European Journal of Vascular and Endovascular Surgery

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Screening for Cardiovascular Disease. Too Early and Too Late?

17 January 2019 - 11:45pm
The Viborg Vascular (VIVA) randomised controlled trial described a population screening program for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and hypertension, and provided subsequent lifestyle advice and recommendations for medical and interventional treatment in men aged 65–74 years.1 Some 50,156 men participated in VIVA, and a significant reduction in all cause mortality was found from 10.8% in the control group to 10.2% in the intervention group after a mean follow up of 4.4 years.

Can we learn anything from the dinosaurs?

17 January 2019 - 11:45pm
In this edition of European Journal of Vascular and Endovascular Surgery, Jungi et al. report results of strictly open surgical treatment of patients with thrombosed popliteal artery aneurysm (PAA): 55 patients during 10 years, most of them with severe ischaemia, with 16% undergoing amputation at ≤30 days.1 The Bern group are sceptical of endovascular surgery, and have published excellent results of ruptured abdominal aortic aneurysm (AAA) repair performed by open surgery alone.2 They use a similar approach for the treatment of thrombosed PAA.

Distal Landing in TEVAR: Challenges in Reaching “The Dead Centre”

17 January 2019 - 11:45pm
“Accuracy landing” is one of the oldest skydiving disciplines in which jumpers must land as closely as possible to a defined target on the ground. This target is called “dead centre”. The diameter of this dead centre used to be 10 cm, but it has been reduced to just 2 cm since 2007. As skydivers usually land on their feet, most try to hit the dead centre with the heel of one shoe. The world record in accuracy landing was broken in 2014 with 10 consecutive landings on the 2 cm target.

Commentary on “An Experimental Study of Paclitaxel Embolisation During Drug Coated Balloon Angioplasty”: Are All DCBs Created Equal?

6 January 2019 - 11:00pm
The paper by Boitet et al.1 is timely, given the problems with below knee (BTK) drug coated balloons (DCBs), and concerns over increased amputations in those patients treated with the Amphirion DCB (Medtronic Inc. Minneapolis, MN, USA) leading to device recall and stoppage of the IN.PACT DEEP trial,2 though causal links could not be established. This study indicates the In.Pact balloon has the highest amounts of paclitaxel (PTX), but what that amounts to in this context remains unknown. Studies suggest that DCBs are superior to drug eluting stents (DESs) in terms of the primary objective, i.e.

Re: “Conservative Therapy vs. Extensive Stenting in Superior Mesenteric Artery Dissection: the Right Balance has to Be Found”

3 January 2019 - 11:00pm
I thank Ben Abdallah and colleagues for their letter. I would certainly agree that most patients with isolated mesenteric artery dissection resolve completely with conservative management. Most of the patients were treated before 2014 in our three institutions. In recent years, especially since 2015, endovascular stent placement has declined. Although bare stents do not aim to exclude an aneurysm, endovascular stenting is a favourable factor for mesenteric artery remodelling in our further study.

Carotid Body Tumours: Benign but Challenging

2 January 2019 - 11:00pm
In a landmark publication back in 1971, Shamblin et al. reported that carotid body tumour (CBT) resection is associated with a high mortality rate, which is “usually related to carotid arterial damage or ligation”.1 Based on this observation, they developed the renowned classification scheme that we all use nowadays. They also suggested that Shamblin 3 tumours should not be resected because the nature of the CBT rarely warrants the mortality associated with the inevitable, at that time, interruption of the internal carotid circulation and subsequent re-establishment through Dacron or autogenous vein grafts.

Conservative Therapy vs. Extensive Stenting in Superior Mesenteric Artery Dissection: the Right Balance remains to Be Found

1 January 2019 - 11:00pm
In their paper, Jia et al.1 reported an impressive experience of bare stents with or without assisted coiling for isolated mesenteric artery dissection (IMAD) aneurysms. Interestingly, this paper questions the benefit of a more interventionist attitude in IMAD, as 35% of IMAD patients were treated by stenting for aneurysm, which contrasts with the current trend favouring conservative therapy.2 This rate is much higher than that reported by Wang et al.3 in a recent meta-analysis gathering 904 symptomatic IMAD, where only 3% (29/904) of patients underwent an intervention for aneurysmal degeneration.

Lower Extremity Amputation: Analysis by Postcode

27 December 2018 - 11:00pm
The Scottish Index of Multiple Deprivation (SIMD) is a postcode based system in which addresses are ranked in one of five nationally calculated quintiles, with SIMD1 being the most deprived area by this estimate. Davie-Smith et al.1 investigated the relationship between patient SIMD grouping and mobility, social participation, and quality of life following lower extremity amputation. It is perhaps not surprising that the authors found it impossible to draw any conclusions: only 67 questionnaires were completed at six months, decreasing to 50 at 12 months.

