Journal of Vascular Surgery

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Introduction

June 1, 2018 - 00:00
The Society for Vascular Surgery (SVS) is dedicated to providing timely, compelling, and original educational content to vascular specialists of all backgrounds and interests. To fulfill this mission, the SVS organizes and presents the Vascular Annual Meeting, or VAM – one of the world’s largest and most influential annual scientific meetings focused solely on the care of the vascular patient.

Correction

June 1, 2018 - 00:00
In the April 2017 issue of the Journal of Vascular Surgery, the article by Goodney et al (Goodney PP, Spangler EL, Newhall K, Brooke BS, Schanzer A, Tan T-W, et al. Feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons in the Vascular Physician Offer and Report (VAPOR) Trial. J Vasc Surg 2017;65:1152-60) incorrectly listed this article as having been presented at the 2016 Vascular Annual Meeting when it was presented at the New England Society for Vascular Surgery.

Reply

June 1, 2018 - 00:00
We thank Dr Xiang et al for their comments and critiques of our recent article, “Isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac vein injury.”1 As they point out, our study demonstrated that iliac vein ligation is independently associated with increased mortality. They have concerns regarding the fact that morbidity rates were not higher in the ligation cohort and question whether including intraoperative and postoperative anticoagulation therapy would have changed these results.

Regarding “Isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac vein injury”

June 1, 2018 - 00:00
With great interest, we read the recent article titled “Isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac vein injury”1 that was published in your esteemed Journal. The study had filled the knowledge gap on isolated iliac vascular injuries and reported the morbidity and mortality rates after isolated iliac vein injuries. In the article, the mortality rate was higher in patients who underwent ligation compared with those who underwent repair, whereas morbidity was similar between the two groups.

Reply

June 1, 2018 - 00:00
On behalf of our coauthors, we thank Dr Kendall for his reply to our article, “Risk factors for unplanned readmission and stump complications after major lower extremity amputation.”

Regarding “Risk factors for unplanned readmission and stump complications after major lower extremity amputation”

June 1, 2018 - 00:00
I read with great interest the article of Phair and colleagues in a recent issue of the Journal.1 The authors performed a retrospective cohort study of 739 patients undergoing major lower extremity amputation and concluded that the 30-day readmission rate after major lower leg amputation is high, with wound infections accounting for a significant proportion of these readmissions. There was no difference in readmission rates based on the level of amputation. The authors should be congratulated for performing a well-designed study on an important topic (eg, hospital readmissions) in patients undergoing surgery.

A systematic review of the efficacy of aspirin monotherapy versus other antiplatelet therapy regimens in peripheral arterial disease

June 1, 2018 - 00:00
Dual antiplatelet therapy (DAPT) usually refers to the administration of aspirin plus a platelet P2Y12 receptor blocker. This combination is commonly prescribed after revascularization procedures in patients with peripheral arterial disease (PAD) to prevent failure of the intervention. However, there is not a consensus among peripheral vascular specialists regarding whether the optimal treatment regimen for their patients is mono antiplatelet therapy (MAPT) or DAPT. Furthermore, there is no consensus regarding the optimal duration of DAPT.

VH10. Two-Staged Open Surgical Approach for Aortoesophageal Fistula

June 1, 2018 - 00:00
An aortoesophageal fistula is a rare and life-threatening condition that can cause massive bleeding and sepsis. Thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms and transections is widely used but has been associated with the development of fistulas in the long term. The most significant risk factor for fistula formation is an infection of the endograft. Thus, an open surgical approach with an extra-anatomic bypass followed by repair of the fistula can be used as definitive surgical therapy in subacute cases of aortoesophageal fistula without hemodynamic decompensation.

VH09. Carotid-Axillary Bypass

June 1, 2018 - 00:00
A 46-year-old woman presented with acute right upper extremity ischemia owing to a deep venous thrombosis and patent forman ovale. Lysis failed, and she was transferred to our institution with an ischemic right upper extremity and clot in her right subclavian artery. She was subsequently taken to the operating room for a right carotid to axillary bypass with saphenous vein.

