smoking of 25 or more cigarettes daily (OR = 7.3, 95% Cl 4.2-12.8). In this population, 32% of PAD was attributable to current smoking and a further 40% was attributable to past smoking by men who did not smoke currently. CONCLUSIONS: This large observational study shows that PAD is relatively common in older, urban Australian men. In contrast with its relationship to coronary disease and stroke, previous smoking appears to have a long legacy of increased risk of PAD. IMPLICATIONS: This research emphasises the importance of smoking as a preventable cause of PAD.

Surveys of plasma vitellogenin and intersex in male flounder (Platichthys flesus) as measures of endocrine disruption by estrogenic contamination in United Kingdom estuaries: temporal trends, 1996 to 2001.

Plasma vitellogenin (VTG) concentrations and the presence of the ovo-testis (intersex) condition have been recorded in male flounder (Platichthys flesus) captured from several United Kingdom (UK) estuaries since 1996 as part of the endocrine disruption in the Marine Environment (EDMAR) project and earlier programs. It has been confirmed that plasma VTG concentrations in male flounder have remained elevated in several UK estuaries (e.g., Tees, Mersey, and Tyne) throughout the period covered by this study. However, the time-series data indicate that plasma VTG, a measure of environmental estrogen contamination, has decreased in fish captured from several estuaries, especially those of the Tyne and Mersey. Shorter time-series data sets from the Forth and Clyde estuaries also suggest a decrease in estrogen contamination at these sites. Trends associated with specific point sources of estrogenic contamination show site-specific patterns. For instance, plasma VTG levels in male flounder captured near the Howdon sewage treatment outfall (Tyne) have shown a steady decline to near baseline levels in 2001, while the plasma of male fish captured at a site adjacent to the Dabholm Gut discharge in the Tees estuary have shown little evidence of a sustained decline. The occurrence of the intersex condition was detected at a low but consistent prevalence through the study period, with the majority of cases recorded in fish captured from the Tyne and Mersey estuaries. The data set does not allow conclusions to be drawn about any temporal trends associated with this condition. The significance of the findings and possible mitigating influences are discussed in terms of the impacts on wild fish and the role of effluent treatment in reducing these.

Improving maximum walking distance in early peripheral arterial disease: randomised controlled trial.

The purpose of this study was to determine the impact of increased physical activity and cessation of smoking on the natural history of early peripheral arterial disease. We conducted a randomised controlled trial in Perth, Western Australia, involving 882 men with early peripheral arterial disease identified via population-based screening using the Edinburgh Claudication Questionnaire and the ankle:brachial index. Members of the control group (n = 441) received "usual care" from their general practitioner while members of the intervention group (n = 441) were allocated to a "stop smoking and keep walking" regime - a combined community-based intervention of cessation of smoking (where applicable) and increased physical activity. Postal follow-up occurred at two and 12 months post-entry into the trial. The main outcome of interest was maximum walking distance. There were no statistically significant differences in the characteristics of the "intervention" and "usual care" groups at recruitment. Follow-up information at two and 12 months was available for 85% and 84% of participants, respectively. At 12 months, more men allocated to the intervention group had improved their maximum walking distance (23% vs 15%; chi2 = 9.74, df = 2, p = 0.008). In addition, more men in the intervention group reported walking more than three times per week for recreation (34% vs 25%, p = 0.01). Although not statistically significant, more men in the intervention group who were smokers when enrolled in the trial had stopped smoking (12% vs 8%, p = 0.43). It is concluded that referral of older patients with intermittent claudication to established physiotherapy programs in the community can increase levels of physical activity and reduce disability related to peripheral arterial disease. A combination of simple and safe interventions that are readily available in the community through physiotherapists and general practitioners has the potential to improve early peripheral arterial disease.

The impact of oestrogenic and androgenic contamination on marine organisms in the United Kingdom--summary of the EDMAR programme. Endocrine Disruption in the Marine Environment.

This paper summarises results of the EDMAR programme which is investigating oestrogenic and androgenic endocrine disruption in UK coastal waters. Most of the data concern fish. Four species (flounder, viviparous blenny and two sand gobies) are experiencing feminisation in industrialised estuaries. In males this includes vitellogenin (VTG) synthesis, ovotestis induction and/or feminised sexual characteristics. Although reproductive success may be impaired in some cases, implications for fish populations are still unclear. Suspected causative contaminants include natural oestrogenic substances and synthetic oestrogen mimics. The majority of the oestrogenic activity is adsorbed to sediments, and routes of exposure may include benthic food chain transfer. Some natural androgenic substances are also being discharged to estuaries, but their activity appears low.

Multislice CT angiography of fenestrated endovascular stent grafting for treating abdominal aortic aneurysms: a pictorial review of the 2D/3D visualizations.

Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images.

Computed tomography virtual intravascular endoscopy in the evaluation of fenestrated stent graft repair of abdominal aortic aneurysms.

