Journal of Vascular Surgery

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The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

July 1, 2018 - 00:00
Practice guidelines are a critical component in providing high-quality, cost-effective care. The best guidelines are based on evidence supported by relevant research from the world's literature. There are many gaps in scientific evidence, so when that occurs, disease experts must develop a consensus, using their best expertise and judgement about best practice and optimal care.

Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis

July 1, 2018 - 00:00
Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA.

One year Rat Study of iBTA-induced “Microbiotube” Microvascular Grafts With an Ultra-Small Diameter of 0.6 mm

July 1, 2018 - 00:00
The world's smallest calibre “microbiotube” vascular graft was recently developed, with an inner diameter of 0.6 mm. It was formed using in-body tissue architecture (iBTA) and has a high degree of patency and capacity for regeneration in the acute phase, 1 month after implantation. This consecutive study investigated the compatibility and stability of microbiotubes in the chronic phase of implantation for 12 months for potential application in microsurgery.

Limited Adherence to Peripheral Arterial Disease Guidelines and Suboptimal Ankle Brachial Index Reliability in Dutch Primary Care

July 1, 2018 - 00:00
The Dutch College of General Practitioners' guideline on peripheral arterial disease (PAD) provides clear recommendations on the management of PAD. An ankle brachial index (ABI) measurement, prescription of antiplatelet drugs and statins, and supervised exercise therapy (SET) for intermittent claudication (IC) are advised. The aims of this study were to determine the adherence of general practitioners (GPs) to their own guideline on PAD and to evaluate the reliability of primary care ABI measurements.

Clinical Effect and Cost-Effectiveness of Screening for Asymptomatic Carotid Stenosis: A Markov Model

July 1, 2018 - 00:00
The cost-effectiveness of screening depends on the cost of screening, prevalence of asymptomatic carotid artery stenosis (ACAS), and the potential effect of medical intervention in reducing the risk of stroke. The aim of the study was to determine the threshold values for these parameters in order for screening for ACAS to be cost-effective.

Spinal Cord Ischaemia in Endovascular Thoracic and Thoraco-abdominal Aortic Repair: Review of Preventive Strategies

July 1, 2018 - 00:00
The incidence of spinal cord ischaemia (SCI) and subsequent paraplegia after thoracic endovascular aneurysm repair (TEVAR) and thoraco-abdominal endovascular aneurysm repair is estimated to be between 2.5% and 8%. The aim of this review is to provide an overview of SCI preventive strategies in TEVAR and thoraco-abdominal repair and recommend an optimal strategy.

A systematic review and meta-analysis of one-stage versus two-stage brachiobasilic arteriovenous fistula creation

July 1, 2018 - 00:00
Long-term patency of arteriovenous fistulas (AVFs) is critical for hemodialysis vascular access. We compared the efficacy of a one-stage vs two-stage approach to brachiobasilic AVF creation by primarily investigating primary and secondary patency rates. We hypothesize that the two-stage is superior to the one-stage procedure in terms of efficacy and safety.

The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

July 1, 2018 - 00:00
Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures.

Reply

July 1, 2018 - 00:00
We greatly appreciate the comments of Drs Chick and Srinivasa. We agree that surgical therapy should be performed in patients who fail more conservative managements that may also include percutaneous ablation of the sympathetic chain and ganglia.1,2 Kim et al3 and Garcia-Barquin et al4 reported satisfactory early results with percutaneous computed tomography-guided nerve ablations using either alcohol injection or a radiofrequency generated heat. Late recurrent symptoms and a lower patient satisfaction with longer follow-up, however, have also been reported.

Regarding “Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis”

July 1, 2018 - 00:00
Lima et al1 described 58 patients who underwent retroperitoneoscopic lumbar sympathectomy of the L2, L3, and L4 ganglia 116 times for plantar hyperhidrosis. Plantar hyperhidrosis resolved in 100% of patients at 30 days.1 Nineteen patients (33%) experienced transient lower extremity paresthesias and three (5%) reported transient thigh neuralgia.1 No patients died.1

Reply

July 1, 2018 - 00:00
We would like to thank Dr Kocaaslan et al for their thoughtful and interesting comments in response to our article on the use of duplex ultrasound guidance to salvage acutely occluded arteriovenous fistula (AVF).1 As Dr Kocaaslan pointed out, thrombosis of AVF is one of the most dreaded complications in end-stage renal disease patients as it threatens the long-term viability of the AVF.

