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Background: Transcranial Doppler is a sensitive test for patent foramen ovale (PFO), but an absent temporal window precludes this in 12–15% of patients. We investigated whether the brachial (BrA), common carotid (CCA) or common femoral (CFA) artery provided reliable alternatives. Methods: Patients underwent simultaneous insonation of a middle cerebral artery (MCA, n = 66) and either (a) the BrA (n = 22), (b) CCA (n = 20) or (c) CFA (n = 24) with a 2-MHz transcranial Doppler probe. Results: The correlation between microbubble emboli counts in the MCA and the peripheral arteries was (a) r = 0.67 (95% CI 0.53–0.77) for the BrA, (b) r = 0.80 (95% CI 0.71–0.87) for the CCA and (c) r = 0.92 (95% CI 0.89–0.95) for the CFA. The agreement for detection of PFO was best using the CFA with a kappa of 0.95 (95% CI 0.66–1.0). Conclusion: The CFA is a simple and reliable alternative to the MCA, but the criteria for diagnosis of a PFO are different. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Aortic aneurysms are common in the elderly and a frequent cause of sudden death. As elective aneurysm repair has a mortality drastically lower than that associated with rupture, the emphasis must be on early detection and repair free from complications. Recent advances include ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA) and clinical trials on the size of AAA that require repair. Pre-operative assessment, management of cardiac risk, autologous blood transfusion strategies, and endovascular stent graft technology to avoid major open surgery are all issues to be addressed. Methods: Following a computerized Medline search for publications on the detection and treatment of abdominal and thoracic aortic aneurysm, the publications identified were then read and the references within those publications examined for further publications on this topic. We have reviewed these publications without attempting a meta-analysis. Results: Randomized population studies have addressed ultrasound screening for AAA. Attendance for screening was good and AAA detection inexpensive. Screening men from 65 years reduces the mortality from rupture and is cost-effective. Open thoracic and abdominal aneurysm repair has a mortality of around 8%, with myocardial infarction being a frequent cause of death. Pre-operative reduction of cardiac risk by cardiac investigations and beta-blockade may reduce this mortality. Autologous transfusion techniques such as acute normovolaemic haemodilution and interoperative cell salvage reduce the need for allogeneic blood and the complications associated with open surgery. Minimally invasive endovascular repair is now possible for 40% of the AAA and an increasing proportion of thoracic aneurysms. Conclusions: The combination of screening, reduced pre-operative risk, and new minimally invasive techniques extends aortic aneurysm treatment into an increasingly elderly population. The combination of these techniques will reduce mortality from ruptured aortic aneurysm in the elderly and also reduce the stress associated with aneurysm surgery. [ABSTRACT FROM AUTHOR]

A reply to a letter to the editor in the 2008;26:569 issue is presented which discusses the use of an occipital window for investigating shunts in arteries.