|ANTHOLOGIES OF VASCULAR SPECIALTY ARTICLES - 1
|Year : 2020 | Volume
| Issue : 1 | Page : 76-77
Anthologies of vascular specialty articles - 1
|Date of Web Publication||16-Mar-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies of vascular specialty articles - 1. Indian J Vasc Endovasc Surg 2020;7:76-7
1. Classics in vascular surgery:
Surgical treatment of aneurysms and occlusive disease of the Aorta; February1954 (vol.15, No 2. Issue of post graduate Medicine-Michael E DeBakey, Denton A Cooley, Oscar Creech Jr; Baylor college of medicine-Access for reading through Michael DeBakey selected papers.
A classic treatise on the management of Aortic diseases by the famed trio of Michael DeBakey and Denton Cooley from the Baylor college of Medicine, where they discuss the surgical management of 30 consecutive cases of Abdominal aortic aneurysms treated successfully by resecting the aneurysm and replacing them with freeze-dried aortic Homograft. Anastomosis done with 0000 Silk sutures! Total clamp time was around 78 minutes. The operation was well tolerated, except for 5 patients who died in the post-op period due to various causes. A remarkable achievement in those days, where not much progress was there in terms of Anaesthesia and post-operative care. A case history of one of the patients who was operated for aneurysm is presented, but patient also had bilateral lumbar sympathectomy after aneurysm resection!! They also have given account of 11 cases of Aorto-iliac occlusive diseases operated by them, by similar method and given account of a case who also underwent Billroth type 2 procedure for a bleeding peptic ulcer in the same setting, a strict no-no in these days.
This paper should be read by all those practicing vascular surgery and the post-graduates in particular for the sheer ingenuity and dexterity and perseverance of the founding fathers of vascular surgery. A true classic indeed.
2. Overuse of early peripheral vascular interventions for claudication.
Caitlin W. Hicks MD, MS; Courtenay M. Holscher.MD.
This paper analyses the practice patterns of more than 6000 physicians in the management of patients with claudication and found the mean early peripheral vascular intervention (PVI) rate (within 6 months of diagnosis) was 3.5%. 320 physicians however had an >14% intervention rate and with higher interventions in an ambulatory centre or office-based set up than in an hospital setting. The paper also outlines the fact that interventions done by cardiologists are also on the raise. The authors infer that SVS guidelines and Choosing wisely initiative will help to reduce such unnecessary early intervention for claudicants.
3. Factors predicting failure of retrieval of inferior vena-cava filters: Katherine L Morrow et al.; JVS-VL Jan 2020; https://doi.org/10.1016/j.jvsv.2019.07.010.
The use of IVC filters has shown a consistent downward trend and this paper, a retrospective study from Cleveland clinic, analyses the causes for failure to retrieve IVC filters in a series of 295 patients, the authors conclude that all IVC filters should be retrieved irrespective of the chronicity and complexity.
4. Spontaneous hemorrhage from varicose veins; JVS-VL; Jan 2020; Anil Hingroni et al., Vascular institute of New York. https://doi.org/10.1016/j.jvsv.2019.05.004
Bleeding from varicose veins is not an uncommon problem and this single centre study found that about 3.96% of patients suffer, from a total of 808 pts studied and found that about 50% of these patients bled in the shower after contact with hot water, an interesting proposition indeed and these pts had a faster healing rates than those without contact with hot water (1.75 vs3.5weeks). The authors advocate the use of Unna boots compression in addition to basic medical care for these patients and some of them underwent intervention procedures for their axial reflux as well.
5. A systematic review of venous stents for iliac and venacaval occlusive disease-Zachary F Williams et al.; JVS-VL; Jan.2020 https://doi.org/10.1016/j.jvsv.2019.8.015
Venous stenting for ileo-caval stenotic and occlusive lesions are on the raise even though there is no clear-cut evidence for the same. This paper analyses 20 articles related to venous stenting, though it is not a meta –analysis, various types of stents including dedicated venous stents were also included and are found to be safe and are as good as or better than previously used standard stents.
