Journal of Vascular Surgery

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Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial

8 January 2019 - 11:00pm
Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA).

Discussion

8 January 2019 - 11:00pm
Ali F. AbuRahma (Charleston, WVa). The Ochsner group presents to us this study on the correlation between the severity of neurologic deficits and the timing of carotid intervention, either carotid endarterectomy (CEA) or carotid artery stenting (CAS), to functional recovery of these patients. This analysis is important because it covers a relatively common clinical vascular practice.

Patients with moderate to severe strokes (NIHSS score >10) undergoing urgent carotid interventions within 48 hours have worse functional outcomes

8 January 2019 - 11:00pm
Increasing evidence suggests that urgent carotid intervention after a nondisabling stroke is safe. However, the functional outcome of such patients has not been quantified for various degrees of stroke. We aimed to determine whether increased presenting stroke severity and timing to intervention are associated with poor functional outcomes in patients undergoing urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS) after an acute transient ischemic attack or stroke.

Discussion

6 January 2019 - 11:00pm
Dr Mark A. Farber (Chapel Hill, NC). I would like to congratulate the authors on a wonderful presentation and for providing me with a draft of the manuscript for review.

Ischemia-induced lower extremity neurologic impairment after fenestrated endovascular aneurysm repair

6 January 2019 - 11:00pm
Placement of large sheaths in the iliac system during fenestrated endovascular aneurysm repair (FEVAR) leads to lower extremity (LE) ischemia that can be associated with serious neurologic complications. We sought to determine the effect of LE ischemic time on neurologic impairment after FEVAR.

Educational resources for vascular laboratory education in vascular surgery residencies and fellowships: Survey of Vascular Surgery Program Directors

5 January 2019 - 11:00pm
The Registered Physician in Vascular Interpretation (RPVI) credential is a prerequisite for certification by the Vascular Surgery Board of the American Board of Surgery. Of concern, as more current trainees and recent program graduates take the Physician Vascular Interpretation (PVI) examination, vascular surgery trainee pass rates have decreased. Residents and fellows have a lower PVI examination pass rates than practicing vascular surgeons. The purpose of this study was to assess current vascular laboratory (VL) training for vascular surgery residents and fellows and to identify gaps that residency and fellowship programs might address.

A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy

5 January 2019 - 11:00pm
Transcarotid artery revascularization (TCAR) is a novel approach to carotid intervention that uses a direct carotid cut-down approach coupled with cerebral blood flow reversal to minimize embolic potential. The initial positive data with TCAR indicates that it may be an attractive alternative to trans-femoral carotid artery stenting and possibly carotid endarterectomy (CEA) for high-risk patients. The purpose of this study was to present 30-day and 1-year outcomes after treatment by TCAR and to compare these outcomes against a matched control group undergoing CEA at the same institutions.

Ankle-brachial index in patients with intermittent claudication is a poor indicator of patient-centered and clinician-based evaluations of functional status

5 January 2019 - 11:00pm
The association between the severity of ankle-brachial index (ABI), a traditional measure of the severity of peripheral artery disease (PAD), and patients' perceptions of their health status is poorly characterized. In Patient-Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease: Investigating Trajectories (PORTRAIT), a study of patients with intermittent claudication (IC), we studied the correlation of ABI values and Rutherford symptom classification with PAD-specific health status as measured by the Peripheral Artery Questionnaire (PAQ).

Technical aspects and 30-day outcomes of the prospective early feasibility study of the GORE EXCLUDER Thoracoabdominal Branched Endoprosthesis (TAMBE) to treat pararenal and extent IV thoracoabdominal aortic aneurysms

2 January 2019 - 11:00pm
This study reports the technical aspects and 30-day outcomes of the prospective, multicenter early feasibility study designed to evaluate the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE; W. L. Gore & Associates, Flagstaff, Ariz).

