Journal of Vascular Surgery

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Invited commentary

31 December 2018 - 11:00pm
Endovascular aneurysm repair (EVAR) represented a true paradigm shift in vascular surgery, evidenced by its rapid proliferation after its introduction in 1990.1 By 2003, EVAR surpassed open repair as the dominant treatment modality in the Medicare population.2 However, much as for other novel technologies, physicians experience a learning curve, and devices undergo multiple iterations as long-term data reveal previously unforeseen issues. To date, several endografts have been withdrawn from the market, and none of the most commonly implanted devices are in their first generation.

Invited commentary

31 December 2018 - 11:00pm
This basic science study's goal is to address an area of clinical ambiguity: how to coat an endovascular stent graft with rifampin in a standard and optimized manner for immediate use in an infected field. It optimizes two variables, concentration and incubation period, in an ex vivo experiment and on the basis of the results suggests a rapid real-time perioperative protocol. The graft chosen to study is a standard Dacron endograft of various diameters and lengths. There are reports of using a rifampin-coated endograft in an infected field with preparation extrapolated from methods used during open operation (60 mg/mL rifampin incubated for 1 hour).

Iliac conduits remain safe in complex endovascular aortic repair

27 December 2018 - 11:00pm
Iliac conduits (ICs) are used for challenging iliac access during endovascular aortic aneurysm repair (EVAR) with contradictory reports of safety and increased surgical complications, morbidity, and mortality in national database reviews. The objective of this study was to examine outcomes related to IC placement before or concomitant with EVAR at a high-volume single center.

Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset

27 December 2018 - 11:00pm
To date, no single scoring system for predicting 30-day mortality in patients with ruptured abdominal aortic aneurysms (rAAAs) has been endorsed by any vascular society or proven to definitively predict treatment futility. Three recently developed scoring systems for predicting 30-day mortality in patients with rAAA have been validated by their respective institutional data. The purpose of this study was to evaluate the accuracy of these rAAA mortality risk scores using an independent community hospital dataset.

Comparison of major adverse event rates after elective endovascular aneurysm repair in New England using a novel measure of complication severity

27 December 2018 - 11:00pm
Major adverse event (MAE) rates are used as an outcome measure after surgical procedures. Although MAE rates summarize the occurrences of adverse events, they do not reflect differences in severity of these events. We propose that a measure of complication severity could provide a more accurate assessment about the quality of care. We aimed to analyze and to describe the regional variation in elective endovascular aneurysm repair (EVAR) MAE rates across centers in the Vascular Study Group of New England and to create an index for describing complication severity.

Systematic review and meta-analysis of acute type B thoracic aortic dissection, open, or endovascular repair

27 December 2018 - 11:00pm
The purpose of this study was to compare perioperative and mortality outcomes of endovascular aortic repair against open repair in acute type B thoracic aortic dissection.

Derivation and validation of thoracic sarcopenia assessment in patients undergoing thoracic endovascular aortic repair

27 December 2018 - 11:00pm
Sarcopenia, as assessed by computed tomography (CT)-based measurements of muscle mass, is an objective and patient-specific indicator of frailty, which is an important predictor of operative morbidity and mortality. Studies to date have primarily focused on psoas-defined sarcopenia, which may not be valid among patients with thoracic aortic disease. Using psoas sarcopenia as the reference for sarcopenia, the purpose of this study was to create and to validate a new thoracic-level method of measuring sarcopenia as a novel method to assess frailty among patients undergoing thoracic endovascular aortic repair.

Preoperative beta blockade is associated with increased rates of 30-day major adverse cardiac events in critical limb ischemia patients undergoing infrainguinal revascularization

27 December 2018 - 11:00pm
The association between beta blockers and cardiovascular or limb-related outcomes after revascularization for critical limb ischemia (CLI) remains unclear. The objective of this study was to assess the impact of preoperative beta blockade on 30-day major adverse cardiac events (MACEs) and major adverse limb events (MALEs) in patients undergoing infrainguinal revascularization for CLI. We hypothesized that rates of MALEs and MACEs will be higher in patients not receiving preoperative beta blockade.

Removal of infected arteriovenous grafts is morbid and many patients do not receive a new access within 1 year

23 December 2018 - 11:00pm
Infection of a prosthetic arteriovenous graft (AVG), in patients who have many comorbidities and limited access options, is a feared complication. Our objective was to investigate our contemporary series of infected AVG operations and analyze perioperative and long-term outcomes.

