|ANTHOLOGIES IN VASCULAR SURGERY
|Year : 2021 | Volume
| Issue : 3 | Page : 301-302
Anthologies in Vascular Surgery - Part 6
|Date of Web Publication||6-Jul-2021|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies in Vascular Surgery - Part 6. Indian J Vasc Endovasc Surg 2021;8:301-2
1. Comparison of open-closed cell stent design outcomes after carotid artery stenting in the Vascular Quality initiative.
Muhammad Faateh MD, et al.. Division of Vascular surgery, Department of Surgery, John Hopkins University School of Medicine, Baltimore. JVS May2021.P(1639-1648)
This a multicenter retrospective analysis of the Vacular Quality Initiative database, comparing 1384 carotid artery stenting (CAS) procedures performed using closed-cell stents and 1287 CAS procedures using open-cell stents between November 2016 to october 2018 which showed no significant differences in in-hospital mortality (1.8% vs1.4%;P=.40),stroke (1.8% Vs 2.4%;P=.28) and stroke/death(3.3% vs3.5%;P=.81) no difference was noted in the incidence of in-hospital stroke/death between the two stent designs. However, when stratified according to the location of the lesion, the closed cell stents were associated with five times the odds of in-hospital stroke/death when used across the carotid bifurcation(OR,5.5;95%CI 1.3-22.2;P=.020).When used in the ICA only, no difference was noted between the two groups. This may be attributed to the lower conformablity of closed-cell stents in the tortous bifurcation compared to the linear ICA anatomy. Though current practice consensus suggests that both stent types can be used however, some pathologies may require specific design to be used, open-cell stents will confirm better to different diameters. The study has some limitations in that it is a retro-spective study with some confounding residual bias and no idea why a specific stent was chosen for each case and lastly newer stent technologies like covered stents, hybrid stents, stents with Trans-carotid revascularization techniques were not studied and may need further evaluation.
2. Endovascular interventions for claudication do not meet minimum standards for the society for Vascular Surgery efficacy guidelines.
Jonathan Bath MD et al..Division of Vascular surgery and Department of Family medicine, University of Missouri, Columbia. JVS May 2021.P 1693-1700.
The study objective was to examine the outcomes of endo-vascular management of Intermittent Claudication (IC) reported in the Vascular Quality Initiative (VQI) and compare them with the Society for Vascular Surgery(SVS) guidelines for IC treatment and to determine whether real world results are within these guidelines. This is essentially a retrospective analysis of prospectively collected data. Amoung the study population, a total of 16,152 patients met the inclusion criteria,pts undergoing Peripheral vascular intervention for IC from 2004 to 2017 with complete data and >9 month followup were included, the primary outcome measured were IC recurrence and repeat procedures performed <2 years after initial treatment. The study found that a large proportion of patients were poorly optimized before the invasive procedure and symptom recurrence was found in 78% of patients at 2 years and more likely with treatment of more than two arteries (Odds Ratio,1.19 )and atherectomy procedures (OR.1.29)and the use of anti-platlet medications and statins was associated with a decreased odds of recurrent symptoms(OR,0.85) and repeat procedures (OR,0.77). The study concluded that majority of the patients undergoing endovascular approach to IC did not meet the SVS guidelines for longterm freedom from recurrent symptoms of >50% at 2 years and that many lacked preprocedure optimization with medical management and procedures involving multiple vessels and atherectomy devices have poor long term outcomes. A case for more conservative approach and life style modifications and medical therapy.
3. Society for vascular Surgery implementation of clinical practice guidelines for patients with an abdominal aortic aneurysm:Repair of an abdominal aortic aneurysm.
Rae S.Rokosh.MD,et al..dept of Vascular and Endo-vascular Surgery, Beth Israel Deaconess Medical Center, Boston.
https://doi.org/10.1016/j.jvs.2020.12.103. JVS, May 2021,P 1485-1487.
This article discusses the background which includes optimal timing of aneurysm repair, EVAR vs Open repair, the surgical approach, practice based Implementation strategy, commentary and future directions and also includes an algorithm for the management of suspected ruptured Abdominal aortic aneurysm. Though the recommendations are heavily biased towards EVAR, the guidelines discusses the short term, mid-term and long term benefits of both the approaches, an interesting article indeed.
4. Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery.
Brenig L Gwilym, George Dovell et al, South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK.
Eur J Vasc Endovasc Surg(2021)61,636-646.
Groin incision surgical site infections (SSI) are common following arterial surgery causing considerable morbidity and length of stay in hospitals. This article reviews various interventions and adjuncts used before, during and after skin closure, to prevent SSIs in patients undergoing arterial interventions involving groin incisions. The search identified 1,532 articles ,seventeen RCTs and seven observational studies reporting on 3,747 patients with 4,130 groin incisions.The study found that Prophylactic closed incision negative pressure wound theraphy (ciNPWT)reduced groin SSIs compared with standard dressings. Local antibiotics did not reduce groin SSIs. Subcuticular sutures reduced SSIs in comparison to transdermal sutures or clips. Wound drains, Platlet rich plasma, fibrin glue and silver alginate dressings did not show any significant effects on SSI rates. The study however has few limitations in that it spans surgical practices spaning over 40 years with significant changes in surgical techniques, microbial characteristics, patient factors, operative techniques and theatre environment etc. And also regarding the type of incisions used (Longitudinal Vs oblique) and indications for surgery where some heterogenesity has been recorded. However the study highlights the need for high quality, multicenter prospective RCTs to evaluate the clinical and cost effectiveness of wound adjuncts in preventing SSIs in vascular groin wounds.
5. COVID-19 Infection in critically ill patients carries a high risk of venous Thrombo-embolism.
Sergi Bellmunt- Montoya et al..Angiology and vascular surgery Department, Hospital Universitari Vall d“Hebron, Barcelona, Spain.
Eur J vasc Endovasc Surg(2021)61,628-634.
The COVID-19 infection due to SARS-CoV-2 has been found to have an increased risk of venous thrombo-embolism(VTE).The objective of the study was to determine the frequency of VTE in critically ill patients due to COVID-19, its correlation with D-Dimer levels and pharmacological prophylaxis.
All patients admitted to the ICU on the same day of April 2020 were selected regardless of length of stay and a single bilateral Venous Doppler ultrasound in the lower extremities were performed upto 72 hours later. Pulmonary embolism(PE)was diagnosed by CT-Angiography. Asymptomatic and symptomatic VTE were registered. Patient characteristics, blood test results, thromboprophylaxis dose received, VTE events and mortality after seven day followup were recorded. Study cohort of 230 critically patients were studied, median ICU stay was 12 days. After seven days follow up,the frequency of patients with VTE, both symptomatic and asymptomatic was 26.5%:45 with DVT and 16 with PE. The cumulative frequency of symptomatic VTE was 8.3%.D-Dimer levels >1,500 ng/ml were diagnostic of VTE, with sensitivity of 80% and specificity of 42%. During the followup period 6 patients developed recurrent DVT in spite of receiving therapeutic doses of Heparin. Mortality rates at seven days follow up were the same for those with (6.6%)and without (5.3%) VTE. The paper concludes that patients with severe COVID-19 infection are at high risk for VTE and recurrence of VTE in spite of anticoagulation and recommends increasing the dose of prophylactic anticoagulant use in patients with a low risk of bleeding. The study has its limitation in that they have not done a systematic screening of the patient throughout the hospital stay, thus picking up only symptomatic VTE events on the seventh day only secondly, the followup and sample size were small and more patients are needed to develop a prognostic model as such, otherwise interesting article, relevant in today's COVID days.
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