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Recommendations for Registry Data Collection for Revascularisations of Acute Limb Ischaemia: A Delphi Consensus from the International Consortium of Vascular Registries

To develop a minimum core data set for evaluation of acute limb ischaemia (ALI) revascularisation treatment and outcomes that would enable collaboration among international registries.

Reporting of Complications and Mortality in Relation to Risk Communication in Patients with an Abdominal Aortic Aneurysm: A Systematic Review

High-quality reporting of surgical risks is necessary for evidence-based risk communication in clinical practice. Risk communication is defined as the process of discussing benefits and harms of treatment options with patients. This review addressed the current quality of reporting of complications and mortality in publications on abdominal aortic aneurysm treatment, with a focus on items relevant to risk communication.

Fenestrated endovascular aneurysm repair is associated with lower perioperative morbidity and mortality compared with open repair for complex abdominal aortic aneurysms

Journal of Vascular Surgery - 2 hours 56 min ago
The Zenith Fenestrated Endovascular Graft (ZFEN; Cook Medical, Bloomington, Ind) has expanded the anatomic eligibility of endovascular aneurysm repair (EVAR) for complex abdominal aortic aneurysms (AAAs). Current data on ZFEN mainly consist of single-institution experiences and show conflicting results. Therefore, we compared perioperative outcomes after repair using ZFEN with open complex AAA repair and infrarenal EVAR in a nationwide multicenter registry.

Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes

Journal of Vascular Surgery - 2 hours 56 min ago
Concurrent abdominal aortic aneurysm (AAA) and unilateral iliac occlusion is a challenge in the implantation of bifurcated stent grafts (BFGs). The endovascular approach is less invasive than open surgery; the aortouni-iliac (AUI) graft with crossover femorofemoral bypass (CFFB) has many problems associated with extra-anatomic reconstruction. We attempted endovascular aneurysm repair (EVAR) using BFGs in such cases and evaluated the outcomes.

Fresh frozen cadaver workshops for general surgical training

ANZ Journal of Surgery - May 23, 2019 - 22:04
Background

The technical proficiency of a surgeon is intricately linked to training and experience. Reduction in working hours, decreased operating time and ethical imperatives to protect patients have all resulted in a decrease in hands‐on experience. The introduction of laparoscopic procedures has also decreased trainees' exposure to open operative procedures not routinely performed in the current era.

Methods

The Clinical Training and Evaluation Centre at The University of Western Australia introduced the Core Skills Workshop for general surgical trainees in 2007. The workshop provides cadaveric dissection time for a range of open procedures. We describe in this article the logistics of setting up and running a cadaveric workshop, the performance and report our trainees' evaluation of the workshop.

Results

The Clinical Training and Evaluation Centre has hosted 26 General Surgery Core Skills Workshops since 2007. There were 227 participants with 196 evaluations returned (response rate 86%). Feedback was strongly positive for the course meeting the participants' expectations as well as its contribution to their skillset. Participants value the use of cadavers and high instructor:student ratios along with performance of a large number of open procedures in the setting of a stress‐free workshop and looked forward to more similar courses in the future.

Conclusions

Fresh frozen cadaver workshops are of value in the face of current surgical training challenges in providing an efficient, effective and safe environment.

Retrospective Study Comparing WBC scan and 18F-FDG PET/CT in Patients with Suspected Prosthetic Vascular Graft Infection

Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared.

Ten Year Experience of Using Cryopreserved Arterial Allografts for Distal Bypass in Critical Limb Ischaemia

In critical limb ischaemia (CLI), current guidelines recommend revascularisation whenever possible, preferentially through endovascular means. However, in the case of long occlusions or failed endovascular attempts, distal bypasses still have a place. Single segment great saphenous vein (GSV), which provides the best conduit, is often not available and currently there is no consensus about the best alternative graft.

Time is of the essence: evaluation of emergency department triage and time performance in the preoperative management of acute abdomen

ANZ Journal of Surgery - May 21, 2019 - 22:54

Time is of the essence: Evaluation of emergency department triage and time performance in the pre‐operative management of acute abdomen.


Background

Acute abdomen is a time‐critical condition, which requires prompt diagnosis, initiation of first‐line preoperative therapy and expedient surgical intervention. The earliest opportunity to intervene occurs at presentation to the emergency department triage. The aim of this audit was to evaluate the relationship between emergency triage and time performance measures in the preoperative management of abdominal emergencies.

Methods

Retrospective audit of time performance measures of key clinical events from emergency triage. Patient characteristics, elapsed time from triage to commencement of fluid resuscitation, intravenous antibiotics and emergency surgery and post‐operative outcomes were obtained from review of operative medical records data over a 1‐year duration.

Results

There was variability in triage allocation of patients with acute abdomen requiring urgent surgery. Category 3 was the most commonly assigned triage category (65.6%). The majority of patients (94.8%) had initial clinical assessment within the National Emergency Access Target ‘4‐hour’ rule, and 41.7% seen within 1‐h from triage. Despite this, in cases of intra‐abdominal sepsis, there was nearly a fourfold elapsed time for first dose intravenous antibiotics, beyond the 1‐h recommendation in the Sepsis Kills pathway. There was non‐significant trend in faster overall time performances with successive higher triage category allocation.