VH08. Surgical Repair of a Retropancreatic Portal Vein Aneurysm With Pancreatic Preservation

June 1, 2018 - 00:00
We present our surgical management of a 38-year-old woman with a symptomatic 4.5-cm portal vein aneurysm. She had no prior liver disease or portal hypertension and our video demonstrates our approach to mobilize the pancreas to directly repair the aneurysm, which occurred at the confluence of the portal vein, superior mesenteric vein, and splenic vein.

VH07. Aortic Arch Branch Reconstruction for Multivessel Atherosclerotic Disease

June 1, 2018 - 00:00
This case demonstrates open revascularization of the aortic arch vessels in the setting of severe atherosclerotic occlusive disease and symptomatic global cerebral hypoperfusion. A median sternotomy incision was extended into the right neck. A bifurcated Dacron graft was taken off the ascending aorta, with anastomoses to the right subclavian and left common carotid arteries, and reimplantation of the right common carotid artery onto the right subclavian artery limb.

VH06. Endovascular Retrieval of an Inferior Vena Cava Filter and Fragment

June 1, 2018 - 00:00
This is a presentation demonstrating an endovascular retrieval of a fractured Optease filter and embedded filter fragment. The video highlights the advantages of intraoperative cone-beam computed tomography for identifying the embedded segment of the free filter fragment, allowing for the best approach for retrieval with minimal caval disruption. This imaging allowed for better identification over intravascular ultrasound examination and other imaging modalities.

VH05. Cervical Debranching for Aortic Arch Reconstruction

June 1, 2018 - 00:00
With the development of branched stent grafts designed for the aortic arch, and the increasing use of hybrid approaches to arch reconstruction, there is current and future need for surgical debranching of the arch vessels. This video describes the cervical debranching of the left carotid and left subclavian arteries from the right carotid artery in a patient with prior sternotomy, to allow subsequent arch branch graft implantation for an aortic pseudoaneurysm.

VH04. Inside-Out Approach to Central Venous Recanalization

June 1, 2018 - 00:00
This video demonstrates first in-human use of the surfacer inside-out approach for recanalization of central venous occlusions in the United States. This was done under an investigational device exemption (IDE) as part of multi-institutional trial. The patient had previously failed multiple attempts of conventional endovascular recanalization.

VH03. A 59-Year-Old Woman with Progressive Right Upper Extremity Exertional Fatigue

June 1, 2018 - 00:00
The following is a supra-aortic trunk reconstruction for a middle age woman with right upper extremity exercise induced fatigue. A bulky, calcific lesion at the origin of a shared innominate left carotid trunk (Bovine arch) necessitated three vessel supra-aortic reconstruction.

VH02. Explant of Infected Thoracic Endovascular Aortic Repair With In-Line Reconstruction

June 1, 2018 - 00:00
Prosthetic graft infection is a rare and serious complication of thoracic endovascular aortic repair (TEVAR) associated with high mortality and posing unique challenges for treatment. We describe the successful medical management and surgical explant of an infected thoracic endograft with an aorta-bronchial fistula, using an inline reconstruction with an antibiotic soaked synthetic graft.

VH01. Gracilis Muscle Flap for Exposed Prosthetic Graft in the Groin of a Patient with Previous Sartorius Myoplasty

June 1, 2018 - 00:00
This video describes a technique for gracilis muscle flap for a patient with exposed prosthetic graft in the groin with prior failed sartorius myoplasty in the setting of multiple revascularization procedures.

SS36. Early and Late Outcomes of Surgical Management of Takayasus Arteritis Four Decades of Experience

June 1, 2018 - 00:00
To evaluate early and late outcomes of surgical management in patients with Takayasu's arteritis.

VS09. Surgical Management of Pediatric Midaortic Syndrome

June 1, 2018 - 00:00
This video demonstrates a step-by-step approach to a complex case of pediatric midaortic syndrome in a 7-year-old child with severe renovascular hypertension. It highlights key steps in the surgical management of this pathology, including exposure, aortic reconstruction, and renal artery revascularization.

VS08. Aortic Stump Blow Out: An Unusual Cause

June 1, 2018 - 00:00
This video described the approach and treatment for an aortic stump blow years after an aortobifemoral bypass. This was repair initially by endovascular approach with an covered stent across the native aortic bifurcation. The patient continued to bleed and an open surgical repair was performed by exploring the aortic stump and oversewing lumbar arteries and reinforcing the stump. After several procedures, a diagnosis of angiosarcoma of the bypassed aortic stump was established.