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Vascular science: A glimpse into the future

Journal of Vascular Surgery - November 30, 2018 - 23:00
Vascular surgery continues to be an exciting and vibrant specialty. At the core of any specialty is the scientific foundations of its knowledge basis; this set of principles remains at the heart of patient care, what we teach our trainees and test them on, and what we place as the opening chapters of our specialty's major textbooks. At the heart of Vascular surgery's core is basic science, the fundamental principles that help us understand the physiology and pathophysiology of vascular disease. Each of the articles in this Journal of Vascular Surgery supplement is written to give the reader a glimpse into some of the exciting developments ongoing in the authors' laboratories that might form the basis of a new treatment or clinical trial.

Information for readers

Journal of Vascular Surgery - November 30, 2018 - 23:00
Communications regarding original articles and editorial management should be addressed to Peter Gloviczki, MD, and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery, 633 N. St. Clair, 22nd Floor, Chicago, IL 60611; telephone: 603-523-2222; fax: 312-334-2320; e-mail: JVASCSURG@vascularsociety.org. Information for authors appears in the January and July issues, at www.jvascsurg.org, and at jvs.editorialmanager.com. Authors should consult this document before submitting manuscripts to this Journal.

Information for authors

Journal of Vascular Surgery - November 30, 2018 - 23:00
Complete information for authors and editorial policies are available in the January and July issues, at our Web site www.jvascsurg.org, or at our Editorial Manager Web site at jvs.editorialmanager.com. An abbreviated checklist for manuscript submission follows. Manuscripts that are accepted for publication become the property of the Journal of Vascular Surgery®, which is copyrighted by the Society for Vascular Surgery®. They may not be published or reproduced in whole or in part without the written permission of the author(s) and the Journal.

Contents

Journal of Vascular Surgery - November 30, 2018 - 23:00

Editorial Board

Journal of Vascular Surgery - November 30, 2018 - 23:00

Resolvin D1 decreases abdominal aortic aneurysm formation by inhibiting NETosis in a mouse model

Journal of Vascular Surgery - November 30, 2018 - 23:00
Resolvins have been shown to attenuate inflammation, whereas NETosis, the process of neutrophils releasing neutrophil extracellular traps (NETs), produces increased inflammation. It is hypothesized that treatment of animals with resolvin D1 (RvD1) would reduce abdominal aortic aneurysm (AAA) formation by inhibiting NETosis.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Neutrophils are one of the first responders in host defense. These abundant white blood cells migrate to the affected site within minutes of an infection. Generation of neutrophil extracellular traps (NETs) is a method used by neutrophils along with phagocytosis, degranulation (release of soluble antimicrobials), and release of cytokines, which in turn recruit and activate other inflammatory cell types to directly attack microorganisms. NETs, composed of webs of chromatin and serine proteases, were first described in 2004 by Brinkmann et al.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
As the quest for stem cell-based therapies to treat nonhealing wounds continues, less effort has examined local, cutaneous treatments that may improve autogenous stem cell function. This exciting translational work by Dr Velazquez and colleagues examines local wound therapy using topical estrogen to improve stem cell function in diabetic wounds. This study is particularly important in light of recent clinical trials in which autogenous stem cells have been only modestly successful in improving healing in diabetic patients.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
With the development of hemodialysis more than a half-century ago, temporary arteriovenous access with Scribner shunts evolved into permanent arteriovenous fistula (AVF). Other than “fistula first” and endovascular intervention for failing AVFs, there has been little progress in constructing adequate, durable, and low-maintenance AVFs for hemodialysis. AVFs are very different from other vascular surgical procedures for arterial occlusive and aneurysmal disease, which generally restore nearly normal physiologic blood flow, whereas adequately functioning AVFs for hemodialysis are highly nonphysiologic anomalies.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Vein bypass grafting remains an important mainstay of revascularization for patients with advanced limb ischemia. Midterm failure of vein grafts occurs in 30% to 40% of patients and generally is manifested as a flow-reducing stenosis within the body of the venous conduit or at the anastomotic regions. On histologic evaluation, these lesions are fibroproliferative in nature, with pronounced neointimal thickening that may be extremely focal or more diffuse. Risk factors for vein graft failure are poorly understood and only partially overlap those for atherosclerosis (eg, smoking and thrombophilic states).