6. Editor's choice; Impact of endo-vascular pedal artery revascularization on wound healing in patients with critical limb ischemia - Hae Won jung et al.; Eur j vasc Endovasc Surg(2019)58,854e863; https://doi.org/10.1016/j.ejvs.2019.07.034
Comment: This paper investigated the impact of endovascular pedal artery revascularization (PAR) on clinical outcomes of patients with critical limb ischemia. PAR was attempted in 141 pts out of 239 pts with CLTI. The PAR group showed higher wound healing rates and higher freedom from amputation, than in the non-PAR group. The authors conclude that PAR significantly improves wound healing and should be attempted, especially when the pedal arch is absent.
7. Comparing 6 –minute walk versus treadmill walking distance as outcomes in randomized trials of peripheral artery disease; Mary M McDermott et al., SVS https://doi.org/10.1016/j.jvs.2019.05.058.
Comment: This article is a meta-analysis of four RCTs in four centers, it showed that among 195 patients with peripheral arterial disease(PAD) who were randomized to a control group (no therapy), 6 –min walking distance decreased by 10.2 m over a 6 month follow-up while maximal treadmill walking distance improved by 25.7 m and the authors concluded that treadmill walking does not detect the functional decline over time and limits the usefulness of treadmill testing as a meaningful outcome measure for PAD patients.
8. Diabetic foot: Primary care assessment and monitoring;the BMJ Visual summary; http://bit.ly/BMJdfoot
Comment: An excellent algorithm for the assessment and monitoring of the “Diabetic foot syndrome” an easy step by step method, so vital for any diabetic foot care professional.
9. Editor's choice: Management of Atherosclerotic Carotid and Vertebral artery disease: 2017 Clinical practice guidelines of the European society for vascular surgery(ESVS); Eur j Vas Endovasc. Surg (2018)55,3e81 A.R. Naylor, J.B. Ricco et al.; http://dx.doi.org/10.1016/j.ejvs.2017.06.021
Comment: The European Society for Vascular Surgery has prepared guidelines for treating patients with atherosclerotic carotid and vertebral disease and doesn't include non-atherosclerotic conditions like fibro muscular dysplasia, dissection, arteritis, trauma etc. It may benefit all Neurologists, Stroke specialists, Vascular surgeons, Cardiologists, Intervention radiologists etc; excellent article by A.R. Naylor et al.
10. Editor's choice: Overview of primary and secondary Analyses from 20 Randomized Controlled trials comparing carotid artery stenting with Carotid endarterectomy - Andrew J. Batchelder et al.; Eur J Vasc Endovasc Surg (2019)58,479-493. https://doi.org/10.1016/j.ejvs.2019.06.003.
Comment: This paper is a systematic review and meta-analysis of 20 Randomized controlled trials, providing an over-view of primary/secondary outcomes comparing carotid endarterectomy (CEA)with carotid artery stenting(CAS) in patients with symptomatic and asymptomatic carotid artery disease, including meta-analysis for peri-operative risks and late ipsilateral stroke. Secondary analysis include 1.risk factors for stroke after CEA/CAS 2. Long term survival after peri-operative stroke 3. Non-stroke complications 4. Significance of new white matter lesions 5. Asymptomatic 70%-99% stenosis does it increase the risk of ipsilateral stroke after CEA/CAS.
11. What is the role for Carotid Stenting Versus Endarterectomy: Kyla Bennett MD, John E Scarborough MD: Advances in surgery 53(2019)37-53.
Comment: Excellent review article from the University of Wisconsin-Madison school of medicine. The authors recommend (A) Carotid endarterectomy for patients with 70%-99% symptomatic carotid artery stenosis, preferentially within two weeks of symptoms onset and less strongly for 50% to 69% stenosis.(B) Carotid endarterectomy may be recommended for patients with asymptomatic 60% to 99% stenosis especially if they have some imaging characteristics placing them in a high stroke risk category.(C) Carotid stenting may be an acceptable alternative to CEA but should not be done in pts >70 years of age or in patients in whom revascularization is done in less than 14 days of symptom onset.
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