|ANTHOLOGIES IN VASCULAR SURGERY APRIL – JUNE 2020
|Year : 2020 | Volume
| Issue : 2 | Page : 178-180
Anthologies in vascular surgery-Part II.
|Date of Web Publication||17-Jun-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies in vascular surgery-Part II. Indian J Vasc Endovasc Surg 2020;7:178-80
| Anthologies in vascular surgery-Part II.|| |
1. The science and art of the vascular whisperers.
Glenn M. LaMuraglia, MD, Boston, Massachusetts.
The president of the New England society for vascular surgery, in his presidential speech quotes extensively from“The book of Courtier”written by Count Baldasare Castiglione, A fictional debate about the ideal qualities of a Courtier and the ideal lady, he interpolates it to the qualities of a “vascular sage” and how to achieve for individuals etc, a must read for any vascular surgeon.
2. Real-world cost analysis of endo-vascular repair versus open repair in patients with non-ruptured abdominal aortic aneurysms. Akshaykumar Gupta et al, Baltimore.
A real –world cost analysis of Endo-vascular aneurysm repair versus open repair(OAR) amoung patients with non-ruptured abdominal aortic aneurysms (non-rAAA), a multi-center study involving more than 38,000 patients, found that overall costs for EVAR was significantly lower than for OAR, probably due to longer hospital stay and also mortality was less compared to OAR. However, Very difficult to interpolate this results in our Indian scenario.
3. European Society for vascular surgery(ESVS)2020 clinical practice guidelines on the management of Acute limb ischeamia.
Martin Bjorck, et al, European Journal of Vascular and Endovascular surgery,
The European Society for Vascular Surgery(ESVS) has come out with guidelines for treating patients with acute limb ischeamia(ALI), with various grades of recommendations and levels of evidence, taken from various studies and trials dating back from the 90“s to the present era, well compiled by a group of authors from various countries including our own, Dr. Kumud Rai. We see various modalities of treatment, from surgery to catheter directed thrombolysis(CDT) and the latest pharmaco-mechanical thrombectomy to aspiration thrombectomy methods, an excellent article reserves a very good acclode for the authors to bring out such a comprehensive document.
4. Do current young surgeons have specific skills to perform safe Aortic open surgery?
Armado Mansilha, Julian Scott et al,
Dept of Angiology and vascular surgery, Faculty of medicine, University of Porta, Porto, Portugal.
The latest European Society for Vascular Surgery(ESVS) guidelines on the management of Abdominal Aorto-Iliac artery aneurysms(AAA) recommends, that centres treating patients with AAAs can offer both Open surgical repair(OSR)and Endovascular aneurysm repair(EVAR) and should have a minimum caseload of 30 cases per year. Data from vascular registries in 11 countries for years 2005-09 and 2010-13, showed, that the volume of OSR decreased from 12.9 %to 10.6% and for EVAR, increased from 10.0% to 17.1%. However, the worrying factor is the operative mortality following OSR worsened from 3.9 to 4.4 %., while for EVAR it decreased from 1.5%to 1.1%. The increased mortality following open repair is a concern and can be attributed to the decreasing numbers of OSRs per centre which may have resulted in reduced technical competence(Volume-Outcome relationship).
Therefore, the article recommends an urgent necessity for National boards to improve Open aortic surgical skills and thus improve patient safety and surgical outcomes. A thought provoking article in the current context.
5. Contrast Associated Acute kidney injury.
Roxana Mehran M.D, George.D. Dangas M.D, Ph.D, Steven D Weisbord M.D.
From the Zena and Michael A. Weiner cardiovascular institute, Zeahn school of medicine at Mt. Sinai, New York;and the Veterans Affairs Pittsburgh health care system and University of Pittsburgh, Pittsburg.
N Engl.j Med 2019;380:2146-55,
DOI:10.1056/NEJM ra 1805256.
An excellent review article which summarizes the patho-physiology of contrast associated acute kidney injury and the diagnostic criteria, risk stratification, current management regarding prevention and various trials related to this condition.
