Journal of Vascular Surgery

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Updated: 11 hours 5 min ago

Regarding “Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms”

August 1, 2017 - 00:00
We read with interest the comparison by Katsargyris et al of fenestrated endovascular aneurysm repair (FEVAR) with one or two fenestrations against FEVAR with three or four fenestrations in their center. They observed no significant difference in outcomes in the postoperative period or in the early follow-up. They concluded that more complex FEVAR is as safe as less complex FEVAR and advocated more liberal use of complex FEVAR. These results differ from our similar analysis,1 and as such we suggest that the applicability of this conclusion is compromised for the following reasons.

Regarding “Standard endovascular aneurysm repair in patients with wide infrarenal aneurysm necks is associated with increased risk of adverse events”

August 1, 2017 - 00:00
We read with great interest the paper published by Oliveira et al in the Journal.1 In this study, the authors highlighted the potential role of wide abdominal aortic aneurysm neck diameter on the outcomes using the Endurant endograft, and they found that neck diameter ≥30 mm may be related to adverse events during the midterm follow-up. This finding apparently will have a potential influence on the decision-making for the treatment of patients with large necks. Nevertheless, the results of this study should be interpreted with caution.

Hip flexor muscle dysfunction during walking at self-selected and fast speed in patients with aortoiliac peripheral arterial disease

August 1, 2017 - 00:00
Intermittent claudication aggravates physical function and is associated with an increased risk of death in patients with peripheral arterial disease (PAD). Previous studies on kinetic parameters (joint moment and power) of lower limbs in these patients have largely focused on the decline in the ankle plantar flexor moment and power at self-selected (SS) walking speed, which may not be an optimal condition to induce claudication pain. In the present study, we investigated the abnormalities in joint kinetic parameters in patients with PAD at both SS and at fast walking speeds.

Associations between clinical diagnostic criteria and pretreatment patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome

August 1, 2017 - 00:00
Neurogenic thoracic outlet syndrome (NTOS) is caused by dynamic compression of the brachial plexus at the level of the supraclavicular scalene triangle or the subcoracoid (pectoralis minor) space, or both. The purpose of this study was to characterize relationships between 14 clinical diagnostic criteria (CDC) and seven pretreatment patient-reported outcomes measures (PROMs) in a prospective cohort of patients with NTOS.

Presentation, clinical features, and results of intervention in upper extremity fibromuscular dysplasia

August 1, 2017 - 00:00
We present a case series of upper extremity fibromuscular dysplasia (UE FMD) consisting of 22 patients from two tertiary referral centers focusing on clinical presentation, diagnostic findings, and interventional outcomes. FMD is a noninflammatory, nonatherosclerotic arteriopathy that has a predisposition for middle-aged women. Involvement of the UE is thought to be rare. Patients with UE FMD can present with claudication or ischemia, or they can be incidentally diagnosed. The treatment approach is dictated by clinical presentation.

Invited commentary

August 1, 2017 - 00:00
In this study by Lin et al, the question of specific therapy to prevent vascular calcification is addressed in a number of ex vivo experimental models. Vascular surgeons have long known vascular calcification is a hallmark of advanced disease, primarily because it has traditionally complicated the technical execution of both open and endovascular revascularization. Extensive arterial calcification makes application of vascular clamps ineffective and hazardous because it increases risk of dissection and embolization.

Invited commentary

August 1, 2017 - 00:00
The authors present the results of treatment of acute type B dissection with endograft and the effect of distal re-entry tear. Their data show that patients with no distal entry tear have better outcome than patients with distal entry tear over the long term. The authors have demonstrated that in patients with only proximal entry tear, the false lumen can be sealed using proximal endograft, and this leads to false lumen thrombosis and remodeling of the aorta. Patients with a false lumen that is perfused by a distal tear will have at best only partial thrombosis of the false lumen; they are more likely to have progression and evolution of the dissection and degeneration of the aorta into a dissecting aneurysm over time, and they are less likely to have aortic remodeling.

Invited commentary

August 1, 2017 - 00:00
Optimal antithrombotic management after lower extremity revascularization (both open and endovascular) remains an important area in need of better evidence. Whereas existing data support single antiplatelet therapy (generally aspirin) after lower extremity bypass, the role of oral anticoagulants (OACs) or combination therapies remains unclear. As a result, current guidelines from both the Society for Vascular Surgery1 and the American Heart Association2 recommend antiplatelet use and regard the role of OACs as uncertain.

Invited commentary

August 1, 2017 - 00:00
Thoracic endovascular aortic repair (TEVAR) is now the treatment of choice for most, if not all, thoracic aortic pathology. The study, “Five-year results of the VALOR II trial of the Medtronic Valiant Thoracic Stent Graft,” provides additional contemporary information on the durability and effectiveness of TEVAR. The authors, on behalf of VALOR II investigators, detail the 5-year outcomes of 160 patients with descending thoracic aortic aneurysms treated by the Valiant stent graft (Medtronic, Minneapolis, Minn).

