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Screening for Cardiovascular Disease. Too Early and Too Late?

The Viborg Vascular (VIVA) randomised controlled trial described a population screening program for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and hypertension, and provided subsequent lifestyle advice and recommendations for medical and interventional treatment in men aged 65–74 years.1 Some 50,156 men participated in VIVA, and a significant reduction in all cause mortality was found from 10.8% in the control group to 10.2% in the intervention group after a mean follow up of 4.4 years.

Can we learn anything from the dinosaurs?

In this edition of European Journal of Vascular and Endovascular Surgery, Jungi et al. report results of strictly open surgical treatment of patients with thrombosed popliteal artery aneurysm (PAA): 55 patients during 10 years, most of them with severe ischaemia, with 16% undergoing amputation at ≤30 days.1 The Bern group are sceptical of endovascular surgery, and have published excellent results of ruptured abdominal aortic aneurysm (AAA) repair performed by open surgery alone.2 They use a similar approach for the treatment of thrombosed PAA.

Distal Landing in TEVAR: Challenges in Reaching “The Dead Centre”

“Accuracy landing” is one of the oldest skydiving disciplines in which jumpers must land as closely as possible to a defined target on the ground. This target is called “dead centre”. The diameter of this dead centre used to be 10 cm, but it has been reduced to just 2 cm since 2007. As skydivers usually land on their feet, most try to hit the dead centre with the heel of one shoe. The world record in accuracy landing was broken in 2014 with 10 consecutive landings on the 2 cm target.

Commentary on “A Wearable Compression Device Normalises Calf Muscle Pump Function in Chronic Venous Insufficiency by Applying Appropriate Pressures for Each Postural Position”

The current state of knowledge regarding compression therapy makes any new publication addressing this therapeutic modality a valuable contribution. It is especially true when the authors are renowned subject matter experts such as Mosti and Partsch.1 Unlike other studies that simply compare new against established devices, the authors used the opportunity presented by newer technology to address more fundamental questions of compression therapy. The new device automatically increases pressure in the standing position, mimicking high static stiffness index (SSI) - the change in the interface pressure (IP) after moving patient from supine to standing position.

Re: “Editor's Choice – Cerebral Hyperperfusion Syndrome after Carotid Artery Stenting: A Systematic Review and Meta-analysis”

I have read the meta-analysis by Huibers et al.1 regarding cerebral hyperperfusion syndrome (CHS) after carotid artery stenting, but some points should be addressed.

Title: Spatial distribution of abdominal aortic aneurysm surface expansion and correlation with maximum diameter and volume growth

Annals of Vascular Surgery - 14 February 2019 - 11:00pm
The growth rate of abdominal aortic aneurysm (AAA) is used as a surrogate marker of rupture risk. Its determination is based on maximum diameter increase. However, AAA expansion presents a significant spatial variability. We aim to record the spatial distribution of regional wall surface expansion.

A Step Closer to Finding Mr. Right

Finally, there is a study that tests a potential biomarker solely in asymptomatic patients with carotid artery stenosis. Once a protein has (repeatedly) proved to be elevated in symptomatic patients compared with asymptomatic patients, both in serum and in plaques, the next step is to focus on asymptomatic patients, in whom the biomarker can indeed eventually prove useful. Unfortunately, too many promising biomarkers seem to get lost in this transition to the asymptomatic population.1

Fenestrated endovascular aneurysm repair is associated with lower perioperative morbidity and mortality compared with open repair for complex abdominal aortic aneurysms

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
The Zenith Fenestrated Endovascular Graft (ZFEN; Cook Medical, Bloomington, Ind) has expanded the anatomic eligibility of endovascular aneurysm repair (EVAR) for complex abdominal aortic aneurysms (AAAs). Current data on ZFEN mainly consist of single-institution experiences and show conflicting results. Therefore, we compared perioperative outcomes after repair using ZFEN with open complex AAA repair and infrarenal EVAR in a nationwide multicenter registry.

Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
Concurrent abdominal aortic aneurysm (AAA) and unilateral iliac occlusion is a challenge in the implantation of bifurcated stent grafts (BFGs). The endovascular approach is less invasive than open surgery; the aortouni-iliac (AUI) graft with crossover femorofemoral bypass (CFFB) has many problems associated with extra-anatomic reconstruction. We attempted endovascular aneurysm repair (EVAR) using BFGs in such cases and evaluated the outcomes.

Discussion

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
Dr Nathan Orr (Lexington, Ky). I would like to congratulate the authors on an excellent presentation and manuscript as they begin to sort through the incidence and characteristics of secondary aortic interventions after thoracic endovascular aortic repair (TEVAR) for type B aortic dissections. As you have just heard, secondary aortic interventions are commonly required in this cohort, with an overall incidence of 27%. Further, this is fairly consistent for all comers, with relatively few predictors of increased incidence.

