Journal of Vascular Surgery

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

17 March 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

17 March 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

17 March 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

17 March 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

17 March 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

17 March 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.

Why randomized controlled trials do not always reflect reality

12 March 2019 - 11:00pm
Randomized controlled trials (RCTs) constitute level I evidence and are used as the backbone of guidelines and recommendations for treatment. Although RCTs are theoretically the studies of choice for the assessment of the effectiveness of health care interventions, these trials (and their interpretation) may sometimes result in erroneous conclusions, erroneous therapeutic decisions, and incorrect recommendations. We aimed to check the applicability of the results of RCTs to everyday practice.

The natural history of type B aortic dissection in patients with PRKG1 mutation c.530G>A (p.Arg177Gln)

10 March 2019 - 11:00pm
The c.530G>A (p.Arg177Gln) mutation in PRKG1 has been shown to be associated with thoracic aortic aneurysms and dissections. This rare mutation accounts for an estimated 1% of nonsyndromic heritable thoracic aortic disease. We sought to describe the clinical presentation of type B aortic dissection (TBAD), management, and outcomes in patients with this mutation.

Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer

10 March 2019 - 11:00pm
The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU.

iTalian RegIstry of doUble inner branch stent graft for arch PatHology (the TRIUmPH Registry)

10 March 2019 - 11:00pm
The objective of this study was to assess early and midterm results after endovascular aortic arch repair using a double inner branch stent graft (DIBSG) in patients with aortic arch aneurysm or dissection unfit for open surgery.

Association between stress hormones and perioperative risk in patients with critical limb ischemia undergoing revascularization

7 March 2019 - 11:00pm
It is well known that the clinical outcome of patients with critical limb ischemia (CLI) is poor. However, the relationship between stress-related hormone levels and CLI outcome remains unclear. The aim of this study was to reveal the association of stress hormones with the risk of a perioperative major adverse cardiovascular event (pMACE) in CLI patients undergoing surgical and endovascular revascularization.

Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting

6 March 2019 - 11:00pm
Transcarotid artery revascularization (TCAR) has emerged as an alternative to transfemoral carotid artery stenting (tfCAS). We investigated the proportion of carotid arteries undergoing revascularization procedures that would be eligible for TCAR based on anatomic criteria and how many arteries at high anatomic risk for tfCAS would be amenable to TCAR.

Return of baseline kidney function after bilateral renal artery stent occlusion and treatment delay following fenestrated endografting

6 March 2019 - 11:00pm
Although renal artery restenosis and thrombotic stent occlusion are not rare occurrences, the literature suggests that prompt diagnosis and treatment are essential to preserve renal function, particularly in the setting of occlusion. We describe the case of a 75-year-old woman who underwent fenestrated endovascular aneurysm repair and experienced acute anuric renal failure requiring dialysis secondary to bilateral renal artery stent occlusion for >48 hours. She was successfully treated with revisional endovascular therapy and made a full renal recovery.

Practice patterns in arteriovenous fistula ligation among kidney transplant recipients in the United States Renal Data Systems

6 March 2019 - 11:00pm
Arteriovenous fistulas (AVF) and grafts (AVG) have been associated with significant cardiac morbidity that often improves after ligation. However, AV access ligation after kidney transplant (KT) is controversial due to concern for potential long-term allograft failure. We investigated US trends in AV access ligation after KT and the association between ligation and allograft failure.

The effect of income and insurance on the likelihood of major leg amputation

6 March 2019 - 11:00pm
Although it has been suggested that individuals of low socioeconomic status and those with Medicaid or no insurance may be more likely to have their peripheral artery disease treated by leg amputation rather than by limb-saving revascularization, it is not clear if this disparity occurs consistently on a national basis, and if it does so in a linear fashion, such that poorer individuals are at progressively greater risk for amputation.

Knowledge gap of peripheral artery disease starts in medical school

5 March 2019 - 11:00pm
Previous data suggest that physicians have suboptimal knowledge about peripheral artery disease (PAD). Our aim was to evaluate Canadian medical students' knowledge of PAD to determine if this knowledge gap exists early in medical training.

Preoperative hemoglobin A1c levels and increased risk of adverse limb events in diabetic patients undergoing infrainguinal lower extremity bypass surgery in the Vascular Quality Initiative

5 March 2019 - 11:00pm
The impact of preoperative glycemic control on the risk of adverse perioperative outcomes in diabetic patients undergoing lower extremity bypass (LEB) surgery is not well-understood. We determined whether higher preoperative hemoglobin A1c (HbA1c) levels are associated with an increased risk of major adverse limb events, major adverse cardiovascular events, and mortality in diabetic patients undergoing infrainguinal LEB.

Sarcopenia predicts mortality and adverse outcomes after endovascular aneurysm repair and can be used to risk stratify patients

5 March 2019 - 11:00pm
Endovascular aneurysm repair (EVAR) is currently the most common treatment of abdominal aortic aneurysms. Potential predictors of long-term survival after EVAR include physiologic, functional, and cognitive status, but assessments of these conditions have been difficult to standardize. Objective radiographic findings, such as skeletal muscle atrophy, or sarcopenia, may provide an additional means for selection of patients. This study investigates sarcopenia as a method to predict 1-year survival in patients undergoing EVAR.

Physical therapy management, surgical treatment, and patient-reported outcomes measures in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome

5 March 2019 - 11:00pm
To assess the results of physical therapy management and surgical treatment in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome (NTOS) using patient-reported outcomes measures.

Preoperative risk score for access site failure in ultrasound-guided percutaneous aortic procedures

5 March 2019 - 11:00pm
The factors associated with access site failure after ultrasound-guided percutaneous access for aortic endograft procedures remain poorly characterized. We developed a prediction model to risk stratify patients for access site failure.