At the dawn of a new year, it should come as no surprise that yet a further update on the status of carotid stenting (CAS) is warranted. Developments of the past several months appear to have triggered (or quickened the pace of) changes in the carotid landscape, and I cannot say this is unexpected. In fact, the VDM Editor’s Corner in July/August 2006 saw it coming: “… the boundless enthusiasm (for CAS) of the early days is — appropriately — beginning to be tempered by two powerful forces: data and reality!” The truth is that new trial results and the reactions that followed seem to

A 66-year-old man presented with lifestyle-limiting, severe bilateral buttock and thigh claudication (Fontaine class IIb). Only resting ankle-brachial indices (ABI) were obtained at presentation and were normal (0.93 right and 0.91 left). Diagnostic cine-angiographic images of the distal aorta with run-off using a 9-inch diameter image intensifier revealed diffuse atherosclerotic changes in the distal aorta, patent bilateral main renal arteries (Figure 1, arrowheads), and high-grade stenoses of both common iliac arteries with good distal outflow (Figure 1, white arrow). A medium caliber arte

Introduction
The use of fluoroscopic imaging continues to increase during medical procedures. Fluoroscopic imaging plays a fundamental role in the diagnostic and treatment of cardiac and vascular disease. The cumulative operator and/or staff occupational exposure from scatter radiation may be considerable.¹ Cardiologists are the most common physician specialty with overexposure to radiation, and the number is felt to be grossly underreported.² The risk of these exposures may not be appreciated by physicians because the adverse consequence is not immediate. Though

The EPics 1 study reported by Dall’Olmo et al,¹ in this issue of Vascular Disease Management reports on one surgical group’s evaluation of patients age 60 and older, both male and female, with a history of surgical, coronary revascularization invited to participate in an abdominal aortic aneurysm (AAA) screening program. The authors identified aneurysms in 9% of males screened and 5% of females screened with the majority of these in both groups having been previously unrecognized. This study is important in that it confirms the presence of increased risk for the presence of AAA

Introduction
Digital ischemia in the upper extremity, with ulceration and gangrene due to primary or secondary Raynaud’s phenomenon, may be a difficult problem for the hand surgeon to solve. Ischemic pain, numbness, cold intolerance and disabling symptoms of the hands may be the early manifestations of the Raynaud’s phenomenon, but patients are usually referred to hand surgeons in later stages of the disease, when they have developed refractory ulcers and necroses at the fingers.

Many conventional therapies have been used. Behavioral therapy such as cessation of smoking, avoidan