Journal of Vascular Surgery

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Rupture of a previously thrombosed hepatic artery aneurysm

March 24, 2019 - 23:00
Hepatic artery aneurysm (HAA) is a rare form of visceral artery aneurysm. Historically, most HAAs were ruptured at presentation, but advances in imaging have led to an increase in the diagnosis of asymptomatic HAAs. Description of the natural history of patent HAAs has been difficult because of their rarity, even more so for less common thrombosed HAAs. We report the case of a 74-year-old man who experienced the rupture of a previously thrombosed HAA. He was successfully surgically treated with ligation of the aneurysm.

Double homemade fenestrated stent graft for total endovascular aortic arch repair

March 24, 2019 - 23:00
The aim of this retrospective analysis was to evaluate the outcomes of physician-modified double fenestrated stent grafts for total endovascular aortic arch repair: one proximal large fenestration for the brachiocephalic trunk and the left common carotid artery and one distal fenestration for the left subclavian artery (LSA).

Carotid stenting and endarterectomy and contralateral carotid occlusion

March 24, 2019 - 23:00
The presence of contralateral carotid occlusion (CCO) has been controversial throughout the history of carotid intervention. Some studies cite a higher stroke risk in the setting of CCO, whereas other studies document no difference in stroke risk. We investigated the risk of stroke after intervention in the setting of CCO in a large, national, validated dataset.

Association of opioid use and peripheral artery disease

March 24, 2019 - 23:00
Prescription opioids account for 40% of all U.S. opioid overdose deaths, and national efforts have intensified to reduce opioid prescriptions. Little is known about the relationship between peripheral artery disease (PAD) and high-risk opioid use. The objectives of this study were to evaluate this relationship and to assess the impact of PAD treatment on opiate use.

A comprehensive report of long-term outcomes after catheter-directed thrombolysis for occluded infrainguinal bypass grafts

March 24, 2019 - 23:00
The objective of this study was to assess the technical and short- and long-term clinical outcomes of catheter-directed thrombolysis (CDT) with urokinase for occluded infrainguinal bypass grafts. In addition, factors associated with technical success and amputation-free survival were assessed.

Molecular changes associated with vascular malformations

March 24, 2019 - 23:00
Vascular anomalies are typically classified into two major categories, vascular tumors and vascular malformations. Most vascular malformations are caused sporadically by somatic mosaic gene mutations, and genetic analyses have advanced our understanding of the biomolecular mechanisms involved in their pathogenesis. Culprit gene mutations typically involve two major signaling pathways; the RAS/MAPK/ERK pathway is typically involved in fast-flow arteriovenous malformations, whereas the PI3K/AKT/mTOR pathway is typically mutated in slow-flow venous and lymphatic malformations.

Cost-effectiveness of the treatments for critical limb ischemia in the elderly population

March 24, 2019 - 23:00
The treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.

Using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification to identify patients most likely to benefit from revascularization

March 24, 2019 - 23:00
The Society of Vascular Surgery Wound Ischemia foot Infection (WIfI) classification system for chronic limb-threatening ischemia was intended to predict 1-year major lower extremity amputation (LEA) risk and to identify which patients benefit most from revascularization. We aimed to identify which WIfI presentations benefited most from revascularization to explore whether a cluster analysis could identify a more data-driven WIfI score, and to quantify which component of the WIfI score was most strongly associated with 1-year LEA after revascularization.

Perioperative major adverse cardiac events in urgent femoral artery repair after coronary stenting are less common than previously reported

March 24, 2019 - 23:00
Noncardiac surgery early after coronary stenting has been associated with a high rate of stent thrombosis and catastrophic outcomes. However, those outcomes were mostly seen when dual antiplatelet therapy (DAPT) was discontinued before surgery. This observational study sought to estimate the risk of major adverse cardiac events (MACEs) after femoral artery repair following recent stent-percutaneous coronary intervention under continued DAPT and to explore potential risk factors. We suspect that in this setting, the risk of MACEs is lower than previously reported.

A prognostic score for clinical success after revascularization of critical limb ischemia in hemodialysis patients

March 24, 2019 - 23:00
The revascularization of critical limb ischemia (CLI) in hemodialysis (HD) patients features poor results in terms of patient survival and limb salvage. Recent predictive models in CLI revascularization did not specifically address HD patients. The aim of this study was to define risk factors for clinical success (CS) after revascularization of CLI in HD patients and to transform findings in a prognostic score.

Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients

March 24, 2019 - 23:00
Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance.

