Journal of Vascular Surgery

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Statin, anesthesia, and renal dysfunction after open repair of abdominal aortic aneurysms

September 1, 2019 - 00:00
We read with great interest the study by O'Donnell et al,1 which investigated the risk factors of postoperative renal dysfunction after open repair of abdominal aortic aneurysm (AAA) in a large retrospective cohort.

Reply

September 1, 2019 - 00:00
We thank Drs Yoon and Kim for their interest in our study and the higher risk for acute kidney injury (AKI) after open repair of juxtarenal abdominal aortic aneurysms in patients taking statins preoperatively. Our understanding of the interaction between statins and postoperative renal function is constantly evolving, as both observational and randomized trials have met with mixed results. Importantly, previous studies showed that initiating statins in the perioperative period was associated with higher rates of postoperative AKI, whereas long-term statin use was associated with lower risk of renal complications.

The role of cardiac risk stratification in preoperative beta blockade

September 1, 2019 - 00:00
In the recent article by Dr Shannon et al,1 “Preoperative beta blockade is associated with increased rates of 30-day major adverse cardiac events in critical limb ischemia patients undergoing infrainguinal revascularization,” the authors highlight the impact of beta blockade on postoperative cardiac events, which demonstrated an increase in 30-day myocardial infarction and major adverse cardiac events. In the accompanying editorial, Dr Powell points out how the enthusiasm for preoperative beta blockers has waned.

Reply

September 1, 2019 - 00:00
We greatly appreciate the comments by Dr Liapis and Dr Giannakopoulos regarding our manuscript titled “Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016).”

Death rates and rupture rates due to abdominal aortic aneurysms are not always the same

September 1, 2019 - 00:00
In a commendable study, Abdulameer et al1 report on mortality by ruptured aortic aneurysms (rAAs) in the United States between 1999 and 2016. The main criticism of this study is that the terms death rate and rupture rate are used interchangeably as being the same. Evidently, death rate is the appropriate term and does not include the patients surviving a rupture. Perhaps these two terms were similar during the earlier study period of open repair. However, their difference becomes greater in the study's recent years, when endovascular aneurysm repair for rupture is increasingly used with significantly lower mortality.

A word of caution on the concentration of rifampin for endografts

September 1, 2019 - 00:00
I read with interest the article by Hennessey et al1 regarding their findings on the optimization of rifampin coating on covered Dacron endovascular stent grafts. They concluded that there was no difference in the rifampin bound to the endograft beyond a concentration of 10 mg/mL, nor how little dwell time was used over 10 minutes. The way they attempted to measure the amount of rifampin that was bound to the graft was by measuring the amount that came off the graft and dissolved into a fixed volume of solvents (methanol or saline).

Reply

September 1, 2019 - 00:00
We would like to thank Dr Escobar for his interest in and commentary of our article.1 A review of the literature before our publication demonstrated that one group, Escobar et al,2 published a case report on the successful treatment of two patients with rifampin-coated Dacron endovascular stent grafts (ESGs). Their coating protocol was similar to that of open graft procedures published in the late 1980s3 using 60 mg/mL of rifampin solution incubated for approximately 1 hour. Our paper attempted to standardize the incubation time and rifampin concentration needed to coat covered Dacron ESGs.

Reply

September 1, 2019 - 00:00
We appreciate the excellent commentary by Dr Abdallah and colleagues and agree with these investigators that in-stent restenosis is the bane of visceral artery stenting (and for that matter, modern-day vascular surgery). We also recognize that in-stent restenosis is a complex process that at times can be directly related to incomplete treatment rather than to progression of disease, edge-stent stenosis, or in-stent restenosis.1 Unfortunately, current controversies regarding local drug delivery for the prevention of restenosis further complicate our treatment options.

The continuing controversy of covered vs bare-metal mesenteric stents

September 1, 2019 - 00:00
In-stent restenosis (ISR) remains the Achilles' heel of endovascular treatment of mesenteric occlusive disease. In their paper, Zhou et al1 reported very interesting results with endovascular reinterventions for ISR, concerning 30% of 91 patients with mesenteric stents. The authors are to be congratulated as this study represents one of the largest cohorts of mesenteric stenting. Reinforcing the findings of Oderich et al,2 the authors found that covered stents (CSs) significantly outperformed bare-metal stents (BMSs) in terms of ISR (11% vs 34%; P = .02).

Optimal closure technique of the arteriotomy after carotid endarterectomy

September 1, 2019 - 00:00
The optimal closure technique of the arteriotomy after carotid endarterectomy (CEA) has been the subject of extensive debate. A recent systematic review and meta-analysis compared outcomes after CEA with patch vs primary closure (N = 29 studies; 9 randomized controlled trials [RCTs] and 20 non-RCTs; n = 13,219 CEAs).1 Primary closure was associated with a higher 30-day stroke rate compared with patch closure when both RCTs and non-RCTs were pooled together (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-2.9) as well as when non-RCTs alone were considered (OR, 1.9; 95% CI, 1.1-3.3).

