Journal of Vascular Surgery

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December 31, 2018 - 23:00
We greatly appreciate the comment of Drs Ghannam, Chick, and Srinivasa. Chick and colleagues have conducted a study examining the benign management of catheter tip-associated thrombi1 and have raised the question of the necessity of anticoagulation and catheter removal in hemodialysis patients. For the management of catheter-related right atrial thrombosis (CRAT) in hemodialysis patients in our study, we treated our patients effectively by replacing catheters and providing oral anticoagulation and antiplatelet therapies.

The proposed UK abdominal aortic aneurysm guidelines: A much needed wakeup call

December 31, 2018 - 23:00
Broadly categorized, surgical revolutions come in three major forms: technical, philosophical, and transformative.

Invited commentary

December 31, 2018 - 23:00
Kapetanios and colleagues have comprehensively reviewed the published literature on the use of contrast-enhanced ultrasound (CEUS) for detection of endoleaks after endovascular aneurysm repair (EVAR). Unfortunately, the methodology used may only amplify biases present in the reviewed publications. Thus, analyses in the current review do not provide substantial new insights.

Discussion

December 31, 2018 - 23:00
Michael M. McNally (Knoxville, Tenn). I want to congratulate Dr Sabra and authors from the University of Florida Jacksonville on their research and presentation on Blunt Traumatic Aortic Injury Occurring at Unusual Locations. This study is a single-institution retrospective study investigating 74 consecutive patients with blunt traumatic aortic injury. The identified patients were then divided between usual and unusual locations based off an anatomic division 5 cm below the left subclavian artery.

Identification of unique characteristics and the management of blunt traumatic aortic injuries occurring at unusual locations in the descending thoracic aorta

December 31, 2018 - 23:00
The usual location of thoracic blunt traumatic aortic injury (BTAI) is just distal to the left subclavian artery; however, injuries can also be found in other locations in the descending thoracic aorta (DTA).

Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease

December 31, 2018 - 23:00
Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease.

Invited commentary

December 31, 2018 - 23:00
Metabolic syndrome (MetS) and peripheral artery disease (PAD) are growing public health problems that are closely intertwined. However, few prospective studies have examined the association of MetS and PAD, with the existing literature showing conflicting results.1 In this edition of the Journal, Sorber et al explore the association between MetS and postoperative outcomes after lower extremity bypass surgery and question whether perioperative use of cardiovascular risk-modifying agents alters outcomes.

Frank C. Spencer, MD, FACS (1925-2018)

December 31, 2018 - 23:00
He is the quintessential surgical teacher first by example (as one of the finest surgeons of his generation), but also through the high standards he set for the scores of individuals who had the honor of working with him. At his widely renowned morbidity and mortality conferences, Dr Spencer stressed thoughtful analysis and introspection as fundamental to achieving surgical competence. He viewed compassion and professionalism as important as technical perfection in providing quality care to our patients.

Vascular interventions in head and neck cancer patients as a marker of poor survival

December 31, 2018 - 23:00
Head and neck cancer can involve the surrounding vasculature and require technically challenging vascular interventions. These interventions can be complicated by tumor invasion, history of prior surgery, and history of radiation therapy. Our aim was to examine patients with vascular interventions in association with head and neck cancer to determine outcomes and best practice.

Invited commentary

December 31, 2018 - 23:00
During the last three decades, vascular surgeons have successfully introduced and embraced a new, minimally invasive approach for the treatment of abdominal aortic aneurysms using endovascular aneurysm repair (EVAR). Whereas countless patients have benefited from EVAR, it is not without its limitations, which include a critical need for lifelong follow-up, a significant reintervention rate that does not plateau over time, and the increased cost.

Invited commentary

December 31, 2018 - 23:00
Dr Columbo and colleagues have used the Vascular Quality Initiative's database to compare long-term mortality in patients undergoing carotid endarterectomy vs carotid stenting. Administrative databases are notoriously unreliable with respect to cause of death, leaving mortality as the most reliable outcome measure in the study. The mortality difference between carotid endarterectomy and carotid stenting in this study is striking, reinforcing several precedent studies cited by the authors. Patients selected for carotid stenting would likely be at somewhat higher risk for any procedure than those patients thought suitable for carotid endarterectomy, although propensity matching would be expected to mitigate differences between the groups, and in this case the excess mortality after carotid stenting persisted despite propensity matching.

Invited commentary

December 31, 2018 - 23:00
Endovascular aneurysm repair (EVAR) represented a true paradigm shift in vascular surgery, evidenced by its rapid proliferation after its introduction in 1990.1 By 2003, EVAR surpassed open repair as the dominant treatment modality in the Medicare population.2 However, much as for other novel technologies, physicians experience a learning curve, and devices undergo multiple iterations as long-term data reveal previously unforeseen issues. To date, several endografts have been withdrawn from the market, and none of the most commonly implanted devices are in their first generation.

Invited commentary

December 31, 2018 - 23:00
This basic science study's goal is to address an area of clinical ambiguity: how to coat an endovascular stent graft with rifampin in a standard and optimized manner for immediate use in an infected field. It optimizes two variables, concentration and incubation period, in an ex vivo experiment and on the basis of the results suggests a rapid real-time perioperative protocol. The graft chosen to study is a standard Dacron endograft of various diameters and lengths. There are reports of using a rifampin-coated endograft in an infected field with preparation extrapolated from methods used during open operation (60 mg/mL rifampin incubated for 1 hour).