Journal of Vascular Surgery

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Outcomes and Complications After Fenestrated/Branched Endovascular Aortic Repair

January 31, 2018 - 23:00
The objective of this study was to report the outcomes of patients enrolled in a physician-sponsored investigational device exemption trial for endovascular treatment of complex thoracoabdominal aortic aneurysms with fenestrated or branched devices.

Increasing Use of Open Conversion for Late Complications After Endovascular Aortic Aneurysm Repair

January 31, 2018 - 23:00
Open procedures are often required for late complications after endovascular aortic aneurysm repair (EVAR). Our aim was to describe the indications for open interventions and their postoperative outcomes and to identify factors that can predict mortality after open conversion.

Regarding “Data, guidelines, and practice of revascularization for claudication”

January 31, 2018 - 23:00
Peripheral vascular disease is an ongoing pandemic with increased prevalence secondary to increase of an elderly population.1 It constitutes >45% of total vascular interventions performed by vascular interventionists.2 There are myriad vascular interventions offered to patients with peripheral vascular disease. Yet, there is no standard protocol, which is especially true for private sector providers.

Seeing light and shadows: A commentary on the 2017 European Society for Vascular Surgery carotid guidelines

January 31, 2018 - 23:00
The 2017 European Society for Vascular Surgery (ESVS) guidelines1 for the management of atherosclerotic carotid and vertebral artery disease is a comprehensive document that is expected to guide clinical practice not only in Europe but also worldwide. Many recommendations are similar to those presented in the 2014 American Heart Association/American Stroke Association (AHA/ASA) guidelines,2 but the 2017 ESVS guidelines include several new features, such as sections on the evidence supporting rapid interventions in recently symptomatic patients, timing of interventions after thrombolysis, and management of concurrent carotid and cardiac disease.

Registry Assessment of Peripheral Interventional Devices (RAPID): Registry assessment of peripheral interventional devices core data elements

January 31, 2018 - 23:00
The current state of evaluating patients with peripheral artery disease and more specifically of evaluating medical devices used for peripheral vascular intervention (PVI) remains challenging because of the heterogeneity of the disease process, the multiple physician specialties that perform PVI, the multitude of devices available to treat peripheral artery disease, and the lack of consensus about the best treatment approaches. Because PVI core data elements are not standardized across clinical care, clinical trials, and registries, aggregation of data across different data sources and physician specialties is currently not feasible.

Invited commentary

January 31, 2018 - 23:00
Improving patient care depends on learning from experience and sharing knowledge. The purpose of clinical registries is to monitor process and outcome measures, and to collate that experience for quality assurance and quality improvement. The foundation of a clinical registry is that patients, procedures, devices, and outcomes will be recorded and available for analysis. If registries from different disciplines pool their data, there is a wider variety of providers, patients, and outcomes providing a more robust reflection of real-world experience.

Endovascular aortic repair: Current techniques with fenestrated, branched and parallel stent-grafts

January 31, 2018 - 23:00
This extremely well-illustrated, detailed, and yet readable text will be a life-long credit to the skilled and dedicated editor, Dr Oderich, the 71 contributors, and the master illustrator, Mr Factor. The illustrations are top notch, add immensely to the chapter content, and are often matched with comparative clinical images. The book is standard textbook size and weight fit for any reference library shelf, personal or general. The 49 chapters are divided by topics into 8 larger groupings that aid in directing the reader through preoperative planning to complex reconstruction in addition to highlighting ways to minimize potential complications.

Invited commentary

January 31, 2018 - 23:00
Patients with critical limb ischemia (CLI) are a clinically diverse group, and “all wounds are not created equal.” As the TNM classification system was developed to stratify and stage the burden of cancer, the Wound, Ischemia, and foot Infection (WIfI) classification system has been similarly developed to stratify the risk of amputation in the diverse group of patients presenting with limb-threatening CLI. Using WIfI, amputation risk is assessed by a clinical score generated by grading wound characteristics, degree of perfusion, and extent of infection.

Invited commentary

January 31, 2018 - 23:00
This study is a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular module database. The authors compared the 30-day reintervention and mortality rates after endovascular aneurysm repair (EVAR) and open repair for 5877 abdominal aortic aneurysms (AAAs). Surprisingly, the 30-day reintervention rate was higher after open repair than after EVAR. Also, reintervention was associated with a 12 times higher mortality after either procedure.

Invited commentary

January 31, 2018 - 23:00
The Vascular Quality Initiative (VQI) is a collaborative of regional quality groups collecting and analyzing data in an effort to improve patient care.—VQI website

Late type II endoleaks after endovascular aneurysm repair require intervention more frequently than early type II endoleaks

January 31, 2018 - 23:00
Type II endoleaks (T2ELs) are commonly observed after endovascular aneurysm repair (EVAR). We sought to determine whether time at onset of T2ELs correlated with the need to intervene based on sac expansion or rupture.

Invited commentary

January 31, 2018 - 23:00
Given that the superficial femoral and popliteal arteries look fairly straight when a patient is lying supine on a fluoroscopy table, the temptation to view this arterial segment as one long biomechanical continuum seems somewhat understandable. However, Poulson et al have adeptly reminded us that this is not necessarily the case. With the use of an innovative system of nitinol markers deployed along the course of cadaveric femoral and popliteal arteries, these authors have depicted the significant deformations that take place during the course of normal daily activities.

Invited commentary

January 31, 2018 - 23:00
Microinhibitory RNA (miRNA) were first described by Ambrose et al1 in 1993. They represented an entirely new and important layer of gene regulation. They are naturally occurring short, single-stranded RNA sequences that typically regulate many different genes. It is interesting to note that Andy Fire and Craig Mello received the 2006 Nobel Prize for Medicine for the use of synthetic double-stranded RNA that could inhibit protein production (small-interfering RNA).2 The discovery of Victor Ambrose is arguably of equal importance.

Liver perfusion dependent on superior mesenteric artery aneurysm

January 31, 2018 - 23:00
A 70-year-old woman with history of non-Hodgkin lymphoma in remission was found to have a 22-mm aneurysm of a jejunal branch of the superior mesenteric artery (SMA). She denied any symptoms, in particular, any pain. Her surgical history was notable for a remote celiac artery (CA) patch angioplasty for median arcuate ligament syndrome, which subsequently occluded. A/Cover and B show three-dimensional reconstructions of the aneurysm in right anterior oblique and left anterior oblique views: aorta and branches (red), hepatic artery (white), aneurysm (yellow), two branches connecting the SMA and CA territories (blue, turquoise).