Journal of Vascular Surgery – July 2020 Audiovisual Summary

Abstract

Hello! My name is Peter Lawrence and I am pleased to introduce the July issue of the Journal of Vascular Surgery and highlight five outstanding papers which are freely available for the next 2 months. The CME and the Editors' Choice article for this issue is “Five-year survival following endovascular repair of ruptured abdominal aortic aneurysms is improving,” by Varkevisser and coauthors using the Vascular Quality Initiative (VQI) multi-institutional database.1Varkevisser R.R.B. Swerdlow N.J. de Guerre L.E.V.M. Dansey K. Stangenberg L. Giles K.A. et al.Five-year survival following endovascular repair of ruptured abdominal aortic aneurysms is improving.J Vasc Surg. 2020; 72: 105-113Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar They did a retrospective review of patients who had a ruptured abdominal aortic aneurysm (AAA) repaired with an endovascular aneurysm repair (EVAR) from an early period (2004-2012) vs a later period (2013-2018). The EVAR data for propensity matched patients was compared in a similar time period with patients who had open ruptured AAA repair. The 5-year survival for EVAR improved from 49% to 63%, while it worsened slightly for open repair from 59% to 52%. This study shows why there is an increasing trend toward EVAR for all ruptured AAA, even transferring patients to hospitals who have the facilities and skillset to do EVAR for a ruptured aneurysm. Our next highlighted article, titled “Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access,” is by Ali and coauthors from Egypt.2Ali H. Elbadawy A. Saleh M. Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access.J Vasc Surg. 2020; 72: 181-187Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar In patients with exhausted upper extremity veins, they performed 89 brachial arterio-arterial prosthetic loop hemodialysis access grafts. The primary patency was 62% and the secondary patency was 90% at 2 years. Complications included pseudoaneurysms, hematomas, and infection, but these are also common complications in arteriovenous upper extremity prosthetic grafts used for hemodialysis. The authors advocate an arterio-arterial procedure as a durable bailout for patients without patent upper extremity superficial veins. The third article, by Cheun and coauthors, is entitled “Implications of early failure of isolated endovascular tibial interventions.”3Cheun T.J. Jayakumar L. Ferrer L. Miseris D. Mitromaras C. Sideman M.J. et al.Implications of early failure of isolated endovascular tibial interventions.J Vasc Surg. 2020; 72: 233-240Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Since there is a debate about the impact of an endo-first approach for chronic limb ischemia on limb salvage and subsequent procedures, the authors retrospectively evaluated 1779 patients from a single center who had an endovascular tibial procedure for chronic limb-threatening ischemia. There were 16% of chronic limb-threatening ischemia patients who had an early failure (<30 days) and when this occurred, there was a significantly lower amputation-free survival of 16% vs 47% in those who did not have failure. Diabetes and renal failure were independent predictors of failure as well as anatomic factors. In addition, the long-term clinical efficacy was significantly worse in those who had early failure, with 11% having limb salvage vs 39% who did not. When failure occurred, it was both hemodynamic and progression of the chronic limb ischemia. The authors concluded that early failure of a tibial intervention for chronic limb-threatening ischemia is a significant predictor for poor early and late outcomes as well as limb salvage. The fourth article is “Similar 5-year outcomes between female and male patients undergoing elective endovascular abdominal aortic aneurysm repair with the Ovation stent graft,” by Varkevisser and colleagues.4Varkevisser R.R.B. Swerdlow N.J. Verhagen H.J.M. Lyden S.P. Schermerhorn M.L. Similar 5-year outcomes between female and male patients undergoing elective endovascular abdominal aortic aneurysm repair with the Ovation stent graft.J Vasc Surg. 2020; 72: 114-121Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar They examined gender differences in outcome related to use of the Ovation endograft for repair of aneurysms. They did a meta-analysis of ∼1300 patients who were reported to have undergone an Ovation endograft treatment of an AAA, with 19% being women. Women were older and had smaller aneurysms and smaller neck diameters, but when adjusted for body surface area, the aneurysms were actually larger. The anatomy of the aneurysms in women showed shorter proximal necks, smaller iliac arteries, more angulated necks, and more reversed taped necks. In spite of many differences, the 5-year freedom from endoleak and freedom from reintervention were similar, with both at >90%. In addition, the all-cause survival at 5 years was similar for men and women at ∼80%. These data show that in spite of many differences in anatomy and size, the outcomes between men and women were similar. The final article highlighted this month is “The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms,” by Chaer, Abularrage, and coauthors.5Chaer R.A. Abularrage C.J. Coleman D.M. Eslami M.H. Kashyap V.S. Rockman C. et al.The Society for Vascular Surgery clinical practice guidelines the management of visceral aneurysms.J Vasc Surg. 2020; 72: 3S-39SAbstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar They provide guidance for treatment of visceral aneurysms, which include renal artery aneurysms and branches of the celiac and superior mesenteric arteries. Each aneurysm has unique aneurysm size and morphology characteristics as well as additional indications for repair, such as pregnancy and hypertension. In addition, the document identifies unique morphology, such as pseudoaneurysms and saccular aneurysms, as well as growth rates, which might suggest the need for earlier repair. This document will become the “gold standard” for visceral aneurysm management, although it will need to be continually updated as additional studies are conducted since some of the recommendations are based on small retrospective studies and therefore are currently level 2 evidence. 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 five 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 August! eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwNjBmY2Y3OWVjODVlZDI5NTc3ZGQ5YjA2YzlkNjJiNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjYwMTAzNDI3fQ.NIDImAFnWZpxFoPuv_H0EWFkaAGnYohWBrdSPcsivLoS8M_gRgqBDsrOhNmBSjN5fc4rAoIsCxPtst-9ofBQZZuSHpdKAnRNH0U40xHrwOLh6nvh9rFfjUG7XXbcIFU7CJ8R0fYRjceUQk0WPURfWnH4-tF9HHKG3P6GLDc60KBqbmxU5wINs8UHPsGVirD7P1soTQdaj38JSem4ad_Ed-FeDvYQUcIeTahkCQAyGl3X29o8NGbBMJK2Ss-y8N0yqSlUYFq9E2EWWYRRhzEe4cJbryTGmgwMzetxneX_rW6qyPnoT7bSbE_xACsJ6jOAGyt-g86Gvwkd1Fp9HpnEPw Download .mp4 (126.65 MB) Help with .mp4 files Video 1 (online only)▪▪▪.