|Year : 2020 | Volume
| Issue : 3 | Page : 313-316
1. Anthologies in vascular surgery - Part 3
|Date of Web Publication||12-Sep-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. 1. Anthologies in vascular surgery - Part 3. Indian J Vasc Endovasc Surg 2020;7:313-6
This section consists of two part, which are not peer reviewed and aim is to offer a comprehensive collation of recently published vascular article for vascular post graduate students and the other part is a pictorial library/CME intended for both vascular specialists and others
| 1. Anthologies in Vascular Surgery/specialty|| |
A new section is added to IJVES, from the issue of January – March 2020, which essentially collates some important articles on vascular diseases published in various journals. Most are copyright protected and hence can be accessed only by the members of various societies and/or purchased by the reader. Also publishing abstracts of open on-line journals would consume large space in IJVES. Hence the articles and their citation/access are provided in these pages and the readers, especially the vascular trainees, are encouraged to access these articles and peruse them in detail. This section will cover some of the important articles published mostly within the previous six months and some can be from further back as deemed appropriate by the Editorial Board and the compiler of this section, but there are several other excellent articles in these journals. Some of the basic review articles are included, which might be more useful for general surgical trainee Some of the “old classic” articles might find their way into this section – Editors
Present Compiler & Reviewer: Dr. Illayakumar, Chennai
| 2. Vascular Images & Techniques|| |
A new section has been added to IJVES since 2019 October – December issue, which essentially depicts the procedures performed by Vascular Surgeons across the country. This would serve as a pictorial library of multitude of vascular pathologies, simple to complex, common to rare and their therapies. We hope this would create awareness among non-vascular specialists about vascular diseases and the treatment modalities offered by vascular surgeons. This would replace the previous lengthy, text-based CME articles and would be an easier read. It would serve as quick reference to numerous vascular diseases seen by practicing doctors in various specialties across India. These reports are non-peer reviewed, non-referenced articles. Neither IJVES nor publishers hold copy right to these articles - Editors
| 1.Anthologies in Vascular Surgery - Part 3|| |
| Carotids|| |
1. Editorial-The jury is still out on optimal management of restenosis after carotid interventions.
Kosmos.I. Paraskevas and Peter Glovoiczki et al, Bristol, United Kingdom and Rochester, Minn. J vascsurg 2019;70.339-41.
This editorial analyses the need for surveillance and optimal management of recurrent stenosis after carotid endarterectomy(CEA) and carotid artery stenting(CAS). The paper looks into the Society of Vascular Surgery(SVS) practice guidelines after carotid surgery and the 2017 European Society for Vascular Surgery(ESVS)carotid guidelines along with the EJVS, article by Naylor ER, May 2018. The article at the end favours the SVS guidelines and recommendations for follow up in high risk patients for recurrent stenosis particularly young patients, female patients, diabetes, hyperlipidaemia, smokers, high grade re-stenosis and echo-lucent plaques; these patients should be followed up with Doppler ultrasound at regular intervals.
| Aortic Surgery|| |
2. The state of complex endovascular abdominal aortic aneurysm repairs in the vascular quality initiative.
Thomas F.X.O“Donnell et al Boston, Mass, Newyork, NY, J vasc surg 2019;70;369-80.
This is a retrospective study of all endovascular repairs of complex Abdominal aortic aneurysms(zone 6 or caudal)done from 2014 to 2018 listed in the Vascular Quality Initiative(VQI) around 1396 complex endovascular procedures and included all commercially available Fenestrated Endovascular Aneurysm Repair(FEVAR), Chimney/Snorkel repairs and physician-modified Endografts(PMEGS). Outcomes studied included death, acute kidney injury(AKI) and major adverse cardiac events(MACE), the composite of death, stroke, myocardial infarction and long term mortality were compared between the groups. The study found that the chimney/snorkel procedure group was associated with higher odds of stroke, myocardial infarction and MACE. The overall survival after elective repair was 91% at 1 yr and 88% at 3 yrs, with no significant differences in the different types of repairs and recommends further studies particularly regarding Chimney/ snorkel procedures.
3. Variation in the elective management of small abdominal aortic aneurysms and physician practice patterns.
Frank M Davies, MD et al. Ann Arbor. J Vasc Surg 2019:1-10.
