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Screening for Cardiovascular Disease. Too Early and Too Late?

The Viborg Vascular (VIVA) randomised controlled trial described a population screening program for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and hypertension, and provided subsequent lifestyle advice and recommendations for medical and interventional treatment in men aged 65–74 years.1 Some 50,156 men participated in VIVA, and a significant reduction in all cause mortality was found from 10.8% in the control group to 10.2% in the intervention group after a mean follow up of 4.4 years.

Can we learn anything from the dinosaurs?

In this edition of European Journal of Vascular and Endovascular Surgery, Jungi et al. report results of strictly open surgical treatment of patients with thrombosed popliteal artery aneurysm (PAA): 55 patients during 10 years, most of them with severe ischaemia, with 16% undergoing amputation at ≤30 days.1 The Bern group are sceptical of endovascular surgery, and have published excellent results of ruptured abdominal aortic aneurysm (AAA) repair performed by open surgery alone.2 They use a similar approach for the treatment of thrombosed PAA.

Distal Landing in TEVAR: Challenges in Reaching “The Dead Centre”

“Accuracy landing” is one of the oldest skydiving disciplines in which jumpers must land as closely as possible to a defined target on the ground. This target is called “dead centre”. The diameter of this dead centre used to be 10 cm, but it has been reduced to just 2 cm since 2007. As skydivers usually land on their feet, most try to hit the dead centre with the heel of one shoe. The world record in accuracy landing was broken in 2014 with 10 consecutive landings on the 2 cm target.

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 - 8 hours 12 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 - 8 hours 12 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.

Discussion

Journal of Vascular Surgery - 8 hours 12 min ago
Dr Nathan Orr (Lexington, Ky). I would like to congratulate the authors on an excellent presentation and manuscript as they begin to sort through the incidence and characteristics of secondary aortic interventions after thoracic endovascular aortic repair (TEVAR) for type B aortic dissections. As you have just heard, secondary aortic interventions are commonly required in this cohort, with an overall incidence of 27%. Further, this is fairly consistent for all comers, with relatively few predictors of increased incidence.

Implications of secondary aortic intervention after thoracic endovascular aortic repair for acute and chronic type B dissection

Journal of Vascular Surgery - 8 hours 12 min ago
Thoracic endovascular aortic repair (TEVAR) has become a mainstay of therapy for acute and chronic type B aortic dissection (TBAD). Dynamic aortic morphologic changes, untreated dissected aorta, and persistent false lumen perfusion have significant consequences for reintervention after TEVAR for TBAD. However, few reports contrast differences in secondary aortic intervention (SAI) after TEVAR for TBAD or describe their influence on mortality. This analysis examined incidence, timing, and types of SAI after TEVAR for acute and chronic TBAD and determined their impact on survival.

Endograft migration after thoracic endovascular aortic repair

Journal of Vascular Surgery - 8 hours 12 min ago
The objective of this study was to evaluate the incidence, timing, and potential risk factors of late endograft migration after thoracic endovascular aortic repair (TEVAR).

Addition of proximal intervention to carotid endarterectomy increases risk of stroke and death

Journal of Vascular Surgery - 8 hours 12 min ago
Adding ipsilateral, proximal endovascular (IPE) intervention to carotid endarterectomy (CEA) for the treatment of tandem bifurcation and supra-aortic trunk disease is controversial. Some suggest that this combined strategy (CEA + IPE) confers no risk over isolated CEA (ICEA). Others disagree, reserving CEA + IPE for symptomatic patients. Using the Vascular Quality Initiative (VQI), this study assessed the effect of adding IPE to CEA on stroke and death risk. We further weighed CEA + IPE outcomes in the context of symptomatic status and Society for Vascular Surgery guidelines.

Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial

Journal of Vascular Surgery - January 8, 2019 - 23:00
Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA).

Discussion

Journal of Vascular Surgery - January 8, 2019 - 23:00
Ali F. AbuRahma (Charleston, WVa). The Ochsner group presents to us this study on the correlation between the severity of neurologic deficits and the timing of carotid intervention, either carotid endarterectomy (CEA) or carotid artery stenting (CAS), to functional recovery of these patients. This analysis is important because it covers a relatively common clinical vascular practice.

Patients with moderate to severe strokes (NIHSS score >10) undergoing urgent carotid interventions within 48 hours have worse functional outcomes

Journal of Vascular Surgery - January 8, 2019 - 23:00
Increasing evidence suggests that urgent carotid intervention after a nondisabling stroke is safe. However, the functional outcome of such patients has not been quantified for various degrees of stroke. We aimed to determine whether increased presenting stroke severity and timing to intervention are associated with poor functional outcomes in patients undergoing urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS) after an acute transient ischemic attack or stroke.

