Journal of Vascular Surgery

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A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters

March 31, 2019 - 23:00
Patients with end-stage renal disease need vascular access to ensure sufficient blood flow during hemodialysis (HD). Patients who are poor candidates for arteriovenous access creation require long-term catheter placement. Problems such as dialysate recirculation, thrombosis, catheter-related infections, and malfunction can occur with HD catheters. Different tip designs (step, split, and symmetrical) have been developed to ameliorate the catheter-related problems. The aim of the study was to compare the efficacy and safety of split-tip, step-tip, and symmetrical-tip HD catheters.

Transcaval embolization as the preferred approach

March 31, 2019 - 23:00
The management of type II endoleaks that develop after endovascular repair of aortic aneurysms now includes the transcaval approach. We reviewed the safety and efficacy of this technique in 10 consecutive patients (82 ± 7 years old; 80% male) who presented with a mean sac enlargement of 1.2 ± 0.7 cm and documented flow within the aortic sac. Patients presented a mean of 5.5 ± 3.1 years after endovascular aneurysm repair, and five (50%) patients had prior attempts at endovascular repair of the documented endoleak.

Invited commentary

March 31, 2019 - 23:00
In this issue of the Journal, Tsilimparis et al report on the largest clinical experience with endovascular aortic arch repair using branched endografts in the Western world. The study highlights the evolution of stent graft design, its patient selection, and the use of a multidisciplinary approach towards open and endovascular techniques in a single center. Overall, endovascular treatment was selected in 30% of 430 patients with aortic pathology, including inner branched devices in 54 patients (13%), fenestrated devices in 46 (10%), and parallel stent grafts in 30 (7%).

The rise and fall of beta-blockers?

March 31, 2019 - 23:00
The study reported by Shannon and coworkers identified that preprocedure beta-blocker therapy was associated with an increased risk of major adverse cardiovascular events (MACEs) in patients undergoing either open surgery or endovascular therapy for chronic limb-threatening ischemia. The authors reviewed 11,785 revascularization procedures using the National Surgical Quality Improvement Program. There are several limitations to the study acknowledged by the authors, such as the absence of knowledge regarding the type, dosage, and duration of the beta-blocker therapy as well as follow-up limited to 30 days.

Endovascular treatment results and risk factors for complications of body and extremity arteriovenous malformations

March 31, 2019 - 23:00
The objective of this study was to investigate the factors associated with the complication rate and treatment outcomes of arteriovenous malformations (AVMs) during a 20-year period.

Age but not sex is associated with higher risk of in-hospital stroke or death after carotid artery stenting in symptomatic and asymptomatic carotid stenosis

March 31, 2019 - 23:00
The aim of this study was to analyze the correlation of age and sex with the outcome after carotid artery stenting (CAS). We used the statutory nationwide quality assurance database in Germany, in which, among others, all endovascular procedures on the extracranial carotid artery are filed.

The myristoylated alanine-rich C kinase substrate differentially regulates kinase interacting with stathmin in vascular smooth muscle and endothelial cells and potentiates intimal hyperplasia formation

March 27, 2019 - 23:00
Restenosis limits the durability of all cardiovascular reconstructions. Vascular smooth muscle cell (VSMC) proliferation drives this process, but an intact, functional endothelium is necessary for vessel patency. Current strategies to prevent restenosis employ antiproliferative agents that affect both VSMCs and endothelial cells (ECs). Knockdown of the myristoylated alanine-rich C kinase substrate (MARCKS) arrests VSMC proliferation and paradoxically potentiates EC proliferation. MARCKS knockdown decreases expression of the kinase interacting with stathmin (KIS), increasing p27kip1 expression, arresting VSMC proliferation.

Impact of fenestrated stent graft misalignment on patient outcomes

March 26, 2019 - 23:00
During fenestrated endovascular aneurysm repair (FEVAR), accurate alignment of the fenestration and the target artery is necessary to prevent complications. This study's objective is to determine the incidence of clinical outcomes following fenestration misalignment during FEVAR.

The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery

March 25, 2019 - 23:00
To determine the prevalence and risk factors of subclavian artery stent fractures and to investigate their impact on in-stent restenosis development.

