Following the flow-Microbial ecology in surface- and groundwaters in the glacial forefield of a rapidly retreating glacier in Iceland.

The retreat of glaciers in response to climate change has major impacts on the hydrology and ecosystems of glacier forefield catchments. Microbes are key players in ecosystem functionality, supporting the supply of ecosystem services that glacier systems provide. The interaction between surface and groundwaters in glacier forefields has only recently gained much attention, and how these interactions influence the microbiology is still unclear. Here, we identify the microbial communities in groundwater from shallow (<15 m deep) boreholes in a glacial forefield floodplain ('sandur') aquifer at different distances from the rapidly retreating Virkisjökull glacier, Iceland, and with varying hydraulic connectivity with the glacial meltwater river that flows over the sandur. Groundwater communities are shown to differ from those in nearby glacial and non-glacial surface water communities. Groundwater-meltwater interactions and groundwater flow dynamics affect the microbial community structure, leading to different microbial communities at different sampling points in the glacier forefield. Groundwater communities differ from those in nearby glacial and non-glacial surface waters. Functional potential for microbial nitrogen and methane cycling was detected, although the functional gene copy numbers of specific groups were low.

Women in radiation (WiR)-a perspective for the strengthening of radiation protection.

Gender balance refers to the equitable treatment and access to opportunities for all genders. In order to achieve true gender balance, a variety of proactive approaches developed collaboratively, with insight from multiple perspectives, need to be implemented. With that purpose, the participation of women in professions related to radiation and radiation protection was prioritised and given high visibility by allocating a 'Women in Radiation' (WiR) Special Session at the 15th International Congress of the International Radiation Protection Association (IRPA), hosted by South Korea on 20 January 2021. In this session, various issues related to gender balance and equity/equality were highlighted by the panellists, and further elaborated in a subsequent discussion with attendees. The main goal of the WiR Special Session was to convene women from different organisations, career and age stages, disciplines and countries, in particular to consider the Asian-Oceanic vision and status of gender equality, along with other topics to support a 'Call for Action', with concrete recommendations subsequently provided to IRPA. The discussion stressed the main needs and challenges faced by women working in various radiation fields, along with raising awareness of possible professional and employment opportunities. This paper identifies some steps necessary to encourage, enhance and support the inclusion of more diversity in nuclear professions with specific emphasis on women. In conclusion, gender balance and equality must be at the heart of any strategic plan for the future of the radiological protection profession; international cooperation between relevant bodies is essential for success and could serve as a catalyst for specific policy statements aimed at achieving a balanced representation of women in radiological protection.

Volcanic controls on the microbial habitability of Mars-analogue hydrothermal environments.

Due to their potential to support chemolithotrophic life, relic hydrothermal systems on Mars are a key target for astrobiological exploration. We analysed water and sediments at six geothermal pools from the rhyolitic Kerlingarfjöll and basaltic Kverkfjöll volcanoes in Iceland, to investigate the localised controls on the habitability of these systems in terms of microbial community function. Our results show that host lithology plays a minor role in pool geochemistry and authigenic mineralogy, with the system geochemistry primarily controlled by deep volcanic processes. We find that by dictating pool water pH and redox conditions, deep volcanic processes are the primary control on microbial community structure and function, with water input from the proximal glacier acting as a secondary control by regulating pool temperatures. Kerlingarfjöll pools have reduced, circum-neutral CO2 -rich waters with authigenic calcite-, pyrite- and kaolinite-bearing sediments. The dominant metabolisms inferred from community profiles obtained by 16S rRNA gene sequencing are methanogenesis, respiration of sulphate and sulphur (S0 ) oxidation. In contrast, Kverkfjöll pools have oxidised, acidic (pH < 3) waters with high concentrations of SO42- and high argillic alteration, resulting in Al-phyllosilicate-rich sediments. The prevailing metabolisms here are iron oxidation, sulphur oxidation and nitrification. Where analogous ice-fed hydrothermal systems existed on early Mars, similar volcanic processes would likely have controlled localised metabolic potential and thus habitability. Moreover, such systems offer several habitability advantages, including a localised source of metabolic redox pairs for chemolithotrophic microorganisms and accessible trace metals. Similar pools could have provided transient environments for life on Mars; when paired with surface or near-surface ice, these habitability niches could have persisted into the Amazonian. Additionally, they offer a confined site for biosignature formation and deposition that lends itself well to in situ robotic exploration.