Commentary on “An Experimental Study of Paclitaxel Embolisation During Drug Coated Balloon Angioplasty”: Are All DCBs Created Equal?

The paper by Boitet et al.1 is timely, given the problems with below knee (BTK) drug coated balloons (DCBs), and concerns over increased amputations in those patients treated with the Amphirion DCB (Medtronic Inc. Minneapolis, MN, USA) leading to device recall and stoppage of the IN.PACT DEEP trial,2 though causal links could not be established. This study indicates the In.Pact balloon has the highest amounts of paclitaxel (PTX), but what that amounts to in this context remains unknown. Studies suggest that DCBs are superior to drug eluting stents (DESs) in terms of the primary objective, i.e.

Discussion

Journal of Vascular Surgery - January 6, 2019 - 23:00
Dr Mark A. Farber (Chapel Hill, NC). I would like to congratulate the authors on a wonderful presentation and for providing me with a draft of the manuscript for review.

Ischemia-induced lower extremity neurologic impairment after fenestrated endovascular aneurysm repair

Journal of Vascular Surgery - January 6, 2019 - 23:00
Placement of large sheaths in the iliac system during fenestrated endovascular aneurysm repair (FEVAR) leads to lower extremity (LE) ischemia that can be associated with serious neurologic complications. We sought to determine the effect of LE ischemic time on neurologic impairment after FEVAR.

Educational resources for vascular laboratory education in vascular surgery residencies and fellowships: Survey of Vascular Surgery Program Directors

Journal of Vascular Surgery - January 5, 2019 - 23:00
The Registered Physician in Vascular Interpretation (RPVI) credential is a prerequisite for certification by the Vascular Surgery Board of the American Board of Surgery. Of concern, as more current trainees and recent program graduates take the Physician Vascular Interpretation (PVI) examination, vascular surgery trainee pass rates have decreased. Residents and fellows have a lower PVI examination pass rates than practicing vascular surgeons. The purpose of this study was to assess current vascular laboratory (VL) training for vascular surgery residents and fellows and to identify gaps that residency and fellowship programs might address.

A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy

Journal of Vascular Surgery - January 5, 2019 - 23:00
Transcarotid artery revascularization (TCAR) is a novel approach to carotid intervention that uses a direct carotid cut-down approach coupled with cerebral blood flow reversal to minimize embolic potential. The initial positive data with TCAR indicates that it may be an attractive alternative to trans-femoral carotid artery stenting and possibly carotid endarterectomy (CEA) for high-risk patients. The purpose of this study was to present 30-day and 1-year outcomes after treatment by TCAR and to compare these outcomes against a matched control group undergoing CEA at the same institutions.

Ankle-brachial index in patients with intermittent claudication is a poor indicator of patient-centered and clinician-based evaluations of functional status

Journal of Vascular Surgery - January 5, 2019 - 23:00
The association between the severity of ankle-brachial index (ABI), a traditional measure of the severity of peripheral artery disease (PAD), and patients' perceptions of their health status is poorly characterized. In Patient-Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease: Investigating Trajectories (PORTRAIT), a study of patients with intermittent claudication (IC), we studied the correlation of ABI values and Rutherford symptom classification with PAD-specific health status as measured by the Peripheral Artery Questionnaire (PAQ).

Re: “Conservative Therapy vs. Extensive Stenting in Superior Mesenteric Artery Dissection: the Right Balance has to Be Found”

I thank Ben Abdallah and colleagues for their letter. I would certainly agree that most patients with isolated mesenteric artery dissection resolve completely with conservative management. Most of the patients were treated before 2014 in our three institutions. In recent years, especially since 2015, endovascular stent placement has declined. Although bare stents do not aim to exclude an aneurysm, endovascular stenting is a favourable factor for mesenteric artery remodelling in our further study.

Carotid Body Tumours: Benign but Challenging

In a landmark publication back in 1971, Shamblin et al. reported that carotid body tumour (CBT) resection is associated with a high mortality rate, which is “usually related to carotid arterial damage or ligation”.1 Based on this observation, they developed the renowned classification scheme that we all use nowadays. They also suggested that Shamblin 3 tumours should not be resected because the nature of the CBT rarely warrants the mortality associated with the inevitable, at that time, interruption of the internal carotid circulation and subsequent re-establishment through Dacron or autogenous vein grafts.
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