Journal of Vascular Surgery

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Poor Medical Management, Atherectomy, and Multilevel Therapy Are Associated With Worse Outcomes After Endovascular Interventions for Claudication

February 28, 2019 - 23:00
Treatment of claudication is elective; thus, good outcomes are imperative. The objective of this study was to examine patterns of claudication management and outcomes after peripheral vascular intervention (PVI) for claudication in the Vascular Quality Initiative.

Economic Burden and Clinical Impact of Opioid Dependence in Patients Undergoing Lower Extremity Bypass Surgery: Quantifying the Cost of a New Epidemic

February 28, 2019 - 23:00
Surgeons’ contributions to the opioid epidemic have received significant attention in the media. Few data exist, however, of the impact of prior or coexistent opioid use on vascular surgery outcomes. This study aimed to quantify the economic impact of pre-existing opioid dependency in patients undergoing lower extremity bypass surgery.

Treatment Strategies and Outcomes of Infected Thoracoabdominal and Pararenal Aortic Aneurysms

February 28, 2019 - 23:00
Mycotic thoracoabdominal and pararenal aortic aneurysms (mTAAAs/PRAAs) or infections of TAAA and PRAA grafts (iTAAAs/PRAAs) are a rare but devastating clinical problem. Treatment requires complex surgical reconstruction to maintain visceral and renal perfusion. There is a paucity of literature describing outcomes for this technically challenging and highly lethal problem. Herein, we report our experience in the management of these patients.

Outcomes of Directional Branches Using Self-Expandable Versus Balloon-Expandable Stent Grafts During Endovascular Repair of Thoracoabdominal Aortic Aneurysms

February 28, 2019 - 23:00
The objective of this study was to evaluate outcomes of directional branches using self-expandable stent grafts (SESGs) or balloon-expandable stent grafts (BESGs) during fenestrated-branched endovascular aneurysm repair of thoracoabdominal aortic aneurysms.

Predicting Visceral Aortic Growth After Infrarenal Abdominal Aortic Aneurysm Repair

February 28, 2019 - 23:00
The objective of this study was to identify predictors of aortic aneurysm growth above an infrarenal abdominal aortic aneurysm (AAA) repair.

In Situ Bypass and Extra-anatomic Bypass Procedures Result in Similar Survival in Patients With Secondary Aortoenteric Fistula

February 28, 2019 - 23:00
The optimal revascularization modality in secondary abdominal aortoenteric fistula (SAEF) is debated, although in situ bypass (ISB) has increasingly been used. Therefore, we aimed to quantify the association between extra-anatomic bypass (EAB) and ISB mortality in SAEF.

This is an attractive book dealing with

February 28, 2019 - 23:00
This is an attractive book dealing with the diagnosis and endovascular and surgical management of carotid and vertebral artery disease. Each chapter is relatively short, the reading is easy, and there are multiple images and well-designed color drawings clearly showing anatomy and intended techniques. The book includes traditional chapters exploring medical therapy and various surgical techniques and endovascular interventions to treat atherosclerotic lesions, fibromuscular dysplasia, dissection, carotid body tumors, recurrent stenosis, trauma, and aneurysms.

The 2019 update of the European abdominal aortic aneurysm guidelines

February 28, 2019 - 23:00
The updated 2019 European Society for Vascular Surgery (ESVS) guidelines add welcome context and perspective to management of the patient with abdominal aortic aneurysm (AAA) disease.1 This document, replacing the original 2011 European compilation, refreshes recommendations in existing topic categories and includes new guidance on quality standards, institutional resource requirements, and minimal surgical volumes believed to be necessary to provide adequate AAA care as well as specific disease subtypes (juxtarenal, mycotic, inflammatory, syndromic, saccular) not previously considered separately.

Immediate and Delayed Procedural Stroke or Death in Stenting Versus Endarterectomy for Symptomatic Carotid Stenosis

February 28, 2019 - 23:00
The Carotid Stenosis Trialists’ Collaboration pooled data of four randomized trials that recruited patients between 2000 and 2008: Endarterectomy vs Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S), Stent-Protected Angioplasty vs Carotid Endarterectomy (SPACE), International Carotid Stenting Study (ICSS), and Carotid Revascularization Endarterectomy vs Stenting Trial (CREST).

