Journal of Vascular Surgery

Syndicate content
Journal of Vascular Surgery RSS feed.
Updated: 7 hours 17 min ago

Regarding “Controversies and evidence for cardiovascular disease in the diverse Hispanic population”

May 1, 2018 - 00:00
We read with great interest the recent study published by Shaw et al1 consisting of a systematic search of the literature to identify English-language publications with the terms “cardiovascular disease,” “prevalence,” “vascular,” and “Hispanic,” with additional searches including countries such as Mexico, Cuba, and Puerto Rico and geographic regions such as Latin America, and we congratulate the valuable effort.

Reply

May 1, 2018 - 00:00
We would like to thank Drs Hanis and Mansori for their interest in our recently published paper entitled “Prediction of 6-minute walk performance in patients with peripheral artery disease.”1 This letter is in response to their letter, which offers two suggestions regarding alternative design and statistical analysis approaches.

Regarding “Prediction of 6-minute walk performance in patients with peripheral artery disease”

May 1, 2018 - 00:00
We read with much interest the article by Chen et al1 entitled “Prediction of 6-minute walk performance in patients with peripheral artery disease” that was published in the Journal of Vascular Surgery in October 2017. The aim of this research was to develop a statistical model to predict 6-minute walk test (6MWT) gait speed from 4-meter walk test results and clinical characteristics among patients with peripheral artery disease. Finally, the authors mentioned that the variables of slower 4-meter walking speed, lower ankle-brachial index, and presence of dyspnea all predict slower 6MWT gait speed, which corresponds to shorter 6MWT distance.

Reply

May 1, 2018 - 00:00
We appreciate the opportunity to emphasize the value of lifelong limb preservation (LLP) as a valuable patient-centered outcome measure. Dr Kuo et al raise several questions, all of which revolve around the “legitimacy” of not censoring death as an outcome in our life-table analysis. This conceptual stumbling block arises from the specific nature of limb salvage procedures and the context within which they are performed. The purpose of lower extremity revascularization is not to prolong life but to avoid amputation and disability in the final few years of life.

Regarding “Lifelong limb preservation: A patient-centered description of lower extremity arterial reconstruction outcomes”

May 1, 2018 - 00:00
We are interested in the concept of lifelong preservation (LLP) that Shean et al1 proposed recently. To apply survival analysis to quantifying the benefits of intervention on critical limb ischemia, we have to explicitly define risk set, failure (event), and censoring.2-6

Reply

May 1, 2018 - 00:00
Drs Krzanowski and Partyka are to be congratulated on their single-center retrospective experience highlighting outstanding outcomes in a high-volume center of excellence. While we agree that additional prospective randomized trials are needed to definitively answer the question of superiority of approach for treatment of critical limb-threatening ischemia (CLI), this comment highlights the value of multicenter data. While a majority of publications and trial data are drawn from high-volume centers of excellence, including recent Society for Vascular Surgery objective performance goals for CLI, these data may not represent outcomes for a majority of patients undergoing procedures for CLI as many patients are not treated at high-volume centers of excellence.

Regarding “Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention”

May 1, 2018 - 00:00
Mehaffey and colleagues' work, “Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention,”1 adds to the growing debate on whether endovascular or open repair is the best management for critical limb ischemia (CLI). The results they report on 30-day outcomes of endovascular treatment, however, do not comport with data we have accrued at our center in southern Poland.2,3 During the last 8 years, we have percutaneously treated 5195 patients with CLI (78% of them with tissue loss).

Management of visceral aortic patch aneurysms after thoracoabdominal repair with open, hybrid, or endovascular approach

May 1, 2018 - 00:00
The objective of this study was to investigate the outcomes of patients with visceral aortic patch (VAP) aneurysms after open repair of thoracoabdominal aortic aneurysm (TAAA) treated with three different approaches: open, hybrid, and endovascular repair.

Early sac shrinkage is a good surrogate marker of durable success after endovascular aneurysm repair in Japanese patients

May 1, 2018 - 00:00
The applicability of early sac shrinkage as a predictor of a low risk of late complications after endovascular aneurysm repair (EVAR) in Asian populations has not been validated. This study aimed to analyze early sac shrinkage and its relationship with late complications in Asian people using a Japanese multicenter database. We also assessed the impact of endoleaks.

Invited commentary

May 1, 2018 - 00:00
Recognizing that some abdominal aortic aneurysm (AAA) endografts have a small offset between the radiopaque markers and the proximal fabric edge that may result in unintended partial renal artery coverage, the authors investigated the hemodynamic effect of this potentially adverse event. It is generally accepted that blood flow-induced low arterial wall shear forces are associated with development of atherosclerosis (wall shear force per unit wall area is wall shear stress, WSS) and that extremely high shear rates may produce thromboembolism with or without local turbulence.

Collet-Sicard syndrome secondary to internal carotid artery pseudoaneurysm

May 1, 2018 - 00:00
A 43-year-old female patient with migraines presented with right-sided headaches, jaw and ear pain, tongue and uvula deviation, right arm weakness, and dysphagia of solids and liquids resulting in a 7-pound weight loss. Neurologic examination included serologic and cerebrospinal fluid evaluation, which ruled out infectious, inflammatory, and paraneoplastic diseases. Magnetic resonance imaging of the brain and computed tomography angiography of the head and neck ruled out cerebrovascular accident and vasculitis.

Invited commentary

May 1, 2018 - 00:00
Although carotid endarterectomy and stenting for symptomatic significant carotid artery stenosis are widely accepted for stroke prevention, their use for asymptomatic stenosis is more controversial. With the advances in medical therapy, particularly the use of statins, and with an annual stroke risk of 1% to 2% for asymptomatic disease, justifying these interventions in these patients is more difficult. What is more disturbing is that ∼90% of all carotid endarterectomy and stenting procedures in the United States are performed on asymptomatic patients and that many were felt to be unnecessary, resulting in a cost of >$2 billion annually.

Procedural and perioperative results in patients treated with fenestrated endovascular aneurysm repair planned by automated software in a physician-sponsored investigational device exemption trial of physician-modified endografts

April 26, 2018 - 00:00
Fenestrated endovascular aneurysm repair (FEVAR) has been used successfully to treat patients with juxtarenal abdominal aortic aneurysms (JAAAs). Barriers to wide adoption of FEVAR include complexity in planning of fenestration locations on endografts. The purpose of this study was to validate the use of automated planning software to design fenestrated endografts and to treat patients with complex abdominal aortic aneurysms.