Journal of Vascular Surgery

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NESVS9. Chimney Stent Graft for Left Subclavian Artery Revascularization During Thoracic Endograft Placement

October 1, 2018 - 00:00
Carotid to subclavian artery bypass (CSB) has been the standard for revascularizing the left subclavian artery during coverage by thoracic endografts (thoracic endovascular aortic repair [TEVAR]). The purpose of this study was to determine whether a chimney stent graft (CSG) offers similar outcomes to an alternative to open bypass.

NESVS8. Emergency Intraoperative Vascular Surgery Consultations at a Tertiary Academic Center

October 1, 2018 - 00:00
Vascular surgeons are frequently called on to provide emergency assistance to surgical colleagues. Whereas previous studies have included elective preoperative vascular consultations, we sought to characterize the breadth of assistance provided during urgent consultations at a single tertiary academic center.

NESVS7. Fenestrated Endovascular Aortic Aneurysm Repair Using a Supraceliac Aortic Proximal Seal Zone Versus an Infraceliac Aortic Proximal Seal Zone

October 1, 2018 - 00:00
Fenestrated endovascular aneurysm repair (FEVAR) achieves more extensive proximal seal than conventional infrarenal devices, thereby increasing aneurysm exclusion durability. Optimal seal zone length remains undefined. We assessed relative risks and benefits of extending proximal seal above the celiac artery.

NESVS6. Multispecialty Surgical Management of Carotid Body Tumors in the Modern Era

October 1, 2018 - 00:00
The objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach.

NESVS5. Lymphedema Comorbidities and Treatment Rate in the United States

October 1, 2018 - 00:00
Lymphedema (LED) has been called the forgotten vascular disease, given such scant knowledge about LED-associated comorbidities or causes, especially in the United States. Such knowledge of LED disease comorbidities and treatment (Tx) may assist in improving diagnostic decisions and health care planning.

NESVS4. Broad Variation in Prosthetic Conduit Utilization for Femoropopliteal Bypass Is Not Justified on the Basis of Contemporary Outcomes Favoring Autologous Great Saphenous Vein

October 1, 2018 - 00:00
Single-segment great saphenous vein (GSV) is the preferred conduit for femoropopliteal (FP) bypass, particularly for a below-knee (BK) popliteal artery target. Controversy persists surrounding whether prosthetic bypass can yield comparable outcomes to GSV for FP bypass to either an above-knee (AK) or BK popliteal target. We sought to analyze national variation in conduit utilization and to compare contemporary outcomes in FP bypass.

NESVS3. The Impact of Combined Iliac Occlusive Disease and Aortic Aneurysm on Open Surgical Repair

October 1, 2018 - 00:00
Severe aortoiliac occlusive disease is a relative contraindication to endovascular aneurysm repair. Open abdominal aortic aneurysm (AAA) repair requiring aortobifemoral (ABF) bypass, however, may represent a unique population with differing outcomes from standard open repair. We sought to compare the demographic and procedural characteristics as well as outcomes of patients undergoing standard intra-abdominal repair (STD) vs those requiring ABF bypass.

NESVS2. Outcomes of Carotid Endarterectomy in the Vascular Quality Initiative Based on Patch Type

October 1, 2018 - 00:00
The Vascular Quality Initiative (VQI) is the largest registry of vascular surgical procedures, and as such, it is capable of distinguishing small but important differences in outcomes. The goal of this study was to determine the outcomes of carotid endarterectomy (CEA) based on patch type, including bovine pericardium, autogenous vein, polytetrafluoroethylene (PTFE), and Dacron.

NESVS1. Outcomes After Open and Endovascular Treatment of Infrainguinal Occlusive Disease in Morbidly Obese and Superobese Patients

October 1, 2018 - 00:00
Although the effect of body mass index on the treatment of infrainguinal peripheral arterial disease (PAD) has been analyzed, outcomes of patients on the high end of the spectrum of morbid obesity (MO; body mass index >40) and superobesity (SO) are unclear. Our goal was to analyze perioperative outcomes of infrainguinal PAD after lower extremity bypass (LEB) and peripheral vascular interventions (PVIs) in this population of patients.

Alarmingly high stroke and death rates after carotid artery stenting

October 1, 2018 - 00:00
Three recent studies report alarming results for carotid artery stenting (CAS).1-3 The first is a report of patients undergoing CAS (n = 12,298) and carotid endarterectomy (CEA; n = 66,169) during 2009 to 2016 in the Vascular Quality Initiative (n = 18 regional quality groups).1 For asymptomatic patients, perioperative stroke/death rates after CEA were within the recommended thresholds by the American Heart Association (AHA) guidelines (<3%)4 in 17 of 18 regions. The only exception was a single region with perioperative stroke/death rates of 3.1%.

