An incidental finding on a patient who was followed up after presenting to the hospital with a cerebrovascular event. The angiogram performed showed Spontaneous Coronary Artery Dissection (SCAD) of Left Anterior Descending (LAD) artery. This has resulted in thrombus formation within the left ventricle which led to a thromboembolic stroke. The patient did not have any typical associated conditions for SCAD and it is theorized that heavy smoking and secondary polycythaemia might be contributing factors to the findings.

Background: Wide-necked intracranial bifurcation aneurysms are complex and difficult to treat. Several novel devices have been developed for treatment using endovascular approaches. We present the results of our initial experience of using the pCONus device in our centre. Methods: This retrospective study includes 7 patients who underwent endovascular treatment for wide-necked (=4mm) intracranial aneurysms. 4 aneurysms were unruptured and 3 were acutely ruptured at the time of treatment. Initial and follow up radiological and clinical outcomes are presented. Results: A total of 6 aneurysms were successfully treated with the pCONus device whilst one aneurysm resulted in barrel stent assisted coiling due to the inability to deploy pCONus. There were two complications with the development of a thrombus during the procedure-resolution was observed following further administration of anti-coagulation. At six month follow-up, 83% of the aneurysms showed complete occlusion or stable sub-total occlusion on radiological imaging and all patients had a mRS score of 0. Conclusion: In this initial case series, pCONus stent assisted coiling for wide-necked bifurcation aneurysms is safe and provides good clinical and radiological outcomes. Long term follow-up is required to determine efficacy of this device.

Background: Pseudoaneurysms of the Superficial Temporal Artery (STA) are rare and originate in most cases post-traumatically, often in young to middle-aged men. A palpable pulsatile mass at the temporal region is present, and pulsations can be eliminated or reduced by proximal compression of the STA. Diagnosis is often confirmed by duplex-sonography. Methods: Between 2006 and 2016, five patients with a palpable pulsatile mass of the forehead presented at our institution. Case history, clinical, technical and histo-pathological patient data and corresponding treatment is presented and compared with current literature on pseudoaneurysms of the STA. Results: In four cases the pulsatile mass was caused by a trauma, while in one case the mass arised spontaneously. Clinical examination revealed a palpable pulsatile mass on the forehead. The pulsatile quality of all tumors disappeared by unilateral compression of the STA. Duplex-sonography revealed a traumatic pseudoaneurysm in four cases and an Arteriovenous (AV) malformation in one case. A resection of the pseudoaneurysms and AV malformation was performed. Histo-pathological examination confirmed the clinical diagnosis. Conclusion: Despite recent advances in endovascular approaches, surgical resection remains the treatment of choice. Our results are concordant with current literature regarding pseudoaneurysms of the STA.

Survival following elective Endovascular Aneurysm Repair (EVAR) in the Octogenarian Aim: Increasing age is a recognized independent predictor of mortality in aneurysm surgery. However, the long term survival benefit in octogenarians following Endovascular Aneurysm Repair (EVAR) remains unclear despite supporting evidence of safe use. Methods: Consecutive subjects who underwent elective EVAR for AAA in a single tertiary centre between 1st July 2000 and 31st January 2015 were identified and survival data extracted through hospital electronic records. Subjects were categorized into two cohorts based on age, Group 1 (G1): < 80 years and Group 2 (G2): =80 years. Primary endpoints of interest were (i) 30-day mortality; (ii) early and late aneurysm related deaths; (iii) overall survival at follow up at 31 March 2015. Results: 266 patients (235 male, 88.3%) were included in the study. G1 comprised 195 patients (180 male, 92.0%), mean age 71.9 years (Standard Deviation (SD) 5.7) whilst G2 comprised 71 patients (55 male, 77%), mean age 83.2 years (SD 2.1).The mean AAA sac diameter were similar between groups (6.5cm v 6.3cm, p > 0.05). G2 had higher proportion of patients with chronic kidney disease (32% v 12%, p < 0.001). Thirty-day mortality: 3 deaths occurred in G1 and 1 in G2. The odds ratio for octogenarians developing post-operative 30-day complications was 1.99 (95% confidence interval (CI) 1.11- 3.61, p = 0.02). At follow up, 81 deaths occurred (G1: 55, G2: 26). Overall median survival was 91 months (Standard Error (SE) 4.6). Median survival in G1 = 92 (SE 16.6) months and G2 = 87 (SE 14.8) months. No survival differences were observed between groups on Kaplan Meier analysis (Log Rank, p > 0.05). Multivariate Cox proportional hazards model demonstrated that ASA scores more than 3 significantly predicted risk of mortality during follow up with hazard ratio of 3.97 (95% confidence interval 2.06 - 7.65). Conclusion: Survival of selected octogenarian patients undergoing elective EVAR is comparable to younger co-hort of patients undergoing EVAR.

Objectives: To show a simple endovascular technique both to do the diagnosis of the steno-obstructions of caval iliac femoral veins, in chronic venous hypertensions and to evaluate the results of angioplasty and stent treatment. Materials and methods: A total of 90 Patients (Pt) in CEAP clinical class 3-6 (according to CEAP classification-clinical, etiologic, anatomic, pathophysiologic for chronic venous disease) were evaluated for steno-obstructions of caval iliac femoral veins with a new technique of measurement of Venous Pressure Gradient (VPG) and with a morphological evaluation of these deep veins; we considered as indicator of venous hypertension a pressure gradient = 3mmHg /400 Pa. In the first experience we analyzed 60 Pt; we considered eligible for the treatment of venous iliac Percutaneous Transluminal Angioplasty/Stenting (PTA/Stent). Only the patients with the presence of pressure gradient associated to a morphological stenosis >50%, measured through retrograde Digital Phleboscopy (DPh).We named Pt DPh this court of patients. In the second experience with the remaining patients, we considered the patients with positivity to the pressure gradient are eligible for the treatment. In this case we used a new morphological technique Intra-Venous Ultrasound (IVUS), only to have a few details about neointima (Pt Iv). Technical success will be considered after the PTA /stent value of VPG is equal to 0mmHg/Pa. Clinical and Ultrasound (US) evaluation was performed before and after the treatment; in case of stenting we performed Computerized Tomography (CT) evaluation during follow up. Results: We have totally evaluated 90 Pt; in the first experience with 60 consecutive Pt ranked as CEAP III-VI. In 15 Pt we found VPG = 3mmHg (= 400 Pa) and only 5 Pt with stenosis = 50% by DPh. In these 5 Pt we performed iliac venous 4 PTA and 1 stenting. In the second experience with the remaining 30 consecutive Pt ranked as CEAP III-VI. In 6 Pt we found VPG = 3mmHg (= 400 Pa). In all these Pt IVUS confirmed a morphological wall thickening without morphological stenosis to DPh. We performed iliac venous 4 PTA and 2 Stenting. We obtained the technical success after angioplasty/stenting of iliac vein steno-obstructions in all cases. No other complications is observed during the procedure. F.W. at 12 months (range: 3-24 months) showed a clinical down-staging in all patients with no occlusion in the site of the treatment. Conclusion: Our endovascular technique allows the measurement of the pressure gradient and the discover of the venous chronic hypertension in caval iliac femoral veins. The measurement of VPG provides the finding of iliac steno-obstructions without the evidence of stenosis by DPh. Moreover it is possible that the minimal changes in neointima can alter wall characteristics and its capacitance and increase the venous pressure. The VPG equal to 0mmHg/Pa after iliac venous PTA/stenting together with good clinical outcome could be used to show the effectiveness of the treatment of venous chronic hypertension.