This is a retrospective review of a state-wide vascular surgery registry of all elective endovascular or open surgical abdominal aortic aneurysm(AAA) repairs done from January 2012 to January2016, to analyse variation in management of AAAs based on diameter and to determine the physician's rationale for intervention on small AAAs in relation to recommended treatment guidelines. The study found that of the 3932 elective AAA repairs,485(12.3%)were performed with aneurysm size below SVS guideline thresholds (men <5.5cm, women<5.0cm, growth<1cm/yr).
The rationales for intervention being 1)Patient anxiety2)Aorto-iliac occlusive disease 3)Aneurysm anatomy ie involving iliac segments 4)Saccular configuration and plainly disregarding guidelines in 30% of cases. It recommends a continuous feedback and monitoring of AAA repair criteria to provide quality care. The study like the previous PIVOTAL and CAESAR study, found no survival benefit with repair of small AAAs.
4. Hybrid surgery for bilateral lower extremity inflow revascularization.
Saman Doroodgar Jorshery et al j.vasc surg2019:70;768-75.
This is a retrospective analysis of data of 1426 patients from the American college of surgeons National surgical quality program files from 2012 to 2015;all patients undergoing Aorto-bifemoral bypass(ABF), Axillo-Bifemoral Bypass(AXBF) and Hybrid surgery(HYB) in the form of Femoro-Femoral Bypass and retro-grade endo-vascular Aorto-iliac interventions were included. Patient demographics, co-morbidities and outcomes were compared between the three groups. A propensity matched analysis was performed to compare ABF bypass with Hybrid surgery only. The study found that hybrid surgery(HYB) for Bilateral lower extremity inflow revascularization had significantly reduced morbidity(32.6% vs 55%)and mortality(1% vs 4.2%)with shorter hospital stay(5.8% vs 9.8%)compared with Aorto-bifemoral patients. However, there was no significant difference in major Amputation and re-admission rates between the 2 groups.
| Peripheral Arterial System|| |
5. Editor“s choice- Using the society for vascular surgery Wound, Ischemia and Foot Infection classification to identify patients most likely to benefit from revascularization.
Jessica Mayor, Jayer Chung, Houston, Texas: Worcester, Mass: j.vasc surg2019:70:776-85.
This is a multi-institutional retrospective cohort study of data from 10 centres collected between 2002 to 2015, which validated the Society of Vascular surgery Wound ischemia Foot Infection(WIFI) for Chronic Limb Threatening ischemia (CLTI). A subset of patients who underwent Revascularization(1654 limbs)169 major lower extremity Amputation (LEA) were analysed. Each patient's WIFI component grades and whether LEA was performed was noted. This study concluded that the WIFI score can identify which subset of patients will benefit most and which set of patients will benefit least from revascularization. From Cluster analysis, it found that wound severity is the single most predictive component to predict major amputation. This is an excellent study with very few limitations, future cluster analysis comparing specific WIFI presentations treated with and without revascularization will be required to further refine WIFI.
6. Spot stenting versus Full coverage stenting after endo-vascular therapy for Femoro-popliteal artery lesions.
Yasuke Tomoi et al, Kita Kyushu, Japan. J vasc surg 2019:1-11.
A multi-centre, retrospective study of 1554 patients who underwent Femoro-popliteal(FP) endo-vascular therapy for symptomatic peripheral artery disease from January 2010 to December 2016;to find out whether Spot stenting(SS) or Full coverage stenting(FCS) is superior in terms of primary patency and primary assisted Patency.
The study found that both primary and primary assisted patency at 3 years were significantly lower with Spot stenting(SS) compared to FCS of the Superficial femoral artery(SFA)and proximal popliteal artery. And in the Chronic total occlusions, lesions of proximal SFA and lesion length >_138mm were associated with noninferiority of SS compared with FCS. SS strategy might be suited for more complex Femoro-popliteal lesions.
7. Rivaroxaban in peripheral artery disease after revascularization.
Marc P Bonaca et al University of Colorado. Published on March 28,2020, at NEJM.org.
https://DOI:10.1056/NEJM oa 200052.