Ultradeep Microbial Communities at 4.4 km within Crystalline Bedrock: Implications for Habitability in a Planetary Context.

The deep bedrock surroundings are an analog for extraterrestrial habitats for life. In this study, we investigated microbial life within anoxic ultradeep boreholes in Precambrian bedrock, including the adaptation to environmental conditions and lifestyle of these organisms. Samples were collected from Pyhäsalmi mine environment in central Finland and from geothermal drilling wells in Otaniemi, Espoo, in southern Finland. Microbial communities inhabiting the up to 4.4 km deep bedrock were characterized with phylogenetic marker gene (16S rRNA genes and fungal ITS region) amplicon and DNA and cDNA metagenomic sequencing. Functional marker genes (dsrB, mcrA, narG) were quantified with qPCR. Results showed that although crystalline bedrock provides very limited substrates for life, the microbial communities are diverse. Gammaproteobacterial phylotypes were most dominant in both studied sites. Alkanindiges -affiliating OTU was dominating in Pyhäsalmi fluids, while different depths of Otaniemi samples were dominated by Pseudomonas. One of the most common OTUs detected from Otaniemi could only be classified to phylum level, highlighting the uncharacterized nature of the deep biosphere in bedrock. Chemoheterotrophy, fermentation and nitrogen cycling are potentially significant metabolisms in these ultradeep environments. To conclude, this study provides information on microbial ecology of low biomass, carbon-depleted and energy-deprived deep subsurface environment. This information is useful in the prospect of finding life in other planetary bodies.

Biogeochemical probing of microbial communities in a basalt-hosted hot spring at Kverkfjöll volcano, Iceland.

We investigated bacterial and archaeal communities along an ice-fed surficial hot spring at Kverkfjöll volcano-a partially ice-covered basaltic volcano at Vatnajökull glacier, Iceland, using biomolecular (16S rRNA, apsA, mcrA, amoA, nifH genes) and stable isotope techniques. The hot spring environment is characterized by high temperatures and low dissolved oxygen concentrations at the source (68°C and <1 mg/L (±0.1%)) changing to lower temperatures and higher dissolved oxygen downstream (34.7°C and 5.9 mg/L), with sulfate the dominant anion (225 mg/L at the source). Sediments are comprised of detrital basalt, low-temperature alteration phases and pyrite, with <0.4 wt. % total organic carbon (TOC). 16S rRNA gene profiles reveal that organisms affiliated with Hydrogenobaculum (54%-87% bacterial population) and Thermoproteales (35%-63% archaeal population) dominate the micro-oxic hot spring source, while sulfur-oxidizing archaea (Sulfolobales, 57%-82%), and putative sulfur-oxidizing and heterotrophic bacterial groups dominate oxic downstream environments. The δ13 Corg (‰ V-PDB) values for sediment TOC and microbial biomass range from -9.4‰ at the spring's source decreasing to -12.6‰ downstream. A reverse effect isotope fractionation of ~3‰ between sediment sulfide (δ34 S ~0‰) and dissolved water sulfate (δ34 S +3.2‰), and δ18 O values of ~ -5.3‰ suggest pyrite forms abiogenically from volcanic sulfide, followed by abiogenic and microbial oxidation. These environments represent an unexplored surficial geothermal environment analogous to transient volcanogenic habitats during putative "snowball Earth" scenarios and volcano-ice geothermal environments on Mars.

The UK Centre for Astrobiology: A Virtual Astrobiology Centre. Accomplishments and Lessons Learned, 2011-2016.

The UK Centre for Astrobiology (UKCA) was set up in 2011 as a virtual center to contribute to astrobiology research, education, and outreach. After 5 years, we describe this center and its work in each of these areas. Its research has focused on studying life in extreme environments, the limits of life on Earth, and implications for habitability elsewhere. Among its research infrastructure projects, UKCA has assembled an underground astrobiology laboratory that has hosted a deep subsurface planetary analog program, and it has developed new flow-through systems to study extraterrestrial aqueous environments. UKCA has used this research backdrop to develop education programs in astrobiology, including a massive open online course in astrobiology that has attracted over 120,000 students, a teacher training program, and an initiative to take astrobiology into prisons. In this paper, we review these activities and others with a particular focus on providing lessons to others who may consider setting up an astrobiology center, institute, or science facility. We discuss experience in integrating astrobiology research into teaching and education activities. Key Words: Astrobiology-Centre-Education-Subsurface-Analog research. Astrobiology 18, 224-243.

