Journal of Vascular Surgery

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Invited commentary

February 28, 2018 - 23:00
The preceding manuscript by Ding et al describes a hybrid procedure for the management of an acute type B aortic dissection in 16 patients with an aberrant right subclavian artery (ARScA). Although this particular clinical situation may be encountered infrequently, some of the management strategies may prove useful in the management of other pathologies associated with an ARScA, that is, a Kommerell diverticulum. Although open management of arch pathologies involving an ARScA are manageable, sternotomies with cardiopulmonary bypass, likely requiring circulatory arrest and some means of cerebral protection, certainly pose at least the potential for major morbidity.

Invited commentary

February 28, 2018 - 23:00
The use of large databases in evaluating outcomes is becoming more prominent in all fields of medicine including vascular surgery.1 It is unlikely someone can pick up a recent issue of Journal of Vascular Surgery without seeing multiple papers using various databases to analyze procedural outcomes. There is no doubt that this type of research is vitally important and helps position physicians to better deal with the changing health care climate. The main benefit for using large databases is the availability of a large cohort of patients and health information at relatively low cost.

MicroRNA-155 promotes neointimal hyperplasia through smooth muscle-like cell-derived RANTES in arteriovenous fistulas

February 28, 2018 - 23:00
Arteriovenous fistula (AVF) suffers from a high number of failures caused by insufficient outward remodeling and venous neointimal hyperplasia formation. The aim was to investigate the exact mechanism by which microRNA-155 (miR-155) in the outflow vein of AVF is regulated.

Impending rupture of an abdominal aortic aneurysm and aortoenteric fistula formation

February 28, 2018 - 23:00
An 81-year-old man presented to a local general practitioner with complaints of passage of black stools for 3 days, followed by nausea and abdominal discomfort. His medical history included hypertension, hyperlipidemia, and remote smoking. Five years ago he was noted to have a small abdominal aortic aneurysm measuring 35 mm in diameter. While being examined by the local general practitioner, he became hypotensive and had a syncopal episode. Blood analysis showed anemia, with a hemoglobin level of 9.4 g/dL.

Invited commentary

February 28, 2018 - 23:00
The article by Zhang et al underscores the importance of innate immune mechanisms involving specific subsets of T lymphocytes in regulating abdominal aortic aneurysm (AAA) formation. This study demonstrates that γδT-cell deficiency inhibits the inflammatory response of vascular tissue and is accompanied by increased cell proliferation and decreased apoptosis, thereby resulting in mitigation of AAA.

The impact of race on outcomes after carotid endarterectomy in the United States

February 22, 2018 - 23:00
Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown.

Low carotid stump pressure as a predictor for ischemic symptoms and as a marker for compromised cerebral reserve in octogenarians undergoing carotid endarterectomy

February 22, 2018 - 23:00
Carotid artery occlusive disease can cause stroke by embolization, thrombosis, and hypoperfusion. The majority of strokes secondary to cervical carotid atherosclerosis are believed to be of embolic etiology. However, cerebral hypoperfusion could be an important factor in perioperative stroke. We retrospectively reviewed the stump pressure (SP) of carotid endarterectomy (CEA) of patients at Pennsylvania Hospital to identify whether physiologic perfusion differences account for differences in perioperative stroke rates, particularly in octogenarians.

Potential benefits and harms of offering ultrasound surveillance to men aged 65 years and older with a subaneurysmal (2.5-2.9 cm) infrarenal aorta

February 20, 2018 - 23:00
The objective of this review was to perform a rapid evidence summary to determine the prevalence of subaneurysmal aortic aneurysms, growth rates, and risk factors that modulate growth in average-risk men aged 65 years and older. Secondary objectives were to evaluate benefits and harms of lifelong ultrasound (US) surveillance and treatment outcomes for any large aneurysms that develop in the screened population.

Empowerment and involvement

February 16, 2018 - 23:00
The Eastern Vascular Society (EVS) has always been special to me as I began my exposure to the field of vascular surgery at the EVS when I was a general surgical resident and had the opportunity to present at this meeting about ruptured aortic aneurysms in 1991. I have missed few meetings since that time, and I hope to inspire all those who are here today to want to attend regularly.

Intraoperative cone beam computed tomography-guided endovascular recanalization of an interrupted aorta

February 16, 2018 - 23:00
A 42-year-old man sustained a stroke secondary to malignant hypertension and was found to have complete aortic interruption. We report a case of real-time image-guided endovascular repair to highlight the value of preprocedural planning and intraprocedural cone beam computed tomography. Two-dimensional fluoroscopy enhanced with three-dimensional landmarks from cone beam computed tomography was used to direct a Nykanen radiofrequency wire (Baylis Medical, Montreal, Quebec, Canada) through the interruption, avoiding critical adjacent structures.

Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia

February 15, 2018 - 23:00
Acute mesenteric ischemia (AMI) continues to be one of the most devastating diagnoses requiring emergent vascular intervention. There is a national trend toward increased use of endovascular procedures, with improved survival for the treatment of these patients. Our aim was to evaluate whether this trend has changed the treatment of AMI and the subsequent impact on length of hospitalization and hospitalization costs.

Regional variation in racial disparities among patients with peripheral artery disease

February 15, 2018 - 23:00
Prior studies identified significant racial disparities as well as regional variation in outcomes of patients with peripheral artery disease (PAD). We aimed to determine whether regional variation contributes to these racial disparities.

Pain and analgesic drugs in chronic venous ulcers with topical sevoflurane use

February 12, 2018 - 23:00
Pain in chronic venous ulcers (CVUs) notably increases with the usual cleaning of the wound. Chronic pain is usually poorly controlled even with the multiple analgesic treatments available. Analgesics can have different serious adverse effects and medical interactions in old patients with several comorbidities. This study reports the efficacy and safety of topical sevoflurane for treatment of pain in CVUs.

Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging

February 12, 2018 - 23:00
Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging.

Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury

February 12, 2018 - 23:00
The traditional approach to stable blunt thoracic aortic injury (BTAI) endorsed by the Society for Vascular Surgery is early (<24 hours) thoracic endovascular aortic repair (TEVAR). Recently, some studies have shown improved mortality in stable BTAI patients repaired in a delayed manner (≥24 hours). However, the indications for use of delayed TEVAR for BTAI are not well characterized, and its overall impact on the patient's survival remains poorly understood. We sought to determine whether delayed TEVAR is associated with a decrease in mortality compared with early TEVAR in this population.

Discussion

February 12, 2018 - 23:00
The authors have performed an elegant prospective study comparing preoperative and intraoperative duplex ultrasound of the cephalic and basilic veins in patients undergoing arteriovenous hemodialysis access creation under regional anesthesia. They reported that cephalic vein diameters in the forearm that were measured in the operating room were significantly larger and that the results of the intraoperative findings altered the preoperative plan more than 50% of the time, with the primary result being the creation of more radial-cephalic autogenous accesses.

A comparison of preoperative and intraoperative vein mapping sizes for arteriovenous fistula creation

February 12, 2018 - 23:00
Duplex ultrasound (DUS) mapping of the veins and arteries of the upper extremity is a well-established practice in arteriovenous fistula creation for long-term hemodialysis access. Previous publications have shown that vein diameters varying from 2 to 3 mm are predictive of success. Regional anesthesia is known to result in vasodilation and thus to increase the diameter of upper extremity veins. This study compares the sizes of veins measured by preoperative DUS mapping with those obtained after regional anesthesia to determine whether intraoperative DUS results in increased vein diameters and thus changes in the operative plan.

Distal vein patch use and limb events after infragenicular prosthetic bypasses

February 9, 2018 - 23:00
In the absence of suitable autologous vein, the use of prosthetic grafts for infragenicular bypasses in peripheral arterial disease has become standard practice. The purpose of this study was to investigate whether creating a vein patch at the distal anastomosis would further improve patency and freedom from major adverse limb events (MALEs). Furthermore, we sought to investigate whether the use of a distal vein patch (DVP) was associated with lower rates of acute limb ischemia (ALI) for those presenting with occluded prosthetic bypass graft.

Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair

February 3, 2018 - 23:00
Fenestrated endovascular aneurysm repair (FEVAR) is an evolving technique to treat juxtarenal abdominal aortic aneurysms (AAAs). Catheterization of visceral and renal vessels after the deployment of the fenestrated main body device is often challenging, usually requiring additional fluoroscopy and multiple digital subtraction angiograms. The aim of this study was to assess the clinical utility and accuracy of a computed tomography angiography (CTA)-fluoroscopy image fusion technique in guiding visceral vessel cannulation during FEVAR.

Prediction of advanced endovascular stent graft rotation and its associated morbidity and mortality

February 3, 2018 - 23:00
Advanced endovascular aneurysm repair (EVAR) with fenestrated and branched stent grafts is increasingly being used to repair complex aortic aneurysms; however, these devices can rotate unpredictably during deployment, leading to device misalignment. The objectives of this study were to quantify the short-term clinical outcomes in patients with intraoperative stent graft rotation and to identify quantitative anatomic markers of the arterial geometry that can predict stent graft rotation preoperatively.