BACKGROUND: This study aimed to investigate the diagnostic value of computed tomography virtual intravascular endoscopy (VIE) in the follow-up of patients with abdominal aortic aneurysm (AAA) treated with fenestrated stent grafts. METHODS: A total of 19 patients (17 males and 2 females; mean age: 75 years) with AAA undergoing fenestrated stent grafts were retrospectively studied. Pre- and post-fenestration computed tomography data were reconstructed for the generation of VIE images of aortic ostia and fenestrated stents and compared with two-dimensional axial and multiplanar reformation (MPR) images. Serum creatinine was measured pre and post fenestration to evaluate the renal function. RESULTS: The mean intra-aortic length measured by VIE, two-dimensional axial and MPR were 4.7, 4.4 and 4.6 mm, respectively, for the right renal stent; 5.0, 4.9 and 5.0 mm, respectively, for the left renal stent; and 5.9, 6.0 and 6.0 mm, respectively, for the superior mesenteric artery stent. Comparisons of these measurements did not show significant difference (P > 0.05). The mean diameters of renal artery ostia measured on VIE visualization pre and post fenestration were 9.2 x 8.3 and 10 x 8.9 mm for the right renal ostium; 8.3 x 7.1 and 9.9 x 8.9 mm for the left renal ostium, with significant changes observed (P < 0.01). No renal dysfunction was observed in this group. CONCLUSION: VIE is a valuable visualization tool in the follow-up of fenestrated stent graft repair of AAA by providing intraluminal appearance of fenestrated stents and measuring the length of stent protrusion.

The model anti-androgen flutamide suppresses the expression of typical male stickleback reproductive behaviour.

Over the past 15 years considerable attention has been given to the presence in the environment of endocrine disrupting chemicals (EDCs) that may have harmful effects on organisms. Specific test guidelines for the detection of EDCs used for short-term fish screening assays have been developed by the Organisation for Economic Cooperation and Development (OECD). Compared to the core species used in the OECD guidelines, the three-spined stickleback (Gasterosteus aculeatus) has an additional and unique endpoint for (anti-)androgenic substances through the androgen-dependent glue protein (spiggin) used in the nest building. Here we describe a specific behavioural assay that was developed in parallel to the OECD protocol, utilising unique behavioural features of sticklebacks. In the assay, a photoperiod of 16L:8D (light:dark) and a temperature of 17+/-1 degrees C was used to induce breeding in quiescent male sticklebacks that were simultaneously exposed for a 21-day period to the mammalian anti-androgen flutamide (FL) at 100, 500 and 1000 microg/l (plus a water control). Spiggin production and the reproductive behaviour (nest building and courtship) of male sticklebacks were the main measured endpoints. The control fish entered an active breeding cycle including nest building and courtship behaviours as expected due to the stimulating temperature and photoperiodic conditions. The FL-exposed males showed significantly lower spiggin levels at 500 and 1000 microg/l. In addition, there was a significant decrease in the number of nests built by the FL-treated males at 100 microg/l with no nest built at 500 and 1000 microg/l. Finally, FL affected the courtship behaviour of the males with a significant reduction of the number of zigzags towards the female. When the breeding status of the stickleback males is controlled, the behavioural assay developed here is a suitable tool for the detection of androgen antagonists.

CT virtual intravascular endoscopy in the visualization of fenestrated stent-grafts.

PURPOSE: To report the diagnostic value of computed tomographic (CT) virtual intravascular endoscopy (VIE) in the assessment of patients with abdominal aortic aneurysm (AAA) treated with fenestrated endovascular grafts. METHODS: Eight patients (7 men; mean age 76 years, range 70-82) with AAAs unsuitable for open surgery or conventional endovascular repair had fenestrated endovascular grafts implanted. Both pre- and post-fenestration multislice CT data were used to generate VIE images of the visceral artery ostia and the side branch fenestrated stents. CT VIE images were compared with conventional 2-dimensional (2D) axial CT and multiplanar reformatted (MPR) images for the ability to visualize the intraluminal appearance of stents, as well as to measure the length of stents that protruded into the aortic lumen. RESULTS: Various fenestrations were deployed in 27 aortic branches. Scalloped and large fenestrations were implanted in 6 side branch ostia, respectively, and small fenestrations in 15 renal artery ostia. Fewer than half of the stents (37%) were found to be circular on VIE images, while the remaining stents were flared to varying extents at the inferior portion. The majority (96%) of stents protruded into the lumen up to 7.0 mm. Although the configuration of the side branch ostia changed to a variable extent, no significant difference was apparent between the diameters of branch ostia before and after fenestration (p>0.05). CONCLUSION: Our preliminary study shows that VIE proved superior to conventional 2D or MPR images in visualizing the final configuration of the fenestrated vessels and was comparable to the other techniques in measuring stent protrusion into the aortic lumen. VIE could be a valuable technique to identify any suspected abnormalities associated with fenestrated endovascular grafts by demonstrating the final intraluminal configuration of the stents in the fenestrated vessels.