Implications of secondary aortic intervention after thoracic endovascular aortic repair for acute and chronic type B dissection

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
Thoracic endovascular aortic repair (TEVAR) has become a mainstay of therapy for acute and chronic type B aortic dissection (TBAD). Dynamic aortic morphologic changes, untreated dissected aorta, and persistent false lumen perfusion have significant consequences for reintervention after TEVAR for TBAD. However, few reports contrast differences in secondary aortic intervention (SAI) after TEVAR for TBAD or describe their influence on mortality. This analysis examined incidence, timing, and types of SAI after TEVAR for acute and chronic TBAD and determined their impact on survival.

Endograft migration after thoracic endovascular aortic repair

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
The objective of this study was to evaluate the incidence, timing, and potential risk factors of late endograft migration after thoracic endovascular aortic repair (TEVAR).

Addition of proximal intervention to carotid endarterectomy increases risk of stroke and death

Journal of Vascular Surgery - 13 February 2019 - 11:45pm
Adding ipsilateral, proximal endovascular (IPE) intervention to carotid endarterectomy (CEA) for the treatment of tandem bifurcation and supra-aortic trunk disease is controversial. Some suggest that this combined strategy (CEA + IPE) confers no risk over isolated CEA (ICEA). Others disagree, reserving CEA + IPE for symptomatic patients. Using the Vascular Quality Initiative (VQI), this study assessed the effect of adding IPE to CEA on stroke and death risk. We further weighed CEA + IPE outcomes in the context of symptomatic status and Society for Vascular Surgery guidelines.

Paclitaxel Eluting Endovascular Technology and Long-Term Mortality: Safety Concern or a Reminder of an Obvious Literature Gap?

The use of drug eluting endovascular technologies in the form of a drug coated balloon (DCB) or drug eluting stent (DES) has greatly increased in recent years. The European Society for Vascular Surgery (ESVS) guidelines recommend that DCB or DES may be considered for the treatment of short atherosclerotic lesions.1 This is based on industry funded randomised controlled trials (RCTs) reporting that drug eluting devices may be associated with better patency rates compared with standard percutaneous transluminal angioplasty (PTA) in the femoropopliteal (F-P) segment.

Perceptions of Canadian vascular surgeons toward pharmacologic risk reduction in patients with peripheral artery disease: 2018 update

Annals of Vascular Surgery - 12 February 2019 - 11:00pm
Vascular surgeons have a central role in managing peripheral artery disease (PAD). This study assessed their knowledge, attitudes, and behaviours regarding pharmacologic risk reduction in PAD and results were compared to a similar 2004 survey conducted by our group.

Consistency of Proximal-to-Distal Tapering of Descending Thoracic Aortic Diameter: Quantification Using a Novel Computer Tomography Based Assessment

Annals of Vascular Surgery - 11 February 2019 - 11:00pm
Successful endovascular repair of thoracic aorta for type B aortic dissection requires correct stent-graft sizing, particularly of distal landing zone which is mainly based on operator experience. The present study aimed to quantitatively define proximal-to-distal tapering of descending thoracic aortic diameter and its consistency.

Association between Drug Use and In-Hospital Outcomes after Infrainguinal Bypass for Peripheral Arterial Occlusive Disease

Annals of Vascular Surgery - 11 February 2019 - 11:00pm
Drug abuse may affect lower extremity vessels due to ischemia following intra-arterial injections, vasospasm, arterial and venous pseudoaneurysms, arteriovenous fistulae, vasculitis and complicated abscesses. Little is known about the outcomes of Lower Extremity Bypass (LEB) for peripheral arteries disease (PAD) in patients with a history of drug abuse disorder. The aim of this study is to evaluate the outcomes of LEB in this patient population.

Visual outcome of carotid endarterectomy in patients with carotid artery stenosis

Annals of Vascular Surgery - 11 February 2019 - 11:00pm
Carotid endarterectomy (CEA) is deemed to restore the blood flow of the carotid and ophthalmic arteries in patients with carotid artery stenosis. However, specific changes in visual function before and after CEA are not well understood; hence, this observational study aimed to investigate the functional and structural changes in vision after CEA in those patients.

Assessment of the utility of a Vascular Early Warning System (VEWS) device in the assessment of peripheral arterial disease in patients with diabetes and incompressible vessels

Annals of Vascular Surgery - 11 February 2019 - 11:00pm
To assess the ability of a novel, automated CE marked vascular early warning system (VEWS) device to detect peripheral arterial disease in patients with incompressible ankle arteries and non-measurable ankle brachial pressure index (ABPI) secondary to diabetes.
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