Journal of Vascular Surgery

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Aortic Arch Debranching With Thoracic Endovascular Aortic Repair and Simultaneous Coronary Bypass Grafting

August 1, 2018 - 00:00
Recent advances have allowed simultaneous hybrid repair with open surgical arch debranching and thoracic endovascular stent placement. We describe an asymptomatic patient with a degenerative aneurysm and concurrent coronary disease who successfully underwent a hybrid aortic arch and descending aorta repair and coronary revascularization.

Combined Open and Endovascular Approach to a Descending Aortic Pseudoaneurysm With Functional Coarctation

August 1, 2018 - 00:00
Recurrent coarctation of the aorta with associated pseudoaneurysm after previous open repair poses unique surgical challenges. We present a hybrid approach to correct this lesion.

Contribution of 30-Day Readmissions to the Soaring Costs of Care for the Diabetic Foot

August 1, 2018 - 00:00
The inpatient cost of care for diabetic foot ulcers (DFUs) is estimated to be $1.4 billion per year in the United States. We have previously demonstrated that the risk of 30-day unplanned readmission in DFU patients is nearly 20%. Our aim was to quantify the cost of readmissions in patients admitted with DFU.

Long-Term Outcomes of an Endovascular-First Approach for Diabetic Patients With Predominantly Tibial Disease

August 1, 2018 - 00:00
Recent studies suggest that lower extremity bypass (LEB) is associated with improved outcomes compared with endovascular peripheral vascular interventions (PVIs). The aim of our study was to compare perioperative and long-term outcomes after LEB vs PVI in diabetic patients treated in a multidisciplinary setting.

Hybrid Aortic Arch Repair Using a Ministernotomy

August 1, 2018 - 00:00
Despite advances in surgical techniques, traditional open surgical repair for type B dissections is high risk. Hybrid surgery with open surgical arch debranching and thoracic endovascular aortic repair has been recently proposed as a safe alternative. We present a patient who developed recurrent symptoms 2 months after acute type B dissection and underwent a successful hybrid aortic arch and descending aorta repair with a ministernotomy.

Secondary Interventions in Patients With Implantable Cardiac Devices and Ipsilateral Arteriovenous Access

August 1, 2018 - 00:00
This study aimed to compare secondary intervention rates for arteriovenous access in end-stage renal disease patients with pacemakers placed on the ipsilateral vs contralateral side of the fistula or graft.

A Real-World Experience of Drug-Eluting and Nondrug-Eluting Stents in Lower Extremity Peripheral Arterial Disease

August 1, 2018 - 00:00
Drug-eluting stents (DESs) have been promoted as an alternative to the traditional nondrug-eluting stents (nDESs) and offer the potential for improved patency rates. However, DESs are more expensive than nDESs, and results comparing these stents outside of clinical trials have been limited.

Management and Outcome of 597 Wartime Lower Extremity Arterial Injuries: Results From an International Military Cohort

August 1, 2018 - 00:00
Vascular injury is a leading cause of death and disability in military and civilian settings. Most wartime and an increasing amount of civilian vascular trauma arises from penetrating mechanisms due to gunshot or explosion. The objective of this study was to provide a comprehensive examination of penetrating, lower extremity arterial injury and to characterize long-term limb salvage and differences related to mechanism of injury.

Infraclavicular Thoracic Outlet Decompression Is Superior to Supraclavicular Thoracic Outlet Decompression for the Management of Venous Thoracic Outlet Syndrome

August 1, 2018 - 00:00
The usual treatment of venous thoracic outlet syndrome (VTOS) requires surgical decompression often combined with catheter-directed thrombolysis and venoplasty. Surgical options include transaxillary, supraclavicular, and infraclavicular approaches to first rib resection, but the optimal method has yet to be defined. The purpose of this study was to compare the outcomes of patients who underwent infraclavicular vs supraclavicular surgical decompression for VTOS.

Contemporary Outcomes for Redo Autogenous Infrainguinal Bypass

August 1, 2018 - 00:00
Revascularization after lower extremity bypass failure poses many challenges. Despite nearly seven decades of experience with lower extremity revascularization, few data exist on the success of redo bypass, particularly when autogenous conduit is used. The purpose of this study was to review outcomes of redo infrainguinal bypass constructed solely of autogenous vein.

Intimomedial Mucoid Degeneration: Rare but Potentially Life-Threatening

August 1, 2018 - 00:00
Intimomedial mucoid degeneration (IMD) is a rare vascular disorder characterized by mucinous deposition in the intima and media layers that causes aneurysmal degeneration of the vessel wall in young patients. We describe three patients with IMD (mean age, 30 years; standard deviation, 4.3 years) with variable clinical presentations.

