Journal of Vascular Surgery

Syndicate content
Journal of Vascular Surgery RSS feed.
Updated: 6 days 19 hours ago

BEST-CLI trial on the homestretch

31 January 2019 - 11:00pm
Persistent, widespread clinical uncertainty about the best means by which to revascularize patients with chronic limb-threatening ischemia (CLTI, or critical limb ischemia [CLI]) and the striking paucity of comparative effectiveness data led to efforts by the authors in 2007 to design a randomized, controlled trial that would address these questions. There are huge variations in the clinical management of affected patients. The Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial, funded by the National Heart, Lung, and Blood Institute, is a prospective, multicenter, multispecialty randomized controlled trial designed to compare treatment efficacy, functional outcomes, cost-effectiveness, and quality of life for 2100 patients suffering from CLI.

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

31 January 2019 - 11:00pm
One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.

Invited commentary

31 January 2019 - 11:00pm
The use of administrative databases to study surgical outcomes has led to vast improvements in patient care. These databases are wide ranging, cover a diverse array of diseases and surgical procedures, and report differing outcomes at varying intervals. Furthermore, these databases include a significant amount of data, allowing researchers to overcome power limitations of single-surgeon or single-center experiences. They also give a better understanding of regional and national variations that can lead to improved patient outcomes through standardization of patient care.

Thoracic endovascular repair for acute complicated type B aortic dissections

31 January 2019 - 11:00pm
This study retrospectively assessed in-hospital mortality and long-term results of emergency thoracic endovascular aortic repair (TEVAR) for patients with life-threatening acute complicated type B aortic dissection (acTBD).

Invited commentary

31 January 2019 - 11:00pm
In their article, “Variability in hospital costs for carotid artery revascularization,” Drs Mell and colleagues examined variations in hospital costs for patients undergoing carotid revascularization at a regional referral center in California. The found that costs were lower in asymptomatic patients by more than a third; that surgeon specialties who commonly perform carotid revascularization tended to have lower costs; and that operating room expenses, such as devices, supplies, and materials, made up more than three-quarters of the expenses surrounding the episode of care.

Invited commentary

31 January 2019 - 11:00pm
Postoperative groin complications continue to be the bane of vascular surgeons, often resulting in patients' increased morbidity (or mortality if associated with prosthetic material) and resource utilization with longer lengths of stay, higher rates of readmissions or returns to the operating room, and increased overall costs. Current literature supports a rate of up to nearly 40% of vascular surgery patients' developing groin wound infections after their procedures, and multiple studies have outlined ways to curb these events ranging from negative pressure dressings to perioperative care paths.

Variation in timing and type of groin wound complications highlights the need for uniform reporting standards

31 January 2019 - 11:00pm
Groin wound infections represent a substantial source of patients' morbidity and resource utilization. Definitions and reporting times of groin infections are poorly standardized, which limits our understanding of the true scope of the problem and potentially leads to event under-reporting. Our objective was to investigate the timing and variation of groin wound complications after vascular surgery.

Vascular access for hemodialysis in the elderly

31 January 2019 - 11:00pm
The objective of this study was to compare the outcomes of arteriovenous fistulas (AVFs) with arteriovenous grafts (AVGs) in a large population-based cohort of elderly patients in the United States.

Long-term durability of multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysms

31 January 2019 - 11:00pm
The objective of this study was to assess the durability of multibranched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms by examining the rates of late-occurring (beyond 30 days) complications.

Invited commentary

31 January 2019 - 11:00pm
On first reviewing this manuscript, I did have some concerns. The authors fail to achieve their primary goal; vonapanitase does not result in a significant increase in primary patency in patients receiving a radiocephalic arteriovenous fistula. Statistics in this study, however, may be misleading. The authors employ a hierarchical statistical model, which means that if the primary end point is not achieved, then the secondary and tertiary end points may only be considered descriptive.

A randomized trial of vonapanitase (PATENCY-1) to promote radiocephalic fistula patency and use for hemodialysis

31 January 2019 - 11:00pm
Arteriovenous fistulas created in patients with chronic kidney disease often lose patency and fail to become usable. This prospective trial evaluated the efficacy of vonapanitase, a recombinant human elastase, in promoting radiocephalic fistula patency and use for hemodialysis.

Invited commentary

31 January 2019 - 11:00pm
In laminar flow situations, shear occurs in the zone between the blood vessel wall (velocity = zero) and the central column of flow. In vitro measurement of shear, sometimes difficult, has been achieved with laser Doppler sensors and with magnetic resonance techniques.1,2 Casa et al diagrammed the cross section of flow velocity as parabolic for laminar flow and showed how platelets and blood clotting factors can be activated in the shear zone, the region where the velocity curve becomes asymptotic with the wall (Casa Fig 1).

Invited commentary

31 January 2019 - 11:00pm
The use of foam decay experiments is novel in the vascular surgery literature and emphasizes the science from chemical engineering that can be applied in this area. This technique represents a new initiative in the area of science of sclerotherapy in the quest to improve outcomes and minimize side effects. The authors present a series of experiments looking at the effects of different surfactants on foam stability. The use of sodium morrhuate and polidocanol will be more familiar to physicians using sclerotherapy in the treatment of venous disease.

Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm

27 January 2019 - 11:00pm
Fenestrated or branched endovascular aortic repair (FB-EVAR) usually represents the last stage in endovascular treatment of postdissection aneurysm after thoracic endograft coverage of entry tear and false lumen embolization.

Association of preoperative spinal drain placement with spinal cord ischemia among patients undergoing thoracic and thoracoabdominal endovascular aortic repair

27 January 2019 - 11:00pm
Spinal cord ischemia (SCI) is among the most devastating complications of thoracic endovascular aortic repair (TEVAR). Spinal fluid drainage has been proposed as a viable means to reduce SCI, but few data exist to support its routine use. This study investigated the association of preoperative spinal fluid drainage with the risk of SCI after TEVAR.

Late open conversion after thoracic endovascular aortic repair

24 January 2019 - 11:00pm
With the increasing use of endovascular aortic repair, open repair after aortic stent grafting is of increasing interest. We retrospectively reviewed cases of late open conversion for complications after thoracic endovascular aortic repair (TEVAR).

Discussion

22 January 2019 - 11:00pm
Dr Thomas S. Huber (Gainesville, Fla). The authors have analyzed the impact of preoperative anemia on the perioperative outcomes of both open and endovascular repair for intact aneurysms using the Vascular Quality Initiative. They have reported that anemia is associated with increased 30-day mortality and adverse outcome for endovascular but not open repair in their multivariate analysis. They reported that the adverse outcomes associated with anemia were independent of chronic kidney disease and congestive heart failure.

Anemia and postoperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms

22 January 2019 - 11:00pm
Anemia is associated with increased cardiac adverse events during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the surgical outcomes and prognostic implications of anemia in patients undergoing repair of intact abdominal aortic aneurysms (AAAs).

Invited commentary

21 January 2019 - 11:00pm
Mirza and colleagues present outcomes of upper extremity access (UEA) for complex aortic repair of thoracoabdominal aortic aneurysms (TAAAs).1 To date, this is by far the largest retrospective study on the topic, and the authors are to be congratulated for their results and this important effort to cast some light on a frequently neglected topic. Except for a few reports, UEA for complex aortic repair has rarely been focused on and can be controversially discussed with a diversity of approaches.

Analysis of the results of endovascular and open surgical treatment of acute limb ischemia

20 January 2019 - 11:00pm
The objective of this study was to evaluate the long-term estimates of limb salvage and survival in patients with acute limb ischemia (ALI) receiving open surgery or endovascular revascularization.