|ANTHOLOGIES IN VASCULAR SURGERY-PART 4
|Year : 2020 | Volume
| Issue : 4 | Page : 447-451
Anthologies in vascular surgery-part 4
|Date of Web Publication||24-Dec-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies in vascular surgery-part 4. Indian J Vasc Endovasc Surg 2020;7:447-51
1. Carotid surgery.
Editor“s choice- Prognostic role of pre-operative symptom status in carotid endarterectomy:A systematic review and meta-analysis.
Stephen Ball et al; Dept of vascular and endo-vascular surgery, The Royal Oldham hospital, European journal of vasc and endo vasc surg(2020)59,516-524.
This study was conducted and reported in accordance with the Preferred Reporting Items For Systematic Review and Meta-Analysis(PRISMA),to identify studies reporting peri-operative outcomes of carotid endarterectomy(CEA)in symptomatic and asymptomatic patients.Thus 18 studies reporting a total of 91,895 patients, were included in the meta-analysis.The study found that Asymptomatic patients had a lower peri-operative risk of stroke and Death compared to symptomatic patients and concluded that patients undergoing CEA after a stroke have worse peri-operative outcomes of stroke and death and recommends further research to confirm the value of this finding in risk stratification systems.
2. Aortic surgery.
Editor“s choice: Validation of a pre-operative prediction model for mortality within one year after endo-vascular aortic aneurysm repair of intact aneurysms.
Dan Neal MS,Adam W.Beck et al. J vasc surg 2019;70:449-61.
The aim of the analysis was to create a pre-operative prediction model for 1 year mortality after EVAR for intact AAA in the society for vascular surgery(SVS),vascular quality initiative.All intact EVARs in SVSVQI from 2011-2015 were taken and retro-spectively analysed and a logistic regression model for 1 year mortality was created. It found that more than 25% of patients had a 10% to 22% 1 year mortality Post-EVAR, significant pre-operative predictors of I year mortality Included Chronic obstructive pulmonary disease,age, pre-operative renal insufficiency, ejection fraction <50%,transfer status, BMI<24Kg/m, pre-op Beta-blockers, Large AAA diameter and lower Hb%. Pre-op statin use was protective. This pre-op prediction model for 1 year mortality identifies patients less likely to benefit from EVAR.
3. Open repair versus endo-vascular treatment of complex aorto-iliac lesions in low risk patients.
Michele Antonella et al;Jvasc surg 2019:1-11.
This is a single center retro-spective study comparing open surgical repair(OSR)versus endo-vascular repair(ER)using self-expanding covered stents for complex Trans-Atlantic Inter-society Consensus II
(TASC) class C or D aorto-iliac lesions in low risk younger patients. The study found that patients who underwent ER had 1)Shorter hospitalization and ICU stay. 2)Similar 30 day complications compared with OSR and 3)At 5 years,primary patency(81.4% vs 87.3%),limb salvage and re-intervention rates were similar,however for female patients OSR had a higher patency rate and remains the standard of care.
4. Editor“s choice: Society for Vascular Surgery(SVS) and Society for Thoracic Surgeons(STS) reporting standards for Type B Aortic dissections.
Joseph V.Lombardi.MD(SVS co-chair),J vasc surg 2020:71:723-47.
An excellent article which provides structure to the reporting of type B aortic dissection(TBAD).The reporting committee was headed by two co-chairs,one each from SVS and STS,with each co-chair responsible for a group of six writers evenly balanced between the societies.The article contains seven sections which deal with classification,causes,management strategies etc,a must read article for all specialists involved in the management of TBAD.
5. A meta-analysis of trans-lumbar embolisation versus trans-arterial embolization for type II endo-leak after endo-vascular repair of Abdominal aortic aneurysm.
Qiang Guo MD et al, J vasc surg,march 2019;1-6.
This is a systemic review and meta-analysis comparing the clinical outcomes between trans-arterial and trans-lumbar(direct aneurysm sac puncture)approaches for persistent type II endo-leaks after Endo-vascular abdominal aortic aneurysm repair(EVAR).The primary outcome was clinical success(absence of endo-leak on last clinical examination),the secondary outcomes were technical success and complication rates. Amoung 904 studies,9 studies with 354 participants were included in this review.The study found that the trans-lumbar group had a relatively higher success rate compared to the trans-arterial group ,(however difference was not statistically significant)and also technical success rate was higher in the trans-lumbar group,no significant differences in complication rates were seen between the two groups.The authors also included 5 studies that reported clinical outcomes following open repair,which was done in 60 patients and 58 out of 60 patients had clinical success in the follow-up period.
