Journal of Vascular Surgery

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A Systematic Review and Meta-Analysis of Endovascular Juxtarenal Aortic Aneurysm Repair Demonstrates Lower Perioperative Mortality Compared With Open Repair

October 1, 2019 - 00:00
The objective of this study was to compare outcomes of endovascular versus open repair for the treatment of juxtarenal aortic aneurysms.

Renal Artery Coverage During Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

October 1, 2019 - 00:00
A retrospective analysis was conducted of the Vascular Quality Initiative between 2013 and 2018.

Procedural Success With Radial Access for Carotid Artery Stenting: Systematic Review and Meta-analysis

October 1, 2019 - 00:00
A search of MedLine through PubMed, Embase through Ovid, and Cochrane Library revealed seven appropriate studies published between 2007 and 2018.

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study

October 1, 2019 - 00:00
A national prospective multicenter study from 14 hospitals, the Hyperperfusion Syndrome Post-carotid ANgIoplasty and Stenting (HISPANIAS) study, was conducted between January 2015 and October 2017.

Volume Standards for Open AAA Repair Are Not Associated With Improved Clinical Outcomes

October 1, 2019 - 00:00
A retrospective review was conducted of Medicare beneficiaries >65 years of age between 2013 and 2014 with data from the Vascular Quality Initiative used to estimate total hospital annual volume of open abdominal aortic aneurysm (AAA) repair.

An Analysis of Malpractice Litigation in the Surgical Management of Carotid Artery Disease

October 1, 2019 - 00:00
Three large legal databases (LexisNexis, Westlaw, VerdictSearch) were searched for jury verdicts and settlements between 1984 and 2017.

Endovascular exclusion and open resection of aberrant pulmonary artery aneurysm associated with intralobar pulmonary sequestration

October 1, 2019 - 00:00
A 67-year-old man with recurrent left lower lobe pneumonia and abscess was referred for a calcified lesion within the left chest, initially detected on non-contrast-enhanced computed tomography (CT) scan. CT angiography revealed an aneurysmal, aberrant left lower lobe pulmonary artery with scarred lung parenchyma (A). The aneurysm was bilobed with a 3.6-cm maximum diameter in the distal portion. In addition, the artery was aneurysmal at its origin from the descending thoracic aorta (A), just above the diaphragm.

The systematic analysis of distal revascularization with interval ligation for dialysis access steal syndrome

October 1, 2019 - 00:00
This report is the first systematic review of the distal revascularization with interval ligation (DRIL) procedure using standardized quality assessment methodology (Oxford critical appraisal skills and recommendation for practice using National Institute for Health and Care Excellence checklist). In this study, 22 publications with 459 patients with dialysis access steal syndrome (DASS) treated with DRIL were analyzed.1 The conclusion was that the DRIL procedure is an effective treatment for various grades of DASS.

Reassessment of forearm basilic arteriovenous fistula

October 1, 2019 - 00:00
It is widely accepted that an autogenous arteriovenous fistula is preferred over arteriovenous grafts and/or central venous catheters for dialysis access. To create an arteriovenous fistula, an adequate vein and artery are required. In many patients who require vascular access, the forearm cephalic vein has been damaged owing to multiple venotomies and/or intravenous catheterizations. Thus, the vein is often scarred or occluded, negating the first-line radiocephalic fistula. The forearm basilic vein lies in a medial position, making it more difficult to access for venipuncture or placement of intravenous lines.

The need to improve our understanding of long-term outcomes after endovascular aneurysm repair

October 1, 2019 - 00:00
Reports of open surgical conversions after aortic endografting are becoming increasingly prevalent,1 concomitant with the increasing prevalence of endovascular aortic repair (EVAR) over the past decade.2 The increasing need for open surgical conversion after EVAR is concerning owing to some reports describing the increased risks of perioperative morbidity and mortality of open surgical conversion relative to primary open aortic repairs.3 Some authors have attributed the loss of late survival benefit after EVAR to the increased morbidity and mortality associated with open surgical conversion after EVAR.