Long-term outcomes of patients with Takayasu arteritis and renal artery involvement: a cohort study.

OBJECTIVE: To describe the long-term outcomes of patients with Takayasu arteritis (TAK) and renal artery involvement (RAI). METHODS: A retrospective review of 122 patients with TAK at three tertiary centres in Canada, Sweden and the UK. Data on demographics, laboratory and clinical parameters, medications and angiography findings were collected. Non-renal and renal parameters were compared at baseline and follow-up. RESULTS: A total of 37 patients (30%) with RAI were identified: 18 (49%) with unilateral and 19 (51%) with bilateral RAI. Patients were predominantly female (89%). The median age at diagnosis was 27 years [interquartile range (IQR) 16-38]. The median follow-up time was 7 years (IQR 2-12). Hypertension was seen in 27 patients (73%) at presentation and 25 (68%) at follow-up. The median estimated glomerular filtration (eGFR) at presentation was 94 and 98 ml/min/1.73 m2 in those with unilateral and bilateral RAI, respectively. The corresponding median eGFR at follow-up was 101.5 and 104 ml/min/1.73 m2, respectively. Three patients at presentation and two at follow-up had an eGFR of <60 ml/min/1.73 m2. Five underwent endovascular intervention and three required surgical interventions. Among the 33 patients with radiologic follow-up, 23 (69%) had persistent RAI and 10 (30%) had resolution of RAI. One (6%) patient with unilateral RAI developed bilateral RAI and three (19%) with bilateral RAI regressed to unilateral RAI. Over time, 23 (62%) patients had stable renal function, 7 (19%) had improvement and 4 had a decline in renal function; no patient developed end-stage renal disease (ESRD). CONCLUSION: In this series of TAK patients with RAI, long-term non-renal and renal outcomes were favourable. No patient experienced ESRD or died.

Development of a score for assessment of radiologic damage in large-vessel vasculitis (Combined Arteritis Damage Score, CARDS).

OBJECTIVES: Outcome assessment in large-vessel vasculitis (LVV) remains challenging and this impairs patient management and the conduct of clinical studies. Previous proposals for outcome tools have not included imaging. This study aimed to develop an imaging score to quantify damage in LVV and to assess the difference between Takayasu (TAK) and giant cell arteritis (GCA). METHODS: Ninety-six patients (41 TAK, 55 GCA) were identified from local registries at two University Hospitals in the UK. Radiologic lesions including stenosis, occlusion and aneurysm were evaluated in 25 arterial regions by enhanced computed tomography or magnetic resonance angiography. Lesion correlation with combined damage assessment scores was employed in a multiple regression analysis to define the weight of individual lesions and develop a damage index. RESULTS: A numerical damage index was developed: the "Combined Arteritis Damage Score (CARDS)". The index was derived from a formula: number of regions with mild stenosis × 0.6 + number of regions with moderate to severe stenosis × 1.2 + number with occlusions × 1.6 + number with aneurysms × 0.8 in 25 arterial regions. The median CARDS was higher in TAK than GCA (4.1 and 0.6, interquartile range 1.3-5.7 and 0-3, p<0.001). CONCLUSIONS: We have developed a damage assessment tool, CARDS, based on imaging in LVV of potential value to clinical studies and patient management. TAK and GCA differ in the radiologic severity of disease.

ICRP and Radiological Protection in Medicine.

Standards in relation to radiological protection in medicine are well-documented, particularly with the recent update of the Basic Safety Standards. The principles of justification and optimisation remain key, as dose limitation is not applicable in medical practice. Appropriate justification relies on the knowledge, experience and discretion of the relevant medical practitioners and this may be overlooked in the race for diagnosis and treatment. One argument would be further regulation of medical exposures, although it is difficult to see how this could be imposed without denying patients essential investigations and treatments. Another contentious issue is individual patient dose management with the possible creation of a 'radiation passport'. Individual radiation susceptibility is a topic that has attracted much attention, but how to manage such persons, if identified, raises further questions. Communicating radiation risks and benefits to patients appropriately needs to be addressed, including who should be responsible for this, given accurate knowledge is a prerequisite. Ethics in radiological protection is also being widely discussed and this in relation to medical practice, which already involves numerous ethical issues, is likely to be open to debate in the near future.

