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Venous thromboembolism (VTE) is a grossly underdiagnosed disease associated with high mortality and morbidity. Despite tremendous advances in the interventional field, no significant changes have occurred on a wide scale in the approach to this entity over the last few decades. We report a 52-year-old man with massive bilateral lower extremity deep venous thrombosis extending into the inferior vena cava who underwent power-pulse spray with tissue plasminogen activator and Angiojet thrombectomy, leading to the rapid resolution of symptoms. We would like to use this case to call for a “paradigm shift” in the approach to VTE amongst endovascular specialists and recommend an early aggressive pharmacomechanical approach to its treatment.

Anomalous coronary arteries are rare angiographic findings, especially during acute myocardial infarction (MI). We present the first case of simultaneous-kissing-stent deployment in an anomalous coronary (left circumflex/obtuse marginal bifurcation with 360? loop) during an acute MI. Subsequently, staged transradial stenting of the left anterior descending artery was performed. This procedure, likewise, has not been previously described. Our case simultaneously illustrates the feasibility of both transfemoral and transradial approaches for anomalous coronary intervention in the same patient. The epidemiology and pathophysiology of anomalous coronary arteries are reviewed, with emphasis on anatomic classifications, as well as their associated cardiac mortality risks.

Accurate ABPI measurement is fundamental to the community management of suspected peripheral arterial occlusive disease. This study investigates the correlation and agreement of GP performed ABPI measurements in the community compared to those measured in the vascular laboratory (VL) in the setting of a UK district general hospital. Records of 127 patients attending vascular clinic were reviewed, of whom 25 patients (19.69%) were referred by GPs with ABPI measurements performed. From these, 47 ABPI measurements were available and had limbs assessed by both GPs and VLs. For GP ABPI assessment: mean=0.748, median= 0.780, range=0.39 to 1.14, SD=0.200. For VL ABPI assessment: mean= 0.875, median=0.880, range=0.50 to 1.40, SD=0.245. GP performed measurement were an average of -0.13 (95% CI: -0.19 to -0.06, p = 0.0003), confirmed by Bland-Altman analysis. Using a diagnostic threshold of 0.9 for the GP performed ABPI, sensitivity=96 %, specificity=45.5%, PPV=66.7%, NPV=90.9% and accuracy=72.3

Background. Atrial arrhythmias have been linked to patent foramen ovale (PFO) and in many cases, arise after the operative closure of the PFO. The intention to decrease the frequency of cerebrovascular accidents with operative closure of PFOs is compromised and negated to some extent due to the induction of atrial fibrillation postoperatively. With percutaneous closure of PFOs gaining acceptability as an effective, noninvasive method of closure for PFOs, the effect of this closure technique on atrial arrhythmias and other postprocedure complications needs to be evaluated. Methods and results. We studied a series of 68 consecutive patients (age 55.74 + 14.74, 67.6% male) who underwent percutaneous closure of their PFOs performed between the years 2002–2007 at a single cardiac center. Four patients had atrial fibrillation preprocedure. After the procedure, 3 of these patients (age 57 + 16.46 years, 100% male) experienced resolution of their atrial fibrillation, and 1 remain