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
It is a pleasure to summarize and critique the clever research of Dr Braetz and colleagues, who explored the mechanisms and modulation of arterial proliferative disorders. The investigators procured and denuded segments of human internal mammary arteries from patients undergoing coronary artery bypass grafting and implanted them into nude rats to study their subsequent cellular response. Predictably, the human arteries developed robust thickening in response to denudation and transplantation into another mammalian species.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Neuropathic diabetic foot ulceration (DFU) is a serious problem that is increasing in frequency given the epidemic of diabetes in the United States. Standard treatment, as outlined in the Society for Vascular Surgery DFU guidelines, has focused on wound offloading to relieve pressure, control of infection and wound bioburden, revascularization, and focused wound dressings. However, even in specialized wound treatment programs, the average healing time for DFUs is 4 to 6 months. During this prolonged treatment time, the wound is susceptible to the development of wound infection, increased tissue loss, osteomyelitis, and, occasionally, minor or major amputation.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Until recently, intraluminal thrombus (ILT) was thought to passively accumulate in abdominal aortic aneurysms (AAAs) and possibly to provide protection against rupture by reducing peak wall stress. There is increasing evidence that ILT is biologically active and may promote aortic wall degeneration and rupture either by stimulating inflammatory and proteolytic mechanisms or by providing a barrier to aortic wall oxygenation. AAAs with higher ILT are associated with faster growth rates and a higher risk of rupture.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
The search for effective medical therapies for abdominal aortic aneurysm (AAA) suppression continues. In these experiments, clarithromycin (CAM) was effective in suppressing experimental aneurysm progression in the angiotensin II/hyperlipidemic mouse model as well as in reducing expression of proteases and proinflammatory mediators in cultured macrophages. Thus CAM joins a long list of potential aneurysm-inhibiting agents suggested through similar rodent modeling experiments during the last two decades.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Precision medicine and molecular therapeutics offer significant potential in vascular patients because of the chronicity and heterogeneity of disease. Currently, there is no established, targeted molecular therapeutic intervention for abdominal aortic aneurysm (AAA) disease. The work on using metalloproteinase as a biomarker and targeting its activity as a therapeutic option continues on the basis of earlier work, in whole and in part, in murine models. Initial studies in humans have not come to fruition.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
The study of the unique pathobiology of abdominal aortic aneurysm (AAA) can be traced to the seminal observation by M. David Tilson that “the pathogenic mechanism [of AAA] is not indiscriminate destruction of the media by atherosclerotic involvement” made 30 years ago.1 Dr Tilson was also the earliest to suggest that the unique inflammation of the AAA might well be due to inappropriate antibody responses to self antigens within the matrix of the aortic wall.2 Aneurysms developing in arterial xenografts have been described since 1955,3 and Dr Coscas and colleagues provide a novel modification of this model in the current manuscript that helps elucidate antibody-mediated immune responses to arterial mural matrix.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Since current guidelines based on randomized clinical trials1-6 have established degree of carotid stenosis as the primary surrogate for stroke risk and indication for carotid endarterectomy or stenting, accurate assessment of the degree of carotid stenosis has been the traditional focus of carotid imaging.7 However, the degree of carotid stenosis is an inadequate assessment of stroke risk, and other key factors for determining carotid plaque vulnerability include intraplaque hemorrhage, plaque rupture, and luminal thrombus.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
The potential involvement of exogenous pathogens in clinical progression of abdominal aortic aneurysm (AAA) remains controversial. Several investigative groups reported the detection of genetic materials of viruses in aneurysmal tissues using the polymerase chain reaction-based technique. However, analysis of host immunoglobulin G antibodies against cytomegalovirus (CMV), one of the viruses implicated in AAAs, failed to show different infection burdens among patients with nonruptured AAAs, ruptured AAAs, or no aneurysm.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
In addition to managing patients who present with solid organ ischemia due to acute arterial insufficiency, vascular surgeons also inflict more short-term end-organ ischemia than most other specialists because we control vessels for open reconstructions. With restoration of nutritive blood flow, various forms of reperfusion injury can substantially impair the recovery of patients with prolonged end-organ ischemia. Long clamp times, especially involving large bulk of tissues (eg, the pelvis and both legs) and susceptible organs (such as the brain, nerves, and viscera), remain a significant risk for the ischemia-reperfusion injury storm.

Invited commentary

Journal of Vascular Surgery - November 30, 2018 - 23:00
Abdominal aortic aneurysm (AAA) accounts for >20 million deaths worldwide.1 Extrapolating from the National Inpatient Sample data set capturing 20% of inpatients in the United States, approximately 500,000 operations for AAA were performed from 2000 to 2010.2 The number of aneurysms fixed by endovascular aneurysm repair increased from 5% to approximately 75% during that period, with concomitant improvements in mortality and morbidity within 2 to 3 years of surgery.2,3 Similar to the advancements offered by endovascular aneurysm repair, medical treatments that could reduce the growth rate of AAA even modestly would save lives and radically alter clinical practice.
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