Ionic Strength Is a Barrier to the Habitability of Mars.

UNLABELLED: The thermodynamic availability of water (water activity) strictly limits microbial propagation on Earth, particularly in hypersaline environments. A considerable body of evidence indicates the existence of hypersaline surface waters throughout the history of Mars; therefore it is assumed that, as on Earth, water activity is a major limiting factor for martian habitability. However, the differing geological histories of Earth and Mars have driven variations in their respective aqueous geochemistry, with as-yet-unknown implications for habitability. Using a microbial community enrichment approach, we investigated microbial habitability for a suite of simulated martian brines. While the habitability of some martian brines was consistent with predictions made from water activity, others were uninhabitable even when the water activity was biologically permissive. We demonstrate experimentally that high ionic strength, driven to extremes on Mars by the ubiquitous occurrence of multivalent ions, renders these environments uninhabitable despite the presence of biologically available water. These findings show how the respective geological histories of Earth and Mars, which have produced differences in the planets' dominant water chemistries, have resulted in different physicochemical extremes which define the boundary space for microbial habitability. KEY WORDS: Habitability-Mars-Salts-Water activity-Life in extreme environments. Astrobiology 16, 427-442.

Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair.

Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.

Volcanogenic fluvial-lacustrine environments in iceland and their utility for identifying past habitability on Mars.

The search for once-habitable locations on Mars is increasingly focused on environments dominated by fluvial and lacustrine processes, such as those investigated by the Mars Science Laboratory Curiosity rover. The availability of liquid water coupled with the potential longevity of such systems renders these localities prime targets for the future exploration of Martian biosignatures. Fluvial-lacustrine environments associated with basaltic volcanism are highly relevant to Mars, but their terrestrial counterparts have been largely overlooked as a field analogue. Such environments are common in Iceland, where basaltic volcanism interacts with glacial ice and surface snow to produce large volumes of meltwater within an otherwise cold and dry environment. This meltwater can be stored to create subglacial, englacial, and proglacial lakes, or be released as catastrophic floods and proglacial fluvial systems. Sedimentary deposits produced by the resulting fluvial-lacustrine activity are extensive, with lithologies dominated by basaltic minerals, low-temperature alteration assemblages (e.g., smectite clays, calcite), and amorphous, poorly crystalline phases (basaltic glass, palagonite, nanophase iron oxides). This paper reviews examples of these environments, including their sedimentary deposits and microbiology, within the context of utilising these localities for future Mars analogue studies and instrument testing.

Clinical features and radiological findings in large vessel vasculitis: are Takayasu arteritis and giant cell arteritis 2 different diseases or a single entity?

OBJECTIVE: Takayasu arteritis (TAK) and giant cell arteritis (GCA) are 2 major variants of large vessel vasculitis (LVV). The frequent involvement of large vessels in GCA has raised the possibility that TAK and GCA should be regarded as 1 disease. By detailed phenotyping of a single-center cohort, we aimed to define the differences between TAK and GCA. METHODS: Forty-five patients (23 TAK, 22 GCA) were identified. Baseline characteristics, clinical symptoms, laboratory data, enhanced computed tomography/magnetic resonance imaging, treatments, and clinical courses were retrospectively assessed with descriptive statistics. In addition, latent class analysis of the 45 patients was performed to explore phenotypic differences. RESULTS: Patients with GCA had more frequent headache (p < 0.01), higher C-reactive protein levels (p = 0.01), and higher erythrocyte sedimentation rates (p = 0.03) than did patients with TAK at diagnosis. With the exception of subdiaphragmatic lesions, the distributions of vessel lesions were not different between TAK and GCA. However, focusing on subclavian and carotid arteries, long tapered-type stenotic lesions were more frequent in GCA than in TAK (p < 0.01). The proportion of patients without relapse was higher in GCA (60%) than in TAK (22%, p = 0.01). Latent class analysis also divided patients with LVV into 2 separate groups consistent with TAK and GCA. CONCLUSION: The differences observed in clinical symptoms, inflammatory markers, radiological findings, and clinical courses suggested that TAK and GCA were 2 different diseases. Latent class analysis supported these results. The shape of stenotic lesions in the subclavian and carotid arteries is a useful discriminator between TAK and GCA.

