Kaji Sritharan

Initial experience with a new fenestrated stent graft

OBJECTIVES The Anaconda fenestrated stent graft (Vascutek, Inchinnan, United Kingdom) is a new device that can easily be repositioned during deployment. This study evaluated its feasibility for treating abdominal aortic aneurysms with inadequate infrarenal sealing zones. METHODS Patients undergoing stent graft placement at two institutions in the United Kingdom were recruited. RESULTS A total of 12 visceral vessels were accommodated with 8 fenestrations for renal arteries and 4 superior mesenteric artery valleys/scallops in 4 patients. One type Ib endoleak was identified at the 1-month follow-up and successfully treated. CONCLUSIONS The Anaconda fenestrated stent graft device can be used for the repair of abdominal aortic aneurysms with hostile anatomy and has acceptable immediate and short-term results.

Terrorism-related trauma in Africa, an increasing problem.

Global terrorist activities have increased significantly over the past decade. The impact of terrorism-related trauma on the health of individuals in low- and middle-income countries is under-reported. Trauma management in African countries in particular is uncoordinated, with little or no infrastructure to cater for emergency surgical needs. This article highlights the need for education, training and research to mitigate the problems related to terrorism and surgical public health.

An axillofemoral bypass graft transgressing the chest wall

Explantation of an infected patent vascular graft does not necessarily require concomitant revascularization procedures. The need for revascularization can be determined by a trial cross‐clamping of the graft and clinical assessment of limb perfusion. We report a case of an infected axillofemoral graft transgressing the chest wall in a surgically high risk patient.

Royal Society of Medicine Career Handbook: FY1 - ST2

Doctors often lack the skills needed to give them a competitive edge over their colleagues. Despite being academically gifted they leave medical school after six years ill equipped to attain their own career goals. Management skills that are often the most basic to those working for private companies are left out of their undergraduate training. Some simple tips, strategies and well researched advice will empower doctors to develop their own unique career pathway and help them achieve success in their professional life.

Improving Patient Compliance With Post-EVAR Surveillance May Prevent Late Rupture

Endovascular aneurysm repair (EVAR) has gained increasing popularity in the treatment of infrarenal abdominal aortic aneurysm. Despite its favorable early outcomes, the long-term efficacy of EVAR remains a concern. Late rupture is the ultimate treatment failure and continues to complicate EVAR. Univariate and multivariate analyses have identified factors predictive of late rupture. The importance of EVAR surveillance to prevent late complications is equally widely acknowledged. This article aims to present our current understanding of the precipitating factors of late rupture after EVAR and explores whether the key to its prevention lies within improving patient factors, particularly compliance to follow-up appointments or whether physicians hold the solution.

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

Aorto‐esophageal fistula is often a terminal event in many patients. The commonest causes are thoracic aortic aneurysm and esophageal malignancy. To achieve a good outcome in this condition, a MDT approach is required that combines the expertize of vascular surgeons, radiologists, and emergency physicians.