Journal of Vascular Surgery

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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.

Long-term outcomes after repair of symptomatic abdominal aortic aneurysms

April 25, 2018 - 00:00
Previous studies have reported increased perioperative mortality of nonruptured symptomatic abdominal aortic aneurysms (Sx-AAA) compared with asymptomatic elective AAA (E-AAA) repairs, but no long-term-outcomes have been reported. We sought to compare long-term outcomes of Sx-AAA and E-AAA after repair at a single academic institution.

Transaxillary decompression of thoracic outlet syndrome patients presenting with cervical ribs

April 25, 2018 - 00:00
The transaxillary approach to thoracic outlet decompression in the presence of cervical ribs offers the advantage of less manipulation of the brachial plexus and associated nerves. This may result in reduced incidence of perioperative complications, such as nerve injuries. Our objective was to report contemporary data for a series of patients with thoracic outlet syndrome (TOS) and cervical ribs managed through a transaxillary approach.

Interobserver and intraobserver variability in measuring the tortuosity of the thoracic aorta on computed tomography

April 25, 2018 - 00:00
The variability in measuring the tortuosity of the thoracic aorta has not been previously studied. This study evaluated the interobserver and intraobserver variability of major methods used for measuring the tortuosity of the thoracic aorta in patients with aortic arch or descending thoracic aortic aneurysm.

Improved patency after axillofemoral bypass for aortoiliac occlusive disease

April 21, 2018 - 00:00
Axillofemoral bypasses (AxFBs) have been used since 1962 to treat aortoiliac disease. In the past, reported patency rates (37%-76%) for these extra-anatomic grafts have been inferior to those for anatomic aortic grafting. Reported low survival rates after AxFB (40%-50%) have confirmed that these procedures have been used primarily in patients at high risk for complications from aortofemoral bypass. However, modern medical and anesthesia management, preoperative scanning, donor artery preparation, postoperative graft surveillance, and graft technology may improve outcomes after AxFB, possibly supporting expansion of its use.

The effect of false lumen procedures during thoracic endovascular aortic repair in patients with chronic DeBakey type IIIB dissections

April 21, 2018 - 00:00
Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections.

Primary and secondary arterial fistulas during chronic Q fever

April 21, 2018 - 00:00
After primary infection with Coxiella burnetii, patients may develop acute Q fever, which is a relatively mild disease. A small proportion of patients (1%-5%) develop chronic Q fever, which is accompanied by high mortality and can be manifested as infected arterial or aortic aneurysms or infected vascular prostheses. The disease can be complicated by arterial fistulas, which are often fatal if they are left untreated. We aimed to assess the cumulative incidence of arterial fistulas and mortality in patients with proven chronic Q fever.

Cerebral embolization during endovascular infrarenal, juxtarenal, and suprarenal aortic aneurysm repair, high-risk maneuvers, and associated neurologic outcomes

April 21, 2018 - 00:00
Risk factors for postoperative cognitive decline after noncardiac surgery are multifactorial and poorly understood. Evidence suggests that perioperative microembolic damage to the brain on movement of wires and catheters during endovascular aortic procedures may play an important role. Endovascular aortic aneurysm repair requires invasive manipulation of wires and cannulas within the aorta, but research into cerebral emboli during aortic aneurysm repair and cognitive or neurologic injury is scarce and limited to thoracic aneurysms.

Influence of aortic neck characteristics on successful aortic wall penetration of EndoAnchors in therapeutic use during endovascular aneurysm repair

April 21, 2018 - 00:00
This study sought to quantify EndoAnchor (Medtronic Vascular, Santa Rosa, Calif) penetration into the aortic wall in patients undergoing endovascular abdominal aortic aneurysm repair and to assess predictors of successful penetration and its relationship to postprocedural type IA endoleak.

Improved patency after axillofemoral bypass for aortoiliac occlusive disease

April 21, 2018 - 00:00
Axillofemoral bypasses (AxFBs) have been used since 1962 to treat aortoiliac disease. In the past, reported patency rates (37%-76%) for these extra-anatomic grafts have been inferior to those for anatomic aortic grafting. Reported low survival rates after AxFB (40%-50%) have confirmed that these procedures have been used primarily in patients at high risk for complications from aortofemoral bypass. However, modern medical and anesthesia management, preoperative scanning, donor artery preparation, postoperative graft surveillance, and graft technology may improve outcomes after AxFB, possibly supporting expansion of its use.

The effect of false lumen procedures during thoracic endovascular aortic repair in patients with chronic DeBakey type IIIB dissections

April 21, 2018 - 00:00
Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections.

Primary and secondary arterial fistulas during chronic Q fever

April 21, 2018 - 00:00
After primary infection with Coxiella burnetii, patients may develop acute Q fever, which is a relatively mild disease. A small proportion of patients (1%-5%) develop chronic Q fever, which is accompanied by high mortality and can be manifested as infected arterial or aortic aneurysms or infected vascular prostheses. The disease can be complicated by arterial fistulas, which are often fatal if they are left untreated. We aimed to assess the cumulative incidence of arterial fistulas and mortality in patients with proven chronic Q fever.

Cerebral embolization during endovascular infrarenal, juxtarenal, and suprarenal aortic aneurysm repair, high-risk maneuvers, and associated neurologic outcomes

April 21, 2018 - 00:00
Risk factors for postoperative cognitive decline after noncardiac surgery are multifactorial and poorly understood. Evidence suggests that perioperative microembolic damage to the brain on movement of wires and catheters during endovascular aortic procedures may play an important role. Endovascular aortic aneurysm repair requires invasive manipulation of wires and cannulas within the aorta, but research into cerebral emboli during aortic aneurysm repair and cognitive or neurologic injury is scarce and limited to thoracic aneurysms.