The authors conclude that trans-lumbar route is more successful in obliterating type II endo-leak and when repeated endo-vascular interventions fail,a laporotomy, should be the ideal approach.
Peripheral arterial system.
6. Statin use improves limb salvage after intervention for peripheral arterial disease.
Gaurav M.Parmar MD et al,J vas surg 2019;70:539-46.
This is a retro-spective studyof the effect of statins on limb salvage and survival in patients with PAD after vascular interventions.
A single institution study with a total of 488 patients with PAD,(n=297),underwent surgical and endo-vascular procedures,(n=191) from 2009 to 2010. The study found that Anti-platlet theraphy was not associated with limb salvage but with improved survival;Dual anti-platlet theraphy did not show any benefit over mono-theraphy for limb salvage nor survival. An intresting study though not randomized,advocating the routine use of Statins post-intervention in all PAD patients.
7. Total IN.PACT drug-coated balloon initiative reporting pooled imaging and propensity matched cohorts.
Mehdi H.Shishenbor,Peter A.Schneider et al, J Vasc Surg 2019:70:1177-91.
This is an individual level pooled analysis of Duplex Ultrasonography(DUS) core laboratory adjudicated and clinical events committee adjudicated study of IN.PACT Admiral DCB subjects across two single-arm studies to assess the safety and effectiveness of DCB compared with PTA:and is the largest ,multi-ethnic,pooled DCB series to date. The study found that at 12 months,the IN.PACT Admiral drug coated balloon(DCB)compared to PTA,had significantly higher primary patency(88.8% vs53.9%),freedom from clinically driven target lesion re-vascularization,CD-TLR(94.3% vs 80.2%)and a better primary safety composite end-point(94.1% vs 78.0%). After propensity matched analysis, the IN.PACT Admiral DCB demonstrated superiority over PTA,for patients with femoro-popliteal disease.
8. A conservative approach to select patients,with ischeamic wounds is safe and effective in the setting of deferred re-vascularization.
Joshua A.Gabel M.D,et al. J Vasc surg 2020;71:1286-95.
This is a retro-spective analysis of patients who underwent delayed revascularization compared to early intervention in patients with Critical Limb threatening Ischeamia(CLTI).A total of 855 limbs were prospectively enrolled into the Prevention of Amputation in Veterans Everywhere programme(PAVE).A total of 203 limbs underwent immediate revascularization,and of the 236 limbs,where a conservative approach was followed,185(78.4%)healed and 33(14.0%)underwent deferred revascularization. On follow-up of 51.7+or – 37.0 months deferred compared with immediate re-vascularization demonstrated similar of rates of healing(66.7% vs 57.6%),freedom from major amputation(81.8% vs 74.9%) and survival(54.5% vs 50.7%).After adjustment for Wound,Ischeamia,Foot Infection classification,deferred revascularization yielded results similar to immediate revascularization in limbs with mild to moderate ischeamia and can avoid unnecessary interventional procedures.
COVID-19 Infection: Viral macro- and micro-vascular coagulopathy and thrombo-embolism/Prophylactic and Therapeutic management.
Antonis S.Manolis,MD et al, Journal of cardio-vascular pharmacology and therapeutics 1-13. 2020.
The coronavirus-2019(COVID-19) pandemic is a hugh challenge and its vascular manifestations is a difficult situation to deal with;there is a pro-inflammatory state with endo-thelial dysfunction,platlet activation,stasis contributing to a hyper –coagulable state,which sometimes is refractory to both conventional treatment and Thrombo-prophylaxis. This article reviews data from meta-analysis and states current guidelines in the management, including thrombo-prophylaxis of this virus-associated coagulopathy.
10. An analysis of the vascular injuries and attempted resuscitation surrounding the assassination of Martin Luther King Jr.
Martin Luther King Jr,the civil rights leader in the United States in the 1960“s was shot by an assassin in Memphis ,Tennesse on April 14,1968. He was taken to a local hospital,where he had an unsuccessfull resuscitation for a right subclavian artery transaction.This paper reviews the medical aspects of the assassination and the management of his vascular injury,which in those days was invariably fatal.
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