Journal of Vascular Surgery – February 2020 Audiovisual Summary

Abstract

Hello! My name is Peter Lawrence and I am happy to introduce the February issue of the Journal of Vascular Surgery and highlight four outstanding papers which are freely available for the next 2 months. The Editors' Choice for this issue, “Migration and sac expansion as modes of midterm therapeutic failure after endovascular aneurysm sealing,” by Stenson and co-authors, reports on a relatively new concept in treating aortic aneurysms using endovascular “aneurysm sealing” to fill the aneurysm sac.1Stenson K.M. de Bruin J.L. Loftus I.M. Holt P.J.E. Migration and sac expansion as modes of midterm therapeutic failure after endovascular aneurysm sealing.J Vasc Surg. 2020; 71: 457-469Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The authors used the Nellix device in a variety of situations, including infrarenal, pararenal, and suprarenal aneurysms, occasionally with chimneys for proximal renal or mesenteric vessels. There was a 33% failure rate due to migration, endoleaks, and sac expansion, with some sac expansion progressing to rupture and many of the adverse events occurred more than 2 years after implantation. The authors conclude that adoption of this or any new disruptive technology should be undertaken very cautiously to avoid unanticipated late failures, as occurred with this device, which has been withdrawn from clinical use by the company. Readers may earn CME credit for our next highlighted article, titled “Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians.”2Glousman B.N. Sebastian R. Macsata R. Kuang X. Yang A. Patel D. et al.Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians.J Vasc Surg. 2020; 71: 518-524Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Glousman and co-authors from The George Washington University Hospital addressed the debate about whether asymptomatic carotid stenosis should be treated in octogenarians. They used the National Surgical Quality Improvement Program (NSQIP) database to determine differences in outcomes after elective carotid endarterectomy (CEA) in patients <80 years of age and over age 80. Octogenarians were more commonly women, nonsmokers, and nondiabetics that those <80 years of age who underwent CEA. Octogenarians had a slightly higher but statistically significant 30-day mortality and more octogenarians returned to the operating room postprocedure for bleeding. Otherwise, the outcomes were similar between those above and below age 80. The authors concluded that age alone should not preclude elective carotid surgery in asymptomatic patients, since outcomes were similar, but that patients over 80 undergoing elective CEA should be carefully selected. The third article, by Dakour-Aridi and coauthors, is entitled “The Vascular Quality Initiative 30-day stroke/death risk score calculator after transfemoral carotid artery stenting.”3Dakour-Aridi H. Faateh M. Kuo P.-L. Zarkowsky D.S. Beck A. Malas M.B. The Vascular Quality Initiative 30-day stroke/death risk score calculator after transfemoral carotid artery stenting.J Vasc Surg. 2020; 71: 526-534Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The authors noted that since transfemoral carotid stenting is associated with an increased risk of stroke (4.1% in this study) compared with CEA, they sought to identify factors associated with a higher and lower risk of stroke. Factors associated with a higher risk were age, nonwhite race, congestive heart failure, carotid artery stenting, diabetes, symptomatic status, and contralateral occlusion. Those factors associated with a lower risk were use of statins and dual antiplatelet therapy. These factors were developed into a risk calculator which is shown on the right side of the visual abstract slide. The final article highlighted this month is “Nationwide trends in drug-coated balloon and drug-eluting stent utilization in the femoropopliteal arteries,” by Mohapatra and colleagues.4Mohapatra A. Saadeddin Z. Bertges D.J. Madigan M.C. Al-Khoury G.E. Makaroun M.S. et al.Nationwide trends in drug-coated balloon and drug-eluting stent utilization in the femoropopliteal arteries.J Vasc Surg. 2020; 71: 560-566Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar They addressed the trends in treatment of the superficial femoral and popliteal arteries during the period when drug-eluting technologies were introduced for endovascular interventions of peripheral arterial disease. They found that balloon angioplasty, stents, and atherectomy had evolved into procedures using drug eluting balloon angioplasty and drug eluting stents more frequently. The percentage of atherectomy procedures fell during the same time period. Drug-eluting balloons were used more commonly for shorter lesions and earlier TASC lesions (eg, A and B), while stents were used for longer lesions, worse TASC classification (eg, C and D), and calcified superficial femoral arteries. Thank you for watching! For more information, please follow us on social media and remember to like, comment, and share! We hope you enjoy these four highlighted papers and the other excellent papers in this month's Journal of Vascular Surgery. Remember that these articles are free to read until the end of March! The video accompanying this article may be found online at www.jvascsurg.org. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwYmFjMDM1N2MxN2FkNTQ4ZDUxMDMzMjc5MzEzNzZlMSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjQ0NzQyNDIxfQ.aY3kF4K6vub6SVF3QhTQgTAqdqK8diQrWuzeifjpcgFmgTTuAJgAIDe_2UHmlDq9Yc2NYhNSlFIR5qU3dvZ-Sar-1rJVFl4-N7hKW4uI2Jrrx3W10bXJQyCRKFt9HO3jNiLTYS-f2AbOsY0b5KkZCYtItM1Sk62xDwRVzCqL2-OCdNdWwOJwVWptEz7upb_OokoDPXajzt6Lqp7zI1TvNOZU5y2sl6JP3Dg7Hph4Wn9epV8WOVdkRRonanrSqjqPhhQtmb7FnXxYvgreMhii0sTsS4aD3vxs_94fLsNu-FVxs0Vf2g9cYX0TA46VbdN8nTfsXzXquvHNhPSjEEK2Gw Download .mp4 (33.44 MB) Help with .mp4 files Video