Radiological protection of the patient: an integral part of quality of care.

Modern medicine now demands rapid diagnosis and treatment often centered on multiple investigations using ionizing radiation, particularly computed tomography (CT). Technological development continues at a rapid pace, and there is also an inexorable rise in minimally invasive therapy using fluoroscopically guided techniques. This has offered great benefit to many patients, who otherwise may not be fit enough for more invasive surgery. However, there are now many younger patients being treated using such techniques, where the risks of radiation in the longer term become more of an issue.

Phosphate Activation via Reduced Oxidation State Phosphorus (P). Mild Routes to Condensed-P Energy Currency Molecules.

The emergence of mechanisms for phosphorylating organic and inorganic molecules is a key step en route to the earliest living systems. At the heart of all contemporary biochemical systems reside reactive phosphorus (P) molecules (such as adenosine triphosphate, ATP) as energy currency molecules to drive endergonic metabolic processes and it has been proposed that a predecessor of such molecules could have been pyrophosphate [P2O74-; PPi(V)]. Arguably the most geologically plausible route to PPi(V) is dehydration of orthophosphate, Pi(V), normally a highly endergonic process in the absence of mechanisms for activating Pi(V). One possible solution to this problem recognizes the presence of reactive-P containing mineral phases, such as schreibersite [(Fe,Ni)3P] within meteorites whose abundance on the early Earth would likely have been significant during a putative Hadean-Archean heavy bombardment. Here, we propose that the reduced oxidation state P-oxyacid, H-phosphite [HPO32-; Pi(III)] could have activated Pi(V) towards condensation via the intermediacy of the condensed oxyacid pyrophosphite [H2P2O52-; PPi(III)]. We provide geologically plausible provenance for PPi(III) along with evidence of its ability to activate Pi(V) towards PPi(V) formation under mild conditions (80 °C) in water.

Volcano-ice interaction as a microbial habitat on Earth and Mars.

Volcano-ice interaction has been a widespread geological process on Earth that continues to occur to the present day. The interaction between volcanic activity and ice can generate substantial quantities of liquid water, together with steep thermal and geochemical gradients typical of hydrothermal systems. Environments available for microbial colonization within glaciovolcanic systems are wide-ranging and include the basaltic lava edifice, subglacial caldera meltwater lakes, glacier caves, and subsurface hydrothermal systems. There is widespread evidence of putative volcano-ice interaction on Mars throughout its history and at a range of latitudes. Therefore, it is possible that life on Mars may have exploited these habitats, much in the same way as has been observed on Earth. The sedimentary and mineralogical deposits resulting from volcano-ice interaction have the potential to preserve evidence of any indigenous microbial populations. These include jökulhlaup (subglacial outflow) sedimentary deposits, hydrothermal mineral deposits, basaltic lava flows, and subglacial lacustrine deposits. Here, we briefly review the evidence for volcano-ice interactions on Mars and discuss the geomicrobiology of volcano-ice habitats on Earth. In addition, we explore the potential for the detection of these environments on Mars and any biosignatures these deposits may contain.

The radiation burden from increasingly complex endovascular aortic aneurysm repair.

OBJECTIVES: With increasing experience, endovascular aortic aneurysm repair (EVAR) has been extended to patients with less suitable aorto-iliac anatomy in an attempt to reduce peri-operative mortality. However, more complex EVAR procedures may take longer and can result in higher rates of complications, additional interventional procedures and more frequent radiological imaging, which may offset some of the benefit. This study determined the radiation burden for standard EVAR, as determined by the EVAR-1 trial criteria, and more complex EVAR. METHODS: A total of 123 elective patients aged >60, with aneurysms >5.5 cm who received a bifurcated stent-graft were allocated into a group based on whether or not they fulfilled strict EVAR-1 trial criteria. The mean radiation dose was calculated for each group, together with the additional radiation burden from routine pre- and post-EVAR CT examinations and pre-EVAR iliac artery embolisation. RESULTS: Patients not meeting the EVAR-1 trial criteria had significantly longer fluoroscopic screening times and higher radiation doses. The radiation burden in all patients was higher following exposure from routine CT examinations and following pre-EVAR iliac artery embolisation. CONCLUSION: Whilst the radiation from standard EVAR is acceptable, more complicated and challenging EVARs, accompanied with additional radiological investigations and procedures, can significantly increase the radiation burden.

