|ANTHOLOGIES IN VASCULAR SURGERY
|Year : 2021 | Volume
| Issue : 2 | Page : 192-193
Anthologies in vascular surgery-Part 5
|Date of Web Publication||13-Apr-2021|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies in vascular surgery-Part 5. Indian J Vasc Endovasc Surg 2021;8:192-3
| Anthologies in Vascular Surgery - Part 5|| |
1. European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis
Stavros K. Kakkos et al., Eur J Vasc Endovasc Surg 2020.
These exhaustive guidelines were framed by an expert committee with a few notable names such as Andrew Nicoloides, Peter Gloviczki to name a few. It was dedicated to the memory of Dr. Clive Kearon of McMaster University in Hamilton, Ontario, Canada, who extensively reviewed the first and second versions of the manuscript and in spite of him being unwell, choose to review thefinal version and passed away shortly. Such dedication and determination, no wonder these guidelines are dedicated to his memory.
Excellent but exhaustive, at times debatable, there are 72 recommendations in this article including information to lay persons and patients. Many questions at the end yet to be answered, with scope for further research and of course high time for our own society guidelines!
2. Safety and efficacy of an endovascular first–approach to acute limb ischemia
Olia Poursina, MD, Jayer Chung, MD, Msc, Michael E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
This is a single-center, single-arm, retrospective cohort study of 60 consecutive patients with acute limb ischemia treated with endovascular first strategy using catheter-directed thrombolysis (CDT), rheolytic thrombectomy, and/or aspirational thrombectomy for various classes of ischemia, resulting in a high technical success rate (97%) with no major bleeding complications and very few fasciotomies, a shorter hospital stay, with comparable limb salvage, and low mortality rates compared to open surgery, with only age being the only independent predictor for death and major amputation. This study does not have an open arm and consists of a smaller cohort only but recommends endovascular first approach as a reasonable alternative to traditional open methods.
3. Editorial; The do's and don'ts of open and endovascular thoracoabdominal aortic aneurysm repair
Jonathan C. Hong et al., Division of Cardiothoracic Surgery, Micheal E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
One other article from the “Mecca” of cardiovascular surgery, an interesting review article on the do's and don'ts of thoracic aneurysm repair dealing with both, open repair and TEVAR including selection criteria for both.
4. Large-bore aspiration thrombectomy versus catheter-directed thrombolysis for acute pulmonary embolism: A propensity score-matched comparison
Assaf Graif, MD et al., J Vasc Interv Radiology 2020.
This is a retrospective study of patients with acute massive and submassive pulmonary embolism (PE) treated with large-bore aspiration thrombectomy (LBAT) or catheter-directed thrombolysis (CDT). A propensity score based on PE Severity Index class and PE severity was calculated. The 20 F Triever20 (Inari Medical) aspiration catheter was used in the LBAT group while CDT was done using 5F AP2 infusion angled pigtail catheters (Cook Medical) and ultrasound accelerated catheters with EkoSonic Endovascular System catheters (Boston Scientific). The study concluded that both LBAT and CDT resulted in similar reductions of pulmonary artery pressure and heart rate with CDT causing significant reduction of thrombus load. The bleeding complications were not significantly different, but LBAT group had a higher procedure-related mortality. The study has few limitations such as having a small sample size and nonrandomization with selection bias. More larger sample size needed to get a clear picture.
5. The GermanVasc Score: A pragmatic risk score predicts five year amputation free survival in patients with peripheral arterial occlusive disease
Thea Kreutzburg et al., Department of Vascular Medicine Research Group, GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Eur J Vasc Endovasc Surg 2021;61:248-56.
This is a machine-based prediction scoring which looks at 10 variables including age and sex from retrospective claims data in patients with peripheral arterial occlusive disease which predicts 5-year amputation-free survival in patients with intermittent claudication (IC) and in patients with chronic limb-threatening ischemia (CLTI) with very good accuracy. The risk of amputation or death varied between 9% and 48% in the IC group and between 25% and 88% in patients with CLTI. The GermanVasc score can help in decision-making on invasive revascularizations and in separating high from low-risk patients and may support patient-centered consent.
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