Off label, on target?

September 1, 2019 - 00:00
I read with great interest the article by Martínez-Monsalve et al1 in a recent issue of the Journal. The authors performed a retrospective study of 152 patients undergoing wound debridement and concluded that topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect that allowed a high degree of wound debridement. The authors should be applauded for performing a well-designed study of an important topic (acute pain) in patients undergoing wound debridement.

Reply

September 1, 2019 - 00:00
We are thankful for Dr Hunter's comments on our recent work.1 We fully agree with her appreciation about the need to reduce costs. Coincidentally, we are currently performing a retrospective cost-effectiveness analysis in patients with refractory pain due to leg ulcers who are noneligible for revascularization. These patients were referred to a pain unit for analgesic palliative treatment, and self-administered topical sevoflurane was compared against other conventional analgesic treatments. Preliminary results showed that topical sevoflurane is by far the most cost-effective treatment for this specific condition.

Discordant knowledge about atherosclerosis disease among French general practitioners and residents

September 1, 2019 - 00:00
We read with interest the paper entitled “Knowledge gap of peripheral artery disease starts in medical school” from AlHamzah and colleagues.1 In their study of 72 graduating medical students, the authors found that students have a suboptimal knowledge of coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD). In view of the small number of students, readers may doubt the generality of these results. However, we would like to underscore that we found similar results in two studies in France using a national survey with three clinical cases: one about CAD, one about ischemic stroke, and one about PAD.

A systematic review and meta-analysis of drug-coated balloon versus conventional balloon angioplasty for dialysis access stenosis

September 1, 2019 - 00:00
Arteriovenous fistulas for patients undergoing hemodialysis (HD) are at high risk of stenosis. Despite conventional balloon angioplasty (CBA), restenosis rates are high. The use of a drug-coated balloon (DCB) may offer an alternative to reduce restenosis.

Drug-coated balloon angioplasty superior to conventional balloon angioplasty for stenotic arteriovenous fistula lesions: With caution

September 1, 2019 - 00:00
The key finding of this study is that stenotic peripheral arteriovenous fistulas (AVF) lesions treated with drug-coated balloon angioplasty (DCB) had a significant improvement in the 6-month and 12-month primary patency rates when compared with those lesions treated with conventional balloon angioplasty.1 Treatment of central venous stenosis was also significantly improved with DCB, although this is more controversial because there are no large diameter drug-coated balloons (10-14 mm) that are approved in the United States.

A systematic review and meta-analysis of risk factors for and incidence of 30-day readmission after revascularization for peripheral artery disease

September 1, 2019 - 00:00
Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD.

A systematic review and meta-regression analysis of nonoperative management of blunt traumatic thoracic aortic injury in 2897 patients

September 1, 2019 - 00:00
Thoracic endovascular aortic repair has transformed the management of blunt traumatic thoracic aortic injuries (BTTAI). Recent studies have suggested that the nonoperative management (NOM) of BTTAI may be a viable alternative. We investigated the NOM of BTTAI by conducting a systematic review and meta-analysis of the mortality proportions and incidence of complications.

Invited commentary

September 1, 2019 - 00:00
The Wound Ischemia foot Infection (WIfI) classification has gained widespread acceptance in the vascular community as a method of categorizing disease severity in patients with chronic limb-threatening ischemia (CLTI). The original WIfI system is based on a Delphi consensus model, which relies on an iterative process of consensus amongst experts, but is not necessarily data driven. Twelve experts were selected in the formation of the initial WIfI model. The WIfI classification was initially developed in a cohort of CLTI patients not undergoing revascularization, but since then has been extrapolated to predict outcomes of multiple CLTI patient categories, including revascularized and nonrevascularized patients and patients with a variety of comorbidities, including diabetes and chronic kidney disease.

Invited commentary

September 1, 2019 - 00:00
Perivascular adipose tissue (PVAT) is an important supportive component to vessels. Over the years, PVAT has gained much attention owing to its likely involvement in cardiovascular diseases such as atherosclerosis. The incongruous effects of PVAT—positive vs negative—on atherosclerosis necessitate studies such as the one presented here by Ren et al.1

STABLE II clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design

August 30, 2019 - 00:00
To evaluate the safety and effectiveness of a composite device design (covered stent graft and bare metal stent) for the treatment of patients with acute, complicated type B aortic dissection (TBAD) presenting with aortic rupture and/or branch vessel malperfusion.