Together We are Stronger

23 December 2018 - 11:00pm
In their study, Chang et al. evaluated the outcome of multidisciplinary care after infrapopliteal endovascular revascularisation and free flap reconstruction in diabetic patients.1 They concluded that combined endovascular revascularisation of the below knee vessels and free tissue transfer could be considered a viable option for such diabetic patients.

Commentary on “Quality of Life Impact in Men With Screen Detected Abdominal Aortic Aneurysm Attending Regular Follow Ups: A Narrative Literature Review”

20 December 2018 - 11:00pm
All screening programmes have the potential to affect quality of life (QoL) adversely. Whereas this is overt if a man dies after elective intervention for a large screen detected AAA, the effect of being in surveillance for many years is less well described. Anecdotally, people in any surveillance programme will tell you that most of the time, they don't think about their condition, but they dread each surveillance scan, and the potential news it might bring.

Pre-Operative Masseter Area is an Independent Predictor of Long-Term Survival after Carotid Endarterectomy

20 December 2018 - 11:00pm
Sarcopenia is a predictor of mortality in elderly patients. Masseter area (MA) reflects sarcopenia in trauma patients. It was hypothesised that MA and Masseter density (MD) could be evaluated reliably from pre-operative computed tomography angiography (CTA) scans and that they predict post-operative survival in carotid endarterectomy (CEA) patients.

Progressive Guidance on the Modern Management of Abdominal Aorto-iliac Artery Aneurysms

13 December 2018 - 11:00pm
The European Society for Vascular Surgery (ESVS) guidelines on the management of abdominal aorto-iliac artery aneurysms, published in this issue of EJVES, are essential reading for the vascular practitioner.1 Comprehensive recommendations that demonstrate a balanced insight into the rapid pace of technological innovation are outlined based on contemporary evidence. The writing committee comprised 16 European experts in the management of aortic diseases, most of whom run a cutting edge clinical aortic practice at their home institutions.

Is Bigger Actually Better? The Strengths and Limitations of Large Registry Data

13 December 2018 - 11:00pm
As publications using data from huge registries become more popular, so does the belief that the strength of recommendation that can be made from the results is greater than from smaller cohorts. This very large dataset from Hamburg examines gender differences in peripheral endovascular revascularisation for peripheral arterial disease.1 Such a large dataset is undoubtedly important, but potential sources of error and a low number of events for some significant results means that this study has good examples of the limits inherent to larger retrospective cohorts.

Is In Hospital Mortality Following EVAR Still a Valid Outcome Measure?

12 December 2018 - 11:00pm
This registry based study from Australia investigated the impact of hospital and surgeon volume on the outcome of abdominal aortic aneurysm repair over a seven year period.1 In keeping with contemporary data the authors were unable to identify any volume effect for endovascular aneurysm repair (EVAR),2 and somewhat more surprisingly no volume effect for open repair at surgeon or hospital level. The EVAR group included both complex EVAR cases and thoracic endovascular aneurysm repairs (TEVARs), both of which had expected higher mortalities, of 2.6% and 5.6%, respectively.

Commentary Regarding “Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms”

10 December 2018 - 11:00pm
In this issue of the European Journal of Vascular and Endovascular Surgery, Gombert et al.1 compare open one stage with two stage repair of type II thoraco-abdominal aortic aneurysm (TAAA). The authors conclude that open two stage repair, if anatomically feasible, demonstrates a lower mortality than and similar complication rates to one stage repair. These findings do not come as a surprise and reflect a current trend in TAAA repair strategy: towards endovascular and hybrid repair and towards two stage repair in order to reduce both mortality and morbidity.

How Can We Ensure Vascular Surgical Trainees Become Competent in Open Aortic Surgery in the Future Training Environment?

10 December 2018 - 11:00pm
The use of endovascular aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms (AAAs) is now widespread, with the minimally invasive approach, rapid recovery, and better early survival proving attractive to clinicians and patients. Approximately 60% of all AAA repairs in Europe and 85% in the USA are now by EVAR.1,2

Beyond the AAA Guidelines: Core Outcome Sets to Make Life Better for Patients

9 December 2018 - 11:00pm
The new European Society for Vascular Surgery (ESVS) Clinical Practice guidelines on the management of abdominal aortic aneurysms (AAA) were produced by clinicians for clinicians, but for the first time in the history of ESVS guideline production, the AAA guideline development process included input from patients affected by the recommendations.1 Even from the small patient contribution to these guidelines, and similar patient input to recent AAA repair trials, it is clear that the important outcomes for patients and their relatives may be very different from those usually considered important by vascular surgeons.

A Practical Guide for Application of Network Meta-Analysis in Evidence Synthesis

4 December 2018 - 11:00pm
Meta-analysis is the statistical approach of synthesizing quantitatively the results of multiple studies addressing the same research hypothesis. A common limitation of conventional meta-analysis is the comparison of no more than two interventions at a time. Typically, the researcher is faced with a plethora of competing interventions and is interested in finding which of them are the most safe and effective. Network meta-analysis (NMA) addresses this problem by allowing multiple comparisons among interventions forming a connected network of evidence.