Journal of Vascular Surgery

Syndicate content
Journal of Vascular Surgery RSS feed.
Updated: 4 hours 6 min ago

Lumbar Drain Complications in Patients Undergoing Fenestrated/Branched Endovascular Aortic Aneurysm Repair

September 1, 2019 - 00:00
Lumbar drain placement, with cerebrospinal fluid (CSF) drainage, has been demonstrated to be an effective adjunct for reducing the risk of spinal cord ischemia in patients undergoing complex aortic aneurysm repair. However, lumbar drain placement is a challenging procedure and can be associated with significant complications. We sought to characterize complications occurring as a result of lumbar drain placement in a large, single-center experience of patients who underwent fenestrated/branched endovascular aneurysm repair (F/BEVAR).

Evolution of Fenestrated/Branched Aortic Aneurysm Repair Complexity and Outcomes at an Organized Center for the Treatment of Complex Aortic Disease

September 1, 2019 - 00:00
Fenestrated/branched endovascular aneurysm repair (F/BEVAR) volume has increased rapidly, with favorable outcomes at centers of excellence. We evaluated changes over time in F/BEVAR complexity and associated outcomes at a single-center complex aortic disease program.

Interventions for Claudication Offer Low Morbidity, Yet Patients May Still Experience Limb Loss and Worsening Functional Status

September 1, 2019 - 00:00
Interventional approaches to management of claudication vary widely. Per the Society for Vascular Surgery guidelines, any invasive treatment of claudication must offer long-term benefit at low risk of complications. Our aim was to elucidate contemporary claudication intervention patterns and functional outcomes.

Staged Endovascular Exclusion and Open Resection of Aberrant Pulmonary Artery Aneurysm due to Pulmonary Sequestration

September 1, 2019 - 00:00
Pulmonary sequestration is a rare congenital anomaly in which nonfunctioning lung tissue lacks normal communication with the tracheobronchial tree. Aneurysmal degeneration of the aberrant arterial supply may occur.

Unplanned and Planned Shunting During Carotid Endarterectomy After Acute Stroke Is Associated With Increased Risk of Perioperative Stroke

September 1, 2019 - 00:00
Whether recent stroke mandates shunting during carotid endarterectomy (CEA) is controversial. Our goal was to determine associations of various shunting practices with perioperative outcomes of CEAs performed after acute stroke.

The Evolution of the Financial Delivery of Endovascular Aneurysm Repair in Contemporary Practice

September 1, 2019 - 00:00
Previous work documented the fiscal impact of device cost compared with reimbursement associated with endovascular aneurysm repair (EVAR) delivery at an academic institution. The Centers for Medicare and Medicaid Services have since reclassified EVAR with a new Medicare Severity Diagnosis Related Group and increased reimbursement. We sought to compare the cost and revenue associated with EVAR before and after this change.

Evolution in the Presentation, Treatment, and Outcomes of Patients With Acute Mesenteric Ischemia

September 1, 2019 - 00:00
Acute mesenteric ischemia (AMI) is a life-threatening condition associated with dismal outcomes. This study sought to evaluate the evolution of presentation, treatment, and outcomes in AMI patients during the past two decades.

Statin, anesthesia, and renal dysfunction after open repair of abdominal aortic aneurysms

September 1, 2019 - 00:00
We read with great interest the study by O'Donnell et al,1 which investigated the risk factors of postoperative renal dysfunction after open repair of abdominal aortic aneurysm (AAA) in a large retrospective cohort.

Reply

September 1, 2019 - 00:00
We thank Drs Yoon and Kim for their interest in our study and the higher risk for acute kidney injury (AKI) after open repair of juxtarenal abdominal aortic aneurysms in patients taking statins preoperatively. Our understanding of the interaction between statins and postoperative renal function is constantly evolving, as both observational and randomized trials have met with mixed results. Importantly, previous studies showed that initiating statins in the perioperative period was associated with higher rates of postoperative AKI, whereas long-term statin use was associated with lower risk of renal complications.

The role of cardiac risk stratification in preoperative beta blockade

September 1, 2019 - 00:00
In the recent article by Dr Shannon et al,1 “Preoperative beta blockade is associated with increased rates of 30-day major adverse cardiac events in critical limb ischemia patients undergoing infrainguinal revascularization,” the authors highlight the impact of beta blockade on postoperative cardiac events, which demonstrated an increase in 30-day myocardial infarction and major adverse cardiac events. In the accompanying editorial, Dr Powell points out how the enthusiasm for preoperative beta blockers has waned.

Reply

September 1, 2019 - 00:00
We greatly appreciate the comments by Dr Liapis and Dr Giannakopoulos regarding our manuscript titled “Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016).”

