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Annals of Vascular Surgery - 31 December 2018 - 11:00pm

Table of Contents

Annals of Vascular Surgery - 31 December 2018 - 11:00pm

Editorial Board

Annals of Vascular Surgery - 31 December 2018 - 11:00pm

Masthead

Annals of Vascular Surgery - 31 December 2018 - 11:00pm

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.

Progressive Guidance on the Modern Management of Abdominal Aorto-iliac Artery Aneurysms

The European Society for Vascular Surgery (ESVS) guidelines on the management of abdominal aorto-iliac artery aneurysms, published in this issue of EJVES, are essential reading for the vascular practitioner.1 Comprehensive recommendations that demonstrate a balanced insight into the rapid pace of technological innovation are outlined based on contemporary evidence. The writing committee comprised 16 European experts in the management of aortic diseases, most of whom run a cutting edge clinical aortic practice at their home institutions.

Is Bigger Actually Better? The Strengths and Limitations of Large Registry Data

As publications using data from huge registries become more popular, so does the belief that the strength of recommendation that can be made from the results is greater than from smaller cohorts. This very large dataset from Hamburg examines gender differences in peripheral endovascular revascularisation for peripheral arterial disease.1 Such a large dataset is undoubtedly important, but potential sources of error and a low number of events for some significant results means that this study has good examples of the limits inherent to larger retrospective cohorts.

Is In Hospital Mortality Following EVAR Still a Valid Outcome Measure?

This registry based study from Australia investigated the impact of hospital and surgeon volume on the outcome of abdominal aortic aneurysm repair over a seven year period.1 In keeping with contemporary data the authors were unable to identify any volume effect for endovascular aneurysm repair (EVAR),2 and somewhat more surprisingly no volume effect for open repair at surgeon or hospital level. The EVAR group included both complex EVAR cases and thoracic endovascular aneurysm repairs (TEVARs), both of which had expected higher mortalities, of 2.6% and 5.6%, respectively.

Commentary Regarding “Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms”

In this issue of the European Journal of Vascular and Endovascular Surgery, Gombert et al.1 compare open one stage with two stage repair of type II thoraco-abdominal aortic aneurysm (TAAA). The authors conclude that open two stage repair, if anatomically feasible, demonstrates a lower mortality than and similar complication rates to one stage repair. These findings do not come as a surprise and reflect a current trend in TAAA repair strategy: towards endovascular and hybrid repair and towards two stage repair in order to reduce both mortality and morbidity.

How Can We Ensure Vascular Surgical Trainees Become Competent in Open Aortic Surgery in the Future Training Environment?

The use of endovascular aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms (AAAs) is now widespread, with the minimally invasive approach, rapid recovery, and better early survival proving attractive to clinicians and patients. Approximately 60% of all AAA repairs in Europe and 85% in the USA are now by EVAR.1,2

Beyond the AAA Guidelines: Core Outcome Sets to Make Life Better for Patients

The new European Society for Vascular Surgery (ESVS) Clinical Practice guidelines on the management of abdominal aortic aneurysms (AAA) were produced by clinicians for clinicians, but for the first time in the history of ESVS guideline production, the AAA guideline development process included input from patients affected by the recommendations.1 Even from the small patient contribution to these guidelines, and similar patient input to recent AAA repair trials, it is clear that the important outcomes for patients and their relatives may be very different from those usually considered important by vascular surgeons.

Coexisting hypogastric aneurysms worsen the outcomes of endovascular treatment by the iliac branch devices within the pELVIS Registry

Journal of Vascular Surgery - 9 December 2018 - 11:00pm
Hypogastric aneurysms (HAs) frequently coexist with aortoiliac aneurysms (AIAs). However, the presence of an HA is a contraindication to endovascular aneurysm treatment by iliac branch devices (IBDs) because of the risk of distal sealing-related endoleaks. No robust evidence exists in the published literature, and therefore we sought to evaluate the performance of IBDs in the presence of HAs within a multicenter registry of nine vascular centers.

A Practical Guide for Application of Network Meta-Analysis in Evidence Synthesis

Meta-analysis is the statistical approach of synthesizing quantitatively the results of multiple studies addressing the same research hypothesis. A common limitation of conventional meta-analysis is the comparison of no more than two interventions at a time. Typically, the researcher is faced with a plethora of competing interventions and is interested in finding which of them are the most safe and effective. Network meta-analysis (NMA) addresses this problem by allowing multiple comparisons among interventions forming a connected network of evidence.

Common femoral artery antegrade and retrograde approaches have similar access site complications

Journal of Vascular Surgery - 3 December 2018 - 11:00pm
Ipsilateral antegrade access (AA) is an alternative access option for contralateral retrograde access (RA) in treating infrainguinal occlusive disease. Our goal was to assess whether AA is associated with higher access site complications.

The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting

Journal of Vascular Surgery - 3 December 2018 - 11:00pm
Video motion analysis (VMA) uses fluoroscopic sequences to derive information on catheter and guidewire movement and is able to calculate two-dimensional catheter tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to evaluate the effect of anatomic complexity on the efficiency of completion of defined stages of simulated carotid artery stenting as measured by VMA.

Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair

Journal of Vascular Surgery - 3 December 2018 - 11:00pm
The objective of this study was to analyze the impact of advanced imaging applications and cone beam computed tomography (CBCT) on radiation exposure of the patient and operator and detection of technical problems during fenestrated-branched endovascular aortic repair (F-BEVAR) for treatment of pararenal aneurysms and thoracoabdominal aortic aneurysms (TAAAs).

Influence of multiple stents on periprocedural stroke after carotid artery stenting in the Carotid Revascularization Endarterectomy versus Stent Trial (CREST)

Journal of Vascular Surgery - 3 December 2018 - 11:00pm
In the Carotid Revascularization Endarterectomy versus Stent Trial (CREST), carotid artery atherosclerotic lesion length and nature of the lesions were important factors that predicted the observed difference in stroke rates between carotid endarterectomy and carotid artery stenting (CAS). Additional patient-related factors influencing CAS outcomes in CREST included age and symptomatic status. The importance of the operator's proficiency and its influence on periprocedural complications have not been well defined.
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