Journal of Vascular Surgery

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Scope and Prevalence of Conflicts of Interest Among Highly Cited Peripheral Artery Disease Research Studies

31 December 2018 - 11:00pm
Conflicts of interest (COI) potentially influence interpretation of study results for both authors and journal readers. Scientific journals often require author disclosure of relevant conflicts, but this is usually by self-report and seldom includes detailed quantification of reimbursement. The purpose of this analysis was to characterize COI among highly cited research studies related to peripheral artery disease (PAD) in terms of prevalence, quantity of reimbursement, and associations with manuscript characteristics.

Development of a Multifunctionalized Vascular Scaffolding System to Induce In Situ Endothelialization

31 December 2018 - 11:00pm
Vascular tissue engineered grafts are one of the most promising alternatives to small-diameter prosthetic grafts, which often require reintervention within a decade of use. Previous methods of seeding vascular grafts with autologous patient cells have been successful; however, grafts constructed through these methods require copious amounts of preparation time before implantation. The growth or deposition of endothelial cells (ECs) onto the luminal surface of the prosthetic vessel may be critical for optimal physiological integration of a vascular scaffold to the host environment.

Influence of Hospital Volume on Patient Selection, Risk of Complications, and Mortality From Failure to Rescue After Open Abdominal Aortic Aneurysm Repair

31 December 2018 - 11:00pm
The effect of hospital volume (HV) on mortality after open abdominal aortic aneurysm repair (OAAA) is well-known; however, the underlying mechanism for improved outcomes is poorly understood. Better patient selection, lower risk of complications, and improved ability to rescue patients after adverse events are assumed mechanisms, but few data exist to validate this hypothesis. The purpose of this analysis was to determine the influence of HV on patient selection, incidence of complications and failure to rescue (FTR) after adverse events resulting from OAAA repair.

Impact of Suprarenal Neck Angulation on Endovascular Repair Outcomes

31 December 2018 - 11:00pm
Hostile infrarenal proximal neck (β) anatomy of abdominal aortic aneurysm (AAA) has been associated with increased risk of aneurysm-related complications after endovascular repair (EVAR). However, there is a paucity of literature addressing the suprarenal angle (α). The aim of this study is to evaluate short and long-term outcomes after EVAR in patients with severe suprarenal neck angulation (>60°).

Association of Preoperative Spinal Drainage Placement With Spinal Cord Ischemia Among Patients Undergoing Thoracic Endovascular Aortic Repair

31 December 2018 - 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 risk of SCI after TEVAR.

Type B Aortic Intramural Hematoma: To TEVAR or not to TEVAR?

31 December 2018 - 11:00pm
Intramural hematoma (IMH) is on the spectrum of acute aortic syndrome but optimal management is poorly understood. The aim of this study was to evaluate outcomes of patients with type B IMH after best medical therapy (BMT), and assess what variables are associated with failure of BMT

Comparative Outcomes of Open, Hybrid, and Fenestrated Branched Endovascular Repair of Extent II and III Thoracoabdominal Aortic Aneurysms

31 December 2018 - 11:00pm
Open repair of Crawford extent II and III thoracoabdominal aortic aneurysms (TAAA) is associated with substantial perioperative risk. In an effort to decrease this risk, endovascular technologies are increasingly used and include either a hybrid operation combining proximal thoracic endovascular aortic repair followed by staged open distal TAAA repair (hybrid) or a total endovascular approach using fenestrated/branched endografts (FEVAR). However, the benefits of these alternative approaches compared with open surgery remains unclear.

Technical video of endovascular repair of chronic postdissection thoracoabdominal aortic aneurysm using a five-vessel preloaded fenestrated-branched stent graft

31 December 2018 - 11:00pm
Fenestrated-branched endovascular repair has been applied to treat chronic postdissection thoracoabdominal aortic aneurysms (TAAAs). We report a patient with diffuse postdissection aortic aneurysm involving the arch and thoracoabdominal aorta treated in a staged fashion with redo aortic arch repair using the frozen elephant trunk technique, followed by completion endovascular TAAA using preloaded guidewire system and a five-vessel fenestrated and branched stent graft. A technical video illustrates the use of onlay fusion and sequential catheterization with the preloaded guidewire system to facilitate TAAA repair.

Regarding “Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients”

31 December 2018 - 11:00pm
We read, with interest, “Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients” by Yang et al.1 Central venous catheter insertion is associated with morbidity and mortality,2 with catheter-related right atrial thrombosis (CRAT) described as one common complication in end-stage renal disease patients requiring hemodialysis.3 Yang et al described 20 end-stage renal disease patients with tunneled-cuffed catheters treated for CRAT. Tunneled-cuffed catheter placement was performed secondary to recurrent arteriovenous fistula failure in 18 (90%) patients and refusal of arteriovenous fistula for personal reasons in two (10%) patients.

