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18F-FDG PET in the Diagnosis of Vascular Prosthetic Graft Infection: A Diagnostic Test Accuracy Meta-Analysis

For the diagnosis of vascular prosthetic graft infection (VPGI), an intra-operative peri-graft biopsy is often required. Controversy exists regarding the use of imaging techniques in the diagnostic process. This study aimed to evaluate the diagnostic accuracy of 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in VPGI.

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

To examine the correlation between computed tomography (CT) features and clinical presentation and to assess the management strategy for patients with isolated superior mesenteric artery (SMA) dissection.

Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians

To compare early outcome after complex endovascular aortic repair in octogenarians (age ≥ 80 years) versus non-octogenarians (age < 80 years) treated with fenestrated or branched stent grafts.

Lower Limb Deep Vein Diameters Beneath Medical Compression Stockings in the Standing Position

The mechanism by which compression therapy works is still discussed, especially at calf level. Whether lower limb deep vein diameters change under compression stockings is a matter of debate: no change versus great change. New study material helps to address this question.

Using a Large Bore Sheath to Untwist Tortuous Iliac Arteries at EVAR: A Simple and Effective Technique

Tortuous iliac arteries can hinder delivery of devices during endovascular aneurysm repair (EVAR). Techniques to straighten out such arteries include buddy wires, use of large bore intra-arterial sheaths, tensioning the arterial tree via brachio-femoral pull through wires, or manual iliac support via extraperitoneal access. A technique to straighten and untwist such arteries using a transfemoral torque based approach is described.

Use of a Temporary Vascular Shunt Across the Knee Joint for Proximal Arterial Injury of the Extremity

Temporary vascular shunt (TVS) rejoining the ends of a severed artery has been described in the literature as a damage control tool, providing immediate revascularisation of the distal limb, halting the noxious effects of ischaemia on the skeletal muscle and preventing the harmful local and distant effects of the ischaemia–reperfusion cycle. The use of a TVS for a repeated popliteal artery re exploration in a young woman suffering vein bypass thrombosis due to orthopaedic manipulations while stabilizing a posterior knee dislocation is reported.

Increasing Incidence of Thoracic Aortic Aneurysm Repair in Germany in the Endovascular Era: Secondary Data Analysis of the Nationwide German DRG Microdata

Nationwide population based data on epidemiology and surgical treatment of descending thoracic aortic aneurysms (dTAAs) are not available for Germany. The aim was to assess the in hospital incidence, and to report outcomes of patients who received surgical treatment.

Non-Contrast Enhanced Magnetic Resonance Angiography: A Modern Alternative for Arteriopaths in Renal Failure

Contrast enhanced vascular imaging is typically contraindicated in arteriopaths with severe renal dysfunction because of risks of contrast induced nephropathy (in case of computed tomography angiography) or nephrogenic systemic fibrosis, as in the case of contrast enhanced magnetic resonance angiography (CE-MRA) resulting in duplex ultrasound being the fallback option, despite its known limitations. An alternative is ECG-gated non-CE-time-of-flight-MRA, exemplified by this image in a 51 year old male (after a failed kidney transplant) with foot ulcers, acquired from a 1.5T Magnetom Aera scanner (Siemens AG, Munich, Germany) using the proprietary Quiescent Interval Single Shot (QISS) protocol, which permits global assessment from aortic to crural stations.

Subclavian Vein Aneurysm

A 19 year old boy presented with gradual onset of left supraclavicular swelling, increasing in size during exercise, coughing or straining. On examination, he had a soft supraclavicular mass that was readily compressible. The mass increased in size with a Valsalva manoeuvre. An ultrasound scan suggested a 31 × 28 mm left subclavian vein aneurysm, which was confirmed by venography (A). A transverse incision was made in the left supraclavicular fossa. The aneurysm neck (which had a diameter of 10 mm) was clamped tangential to the subclavian vein and the aneurysm then resected (B).

Patients with Peripheral Artery Disease in the COMPASS Trial

Over 200 million people worldwide have peripheral artery disease (PAD) and this number is increasing because of ageing of the population.1 Patients with PAD are at high risk of major adverse cardiovascular events (MACE), including cardiovascular (CV) death, stroke, and myocardial infarction (MI), as well as major adverse limb events (MALE), including severe limb ischaemia and amputation.2,3 Many patients with PAD are significantly undertreated.4

Continuous Visceral and Distal Perfusion During “Off-pump” Open Thoraco-abdominal Repair

In an emergency, as in the case of a ruptured thoraco-abdominal aortic aneurysm (TAAA), when endovascular options (e.g., off the shelf devices) are not available or morphologically not suitable, open surgical repair (OSR) is indicated. Systems for extracorporeal circulation to maintain visceral and distal perfusion during OSR are not always present.