Astrobiological considerations for the selection of the geological filters on the ExoMars PanCam instrument.

The Panoramic Camera (PanCam) instrument will provide visible-near IR multispectral imaging of the ExoMars rover's surroundings to identify regions of interest within the nearby terrain. This multispectral capability is dependant upon the 12 preselected "geological" filters that are integrated into two wide-angle cameras. First devised by the Imager for Mars Pathfinder team to detect iron oxides, this baseline filter set has remained largely unchanged for subsequent missions (Mars Exploration Rovers, Beagle 2, Phoenix) despite the advancing knowledge of the mineralogical diversity on Mars. Therefore, the geological filters for the ExoMars PanCam will be redesigned to accommodate the astrobiology focus of ExoMars, where hydrated mineral terrains (evidence of past liquid water) will be priority targets. Here, we conduct an initial investigation into new filter wavelengths for the ExoMars PanCam and present results from tests performed on Mars analog rocks. Two new filter sets were devised: one with filters spaced every 50 nm ("F1-12") and another that utilizes a novel filter selection method based upon hydrated mineral reflectance spectra ("F2-12"). These new filter sets, along with the Beagle 2 filter set (currently the baseline for the ExoMars PanCam), were tested on their ability to identify hydrated minerals and biosignatures present in Mars analog rocks. The filter sets, with varying degrees of ability, detected the spectral features of minerals jarosite, opaline silica, alunite, nontronite, and siderite present in these rock samples. None of the filter sets, however, were able to detect fossilized biomat structures and small (<2 mm) mineralogical heterogeneities present in silica sinters. Both new filter sets outperformed the Beagle 2 filters, with F2-12 detecting the most spectral features produced by hydrated minerals and providing the best discrimination between samples. Future work involving more extensive testing on Mars analog samples that exhibit a wider range of mineralogies would be the next step in carefully evaluating the new filter sets.

Midterm results from internal iliac artery branched endovascular stent grafts.

PURPOSE: To evaluate the midterm feasibility, efficacy and safety of internal iliac artery branch grafts for endovascular repair of aortoiliac, common iliac, and internal iliac artery aneurysms. METHODS: Between December 2006 and September 2008, 8 patients underwent elective endovascular repair of aortoiliac, common iliac, and internal iliac artery aneurysms. Computed tomography aortography (CTA) was used to detect postoperative endoleak, stent migration, branch patency, and aneurysm sac expansion. RESULTS: All stent grafts were correctly implanted. However, intraoperative branch occlusion occurred in 2 of 8 cases. Both occlusions have been managed conservatively, with only 1 patient suffering detrimental symptoms. One endoleak was found. Median follow up by CT was 402 days (range 77 to 718 days). No patients died. CONCLUSIONS: Midterm results are encouraging for endovascular branch grafts to include the internal iliac artery. However, patient selection is of great importance and our series illustrates the value of caution and multidisciplinary teamwork.

Hybrid endovascular repair of an aneurysmal chronic type B dissection in a patient with Marfan syndrome with an aberrant right subclavian artery.

Abnormal aortic arch anatomy is relatively uncommon but most frequently involves an aberrant right subclavian artery. Rarely, it is associated with aneurysmal dilatation of a chronic type B dissection. Under such circumstances, the abnormal anatomy may complicate therapeutics options. Furthermore, controversy exists regarding the use of surgical or endovascular techniques in patients with aortic aneurysms and underlying arteriopathies. The current literature is limited with regard to reporting of the latter. We present a hybrid approach to repair such an aneurysm in a patient with Marfan syndrome. In a 2-stage procedure, involving initial supra-aortic bypass to all aortic arch branches, followed by endovascular stent graft deployment, the aneurysm was successfully excluded. There were no immediate complications and no evidence of endoleak at 3 months postoperatively, with thrombosis of the false lumen in the chest. By adapting hybrid open and endovascular techniques, complex thoracic aneurysms may be successfully treated in the short term in the presence of an underlying arteriopathy.