Aortoiliac remodeling and 5-year outcome of an ultralow-profile endograft

23 December 2018 - 11:00pm
Remodeling of the aortoiliac anatomy is a challenge to the long-term performance of stent grafts for endovacular aneurysm repair. Changes in vessel diameter and length can result in loss of seal at attachment sites, limb disunion, or kinking, with the development of high-pressure endoleaks, migration, or limb occlusion. The aim of this study was to assess the durability and conformability of the ultralow-profile INCRAFT AAA endograft (Cordis Corporation, Milpitas, Calif) during 5-year follow-up.

A novel swine model of abdominal aortic aneurysm

23 December 2018 - 11:00pm
Few large-animal models exist for the study of aortic aneurysms. β-Aminopropionitrile (BAPN) is a compound known to cause aortic aneurysms by inhibiting lysyl oxidase, a collagen cross-linking enzyme. It is hypothesized that BAPN plus aneurysm induction surgery would result in significant aneurysm formation in swine with biologic properties similar to human disease.

Pre-emptive nonselective perigraft aortic sac embolization with coils to prevent type II endoleak after endovascular aneurysm repair

23 December 2018 - 11:00pm
Pre-emptive selective embolization of inferior mesenteric artery (IMA), lumbar arteries (LAs), and perigraft sac for prevention of type II endoleak (T2EL) has not been widely adopted. We perform pre-emptive nonselective perigraft aortic sac embolization with coils (PNPASEC) in patients at high risk for development of T2EL (four or more patent LAs, patent IMA ≥3 mm, and ≥30-mm aortic flow lumen). The goal of this study was to see whether PNPASEC decreases T2ELs requiring reinterventions.

Scoping review of frailty in vascular surgery

23 December 2018 - 11:00pm
This review sought to describe the current state of knowledge of the impact of frailty on perioperative clinical outcomes in patients undergoing vascular interventions.

Outcomes and complications after fenestrated-branched endovascular aortic repair

23 December 2018 - 11:00pm
To report the outcomes of patients enrolled in a physician-sponsored investigational device exemption trial for endovascular treatment of complex thoracoabdominal aortic aneurysms with fenestrated and/or branched devices.

Recent advances in therapeutic targeting of inflammation in atherosclerosis

23 December 2018 - 11:00pm
Current prevention of peripheral vascular disease (PVD) focuses on blood pressure control, lipid lowering, and platelet inhibition with statins and aspirin. A critical role for inflammation in the pathophysiology of atherosclerosis has been established for decades and, although both statins and aspirin have anti-inflammatory properties, the management of inflammation is becoming increasingly recognized. Here, we summarize recent clinical and translational discoveries that outline how inflammation may become targeted in PVD in the future.

Midterm results of laser generated in situ fenestration of the left subclavian artery during thoracic endovascular aneurysm repair

23 December 2018 - 11:00pm
To analyze the midterm result of in situ fenestration (ISF) of the left subclavian artery (LSA) during thoracic endovascular aneurysm repair (TEVAR).

Performance of current claims-based approaches to identify aortic dissection hospitalizations

23 December 2018 - 11:00pm
To describe index visits for acute aortic dissection (AD) to an academic center and validate the prevailing claims-based methodology to identify and stratify them.

Inferior mesenteric artery replantation does not decrease the risk of ischemic colitis after open infrarenal abdominal aortic aneurysm repair

23 December 2018 - 11:00pm
Ischemic colitis after an open abdominal aortic aneurysm (AAA) repair remains a serious complication with a nationally reported rate of 1% to 6% in elective cases and up to 60% after an aneurysmal rupture. To prevent this serious complication, inferior mesenteric artery (IMA) replantation is performed at the discretion of the surgeon based on his or her intraoperative findings, despite the lack of clear evidence to support this practice. The purpose of this study was to determine whether replantation of the IMA reduces the risk of ischemic colitis and improves the overall outcome of AAA repair.

Management and therapeutic options for abdominal aortic aneurysm coexistent with horseshoe kidney

23 December 2018 - 11:00pm
Horseshoe kidney (HSK), referring to the abnormal fusion of the lower renal poles, represents one of the most common renal anomalies. One of its most significant features is the anomalous vasculature, with a number of accessory renal arteries originating from the aorta, the mesenteric arteries, and even the iliac arteries supplying both the renal kidneys and the renal isthmus.

Twenty years of experience in vascular reconstructions associated with resection of malignant neoplasms in a single cancer center

23 December 2018 - 11:00pm
Vascular invasion is no longer considered to be an absolute contraindication to tumor removal, and complex reconstructions are part of the daily activity of vascular surgeons in specialized cancer centers. Our aim was to report a single-center experience of complex vascular reconstructions involving en bloc resection of tumors and patients' long-term survival and graft patency outcomes. To the best of our knowledge, this is the largest report of vascular reconstructions published to date, with the longest follow-up.