Invited commentary

August 1, 2017 - 00:00
This carefully performed analysis of the National Inpatient Sample database highlights both the strengths and weaknesses of “big data” in our quest for improving patient outcomes from the complications of vascular disease.

Twisting limbs after endovascular aortic aneurysm repair

August 1, 2017 - 00:00
Endovascular abdominal aortic repair (EVAR) has become the first line of treatment for abdominal aortic aneurysms (AAAs). However, adequate proximal stent graft seal and iliac access both remain paramount to achieving early and long-term success of EVAR.1 To obtain an adequate proximal seal, the Excluder endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) was redesigned with a repositioning deployment system (C3 Excluder) that allows readjustment for proximal stent graft deployment accuracy and contralateral gate orientation.

Discussion

July 28, 2017 - 00:00
Dr Ronald Dalman (Stanford, Calif). I think this instructions for use (IFU) nonadherence, particularly in the neck, is a little less important now in the era of parallel endografting and branched and fenestrated endografting and gives patients some options. But this is an important observation. It's similar to a paper published recently by Dr Beck and associates, which reports an important single-center study.

Any nonadherence to instructions for use predicts graft-related adverse events in patients undergoing elective endovascular aneurysm repair

July 28, 2017 - 00:00
A variety of devices exist for endovascular aneurysm repair (EVAR). Device-specific instructions for use (IFU) detail anatomic constraints to application and deployment of devices and are developed from rigorous bench testing. Nonadherence to IFU occurs frequently to avoid open surgery. The purpose of this study was to determine if IFU violations are associated with increased risk of graft-related adverse events (GRAEs) during follow-up.

The endothelial cell secretome as a novel treatment to prime adipose-derived stem cells for improved wound healing in diabetes

July 28, 2017 - 00:00
Chronic wounds are a common surgical problem exacerbated by diabetes and ischemia. Although adipose-derived stem cells (ASCs) have shown promise as a wound healing therapy, their function and proliferation are hindered in diabetes. This study examines the ability of the human umbilical vein endothelial cell (HUVEC) secretome to reverse the deleterious effects of high glucose concentrations on ASCs through priming, thereby enhancing their ability to participate in angiogenesis and wound healing.

Improved outcomes with proximal radial-cephalic arteriovenous fistulas compared with brachial-cephalic arteriovenous fistulas

July 28, 2017 - 00:00
Brachial-cephalic arteriovenous fistulas (BCFs) are associated with high-flow volumes, leading to potential risks such as arm swelling, steal syndrome, pseudoaneurysm (due to a pressurized access), and cephalic arch stenosis. We hypothesized that a proximal radial-cephalic fistula (prRCF) configuration mitigates these risks because a lower flow state is created. Furthermore, we also hypothesized that despite these lower flows, patencies (primary, primary assisted, secondary) are sustained.

A preoperative risk score for transfusion in infrarenal endovascular aneurysm repair to avoid type and cross

July 26, 2017 - 00:00
Preoperative type and cross are often routinely ordered before elective endovascular aneurysm repair (EVAR), but the cost of this practice is high, and transfusion is rare. We therefore aimed to stratify patients by their risk of transfusion to identify a cohort in whom a type and screen would be sufficient.

Impact of angiosome- and non-angiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia

July 26, 2017 - 00:00
Direct (DIR) or indirect (IND) revascularization of pedal angiosomes in patients with chronic limb-threatening ischemia (CLTI) has an unclear impact on limb salvage and healing. The aim of this study was to evaluate the outcomes of DIR and IND revascularization in patients with a peroneal bypass and tissue loss.

Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry

July 26, 2017 - 00:00
Arterial stiffness and peripheral artery disease (PAD) are both associated with an elevated risk of major adverse cardiac events; however, the association between arterial stiffness and PAD is less well characterized. The goal of this study was to examine the association between parameters of radial artery tonometry, a noninvasive measure of arterial stiffness, and PAD.

Increasing use of endovascular therapy in pediatric arterial trauma

July 26, 2017 - 00:00
Endovascular therapy has been increasingly used for critically injured adults. However, little is known about the epidemiology and outcomes of endovascularly managed arterial injuries in children. We therefore aimed to evaluate recent trends in the endovascular management of pediatric arterial injuries and its association with early survival.

Effectiveness of surgical interventions for thoracic aortic aneurysms: a systematic review and meta-analysis

July 26, 2017 - 00:00
A systematic review and meta-analysis was conducted to evaluate the effectiveness of thoracic endovascular aortic repair (TEVAR) and open repair in patients with descending thoracic aortic aneurysms (TAAs).