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Purpose: To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome.Methods: Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery.Results: A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)).Conclusions: There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effectiveness of bipolar radiofrequency-induced thermal therapy (RFITT) in a multicentre non-randomized study. Methods: Some 672 incompetent saphenous veins (85% great saphenous varicose vein, 15% short saphenous vein) in 462 patients (56.5% CEAP [clinical, aetiological, anatomical and pathological elements] class 3 or worse) were treated in eight European centres. Patients were assessed between 180 and 360 days postoperatively. Occlusion rates were determined by duplex ultrasound and compared with the power used for treatment, pull back rate and experience of the operating surgeon. Results: Complete occlusion rates of 98.4% were achieved when treatments were performed by an experienced operator (more than 20 cases), when the maximum power setting on the RFITT generator was between 18 and 20W and the applicator was withdrawn at a rate slower than 1.5 second/cm Conclusions: RFITT is efficacious, well tolerated by patients and has a low incidence of procedure-related post-operative complications. [ABSTRACT FROM AUTHOR]

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Unlabelled: The traditional surgical treatment of an incompetent great saphenous vein (GSV) and small saphenous vein (SSV) is challenged by endovenous techniques. Bipolar radio frequency induced thermo therapy (RFITT) is a new endovenous treatment, which occludes the vein by using the venous wall as a conductor. Linear endovenous energy density (LEED) describes the amount of energy used for vein closure., Material/methods: From March 2007 till April 2009, two cohorts (23 W and 20 W) were compared, respectively 280 and 178 patients. GSV and SSV were separately analyzed. Follow-up was performed at 3 weeks and 1 year post-operatively with duplex ultrasound, to assess vein closure and perioperative complaints. A visual analog scale (VAS) pain score (range 0-10) was documented. For patients operated after October 2008 follow-up was performed at least 6 months after surgery., Results: 528 GSV and 76 SSV were treated. For the GSV a significant difference in LEED 40.8 17.1 in the 20 W cohort was found, resulting in higher occlusion rates 90.6% compared to 82.7% after 3 weeks. Follow-up of 1 year in the 20 W cohort showed 88.7% occlusion. Multivariate analysis showed that pullback speed (OR 3.7, CI 1.1-12.4) and CEAP classification (OR 3.1, CI 1.7-5.6) were significant predictors for vein occlusion. Despite a higher LEED, post-operative complaints were not significantly worse., Conclusion: RFITT is a safe and effective method to treat incompetent saphenous veins. Slower pullback speed with higher LEED results in higher closure rates without causing more pain., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the operative mortality of ruptured abdominal aortic aneurysm (RAAA) in The Netherlands., Design: Retrospective population-based study of nation-wide in-hospital mortality of RAAA repair., Methods: Data were obtained from a national registry for medical diagnosis and procedures. In-hospital mortality of RAAA repair, defined as death during hospital admission irrespective of the cause of death, was determined in the period 1991-2000. Variables of potential influence on in-hospital mortality, including age, gender, date of surgery and hospital type (0-399 beds, > or =400 beds or university hospitals) were studied in a multivariate analysis., Results: The overall in-hospital mortality of RAAA repair in 5593 patients in the 10-year period was 41% (95% confidence interval: 40-42%). In the multivariate analysis, age and hospital type were the most important independent predictors for in-hospital mortality. Gender, year and season of surgery could not be identified as significant risk factors., Conclusions: Over a recent decade, in-hospital mortality of RAAA repair remained unchanged at 41%. Age and hospital class were the most important independent risk factors.