6. Higher inpatient mortality for women after intervention for lifestyle limiting claudication.
Samuel M. Miller, et al, New Haven, Connecticut, Newyork, Newyork and Providence, Rhode Island.
Ann Vascsurg 2019:58:54-62.
This article analyses the sex-related mortality rates for patients treated for Critical limb ischeamia(CLI) or life style disabling claudication(LLC) receiving Endo-vascular (EV) or Open surgical repair (OSR) from 2003-2012. The study found that women had higher inpatient mortality than men after vascular intervention for PAD and women are likelyto be older, undergo more EV procedures and higher mortality rate particularly while undergoing treatment for LLC than for CLI. And therefore recommends that treatment guidelines should include sex differences in their indication for intervention in patients with lifestyle limiting claudication.
7. Editor“s choice-European Society for Vascular Surgery(ESVS)2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections.
Nabil Chakfe et al,
Eur J Vasc Endovasc Surg (2020) 59,339-384.
The European Society for Vascular Surgery(ESVS) has developed certain guidelines for the management of patients with vascular graft/Endograft infection(VGEI) aimed at vascular surgeons, cardiovascular and general surgeons, infectious disease physicians and radiologists. It includes best management strategies for treatment of different segments like Supra-aortic trunks, thoracic aorta and abdominal aorta and peripheral arteries. The article includes a tribute to Late. Prof. Omke E. Teebken, who headed the vascular and endovascular division at Hanover medical school and was a member and author of the ESVS guidelines writing committee:who passed away on April 8th,2019. An excellent treatise for practicing vascular specialists.
8. Risk factors and outcomes for bowel ischeamia after Open and Endovascular abdominal aortic aneurysm repair. Merve Gurakar et al, Baltimore and California.
JVS, Sept 2019.
This is a retrospective study conducted for all patients who had undergone open aortic repair (OAR) or endovascular aortic repair (EVAR) from 2003 to 2017, a total of 45,474 patients were studied to identify the incidence of Bowel ischeamia(BI) And the independent risk factors for developing BI. They found that OAR was associated with more than three fold times of developing BI compared to EVAR(OAR 6.2% vs EVAR,0.8%;P<.001.). The paper also found that BI is more common after a ruptured aneurysm and OAR and other factors
Include Transperitoneal approach, supraceliac clamping more than 15 minutes and a reimplanted IMA. Thus a high index of suspicion for the signs and symptoms of BI should be maintained to prevent this dreaded complication.
9.CEAP Classification system and reporting standard revision 2020.
Fedor Lurie MD, Ph.D et al,
The CEAP(Clinical-Etiology-Anatomy-Pathophysiology)classification was developed by the American Venous Forum(AVF) in 1993 was updated in 1996 and revised again in 2004, is universally accepted for describing patients with chronic venous disorders. Since there was a need to periodically analyse and to revise this classification, the AVF created a CEAP taskforce in May 2007, to critically analyse and to recommend revisions where needed. This article describes all the revisions made and the rationale behind these changes and also leaves scope for future revisions.
10. Endo-vascular management of acute lower limb DVT:A systematic review and meta-analysis.
Mathew Thomas, et al.
Dept. of vascular surgery, Newcastle upon Tyne, Middlesbrough, UK.
Annals of vas.surgery, July 2019;58:363-370.
This study reviews the evidence available for Endovascular techniques, in the management of acute lower limb Deep vein Thrombosis(DVT) and their role in reducing the rate of reccurence and Post-Thrombotic syndrome(PTS).
Five studies were taken up for meta-analysis, All of which Compared Catheter-directed Thrombolysis(CDT), Pharmaco-Mechanical Thrombolysis(PMT)and or Venous stenting with Oral Anti-coagulation. Only one study, by Vedantham et al.(2017)ATTRACT trial was a randomized control trial, others are Non-randomized studies.
The study concludes that CDT decreases the incidence of PTS when treating the Ileo-femoral segment and also reduces the incidence of recurrent VTE when compared with other modalities. However, more RCT“s are required to determine the role of Endo-vascular techniques for DVT below the inguinal ligament and regarding venous stenting.
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