Death rates and rupture rates due to abdominal aortic aneurysms are not always the same

September 1, 2019 - 00:00
In a commendable study, Abdulameer et al1 report on mortality by ruptured aortic aneurysms (rAAs) in the United States between 1999 and 2016. The main criticism of this study is that the terms death rate and rupture rate are used interchangeably as being the same. Evidently, death rate is the appropriate term and does not include the patients surviving a rupture. Perhaps these two terms were similar during the earlier study period of open repair. However, their difference becomes greater in the study's recent years, when endovascular aneurysm repair for rupture is increasingly used with significantly lower mortality.

A word of caution on the concentration of rifampin for endografts

September 1, 2019 - 00:00
I read with interest the article by Hennessey et al1 regarding their findings on the optimization of rifampin coating on covered Dacron endovascular stent grafts. They concluded that there was no difference in the rifampin bound to the endograft beyond a concentration of 10 mg/mL, nor how little dwell time was used over 10 minutes. The way they attempted to measure the amount of rifampin that was bound to the graft was by measuring the amount that came off the graft and dissolved into a fixed volume of solvents (methanol or saline).

Reply

September 1, 2019 - 00:00
We would like to thank Dr Escobar for his interest in and commentary of our article.1 A review of the literature before our publication demonstrated that one group, Escobar et al,2 published a case report on the successful treatment of two patients with rifampin-coated Dacron endovascular stent grafts (ESGs). Their coating protocol was similar to that of open graft procedures published in the late 1980s3 using 60 mg/mL of rifampin solution incubated for approximately 1 hour. Our paper attempted to standardize the incubation time and rifampin concentration needed to coat covered Dacron ESGs.

Reply

September 1, 2019 - 00:00
We appreciate the excellent commentary by Dr Abdallah and colleagues and agree with these investigators that in-stent restenosis is the bane of visceral artery stenting (and for that matter, modern-day vascular surgery). We also recognize that in-stent restenosis is a complex process that at times can be directly related to incomplete treatment rather than to progression of disease, edge-stent stenosis, or in-stent restenosis.1 Unfortunately, current controversies regarding local drug delivery for the prevention of restenosis further complicate our treatment options.

The continuing controversy of covered vs bare-metal mesenteric stents

September 1, 2019 - 00:00
In-stent restenosis (ISR) remains the Achilles' heel of endovascular treatment of mesenteric occlusive disease. In their paper, Zhou et al1 reported very interesting results with endovascular reinterventions for ISR, concerning 30% of 91 patients with mesenteric stents. The authors are to be congratulated as this study represents one of the largest cohorts of mesenteric stenting. Reinforcing the findings of Oderich et al,2 the authors found that covered stents (CSs) significantly outperformed bare-metal stents (BMSs) in terms of ISR (11% vs 34%; P = .02).

Optimal closure technique of the arteriotomy after carotid endarterectomy

September 1, 2019 - 00:00
The optimal closure technique of the arteriotomy after carotid endarterectomy (CEA) has been the subject of extensive debate. A recent systematic review and meta-analysis compared outcomes after CEA with patch vs primary closure (N = 29 studies; 9 randomized controlled trials [RCTs] and 20 non-RCTs; n = 13,219 CEAs).1 Primary closure was associated with a higher 30-day stroke rate compared with patch closure when both RCTs and non-RCTs were pooled together (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-2.9) as well as when non-RCTs alone were considered (OR, 1.9; 95% CI, 1.1-3.3).

Off label, on target?

September 1, 2019 - 00:00
I read with great interest the article by Martínez-Monsalve et al1 in a recent issue of the Journal. The authors performed a retrospective study of 152 patients undergoing wound debridement and concluded that topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect that allowed a high degree of wound debridement. The authors should be applauded for performing a well-designed study of an important topic (acute pain) in patients undergoing wound debridement.

Reply

September 1, 2019 - 00:00
We are thankful for Dr Hunter's comments on our recent work.1 We fully agree with her appreciation about the need to reduce costs. Coincidentally, we are currently performing a retrospective cost-effectiveness analysis in patients with refractory pain due to leg ulcers who are noneligible for revascularization. These patients were referred to a pain unit for analgesic palliative treatment, and self-administered topical sevoflurane was compared against other conventional analgesic treatments. Preliminary results showed that topical sevoflurane is by far the most cost-effective treatment for this specific condition.

Discordant knowledge about atherosclerosis disease among French general practitioners and residents

September 1, 2019 - 00:00
We read with interest the paper entitled “Knowledge gap of peripheral artery disease starts in medical school” from AlHamzah and colleagues.1 In their study of 72 graduating medical students, the authors found that students have a suboptimal knowledge of coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD). In view of the small number of students, readers may doubt the generality of these results. However, we would like to underscore that we found similar results in two studies in France using a national survey with three clinical cases: one about CAD, one about ischemic stroke, and one about PAD.