Journal of Vascular Surgery – February 2018 Audiovisual Summary

Abstract

Welcome to the February issue of the Journal of Vascular Surgery. We have an excellent lineup of papers for the month and would like to highlight four of them. The first is a paper by Ranney and colleagues from Duke and is entitled “Long-term results of endovascular repair for descending thoracic aortic aneurysms”. It reports on their institution's experience with 192 thoracic aneurysms and the early and long-term outcomes of patients who have undergone thoracic endovascular aortic repair (TEVAR) since it was first approved in 2005. With a mean follow-up of almost 6 years, they report that the long-term survival is 46% and the freedom from aortic death was 96%. Only 7% of patients required an intervention for endoleak and none required open thoracic aortic surgery post-TEVAR. The authors conclude that TEVAR has been established as the treatment of choice for descending thoracic aortic aneurysms. The next paper, by Adkar and colleagues from Duke, entitled “Low mortality rates after endovascular aortic repair expand use to high-risk patients”, reports on National Surgical Quality Improvement Program (NSQIP) data from 2005 to 2013 of ∼25,000 patients undergoing endovascular aneurysm repair (EVAR) that were both high risk (46%) and low risk (54%). They found that the 30-day mortality of 1.7% in high-risk patients was much lower than had previously been reported in the EVAR 2 trial and that the major factor that increased procedural risk by threefold was renal insufficiency. Renal insufficiency had greater impact on operative mortality than cardiac or pulmonary insufficiency. The authors concluded that the marked reduction in operative mortality in high-risk patients undergoing EVAR should lead to selective expansion of the indication for EVAR in high-risk patients. The third paper highlighted this month, “Cryopreserved arterial allografts for in situ reconstruction of abdominal aortic native or secondary graft infection” by Ben Ahmed and colleagues in France, reports on their institution's experience with 71 cryopreserved allografts implanted for aortic graft infections and primary aortic infections. They used locally cryopreserved allografts, different from U.S. allografts preserved commercially, in patients with a variety of indications who had their repairs performed in-line. They found a 17% 30-day mortality and that diabetes and American Society of Anesthesiologists IV patients had worse long-term outcomes, with five anastomotic ruptures at 45 months and a primary allograft patency of 93%. The authors concluded that aortic infection patients are high risk and have significant risk of recurrent allograft rupture but an acceptable long-term survival when the initial graft infection is eradicated and revascularization accomplished. A paper by Soden and coauthors, entitled “Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention”, is the Editors' Choice and CME paper this month. Using data from the Vascular Quality Initiative (VQI), it reports on over 76,000 patients who were treated for vascular diseases, including carotid, aneurysmal, and peripheral arterial disease, from 2009-2014. It addresses racial inequities in vascular disease management by region of the U.S. Among patients with vascular disease during that time period, 14% were black; the authors show that black men present with more uncontrolled risk factors and more advanced disease and receive worse postprocedure risk factor modification for their vascular disease. In all areas of the U.S., it also shows that black women are seen earlier and with less severe disease burden than black men. The paper is accompanied by a very thoughtful commentary by Bill Flinn in which he discusses the implications of the paper and the underlying problem for black patients with vascular disease, which is overall access to health care in all regions of the U.S. We hope you will enjoy reading not only the papers highlighted here today, but also all of the other papers in the February issue of the JVS. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIzYTg4YWFkYTM0NGQ5NTJjNWMyOGE1OTJlYWE1YmZjMCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NjQ1MjM0fQ.eUmqyDmTLt0Xsl-ZhwBO-VU-J5wF_eHKuWo4StheQIyeT6M5gM7yd0ZF7MR8tHzb3yCf6ctxU00Hn_D7YqJBZMtbn6ZOkuF0cEL_Ow6inikl0fHOfIZH_U9-OFuS76zbedtg_4z1G2G4rKUqhuOg0-tFpCiZEtJ76SPqeF9mv7npz_3SYAZjXJOLYIGRLuY6sw-ECWVnCvc3OXWDwsIz7KH9PSsq4LxMz0ogkKfcqYrNSOz1siuisfFwQXreeF7T8Q-bGDW-Od9pgwJRvD1jnjF4v5pzg3BVzsbh97V1WkvsaAQPGCnEv2TjqumZWgFJCXGfOxDSJvuDxCm3Fc4hBQ Download .mp4 (69.64 MB) Help with .mp4 files Video