Journal of Vascular Surgery

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Updated: 14 hours 14 min ago

Controversies and evidence for cardiovascular disease in the diverse Hispanic population

September 23, 2017 - 00:00
Hispanics account for approximately 17% of the U.S. population. They are one of the fastest growing racial/ethnic groups, second only to Asians. This heterogeneous population has diverse socioeconomic conditions, making the prevention, diagnosis, and management of vascular disease difficult. This paper discusses the cultural, racial, and social aspects of the Hispanic community in the United States and assesses how they affect vascular disease within this population. Furthermore, it explores risk factors, medical and surgical treatments, and outcomes of vascular disease in the Hispanic population; generational evolution of these conditions; and the phenomenon called the Hispanic paradox.

Low mortality rates after endovascular aortic repair expand use to high-risk patients

September 23, 2017 - 00:00
The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2.

Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention

September 23, 2017 - 00:00
Although many studies have demonstrated racial disparities after major vascular surgery, few have identified the reasons for these disparities, and those that did often lacked clinical granularity. Therefore, our aim was to evaluate differences in initial vascular intervention between black and white patients.

Discussion

September 22, 2017 - 00:00
Dr David L. Cull (Greenville, SC). Our understanding of the natural history and optimal management of blunt traumatic aortic injury has changed radically in the past decade. Treatment is now delayed until the patient's medical condition is stabilized, and open surgery to repair the aorta has been replaced by thoracic endovascular aortic repair (TEVAR). Several studies have recently reported favorable outcomes with medical management alone for grade I and II injuries. In Greenville, we have selectively treated grade III injuries with medical management.

Discussion

September 22, 2017 - 00:00
Dr Edward H. Garrett (Memphis, Tenn). Once again, the University of Florida has reported outstanding results using thoracic endografts in the correction of an uncommon but not necessarily rare disease of adult aortic coarctation and its complications after surgical repair.

Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia between patients with and without diabetes

September 22, 2017 - 00:00
The effect of diabetes type and insulin dependence on short- and long-term outcomes after lower extremity revascularization for chronic limb-threatening ischemia (CLTI) warrants additional study and more targeted focus. We sought to address this paucity of information by evaluating outcomes in insulin-dependent and noninsulin-dependent patients after any first-time revascularization.

Determinants and outcomes of nonoperative management for blunt traumatic aortic injuries

September 22, 2017 - 00:00
The natural history and parameters for successful nonoperative management of blunt traumatic aortic injuries (BTAIs) involving the descending aorta are poorly understood. We examined our experience with nonoperative BTAI treatment (anti-impulse, blood pressure) and evaluated for determinants of successful outcomes.

Use of the Viabahn stent graft for the treatment of recurrent cephalic arch stenosis in hemodialysis accesses

September 22, 2017 - 00:00
Cephalic arch stenosis (CAS) is a frequent and challenging failure mode of brachiocephalic fistulas. Natural tortuosity of the cephalic arch requires special consideration in selecting a treatment modality. Typical percutaneous angioplasty and bare-metal stent (BMS) treatments provide a short-term treatment solution for CAS without a durable effect. This study assessed Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) stent grafts (SGs) as a first-line percutaneous option to provide a durable treatment for CAS.

Indications, risk factors, and outcomes of 30-day readmission after infrarenal abdominal aneurysm repair

September 22, 2017 - 00:00
Reducing readmissions is an important target for improving patient care and enhancing health care quality and cost-effectiveness. The aim of this study was to assess rates, risk factors, and indications of 30-day readmission after open aortic repair (OAR) and endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs).

Outcomes of thoracic endovascular aortic repair in adult coarctation patients

September 22, 2017 - 00:00
Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR.

Discussion

September 22, 2017 - 00:00
Dr Matthew Smeds (Little Rock, Ark). It seems to me that in your series, there was really bleeding itself that was the issue, not necessarily anemia; there was no correlation with transfusion and a better outcome. Is that correct? So people who got transfused didn't do any better than people who did not get transfused?

Effect of postoperative anemia and baseline cardiac risk on serious adverse outcomes after major vascular interventions

September 22, 2017 - 00:00
Published data suggest that permissive anemia strategies that allow nadir hemoglobin (nHb) values of 7 g/dL or lower are safe in a variety of clinical settings. The appropriateness of these strategies in patients at high risk for adverse postoperative cardiac events remains unclear. We sought to determine the combined effect of postoperative nHb and cardiac risk status on major complications after vascular surgical interventions.

Discussion

September 21, 2017 - 00:00
Dr William A. Marston (Chapel Hill, NC). Overall outcomes for patients with critical limb ischemia (CLI) remain poor despite advances in technology and techniques of revascularization. Even after revascularization attempts, only about half of patients are alive with their affected limb 3 years later. The Wound, Ischemia, and foot Infection (WIfI) system was designed to stage the severity of patients with diabetic foot ulcers, incorporating the presence and severity of the wound, infection, and ischemia into a predictive score.

Comparative effectiveness of one-stage versus two-stage basilic vein transposition arteriovenous fistulas

September 21, 2017 - 00:00
Basilic vein transposition (BVT) fistulas may be performed as either a one-stage or two-stage operation, although there is debate as to which technique is superior. This study was designed to evaluate the comparative clinical efficacy and cost-effectiveness of one-stage vs two-stage BVT.

Neck diameter and inner curve seal zone predict endograft-related complications in highly angulated necks after endovascular aneurysm repair using the Aorfix endograft

September 21, 2017 - 00:00
Many studies have found that preoperative aneurysm anatomy can determine the postoperative complication rates for endovascular aneurysm repair (EVAR). With continual improvement in endograft technology, patients with challenging anatomy are increasingly able to undergo successful treatment with EVAR. This study aimed to quantify the influence of proximal neck anatomy on contemporary outcomes in a cohort of abdominal aortic aneurysm patients with highly angulated aneurysm necks.

Importance of postprocedural Wound, Ischemia, and foot Infection (WIfI) restaging in predicting limb salvage

September 21, 2017 - 00:00
The Wound, Ischemia, and foot Infection (WIfI) classification system was created to encompass demographic changes and expanding techniques of revascularization to perform meaningful analyses of outcomes in the treatment of the threatened limb. The WIfI index is intended to be analogous to the TNM staging system for cancer, with restaging to be done after control of infection and after revascularization. Our goal was to evaluate the effectiveness of WIfI restaging after therapy in the prediction of limb outcomes.

Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis

September 21, 2017 - 00:00
We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time.

A feasibility double-blind randomized placebo-controlled trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication

September 21, 2017 - 00:00
Intermittent claudication is the most common symptom of peripheral arterial disease. Previous research has suggested that extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue. The objective of this feasibility pilot trial was to assess the safety, tolerability, and efficacy of ESWT as a novel treatment.

Outcomes of mini-incision eversion carotid endarterectomy combined with nontouch isolation technique of the internal carotid artery

September 21, 2017 - 00:00
We developed a mini-incision eversion carotid endarterectomy (CEA) procedure (the Jikei method CEA) to prevent perioperative embolic stroke. The aim of this study was to retrospectively analyze perioperative and midterm outcomes after the Jikei method CEA.

Correlation between pelvic congestion syndrome and body mass index

September 21, 2017 - 00:00
Previous studies of men suggested that patients with varicocele may be leaner than the normal population. No such work exists in women with pelvic congestion syndrome (PCS). This study evaluated the correlation between body mass index (BMI) and PCS.