Neurogenic thoracic outlet syndrome: Bringing order to chaos

October 1, 2018 - 00:00
Until about the turn of this century, the diagnosis of neurogenic thoracic outlet syndrome (NTOS) was perhaps the least objective of anything we treat in vascular surgery. I trained under several leaders in the field, but even when I finished fellowship, I still had no sense of any objective criteria for the diagnosis. This all changed starting about 10 years ago, when a group of those interested in this problem met in St. Louis for a long weekend to mutually discuss this issue. Out of this meeting arose the first multiauthor comprehensive textbook on this subject1 and the Society for Vascular Surgery's thoracic outlet syndrome reporting standards document.

Utilization, patency, and complications associated with vascular access for hemodialysis in the United States

October 1, 2018 - 00:00
This study examines the utilization and outcomes of vascular access for long-term hemodialysis in the United States and describes the impact of temporizing catheter use on outcomes. We aimed to evaluate the prevalence, patency, and associated patient survival for pre-emptively placed autogenous fistulas and prosthetic grafts; for autogenous fistulas and prosthetic grafts placed after a temporizing catheter; and for hemodialysis catheters that remained in use.

Invited commentary

October 1, 2018 - 00:00
The current manuscript addresses the concept of “adequate” seal zones to treat blunt thoracic aortic injury (BTAI). All thoracic endograft devices currently available in the United States recommend a proximal seal zone of 20 mm as well as distal seal zones of 20 mm. It is well known that these devices were designed, tested, and validated for the treatment of thoracic aorta aneurysms. Conceptually, the boundary conditions to achieve endograft seal are different for aortic dissection, penetrating ulcers, saccular aneurysms, and BTAI.

Invited commentary

October 1, 2018 - 00:00
The Multilayer Flow Modulator (MFM; Cardiatis, Isnes, Belgium) consists of a three-dimensional, braided cobalt alloy wire, self-expanding mesh that alters the flow from turbulent to laminar, especially within the stent. Within the aneurysm sac, flow stagnates, promoting thrombus formation.1,2 Laminar flow is preserved through the pores of the stent, where there is adequate outflow, thereby preserving branch patency.1,2 Endothelium formation then ensues, thereby excluding the aneurysm from the circulation.

Invited commentary

October 1, 2018 - 00:00
The search for relevant biomarkers that can track or predict peripheral artery disease (PAD) progression has recently accelerated because of the proliferation of new methods including proteomic and genetic analysis. In this manuscript, Dr Joven's group provides evidence for two novel serum biomarkers that can separate patients with mild and severe PAD. The peptides are degradation products of the matrix proteins versican and type IV collagen. To do this, they began by using histology and untargeted proteomics to identify a group of proteins in arterial specimens taken from PAD patients and normal controls.

Sequential aneurysms of the internal carotid artery with fibromuscular dysplasia

October 1, 2018 - 00:00
A 50-year-old woman presented with a 6-month history of left-sided neck discomfort and headaches. She denied any history of lateralizing neurologic deficits and denied vascular risk factors including smoking and connective tissue disorders. Her physical examination demonstrated a tender pulsatile mass on the left side of the neck and an associated carotid bruit.

Invited commentary

October 1, 2018 - 00:00
Critical limb ischemia is a complex multifactorial disease with limited treatment options. The pathophysiologic mechanism of critical limb ischemia is one of underlying inflammation elaborated by a variety of cells including neutrophils, macrophages, lymphocytes, and cytokines. More recently, investigation into means of modulating angiogenesis and arteriogenesis through the use of endogenous small noncoding RNAs (microRNAs) has been described. MicroRNAs have been thought to have a role in angiogenesis as well as being modulators of vascular inflammation.

Invited commentary

October 1, 2018 - 00:00
Treatment of dissection of the aorta remains one of the great challenges in vascular surgery, but one in which steady progress has been made. In years past, even making the diagnosis was difficult, and the best means of doing so was a matter of controversy. The universal availability of high-speed and high-quality computed tomography scanning now requires only a low index of suspicion before an accurate picture of the anatomic nature of the dissection can be defined.

Impact of weekend treatment on short-term and long-term survival after urgent repair of ruptured aortic aneurysms in Germany

September 28, 2018 - 00:00
There is some evidence that weekend admission to the hospital is associated with worse outcomes compared with weekday admission. However, only a few studies have focused on weekend vs weekday surgery outcomes. This study aimed to determine whether there is a weekend effect on outcomes in the treatment of ruptured aortic aneurysms in Germany.

Current challenges in open versus endovascular repair of ruptured thoracic aortic aneurysm

September 22, 2018 - 00:00
A ruptured thoracic aortic aneurysm is considered a surgical emergency; it is often fatal if it is not identified and managed immediately. Since the recognition of this clinical entity, open surgical repair has been the “gold standard” method of management. However, open surgical repair is associated with high morbidity and mortality rates. Among high-risk patients and as an alternative, thoracic endovascular repairs have since transpired, aiming to reduce the morbidity and mortality rates associated with open repair in a number of patients.