OBJECTIVE To assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm. DESIGN Randomised controlled trial. SETTING 30 vascular centres (29 UK, 1 Canadian), 2009-13. PARTICIPANTS 613 eligible patients… (More)
A case of osteogenic sarcoma of the skull in a patient with a long-standing Paget's disease is reported. Osteogenic sarcoma arising within the skull is rare in Paget's disease, although the recent literature emphasizes that it is more common than was realized previously. Intraparenchymal brain invasion, which is rare and present usually only as a… (More)
BACKGROUND Single-centre series of the management of patients with ruptured abdominal aortic aneurysm (AAA) are usually too small to identify clinical factors that could improve patient outcomes. METHODS IMPROVE is a pragmatic, multicentre randomized clinical trial in which eligible patients with a clinical diagnosis of ruptured aneurysm were allocated to… (More)
Fibromuscular hyperplasia is a rare cause of internal carotid artery occlusion. We present a case where long stenoses of both internal carotid arteries were associated with terminal carotid occlusions and a ruptured basilar aneurysm.
Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured… (More)
BACKGROUND The benefits of endovascular repair of ruptured abdominal aortic aneurysm remain controversial, without any strong evidence about advantages in specific subgroups. METHODS An individual-patient data meta-analysis of three recent randomized trials of endovascular versus open repair of abdominal aortic aneurysm was conducted according to a… (More)
BACKGROUND The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. METHODS An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis… (More)
AIMS To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. METHODS AND RESULTS The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter,… (More)