Objectives: We hypothesised that over the past decade, the nation-wide outcome of infrarenal abdominal aortic aneurysm (AAA) repair has improved with the introduction of endovascular treatment. The aim of the study was to identify endovascularly-treated patients in a national registry and to assess the impact on in-hospital mortality of non-ruptured AAA repair, if any, after the introduction of endovascular repair., Materials and Methods: We retrospectively studied the nation-wide outcome of non-ruptured AAA repair over the past decade. Variables studied were age and gender of the patients, hospital size and type and the year in which treatment was performed and the outcome on in-hospital mortality. The in-hospital mortality of non-ruptured AAA repair in 16,446 patients in the 10-year period from 1991 to 2000 was 7.3% (6.2-8.2%). In the 15,589 (95%) patients that underwent conventional treatment, in-hospital mortality was 7.6% (7.0-8.1%), whereas in the endovascular group it was 1.9% (0.6-3.5%). In the multivariate analysis, age and endovascular repair were the most important independent predictors of in-hospital mortality., Conclusion: With the limitations of a national registry aside, the introduction of endovascular aneurysm repair seems to have had a small but significant impact on in-hospital mortality following infrarenal AAA repair.

Objective: To evaluate complications of standard elective repair of infrarenal abdominal aortic aneurysms., Design: Prospective multicentre study., Materials: Two-hundred and ninety-one consecutive patients undergoing standard elective surgery for an infrarenal aortic aneurysm., Methods: Recording adverse events according to the recommendations of the Ad Hoc Committee on Reporting Standards., Results: Seventy-five patients (26%) experienced some complication following elective aortic aneurysm surgery. Twenty-two patients had a mild complication (7.6%, 95% C.I. 4.8-11.2%), 27 a moderate (9.3%, 95% C.I. 6.2-13.2%) and 26 patients had a severe and/or fatal complication (8.9%, 95% C.I. 5.9-12.8%). The in-hospital mortality was 4.1% (12 patients, 95% C.I. 2.2-7.1%). Cardiac failure was the commonest primary cause for death (58%). Twenty-two per cent of the patients had a non-fatal complication: the most frequent being pulmonary (10%) and cardiac (10%). Patients with a history of cardiac events had a five times higher risk of a fatal outcome (95% C.I. 1.1-24.0) and a two and a half times higher risk of any severe fatal or non-fatal complication (95% C.I. 1.0-6.5). Other risk factors were advancing age and the presence of pulmonary disease., Conclusions: In addition to mortality, morbidity figures of standard aneurysm operations are important, as well as associated risk factors. This is especially true when evaluating early repair of small aneurysms and new endovascular techniques.

Objective: To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome., Design: Retrospective study., Setting: Teaching hospital, The Netherlands., Subjects: 97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993., Main Outcome Measures: Initial diagnosis, interval between onset of symptoms and admission, and mortality., Results: 38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment., Conclusions: Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.

Abdominal aortic aneurysm is a life-threatening condition, which usually remains without symptoms until rupture occurs. The only way to reduce the high mortality rate (estimated at over 80%) is elective surgery on suitable patients. Therefore the presence of such an aneurysm has to be detected. For this ultrasonography is the method of choice. We studied 4399 consecutive patients aged 50 years and older, who underwent abdominal ultrasonography for the first time. According to the recommendation of the Dutch Society for Radiodiagnostics the whole abdomen was screened. In 4026 patients (1717 men and 2309 women) the ultrasound examination was performed for non-vascular reasons. In 199 of these patients (4.9%) an abdominal aortic aneurysm was an adventitious finding (133 men (7.7%) and 66 women (2.9%)). In men aged 60 years and older it was even found in 10.2%. When abdominal ultrasonography is performed for the first time in a patient aged 50 years or older, the aorta has to be screened for presence of an aneurysm.

Bacterial aortitis is a rare but serious condition. Even when treated surgically, the prognosis is poor. Prompt diagnosis is mandatory. In the absence of specific clinical signs, radiological assessment by means of ultrasound and CT is most valuable. The treatment of choice is early surgical drainage, debridement and arterial reconstruction, preferably through uncontaminated tissue combined with antibiotic therapy. We report the case of a man aged 80 with Salmonella aortitis in whom the diagnosis of bacterial aortitis was made by means of ultrasound and CT, following which successful intervention was carried out.

Leiomyomatosis peritonealis disseminata is a rare condition characterized by the presence of multiple intraabdominal nodules that consist of benign smooth muscle. We found 42 documented cases in the literature. Malignant degeneration appears to be extremely rare. We describe the second case with proved malignancy.