A prospective, single-blind, randomized, phase III study to evaluate the safety and efficacy of Fibrin Sealant Grifols as an adjunct to hemostasis compared with manual compression in vascular surgery

March 25, 2019 - 23:00
New formulations and applications of hemostatic adjuncts such as fibrin sealant (FS) to support local hemostasis and sutures continue to be developed. In a pivotal, confirmatory, controlled, prospective, single-blinded, randomized, multicenter phase III clinical trial, the efficacy and safety of FS Grifols during vascular surgeries were evaluated.

Late complications after hybrid aortic arch repair

March 24, 2019 - 23:00
Although hybrid arch repair has gained widespread application as an alternative option for high-risk patients, concerns about its long-term durability remain an important issue. The aim of this study was to investigate late complications after hybrid arch repair.

Changes in vascular and inflammatory biomarkers after exercise rehabilitation in patients with symptomatic peripheral artery disease

March 24, 2019 - 23:00
Home-based exercise is an alternative exercise mode to a structured supervised program to improve symptoms in patients with peripheral artery disease (PAD), but little is known about whether the slow-paced and less intense home program also elicits changes in vascular and inflammatory biomarkers. In an exploratory analysis from a randomized controlled trial, we compared changes in vascular and inflammatory biomarkers in patients with symptomatic PAD (typical and atypical of claudication) after home-based exercise and supervised exercise programs and in an attention-control group.

Comparison of open and endovascular procedures in patients with critical limb ischemia on dialysis

March 24, 2019 - 23:00
Peripheral artery disease is a common comorbidity in patients with end-stage renal disease (ESRD), but there is a paucity of data comparing outcomes of different interventions in this group of patients. In this study, we examined perioperative outcomes of lower extremity endovascular revascularization (ER) and open revascularization (OR) in dialysis patients with critical limb ischemia (CLI).

Collapsed bifurcated modular infrarenal endograft

March 24, 2019 - 23:00
Bilateral acute limb ischemia after endovascular aneurysm repair is extremely rare. We present the case of a 70-year-old man treated by endovascular aneurysm repair for a 7.9-cm asymptomatic infrarenal abdominal aortic aneurysm using a bifurcated modular GORE EXCLUDER endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz). The initial recovery was uneventful, but 14 days later, the patient presented with bilateral acute limb ischemia caused by collapse and thrombosis of the endograft, requiring emergency axillobifemoral bypass, fasciotomies, and subsequent endograft removal with open aneurysm repair.

The 10-year outcomes of a regional abdominal aortic aneurysm screening program

March 24, 2019 - 23:00
In 2007, Medicare established ultrasound screening guidelines to identify patients at risk for abdominal aortic aneurysm (AAA). The purpose of this study was to evaluate AAA diagnosis rates and compliance with screening during 10 years (2007-2016) of the Screen for Abdominal Aortic Aneurysms Very Efficiently Act implementation within a regional health care system.

A systematic review and meta-analysis of 18F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography for detection of infected prosthetic vascular grafts

March 24, 2019 - 23:00
The purpose of this investigation was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of vascular prosthetic graft infection (VPGI) using a diagnostic accuracy test.

A systematic review of enhanced recovery after surgery for vascular operations

March 24, 2019 - 23:00
Patients undergoing vascular operations face high rates of intraoperative and postoperative complications and delayed return to baseline. Enhanced recovery after surgery (ERAS), with its aim of delivering high-quality perioperative care and accelerating recovery, appears well suited to address the needs of this population.

Implementation and results of a practical grading system for thoracic blunt aortic injury

March 24, 2019 - 23:00
We previously proposed a grading system for blunt thoracic aortic injury (BTAI) designed to guide therapy. This study analyzed our outcomes since implementing this system.

Systematic review of civilian intravascular ballistic embolism reports during the last 30 years

March 24, 2019 - 23:00
Intravascular ballistic embolization is a rare complication of missile injury. Because of its rarity, much remains to be known about its presentation, pathophysiology, complications, and management. In this study, we analyze case reports of ballistic embolization in the last 30 years and available cases from our institution to determine the likely patient, the nature of the embolization, the possible complications, and a general management strategy.

Regional variation in use and outcomes of combined carotid endarterectomy and coronary artery bypass

March 24, 2019 - 23:00
In treating concomitant carotid and coronary disease, some recommend staged carotid endarterectomy (CEA) and coronary artery bypass grafting, whereas others favor the combined approach (CCAB). Pressure to reduce surgical variation and to improve quality is real, yet little is known about how geographic practice differences affect outcomes. Using the Vascular Quality Initiative (VQI), this study evaluated regional variation in use and outcomes of CCAB.