Infectious Complications of EVAR are Deadlier than Those of Conventional Surgery

The group from the University of Münster have written an interesting paper in which they compare mortality and complications of endoprosthesis and abdominal aortic prostheses explantation for infection.1

Evidence Based Training Strategies to Improve Clinical Practice in Endovascular Aneurysm Repair

Vascular surgery has changed immensely. The introduction of minimally invasive techniques and innovative technology have transformed the vascular surgical theatre into a highly unique and complex environment. To work safely and provide excellent care, vascular surgical teams require specialised knowledge, and technical and non-technical skills. Additionally, a positive safety culture should be created, allowing teams to identify, analyse, and prevent surgical errors.

In Vitro Evaluation of Aortic Stent Graft Deployment Accuracy in the Distal Landing Zone

Thoracic endovascular aortic repair technology focuses on accurately deploying the stent graft in the proximal landing zone in the proximal to distal direction. The aim of this in vitro study was to evaluate the accuracy of stent graft deployment in the distal landing zone.

Metformin prescription status and abdominal aortic aneurysm disease progression in the U.S. veteran population

Journal of Vascular Surgery - September 6, 2018 - 00:00
Identification of a safe and effective medical therapy for abdominal aortic aneurysm (AAA) disease remains a significant unmet medical need. Recent small cohort studies indicate that metformin, the world's most commonly prescribed oral hypoglycemic agent, may limit AAA enlargement. We sought to validate these preliminary observations in a larger cohort.

Variability in hospital costs for carotid artery revascularization

Journal of Vascular Surgery - September 6, 2018 - 00:00
The objective of this study was to understand drivers of cost for carotid endarterectomy (CEA) and carotid artery stenting (CAS) and to compare variation in cost among cases performed by vascular surgery (VS) with other services (OSs).

Identification of Vulnerable Carotid Plaques: Contrasting Results from Contrast Enhanced Ultrasound Scan Studies

The extent of internal carotid artery narrowing is traditionally used to stratify stroke risk and is still one of the key factors in clinical decision making regarding surgical intervention to prevent strokes. However, the degree of stenosis alone cannot accurately predict future stroke in asymptomatic patients. Consequently, there has been a shift in carotid imaging focus to incorporate plaque biology quantification in attempts to better stratify stroke risk.

Aortic Puncture Through Sewn-on Graft for TEVAR and Aortic Bypass

An innovative hybrid approach is described for treating a chronic aortic dissection (AD) after two failed attempts at thoracic endovascular aneurysm repair (TEVAR) because of the impossibility of catheterising the true lumen (TL). The patient was a 67 year old woman with surgical history of ascending aortic replacement for acute Type A AD, aortic arch replacement, and aorto-bi-iliac bypass for aneurysmal degeneration; of note, the bypass had been sewn onto the false lumen (FL) (Fig. 1A). Follow up computed tomography angiography indicated an increase of the descending thoracic aortic diameter (DTA) to 74 mm: the FL was enlarged, perfusing the aorto-bi-iliac graft; the TL that perfused all visceral arteries was collapsing.

Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

Contrast enhanced ultrasound (CEUS) has been suggested as an imaging tool for detection of asymptomatic carotid atherosclerotic disease (ACAD) at high risk of cerebral embolisation. The objective of this study was to evaluate CEUS and immunohistochemical (IHC) patterns in ACAD (i.e., without any neurologic symptoms in the last 6 months) and their correlations with histology.

Peria-ortic Adipose Tissue is More than Plain Fat

Once considered as a plain anti-thrombogenic lining of the inner surface of the blood vessels, endothelium is now known to have a multitude of functions that regulate vascular tone, thrombosis, platelet aggregation, angiogenesis, and inflammation. Gradually, but steadily, peri-vascular adipose tissue (PVAT) is also recognised as something much more than plain fat surrounding blood vessels: it is nowadays accepted as a paracrine and endocrine organ secreting various inflammatory cytokines, adipokines, growth factors, and inhibitors that are involved in vascular function both in health and disease.
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