Reply

31 December 2018 - 11:00pm
We greatly appreciate the comment of Drs Ghannam, Chick, and Srinivasa. Chick and colleagues have conducted a study examining the benign management of catheter tip-associated thrombi1 and have raised the question of the necessity of anticoagulation and catheter removal in hemodialysis patients. For the management of catheter-related right atrial thrombosis (CRAT) in hemodialysis patients in our study, we treated our patients effectively by replacing catheters and providing oral anticoagulation and antiplatelet therapies.

The proposed UK abdominal aortic aneurysm guidelines: A much needed wakeup call

31 December 2018 - 11:00pm
Broadly categorized, surgical revolutions come in three major forms: technical, philosophical, and transformative.

Invited commentary

31 December 2018 - 11:00pm
Kapetanios and colleagues have comprehensively reviewed the published literature on the use of contrast-enhanced ultrasound (CEUS) for detection of endoleaks after endovascular aneurysm repair (EVAR). Unfortunately, the methodology used may only amplify biases present in the reviewed publications. Thus, analyses in the current review do not provide substantial new insights.

Discussion

31 December 2018 - 11:00pm
Michael M. McNally (Knoxville, Tenn). I want to congratulate Dr Sabra and authors from the University of Florida Jacksonville on their research and presentation on Blunt Traumatic Aortic Injury Occurring at Unusual Locations. This study is a single-institution retrospective study investigating 74 consecutive patients with blunt traumatic aortic injury. The identified patients were then divided between usual and unusual locations based off an anatomic division 5 cm below the left subclavian artery.

Identification of unique characteristics and the management of blunt traumatic aortic injuries occurring at unusual locations in the descending thoracic aorta

31 December 2018 - 11:00pm
The usual location of thoracic blunt traumatic aortic injury (BTAI) is just distal to the left subclavian artery; however, injuries can also be found in other locations in the descending thoracic aorta (DTA).

Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease

31 December 2018 - 11:00pm
Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease.

Invited commentary

31 December 2018 - 11:00pm
Metabolic syndrome (MetS) and peripheral artery disease (PAD) are growing public health problems that are closely intertwined. However, few prospective studies have examined the association of MetS and PAD, with the existing literature showing conflicting results.1 In this edition of the Journal, Sorber et al explore the association between MetS and postoperative outcomes after lower extremity bypass surgery and question whether perioperative use of cardiovascular risk-modifying agents alters outcomes.

Frank C. Spencer, MD, FACS (1925-2018)

31 December 2018 - 11:00pm
He is the quintessential surgical teacher first by example (as one of the finest surgeons of his generation), but also through the high standards he set for the scores of individuals who had the honor of working with him. At his widely renowned morbidity and mortality conferences, Dr Spencer stressed thoughtful analysis and introspection as fundamental to achieving surgical competence. He viewed compassion and professionalism as important as technical perfection in providing quality care to our patients.

Vascular interventions in head and neck cancer patients as a marker of poor survival

31 December 2018 - 11:00pm
Head and neck cancer can involve the surrounding vasculature and require technically challenging vascular interventions. These interventions can be complicated by tumor invasion, history of prior surgery, and history of radiation therapy. Our aim was to examine patients with vascular interventions in association with head and neck cancer to determine outcomes and best practice.

Invited commentary

31 December 2018 - 11:00pm
During the last three decades, vascular surgeons have successfully introduced and embraced a new, minimally invasive approach for the treatment of abdominal aortic aneurysms using endovascular aneurysm repair (EVAR). Whereas countless patients have benefited from EVAR, it is not without its limitations, which include a critical need for lifelong follow-up, a significant reintervention rate that does not plateau over time, and the increased cost.

Invited commentary

31 December 2018 - 11:00pm
Dr Columbo and colleagues have used the Vascular Quality Initiative's database to compare long-term mortality in patients undergoing carotid endarterectomy vs carotid stenting. Administrative databases are notoriously unreliable with respect to cause of death, leaving mortality as the most reliable outcome measure in the study. The mortality difference between carotid endarterectomy and carotid stenting in this study is striking, reinforcing several precedent studies cited by the authors. Patients selected for carotid stenting would likely be at somewhat higher risk for any procedure than those patients thought suitable for carotid endarterectomy, although propensity matching would be expected to mitigate differences between the groups, and in this case the excess mortality after carotid stenting persisted despite propensity matching.