The Vascular Outcomes Study of ASA(acetyl salicylic acid) Along with Rivaroxaban in Endovascular Or Surgical Limb Revascularization for PAD(Peripheral arterial disease), VOYAGER PAD is a double-blind RCT designed to test the hypothesis that riveroxaban at 2.5mg twice daily added to aspirin as compared with aspirin alone would reduce the risk of a composite of acute limb ischemia, major amputation for vascular causes, myocardial infarction, stroke or death from cardiac causes in patients with symptomatic peripheral artery disease who had undergone lower extremity revascularization. The trial is very similar to The Cardiovascular Outcomes For people using Anti-coagulation strategies(COMPASS)trial. A total of 6772 patients were enrolled,6564 underwent randomization. 33.2%(1080)pts discontinued riveroxaban while 1011(31.1%) placebo early.
The study concluded that addition of rivaroxaban at a dose of 2.5mg twice daily with aspirin in patients who underwent lower extremity revascularization, had reduced incidence of composite outcomes of Acute limb ischemia, amputation for vascular causes, Myocardial infarction, ischemic stroke or cardiovascular death when compared to placebo. The incidence of principle safety outcome of TIMI (Thrombolysis in Myocardial Infarction) classification was not significantly higher than in the placebo group, however riveroxaban was associated with significantly higher incidence of secondary safety outcome of ISTH(International Society on Thrombosis and Haemostasis)major bleeding. This is an excellent trial with few limitations.
8. Editor“s choice-Survival after major lower extremity amputation in patients with end-stage renal disease.
Isibor Arhuidese et al, Tampa, California.
This is a retrospective study, evaluating the survival of patients with end-stage renal disease(ESRD) after major lower extremity amputation(MLEA). All haemodialysis (HD)patients and renal transplant(RT) recipients who underwent MLEA between January 2007 and December 2011 in the United States Renal Data System(USRDS) was analysed. There were 32,450 MLEAs(HD,92%, RT8%). Among HD patients, median survival was 6 months for Above knee Amputation(AKA) and 16 months for Below knee amputation(BKA). The mortality rate was higher for AKA compared with BKA, Females than Males but lower for blacks and Hispanics compared with white HD patients. Among RT recipients, the median survival was 16 months for AKA and 47 months for BKA, mortality rates were higher for AKA than BKA with no difference in mortality between gender and races in RT patients. In comparison, in a study of 13,807 patients by Sandnes et al from general population with normal renal function, reported a median survival of 2.5 years and 6.0 years for AKA and BKA respectively. Thus ESRD patients fare very poorly particularly HD patients, after AKA and BKA, probably due to significant disease burden in other vascular domains that limit their overall survival.
| Av Access|| |
9.A systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischeamia.
Ali Kordzadeh et al Essex, UK.
J Vasc Surg 2019:1-10.
Distal and interval ligation(DRIL), first described by Schanzer et al in 1988, is used in the management of Dialysis Access Steal Syndrome(DASS) and is practiced for a long time, however this is the first retrospective study, which analyses twenty-two studies(n:459) individuals. The study found that the time to ischemia was 196 days(range of 30-600days)with ischemia grade ¾(52%)being the most common presentation. The overall success rate was 81% during a mean follow up of 22.2 months. The conduit of choice was GSV(65%) and Bypass thrombosis was highest in the Polytetraflouroethlene (PTFE) group(43%). The same author did a systematic review of, revision using Distal Inflow(RUDI) procedures, their review documented 11 studies with 130 patients with 82% success at 12 months. The study concludes that DRIL procedure for DASS has reasonable success rates, and to avoid using PTFE grafts and minimize DASS by use of distal site fistulas if possible.
| Phlebology-Review Article|| |
10. Risks and contra-indications of Medical Compression treatment-A critical reappraisal. An international consensus statement.
Eberhard Rabe, Hugo Partsch, et al Phlebology 0(0)1-14.
This is a systematic literature search of medical compression therapy publications reporting adverse events up until November 2017, performed by a consensus panel comprising 15 international experts from various disciplines including angiology, cardiology, dermatology and vascular surgery, headed by primary author Eberhard Rabe, they critically reviewed the publications and formulated various recommendations. Thus sixty-two publications were reviewed and the panel issued 21 recommendations on medical compression therapy contra-indications, adverse events management and borderline indications. The most frequently reported non-severe adverse events included skin irritation, discomfort and pain. Rare but severe adverse events included soft tissue injury, ischemia and nerve injury. This is an excellent review article with guidelines and appropriate recommendations for Medical compression Therapy.
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