Reply

August 1, 2018 - 00:00
I am pleased Ross Naylor is of the opinion that I have built a convincing case with respect to the implications of increasing stenosis severity in asymptomatic patients with carotid stenosis. Furthermore, it is difficult to refute the statement that carotid interventions are not undertaken to prevent transient ischemic attack (TIA). Virtually all natural history studies (Asymptomatic Carotid Stenosis and Risk of Stroke [ACSRS], North American Symptomatic Carotid Endarterectomy Trial [NASCET]) including ours (see Conrad, reference 3) have indicated that the index neurologic event in previously asymptomatic patients is as likely to be a stroke as it is a TIA.

Hype springs eternal

August 1, 2018 - 00:00
Richard Cambria builds a convincing case for including increasing stenosis severity as a criterion for being considered “high risk for stroke” in asymptomatic patients in the 2017 European Society for Vascular Surgery carotid guidelines.1,2 However (and while trying to avoid further transatlantic tennis), the situation is perhaps not as clear-cut as he would imply.

Regarding “A systematic review of primary endovascular repair of the ascending aorta”

August 1, 2018 - 00:00
We have read with interest Wheatley and coauthors' “A systematic review of primary endovascular repair of the ascending aorta.”1 The review is timely and relevant for various reasons. The endovascular therapies have revolutionized the primary approach in the descending thoracic aorta within the last decade,2 and the endovascular treatment of ascending aortic diseases is moving in the direction of becoming the predominant therapeutics in the not too distant future.3 Currently, the overwhelming majority of case reports and series on devices in the ascending aorta are of off-label use of the descending thoracic stent grafts in heterotopic position.

Aorta-innominate bypass through ministernotomy

August 1, 2018 - 00:00
Atherosclerotic innominate artery occlusive disease can lead to cerebral and upper extremity ischemia. Innominate artery angioplasty and stenting can be complicated by stent fractures and restenosis; furthermore, this technique is limited in treatment of innominate artery occlusions. Ministernotomy to the second or third intercostal space can be used instead of conventional full sternotomy for open surgical revascularization of the innominate artery with excellent perioperative and long-term outcomes.

A systematic review of short-term vs long-term effectiveness of one-time abdominal aortic aneurysm screening in men with ultrasound

August 1, 2018 - 00:00
An up-to-date systematic review on the long-term benefits of one-time abdominal aortic aneurysm (AAA) screening in men with ultrasound is required as new evidence is available. This report was produced for the Canadian Task Force on Preventive Health Care to provide evidence on screening for AAA with ultrasound. The aim of this systematic review was to examine the short-term (3-5 years of follow-up) vs long-term (13-15 years of follow-up) effectiveness of one-time screening for AAA in men.

Open repair of thoracoabdominal aortic aneurysms in experienced centers

August 1, 2018 - 00:00
We performed a systematic review and meta-analysis aiming to assess the mortality and morbidity of all published case series on thoracoabdominal aortic aneurysms (TAAAs) in experienced centers treated with open repair.

Invited commentary

August 1, 2018 - 00:00
Although this review is purported to center on results in experienced centers, for purposes of their analysis, the authors chose a rather modest 50 cases as the threshold for so designating a clinical series. The reported results of such a review are highly dependent on the selection and inclusion and exclusion criteria of the authors' search strategy. Whereas their manuscript details results in nearly 10,000 patients, it would be inaccurate to characterize the results as representative of “contemporary practice.” Indeed, of the 30 clinical series considered in the review, more than half have publication dates 15 or more years old! The authors emphatically illustrate the progress over time as they delineate the history of Dr Coselli's enormous published experience.

Invited commentary

August 1, 2018 - 00:00
Endovascular interventions for aortic aneurysmal disease in the elective, urgent, and emergent settings have accelerated in the last decade, with multiple groups reporting improved outcomes compared with the historical standard of open intervention. This has benefited patients and their families. Starnes et al1 also pointed out the need to stratify emergent patients into survivable and nonsurvivable and advocated for the employment of a third arm, that of palliative care for the patient presenting with a ruptured aortic aneurysm and meeting nonsurvivable criteria.

Invited commentary

August 1, 2018 - 00:00
The authors provide an exhaustive review of patients captured in the Nationwide Readmissions Database who had thoracic endovascular aortic repair performed in 2013. They conclude that early readmission was more likely due to cardiac factors, with later readmissions increasingly related to the aneurysm repair. Not surprisingly, thoracic endovascular aortic repair for rupture was associated with a high likelihood of readmission at all intervals. This review highlights both the strengths and inherent weaknesses of the many database reviews that currently populate our literature.