Thoracic endovascular aortic repair for retrograde type A aortic dissection

2 January 2019 - 11:00pm
The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified.

Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection

2 January 2019 - 11:00pm
A review of the literature was conducted for incidence, outcomes, and risk factors for distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) of aortic dissection.

Analgesic effectiveness of topical sevoflurane to perform sharp debridement of painful wounds

2 January 2019 - 11:00pm
Analgesic topical options to perform wound debridement are scarce. The purpose of this study was to communicate our experience using topical sevoflurane as analgesic for wound debridement.

Decreased mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured abdominal aortic aneurysm in the Vascular Quality Initiative database

1 January 2019 - 11:00pm
Endovascular aneurysm repair (EVAR) is an accepted approach for patients presenting with ruptured abdominal aortic aneurysm (rAAA) and suitable anatomy. The effect of anesthesia modality on mortality outcomes in rAAA has not been well described. Using the Vascular Quality Initiative database, this study compares local anesthesia (LA) vs general anesthesia (GA) in EVAR for rAAA.

Discussion

1 January 2019 - 11:00pm
Dr Mohammed M. Moursi (Little Rock, Ark). Dr Malas and colleagues report the 1-year safety and efficacy outcomes of the ROADSTER trial, Reverse Flow Used During Carotid Artery Stenting Procedure. This trial consists of a transcarotid artery revascularization (TCAR) technique using the ENROUTE neuroprotection reversal of flow system. Inclusion criteria consisted of symptomatic and asymptomatic patients who were considered at high risk for carotid endarterectomy (CEA). At 1 year, the stroke rate was 0.6%.

Analysis of the ROADSTER pivotal and extended-access cohorts shows excellent 1-year durability of transcarotid stenting with dynamic flow reversal

1 January 2019 - 11:00pm
We report the 1-year outcomes of the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial. This trial introduced a novel transcarotid neuroprotection system (NPS), the ENROUTE transcarotid NPS (Silk Road Medical Inc, Sunnyvale, Calif). Postoperative results demonstrated that the use of the ENROUTE transcarotid NPS is safe and effective. The aim of this study was to evaluate the safety of transcarotid artery revascularization (TCAR) and to present the 1-year outcomes.

Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

1 January 2019 - 11:00pm
The outcomes of endovascular treatment of femoropopliteal atherosclerotic lesions have been improving recently. Although open repair is indicated for class D femoropopliteal lesions based on the TransAtlantic Inter-Society Consensus II (TASC II) document, in some cases, it is reasonable to use the endovascular approach for these lesions. The aim of this study was to retrospectively analyze the technical aspects and outcomes of treating TASC II D femoropopliteal disease with endovascular approaches.

A systematic review of infected descending thoracic aortic grafts and endografts

31 December 2018 - 11:00pm
The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair.

African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms

31 December 2018 - 11:00pm
Recently published Society for Vascular Surgery guidelines recommend endovascular aneurysm repair (EVAR) for both elective and emergent treatment of abdominal aortic aneurysm in patients with suitable anatomy. Racial disparities in health care are well known. The aim of this study was to stratify the patients undergoing EVAR on the basis of their racial differences and to determine the differences in preoperative, intraoperative, and postoperative variables among patients of different races.

Quantifying the costs and profitability of care for diabetic foot ulcers treated in a multidisciplinary setting

31 December 2018 - 11:00pm
Increasing Wound, Ischemia, and foot Infection (WIfI) stage has previously been shown to be associated with prolonged wound healing time, higher number of surgical procedures, and increased cost of care in patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. However, the profitability of this care model is unknown. We aimed to quantify the hospital costs and net margins associated with multidisciplinary DFU care.

A systematic review of the impact of preoperative exercise for patients with abdominal aortic aneurysms

31 December 2018 - 11:00pm
Abdominal aortic aneurysm (AAA) surgery carries significant risk of morbidity and mortality. Preoperative exercise may improve the physical fitness capacity of patients with AAA, as well as postoperative outcomes.