Multislice CT angiography in the follow-up of fenestrated endovascular grafts: effect of slice thickness on 2D and 3D visualization of the fenestration stents.

PURPOSE: To investigate the effect of multislice computed tomography (CT) protocols on the visualization of target vessel stents in patients with abdominal aortic aneurysm (AAA) treated with fenestrated endovascular grafts. METHODS: Twenty-one patients (19 men; mean age 75 years, range 63-86) undergoing fenestrated endovascular repair of AAA were retrospectively studied. Multislice CT angiography was performed with several protocols, and the section thicknesses used in each were compared to identify any relationship between slice thickness and target vessel stents visualized on 2-dimensional (2D) axial, multiplanar reformatted (MPR), and 3-dimensional (3D) virtual intravascular endoscopy (VIE) images. Image quality was assessed based on the degree of artifacts and their effect on the ability to visualize the configuration, intra-aortic location, and intraluminal appearance of the target vessel stents and measure their protrusion into the aortic lumen. RESULTS: There were 7 different multislice CT scanning protocols employed in the 21 patients (25 datasets, with 2 sets of follow-up images in 4 patients). The slice thicknesses and numbers (n) of studies included were 0.5 (n=3), 0.625 (n=6), 1.0 (n=1), 1.25 (n=9), 2.5 (n=3), 3.0 (n=1), and 5.0 mm (n=2). Of these CT protocols, images (especially 2D/3D reconstructions) acquired at 2.5, 3.0, and 5.0 mm were significantly compromised by interference from artifacts. Images acquired with a slice thickness of 1.0 or 1.25 mm were scored equal to or lower than those acquired with a submillimeter section thickness (0.5 or 0.625 mm), with minor degrees of artifacts resulting in acceptable image quality. CONCLUSION: Visualization of the target vessel stents depends on the appropriate selection of multislice CT scanning protocols. Our results showed that studies performed with a slice thickness of 1.0 or 1.25 mm produced similar image quality to those with a thickness of 0.5 or 0.625 mm. Submillimeter slices are not recommended in imaging patients treated with fenestrated stent-grafts, as they did not add additional information to the visualization.

Treatment of infrarenal abdominal aortic aneurysms with oversized (36-mm) Zenith endografts.

PURPOSE: To evaluate the outcome of treating infrarenal abdominal aortic aneurysms with unfavorable necks using the 36-mm Zenith endograft. METHODS: The indication for use of the 36-mm endograft for infrarenal aortic aneurysm was a minimum 20-mm-long sealing zone and a diameter >28 mm at any point but <34 mm, varying more than 3 mm in contour. A series of 67 patients (64 men; mean age 76.2 years, range 59.5 to 88.3) who had been treated with the 36-mm endografts between June 1999 and February 2004 were assessed for medium-term outcomes. The patients were identified from the device planning records. Follow-up was carried out using chart review and direct patient contact. The indication for use of the endograft was checked with the aneurysm neck profile from the original planning diagrams. Cause of death was ascertained from the treating clinician, the medical record, or the State Death Registry. Outcome endpoints were proximal type I and type III endoleaks, migration, sac size change, and death. RESULTS: The mean diameter of the sealing zone was 31.9+/-1.6 mm within the 20-mm segment from the lowest renal artery. Stent-graft delivery was achieved in all 67 patients. Two (3%) patients died within 30 days from non-graft-related cardiorespiratory causes. Proximal type I endoleaks were identified in 3 (4.5%) patients: 2 during deployment and another at 9 days. The mean follow-up period for the 65 patients who survived 30 days was 26.9+/-12.6 months (range 2-66). Migration occurred in 1 patient with development of a type III endoleak and sac reperfusion due to separation of the graft body from the bare anchor stent owing to suture breakage. Forty-seven patients were alive at the last review. The aneurysm sac had contracted or was unchanged in 45 (96%) cases. Minor enlargements of the sac were observed in 2 patients. The re-intervention rate was 16.4% (11 patients). There was 1 conversion to open repair to treat perigraft sepsis. The aneurysm- and procedure-related mortality was 4.5%; no patient experienced rupture. All-cause mortality was 29.9% (20/67). CONCLUSION: Large caliber endografts such as the Zenith 36-mm are an alternative option to open surgery or fenestrated endografting for some infrarenal aneurysms.

Large iliac arteries: a high-risk group for endovascular aortic aneurysm repair.

PURPOSE: To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery-related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. METHODS: The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56-91) with large iliac arteries (mean 19.7 mm, range 16-22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. RESULTS: Mean follow-up was 30.1+/-8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery-related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. CONCLUSION: Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.

Outcomes of fenestrated endografts in the treatment of abdominal aortic aneurysm in Western Australia (1997-2004).

PURPOSE: To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts. METHODS: Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5+/-8.5 years, range 60-94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had >/=2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success). RESULTS: Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4+/-1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60 degrees neck angulation, multiple renal vessels, and vessel diameter