Total IN.PACT drug-coated balloon initiative reporting pooled imaging and propensity-matched cohorts

October 1, 2019 - 00:00
Randomized controlled trials have shown that drug-coated balloons (DCBs) provide superior results compared with percutaneous transluminal angioplasty (PTA) for the treatment of femoropopliteal artery disease. However, these trials have generally included short lesions, few occlusions, and small sample sizes. The present study was an individual-level pooled analysis of duplex ultrasonography (DUS) core laboratory-adjudicated and clinical events committee-adjudicated IN.PACT Admiral DCB subjects across two randomized controlled trials and two single-arm prospective studies to characterize the safety and effectiveness of DCB compared with PTA.

Alternative ultrasound modalities to attempt to assess high risk asymptomatic carotid plaques

October 1, 2019 - 00:00
Duplex ultrasound examination, computed tomography scans, and magnetic resonance angiography have traditionally been used as noninvasive methods to assess carotid stenosis severity. The degree of stenosis in asymptomatic patients has often been used as the main criterion to assess risk for plaque embolization and stroke. There has been an effort to find alternate methods to assess vulnerable plaques. This has included many modalities, including magnetic resonance imaging and other ultrasound techniques.

Discussion

October 1, 2019 - 00:00
Dr J. Greg Modrall (Dallas, Tex). I want to begin by congratulating the authors on a very nice study and a well-presented abstract. I also want to thank the authors for providing me with a draft of the manuscript well in advance of the meeting. I applaud the authors for addressing an important question—the impact on fenestrated and branched endograft repairs on short-term and long-term renal function. We all recognize the potential for injury to the kidney via a multitude of pathways, including intentional embolization of accessory renal arteries, unintentional embolization of cholesterol and other debris into the kidneys during manipulation of the aorta during these complex repairs, contrast-induced nephropathy, and the introduction of covered stents into the renal arteries with relatively undefined long-term consequences for the kidney.

Invited commentary

October 1, 2019 - 00:00
Vascular bypasses are one of the defining procedures of vascular surgery. Those bypasses performed for limb salvage cannot only save a limb, but have dramatic effects on quality of life for the patient and their family. However, they remain technically demanding procedures that have a small but significant rate of early and late failures. Since the development of these procedures, investigators have studied the causes of graft failure and tried to determine predictive factors for this costly and devastating complication.

Survival after major lower extremity amputation in patients with end-stage renal disease

October 1, 2019 - 00:00
This study evaluates survival of patients with end-stage renal disease (ESRD) after major lower extremity amputation (MLEA), given the burden of peripheral arterial disease in patients with ESRD, the hindrance posed by cardiovascular disease on their survival, and the national investment in ESRD-related care.

Invited commentary

October 1, 2019 - 00:00
The optimal management of critical limb ischemia (CLI) in dialysis-dependent patients (the majority of whom are diabetic) remains vexing and unsettled. In this study, Ramanan and colleagues1 have attempted to shed light on this difficult area of vascular practice. They conclude that “if feasible,” open revascularization should be considered an option for limb salvage in end-stage renal disease patients with CLI because of its association with a lower risk of major limb amputation, in spite of the higher rate of bleeding and wound complications, compared with endovascular revascularization.

Invited commentary

October 1, 2019 - 00:00
Since the first successful use of fenestrated endografts, nearly two decades ago,1,2 we have seen a rapid evolution of technical advances, with an expanding breadth of anatomic complexity that can be successfully treated with endovascular catheter-based treatments. Endografts designed with scallops, fenestrations, and branches allow stent grafts to be placed across visceral and arch arteries while preserving flow to the critical end organs supplied by these arteries. The days of fenestrated endografts, with one or two renal fenestrations, initially used to gain 1 or 2 cm of proximal seal zone in short-neck infrarenal aneurysms, seem a long way from where we are now, able to successfully treat aortic aneurysm disease involving the aortic arch or the entire thoracoabdominal aorta.

Renal volumes and estimated glomerular filtration rate changes after fenestrated-branched endovascular aortic repair

October 1, 2019 - 00:00
To describe changes in renal volumes (RV) and renal function after fenestrated-branched endovascular repair (F-BEVAR) for complex aortic aneurysms.

Physiology of the aortic wall after endograft exclusion

October 1, 2019 - 00:00
The cellular and matrix responses of the aortic wall after exclusion from direct exposure to normal circulatory pressures and stresses may have important implications for the design of endovascular devices and the management of patients after endografting. The authors have performed a thoughtful collection and inspection of aortic tissue harvested during the open exposure for management of persistent type II endoleaks that were associated with aortic sac enlargement.