Conclusion

This study highlights an opportunity to consider alternative triage methods or fast‐track of patients with acute abdomen to promote early surgical assessment, resuscitation, antibiotic therapy and definitive intervention.

Radiofrequency Venous Ablation: Not Simple and Not Always Effective!

The study by1 reports the success rates of three different radiofrequency devices for great saphenous vein (GSV) ablation. The senior author, who performed all the interventions himself, developed an algorithm (based on the parameters of successful ablation in earlier cases) for re-treating some vein segments depending on their diameter. These differed for each device. This is easy with Venefit (no repositioning required for re-treatment). Conversely, the radiofrequency induced thermotherapy (RFITT) and endovenous radiofrequency treatment (EVRF) catheters deliver energy during “pull back” and must be re-advanced for re-treatment.

Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric Ischaemia: The Importance of Referral Patterns and Triage

Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment.

The Effect of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Vascular Surgery: A Randomised Clinical Trial

The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on arterial stiffness in patients undergoing vascular surgery.

Morphologic performance analysis of the Relay nonbare stent graft in dissected thoracic aorta

Journal of Vascular Surgery - May 21, 2019 - 00:00
The aim of this study was to evaluate morphologic changes in dissected aortas after thoracic endovascular aortic repair (TEVAR) with the use of the Relay Nonbare stent graft stent graft by focusing on the geometric stent graft's performance in remodeling aortas.

A systematic review and meta-analysis of the management of visceral artery aneurysms

Journal of Vascular Surgery - May 21, 2019 - 00:00
The evidence supporting management decisions of visceral artery aneurysms (VAAs) is sparse. Practice guidelines are needed to help patients and surgeons choose between endovascular and open surgery approaches.

A systematic review of nonoperative management in blunt thoracic aortic injury

Journal of Vascular Surgery - May 21, 2019 - 00:00
The objective was to characterize the growing body of literature regarding nonoperative management of blunt thoracic aortic injury (BTAI).

Creating arteriovenous fistulas for children in Guatemala

Journal of Vascular Surgery - May 21, 2019 - 00:00
The Guatemalan Foundation for Children with Kidney Diseases was established in 2003 as the first and only comprehensive pediatric nephrology program and hemodialysis unit in Guatemala. Bridge of Life (BOL) is a not-for-profit charitable organization focused on chronic kidney disease and supplied equipment, training and support during formation of the hemodialysis unit. Pediatric permanent vascular access (VA) expertise had not been established and noncuffed dialysis catheters provided almost all VA, many through subclavian vein access sites.

Meta-analysis and trial sequential analysis of prophylactic negative pressure therapy for groin wounds in vascular surgery

Journal of Vascular Surgery - May 21, 2019 - 00:00
Negative pressure therapy has been proposed as a prophylactic measure to promote surgical wound healing and reduce surgical site complications.

Long-term survival after endovascular and open repair in patients with anatomy outside instructions for use criteria for endovascular aneurysm repair

Journal of Vascular Surgery - May 21, 2019 - 00:00
Randomized controlled trials of long-term survival for infrarenal abdominal aortic aneurysms have compared open surgical repair (OSR) with endovascular aneurysm repair (EVAR) in patients with suitable aortic anatomy for EVAR. However, in clinical practice, patients who do not meet instructions for use (IFU) criteria are often still treated by EVAR despite that some studies show higher graft-related adverse events. The goal of this study was to compare the long-term survival of EVAR and OSR in patients with anatomy outside IFU criteria for EVAR.

Systematic review and updated meta-analysis of the use of drug-coated balloon angioplasty versus plain old balloon angioplasty for femoropopliteal arterial disease

Journal of Vascular Surgery - May 21, 2019 - 00:00
An endovascular-first approach is usually recommended in femoropopliteal occlusive disease. However, despite high technical success, plain old balloon angioplasty (POBA) is burdened with high restenosis rates. To reduce this phenomenon, local delivery of drugs has been proposed by way of drug-coated balloons (DCBs). Our goal was to review the evidence for the use of DCBs in the management of femoropopliteal disease and to determine whether it is associated with improved outcomes compared with POBA.

Locoregional anesthesia is associated with lower 30-day mortality than general anesthesia in patients undergoing endovascular repair of ruptured abdominal aortic aneurysm

Journal of Vascular Surgery - May 21, 2019 - 00:00
The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We hypothesize that mortality after endovascular repair of rAAA is lower when locoregional rather than general anesthesia is used.

Thoracic endovascular stent graft repair for ascending aortic diseases

Journal of Vascular Surgery - May 21, 2019 - 00:00
We describe the preliminary results of thoracic endovascular aortic repair (TEVAR) in a group of patients with ascending aortic disease from the Global Registry for Endovascular Aortic Treatment (GREAT).
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