Journal of Vascular Surgery

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Regarding “A novel technique for duplex-guided office-based interventions for patients with acute arteriovenous fistula occlusion”

July 1, 2018 - 00:00
We read with interest the article by Aurshina et al.1 Thrombosis is one of the most common complications of autologous arteriovenous fistula (AVF) for hemodialysis and often results in failure of the AVF. Arterial and venous track stenoses are usually the main reasons for this scenario, and percutaneous balloon angioplasty has been considered an endovascular treatment option.2 In this study, all venous stenoses were treated percutaneously with traditional balloon angioplasty. Although guidelines have not yet recommended drug-eluting balloons for thrombosed fistulas, the superiority of drug-eluting balloons over plain balloons has recently been reported for failed AVFs and arteriovenous grafts.

Invited commentary

July 1, 2018 - 00:00
Whereas the early mortality benefit of endovascular aneurysm repair (EVAR) over open repair for intact abdominal aortic aneurysms (AAAs) has been confirmed in numerous randomized trials and observational studies, the data regarding outcomes after repair of ruptured AAAs (rAAAs) are conflicting. As summarized in a recent Cochrane review, four randomized controlled trials failed to demonstrate improved short-term mortality after EVAR for rAAA.1 However, these trials were limited by small sample size, inclusion criteria leading to the exclusion of many patients, and frequent treatment variation from randomization.

Invited commentary

July 1, 2018 - 00:00
Treatment of blunt thoracic aortic injury (BTAI) has evolved significantly since early open repair was standard practice. The article by Marcaccio et al provides important new information that even a 24-hour delay before thoracic endovascular aortic repair (TEVAR) is associated with a reduction in mortality. This result contrasts with the 2011 Society for Vascular Surgery guidelines, which recommends repair in the initial 24 hours after injury.1

Hybrid repair of multiple subclavian and axillary artery aneurysms in a patient with Marfan syndrome

July 1, 2018 - 00:00
A 48-year-old man was admitted with sensory deficits in the upper extremities. He had a history of aortic dissection and previously underwent prosthetic graft placement from the aortic root to the bilateral common iliac artery. He also underwent coil embolization of a left subclavian aneurysm 9 years ago. Computed tomography angiography (CTA) performed after coil embolization showed thrombosis of the aneurysm (A, blue arrow) and patency of the prosthetic graft placed from the aortic arch to the left subclavian artery (A, red arrow).

Invited commentary

July 1, 2018 - 00:00
Magnetic resonance imaging (MRI) is becoming an increasingly important tool for anatomic assessment of the cardiovascular system. Development of four-dimensional (4D) flow MRI technology enables us to evaluate in vivo hemodynamics in blood vessels throughout the human body. When it is used to assess hemodynamic changes inside the aortic lumen, 4D flow MRI can provide us with wall shear stress (WSS). By superimposing anatomic images with WSS at different parts of the aorta, WSS maps are generated.

Invited commentary

July 1, 2018 - 00:00
This report represents a thorough analysis of the search for associations between plasma renin or aldosterone levels and excised carotid artery plaque characteristics and composition and includes evaluation of many important intraplaque inflammatory mediators. Because activation of the renin-angiotensin system has been previously described to be associated with an increase in coronary and cerebrovascular events, it seemed logical to assume that these levels should correlate with the atherosclerotic plaque.

Invited commentary

July 1, 2018 - 00:00
Diabetes mellitus affects >170 million people worldwide, and this disease burden is projected to increase to 366 million people by 2030. The presence of diabetes greatly increases the risk of peripheral vascular disease as well as accelerates its course. This puts a considerable portion of the population at risk for ischemic events, impaired functional status, and nonhealing wounds. Diabetes is associated with significant impairments in neovascularization and wound healing. The mechanism for this pathologic process is unknown, but there is evidence for associated dysfunction at both the cellular and molecular level.

Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution

June 28, 2018 - 00:00
The objective of this study was to analyze radiation risk to patients during endovascular aneurysm repair (EVAR) using mobile C-arm (MA) or fixed C-arm (FA) fluoroscopes and to describe the dose distribution during the different phases of the procedure.