Validation of a preoperative prediction model for mortality within 1 year after endovascular aortic aneurysm repair of intact aneurysms

March 24, 2019 - 23:00
Most would agree that at least 1-year survival is necessary after intact abdominal aortic aneurysm (AAA) repair to appropriately justify the cost and risk of the procedure. No validated clinical decision instruments exist to predict survival after endovascular aneurysm repair (EVAR) beyond the perioperative period. The purpose of this analysis was to create a preoperative prediction model for 1-year mortality after EVAR for intact AAA in the Society for Vascular Surgery Vascular Quality Initiative.

Role of nutritional indices in predicting outcomes of vascular surgery

March 24, 2019 - 23:00
Malnutrition is frequent among vascular surgery patients, given their age, chronic comorbidities, and poor functional status, and it is believed to increase their operative risk. We aimed to assess the combined use of recent significant weight loss (>10% body mass) and serum albumin levels as a nutritional status index to predict outcomes.

Moderate-pain versus pain-free exercise, walking capacity, and cardiovascular health in patients with peripheral artery disease

March 24, 2019 - 23:00
Supervised exercise training (walking) is recommended in patients with intermittent claudication, both as a means to improve symptoms (walking distance and quality of life [QoL]) and as a means to improve general cardiovascular health (including vascular function and heart rate variability [HRV]). Our aim was to compare two types of supervised training (moderate-pain and pain-free walking) with comparable intensity based on heart rate, in terms of walking capacity, QoL, vascular function, biomarkers, and HRV in patients with intermittent claudication.

The GORE TAG conformable thoracic stent graft with the new ACTIVE CONTROL deployment system

March 24, 2019 - 23:00
The aim of this study was to describe single-center intraoperative details and early outcome of the new GORE TAG conformable stent graft with ACTIVE CONTROL (C-TAG ACTIVE CONTROL; W. L. Gore & Associates, Flagstaff, Ariz).

Branding vascular surgery should start with Why

March 19, 2019 - 23:00
First and foremost, I want to thank you for the privilege of serving as Eastern Vascular Society (EVS) president. To see my name on the same list as the past presidents is humbling and the greatest honor of my professional life. The opportunity to work and collaborate with the EVS executive council, committee chairs, and members has been nothing short of an incredible personal and professional experience, one that I will forever cherish and hold dear to my heart. Even though we have shared friendships for years, this year was very special for me in that it allowed me to get to know many of my colleagues at a much more personal level, for which I am indebted.

Associations of nutritional status and muscle size with mortality after open aortic aneurysm repair

March 18, 2019 - 23:00
Open surgical repair (OSR) for abdominal aortic aneurysms is a more invasive approach than endovascular aneurysm repair but has more enduring results and may lead to a lower reintervention rate. Therefore, strict selection of patients should be based on assessments of both early and late outcomes. The controlling nutritional status (CONUT) score and skeletal muscle mass index (SMI) have been reported as indicators of nutritional status and muscle size, respectively. The aim of this study was to identify prognostic factors, including sarcopenia and nutritional status, for early and late outcomes.

The forearm arteriovenous graft between the brachial artery and the brachial vein as a reliable dialysis vascular access for patients with inadequate superficial veins

March 16, 2019 - 23:00
The arteriovenous fistula (AVF) is recommended as the preferred hemodialysis access. However, placing an AVF in all patients may result in poor access outcomes and increased central venous catheter (CVC) use because of increased comorbid conditions, age, and suboptimal vessels. In patients with inadequate superficial veins for AVFs, the use of the brachial veins for creation of forearm arteriovenous grafts (AVGs) has received limited attention. This retrospective study aimed to evaluate outcomes of forearm brachial-brachial AVGs (BB-AVGs) placed in patients with poor superficial veins.

Why randomized controlled trials do not always reflect reality

March 12, 2019 - 23:00
Randomized controlled trials (RCTs) constitute level I evidence and are used as the backbone of guidelines and recommendations for treatment. Although RCTs are theoretically the studies of choice for the assessment of the effectiveness of health care interventions, these trials (and their interpretation) may sometimes result in erroneous conclusions, erroneous therapeutic decisions, and incorrect recommendations. We aimed to check the applicability of the results of RCTs to everyday practice.

The natural history of type B aortic dissection in patients with PRKG1 mutation c.530G>A (p.Arg177Gln)

March 10, 2019 - 23:00
The c.530G>A (p.Arg177Gln) mutation in PRKG1 has been shown to be associated with thoracic aortic aneurysms and dissections. This rare mutation accounts for an estimated 1% of nonsyndromic heritable thoracic aortic disease. We sought to describe the clinical presentation of type B aortic dissection (TBAD), management, and outcomes in patients with this mutation.