Regarding “A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion”

July 1, 2018 - 00:00
We read with interest the article by Aurshina et al.1 Thrombosis is one of the most common complications of autologous arteriovenous fistula (AVF) for hemodialysis and often results in failure of the AVF. Arterial and venous track stenoses are usually the main reasons for this scenario, and percutaneous balloon angioplasty has been considered an endovascular treatment option.2 In this study, all venous stenoses were treated percutaneously with traditional balloon angioplasty. Although guidelines have not yet recommended drug-eluting balloons for thrombosed fistulas, the superiority of drug-eluting balloons over plain balloons has recently been reported for failed AVFs and arteriovenous grafts.

Invited commentary

July 1, 2018 - 00:00
Whereas the early mortality benefit of endovascular aneurysm repair (EVAR) over open repair for intact abdominal aortic aneurysms (AAAs) has been confirmed in numerous randomized trials and observational studies, the data regarding outcomes after repair of ruptured AAAs (rAAAs) are conflicting. As summarized in a recent Cochrane review, four randomized controlled trials failed to demonstrate improved short-term mortality after EVAR for rAAA.1 However, these trials were limited by small sample size, inclusion criteria leading to the exclusion of many patients, and frequent treatment variation from randomization.

Invited commentary

July 1, 2018 - 00:00
Treatment of blunt thoracic aortic injury (BTAI) has evolved significantly since early open repair was standard practice. The article by Marcaccio et al provides important new information that even a 24-hour delay before thoracic endovascular aortic repair (TEVAR) is associated with a reduction in mortality. This result contrasts with the 2011 Society for Vascular Surgery guidelines, which recommends repair in the initial 24 hours after injury.1

Hybrid repair of multiple subclavian and axillary artery aneurysms in a patient with Marfan syndrome

July 1, 2018 - 00:00
A 48-year-old man was admitted with sensory deficits in the upper extremities. He had a history of aortic dissection and previously underwent prosthetic graft placement from the aortic root to the bilateral common iliac artery. He also underwent coil embolization of a left subclavian aneurysm 9 years ago. Computed tomography angiography (CTA) performed after coil embolization showed thrombosis of the aneurysm (A, blue arrow) and patency of the prosthetic graft placed from the aortic arch to the left subclavian artery (A, red arrow).

Invited commentary

July 1, 2018 - 00:00
Magnetic resonance imaging (MRI) is becoming an increasingly important tool for anatomic assessment of the cardiovascular system. Development of four-dimensional (4D) flow MRI technology enables us to evaluate in vivo hemodynamics in blood vessels throughout the human body. When it is used to assess hemodynamic changes inside the aortic lumen, 4D flow MRI can provide us with wall shear stress (WSS). By superimposing anatomic images with WSS at different parts of the aorta, WSS maps are generated.

Invited commentary

July 1, 2018 - 00:00
This report represents a thorough analysis of the search for associations between plasma renin or aldosterone levels and excised carotid artery plaque characteristics and composition and includes evaluation of many important intraplaque inflammatory mediators. Because activation of the renin-angiotensin system has been previously described to be associated with an increase in coronary and cerebrovascular events, it seemed logical to assume that these levels should correlate with the atherosclerotic plaque.

Invited commentary

July 1, 2018 - 00:00
Diabetes mellitus affects >170 million people worldwide, and this disease burden is projected to increase to 366 million people by 2030. The presence of diabetes greatly increases the risk of peripheral vascular disease as well as accelerates its course. This puts a considerable portion of the population at risk for ischemic events, impaired functional status, and nonhealing wounds. Diabetes is associated with significant impairments in neovascularization and wound healing. The mechanism for this pathologic process is unknown, but there is evidence for associated dysfunction at both the cellular and molecular level.