Systematic review and meta-analysis of the risk of bowel ischemia after ruptured abdominal aortic aneurysm repair

June 28, 2018 - 00:00
Outcomes after repair of ruptured abdominal aortic aneurysm (RAAA) have improved in the last decade. It is unknown whether this has resulted in a reduction of postoperative bowel ischemia (BI). The primary objective was to determine BI prevalence after RAAA repair. Secondary objectives were to determine its major sequelae and differences between open repair (OR) and endovascular aneurysm repair (EVAR).

Epidemiology, outcomes, and management of acute kidney injury in the vascular surgery patient

June 28, 2018 - 00:00
Conventional clinical wisdom has often been nihilistic regarding the prevention and management of acute kidney injury (AKI), despite its being a frequent and morbid complication associated with both increased mortality and cost. Recent developments have shown that AKI is not inevitable and that changes in management of patients can reduce both the incidence and morbidity of perioperative AKI. The purpose of this narrative review was to review the epidemiology and outcomes of AKI in patients undergoing vascular surgery using current consensus definitions, to discuss some of the novel emerging risk stratification and prevention techniques relevant to the vascular surgery patient, and to describe a standardized perioperative pathway for the prevention of AKI after vascular surgery.

Inability of conventional imaging findings to predict response to laparoscopic release of the median arcuate ligament in patients with celiac artery compression

June 28, 2018 - 00:00
The objective of this study was to identify duplex ultrasound (DUS) or computed tomography angiography (CTA) imaging findings that can predict clinical response to laparoscopic release of the median arcuate ligament (MAL) in patients with celiac artery compression.

Aneurysm sac failure to regress after endovascular aneurysm repair is associated with lower long-term survival

June 28, 2018 - 00:00
The early survival advantage of endovascular aneurysm repair (EVAR) compared with open repair reverses over time, possibly because of higher rates of reintervention related to endoleaks and aneurysm sac expansion. Therefore, we sought to examine the association between sac behavior, endoleaks, reintervention, and long-term survival.

Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia

June 28, 2018 - 00:00
The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI.

Long-term results after open repair of inflammatory infrarenal aortic aneurysms

June 28, 2018 - 00:00
The objective of this study was to investigate the long-term outcome after open repair of inflammatory infrarenal aortic aneurysms.

Episode-based cost reduction for endovascular aneurysm repair

June 28, 2018 - 00:00
Effective strategies to reduce costs associated with endovascular aneurysm repair (EVAR) remain elusive for many medical centers. In this study, targeted interventions to reduce inpatient EVAR costs were identified and implemented.

Infrarenal endovascular aneurysm repair with large device (34- to 36-mm) diameters is associated with higher risk of proximal fixation failure

June 28, 2018 - 00:00
Endovascular aneurysm repair (EVAR) has become the standard of care for infrarenal aneurysms. Endografts are commercially available in proximal diameters up to 36 mm, allowing proximal seal in necks up to 32 mm. We sought to further investigate clinical outcomes after standard EVAR in patients requiring large main body devices.

Survival trends after inferior vena cava and aortic injuries in the United States

June 28, 2018 - 00:00
Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States.

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices

June 28, 2018 - 00:00
Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices.

The role of selective stenting for superior mesenteric artery scallops during fenestrated endovascular aneurysm repair

June 27, 2018 - 00:00
Stenting of small fenestrations of the Zenith fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) is necessary during fenestrated endovascular aneurysm repair (FEVAR) of complex abdominal aortic aneurysms to avoid malalignment. However, stenting of superior mesenteric artery (SMA) scallops of ZFEN devices is optional according to the instructions for use. The objective of this study was to assess the early and midterm outcomes of selective use of stents in SMA scallops of ZFEN during FEVAR procedures.

Early cannulation of bovine carotid artery grafts (Artegraft) after primary vascular access and fistula revision procedures

June 27, 2018 - 00:00
Tunneled dialysis catheter (TDC) use has been associated with increased infectious complications and mortality in hemodialysis-dependent patients. Unfortunately, patients who undergo fistula revisions or creation of a new arteriovenous fistula frequently require a TDC during the postoperative period. Bovine carotid artery grafts (BCAGs) can be used as an early-access dialysis conduit to reduce TDC dependence. This study describes the performance of BCAGs that were cannulated early (<3 days) after implantation and associated clinical outcomes.