Conservative Management of Type IA Endoleaks at Completion Angiogram in Endovascular Repair of Infra-renal Abdominal Aortic Aneurysms With Current Generation Stent Grafts

February 28, 2019 - 23:00
This is a retrospective single-institution review between April 1, 2010, and March 30, 2015.

Long-term Results of Carotid Stenting and Risk Factors in Patients With Severe Carotid Artery Stenosis Undergoing Subsequent Cardiac Surgery

February 28, 2019 - 23:00
This was a prospective observational single-center study between 1997 and 2011.

Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systemic Review and Meta-Analysis

February 28, 2019 - 23:00
This study is a retrospective review of Cochrane CENTRAL database, MEDLINE, and Embase through June 15, 2018.

Transfemoral Carotid Artery Stents Should Be Used With Caution in Patients With Asymptomatic Carotid Artery Stenosis

February 28, 2019 - 23:00
This study is a retrospective review of the Vascular Quality Initiative between 2005 and 2017.

Gene Therapy for Peripheral Arterial Disease

February 28, 2019 - 23:00
This study is a retrospective review of Cochrane Vascular Specialized Register, MEDLINE Ovid, Embase Ovid, CINAHL, and AMED through November 27, 2017.

Regarding “The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm”

February 28, 2019 - 23:00
In the 2018 Society for Vascular Surgery guidelines regarding the care of patients with an abdominal aortic aneurysm (AAA) by Chaikof et al,1 there is a recommendation regarding the level of the proximal anastomosis of an infrarenal AAA open repair. The authors recommend performing the anastomosis as close to renal arteries as possible. They support that performing the anastomosis within healthy aorta is important to minimize the risk of future aneurysmal degeneration. Definitely, an endograft has to be anchored on a good length of normal size aorta just below the lowest renal artery to achieve optimal fixation and decrease the incidence of migration and endoleak.

Reply

February 28, 2019 - 23:00
The 2018 Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm notes that, should an open surgical repair be required, “performing the proximal anastomosis within healthy aorta is important to minimize the risk of aneurysmal degeneration at or above the graft.” The guidelines formally recommend “performing the proximal aortic anastomosis as close to the renal arteries as possible.” Dr Lazaris notes that this may be too restrictive for those patients that present with a healthy aortic neck of normal dimension and of substantial length.

Regarding “Financial implications of coding inaccuracies in patients undergoing elective endovascular abdominal aortic aneurysm repair”

February 28, 2019 - 23:00
The article published in April 2018 by Ayub et al1 revealed substantial lost billing opportunities from miscoding of admissions for elective endovascular aneurysm repair. This finding echoes results found through a study at our tertiary vascular center.

Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades

February 28, 2019 - 23:00
Acute carotid stent thrombosis (ACST) occurring in the first hours after the procedure is an exceedingly rare complication of carotid artery stenting, but it is potentially devastating. This review aimed to evaluate current literature, identifying all reported cases during the last two decades, with the final purpose of reporting predictive factors and early management.

Postanesthesia ultrasound facilitates creation of more preferred accesses without affecting access survival

February 28, 2019 - 23:00
The results of preoperative ultrasound (pre-US) vein mapping for hemodialysis access creation can be affected by environmental and clinical factors, such as ambient temperature, acute illness, recent phlebotomy, and hypovolemia. These factors may inadvertently exclude otherwise viable veins as options for access creation. We hypothesized that repeating the ultrasound vein mapping immediately preoperatively after anesthesia administration (post-US) identifies additional veins not appreciated by pre-US, thereby altering the operative plan and producing more preferred accesses, particularly more forearm accesses.

Invited commentary

February 28, 2019 - 23:00
With 827 consecutive post-carotid endarterectomy completion arteriograms, Dr Wieker and colleagues detected 57 (6.9%) defects requiring immediate surgical revision. One in 14 of their cases required reopening of the artery! Despite their significant incidence of defects requiring immediate revision, the authors' overall results are superb (0.2%, 0.5%, and 0.6% 30-day mortality, stroke, and transient ischemic attack rates, respectively), and immediate revision was not associated with worse outcomes.