Journal Of Vascular Surgery Research Articles

Invited commentary

In this translational study, Dr Dansdill and the group from Loyola show that the synthetic organic compound vepoloxamer (P-188) can potentiate the effects of heparin and tissue plasminogen activator in a rat model. This is a triblock, organic, synthetic, and amphipathic molecule that improves the rheology of blood. It has been studied in the sickle cell population with no reports of bleeding complications. To date, the use of anticoagulants to prevent thromboembolism and recurrent thrombosis in the arterial and venous circulation has been plagued by a very real and problematic attendant risk of bleeding. Whereas the advent of the direct oral anticoagulants has provided a breakthrough in convenience for the patient, the true “Holy Grail” of anticoagulant therapy is to establish a way to prevent pathologic thrombosis with minimal or no bleeding risk. Major bleeding rates for low-molecular-weight heparin approximate 2%, and even for the direct oral anticoagulants, major and clinically nonmajor bleeding may be as high as 8% to 10%.1Crowther M.A. Warkentin T.E. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents.Blood. 2008; 111: 4871-4879Crossref PubMed Scopus (225) Google Scholar, 2Yeh C.H. Gross P.L. Weitz J.I. Evolving use of new oral anticoagulants for treatment of venous thromboembolism.Blood. 2014; 124: 1020-1028Crossref PubMed Scopus (101) Google Scholar As such, this work represents a priority issue in anticoagulation pharmacology. If vepoloxamer allows a lower dose of heparin to be used and potentiation of tissue plasminogen activator, then the use of such a compound could have significant clinical impact and benefit. Importantly, this medication has been shown to be safe in phase I and II trials (albeit for different indications) and thus represents a tangible and realistic translation of bench research. Although this work is interesting and potentially important, areas that need to be clarified include the dose of heparin that was used and how it relates to clinical dosage (the amount of heparin in the current study seems to be low compared with what is clinically used in patients although previously used in other rat studies) and the establishment of parameters by which to monitor the effect of the drug with standard tests. Nonetheless, the data are provocative and the concept an important one. We should all applaud the efforts to look at improving the safety of patients by decreasing dosages of anticoagulants and fibrinolytic agents while maintaining therapeutic efficacy. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Synthetic, organic compound vepoloxamer (P-188) potentiates tissue plasminogen activatorJournal of Vascular SurgeryVol. 67Issue 1PreviewPoloxamer-188 is a synthetic, organic compound that acts by binding hydrophobic pockets on damaged lipid bilayers in the circulation. P-188 reduces blood viscosity and confers anti-inflammatory and cytoprotective effects. Vepoloxamer (Mast Therapeutics, San Diego, Calif) is a purified version of this compound that has limited side effects. The aim of this study was to investigate drug interactions between vepoloxamer and heparin and tissue plasminogen activator (tPA). Full-Text PDF Open Archive

Invited commentary

Invited commentary

Selected Abstracts from the December Issues of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the December Issues of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Invited commentary

Invited commentary

Invited commentary

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) concluded that carotid surgery for symptomatic stenosis is better than medical therapy, and the conferred benefit of surgery is proportional to the degree of stenosis.1North American Symptomatic Endarterectomy Trial CollaboratorsBeneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453Crossref PubMed Scopus (7865) Google Scholar The European Carotid Surgery Trial (ECST) came to a similar conclusion and that “on average, the immediate risk of surgery was worth trading off against the long-term risk of stroke without surgery when the stenosis was greater than 80% diameter.”2European Carotid Surgery Trialists Collaborative GroupRandomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).Lancet. 1998; 351: 1379-1387Abstract Full Text Full Text PDF PubMed Scopus (2966) Google Scholar The preceding and other studies leave little room for doubt that endarterectomy is beneficial to symptomatic patients; what is still being debated is the exact timing of surgery. Most clinicians agree that patients presenting with crescendo transient ischemic attacks or a mobile plaque on imaging deserve to be considered for an emergent endarterectomy to prevent a severe stroke. What is not clear is what type of patient ought to have an urgent (ie, during the same hospitalization and as promptly as possible) carotid endarterectomy. Avgerinos et al attempt to answer the question, When is it optimal to perform endarterectomy for symptomatic patients? They queried the Vascular Study Group of New England database of 14,864 carotid endarterectomies and identified 4076 performed for symptomatic stenosis. Of the latter cases, 989 carotid endarterectomies were performed within a month of symptom onset. They analyzed outcomes based on timing of surgery: same day, <48 hours, 2-5 days, and >6 days. They found that the postoperative stroke rate was highest if surgery was performed <48 hours after presenting stroke or transient ischemic attack, whereas postoperative stroke rates were similar in the other time frames. In a similar analysis from a single center and spanning the same time period, Tsantilas et al found a combined stroke and mortality rate for symptomatic patients of 2.5% and no significant difference in stroke rates in the various time periods of 48 hours, 3-7 days, 8-14 days, and 15-180 days.3Tsantilas P. Kuhnl A. Kallmeyer M. Pelisek J. Poppert H. Schmid S. et al.A short time interval between the neurologic index event and carotid endarterectomy is not a risk factor for carotid surgery.J Vasc Surg. 2017; 65: 12-20Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Other authors have strongly emphasized the need for prompt carotid endarterectomy, provided symptoms are stable, to prevent a recurrent stroke.4Bond R. Rerkasem K. Rothwell P.M. Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery.Stroke. 2003; 34: 2290-2303Crossref PubMed Scopus (246) Google Scholar In performing an urgent carotid endarterectomy, there are many factors that need to be taken into consideration. By the time the surgeon sees the consult, proper imaging is obtained, and the patient is prepared for surgery, several hours would have passed. Adding to the complexity, a patient admitted on a Friday or Saturday may experience longer delays. This paper concludes that there is no major penalty in waiting a few days. Until we have more sophisticated imaging capabilities to detect which plaques are likely to disintegrate and cause recurrent symptoms, it is a guessing game.5Rothwell P.M. Prediction and prevention of stroke in patients with symptomatic carotid stenosis: the high-risk period and the high-risk patient.Eur J Vasc Endovasc Surg. 2008; 35: 255-263Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The prudent approach, though, is to avoid delays in removing the offending plaque. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Early carotid endarterectomy performed 2 to 5 days after the onset of neurologic symptoms leads to comparable results to carotid endarterectomy performed at later time pointsJournal of Vascular SurgeryVol. 66Issue 6PreviewTiming of carotid endarterectomy (CEA) after onset of neurologic symptoms remains controversial. We assessed the association of CEA timing with postoperative outcomes. Full-Text PDF Open Archive

Invited commentary

So you successfully re-establish blood supply to a 70-year-old woman with atrial fibrillation who experienced a right common femoral artery embolus 6 hours prior. Even with four-quadrant fasciotomy, the muscle swelling is tremendous, and some of the anterior compartment muscle appears greyish on initial inspection. You have anticoagulation to prevent recurrent thrombus formation and hydration to aid in managing some of the metabolic consequences but little to actually salvage ongoing muscle damage associated with reperfusion injury. A successful treatment that could be easily provided at the time of reperfusion to ameliorate the associated injury would be a highly desirable addition to our clinical toolbox. Reperfusion injury and its potential treatment is not a new concept. Reperfusion injury is a complex event involving reactive oxygen species, activated neutrophils that release potentially toxic intracellular granules, complement activation, and cytokines that signal activated leukocyte adhesion and transmigration. This, in essence, describes inflammation as a major component of this injury event as it is being recognized for many such events. Attempts at ameliorating the effects of these negative factors have to date not be entirely effective or transferable to the clinical arena. This study recognizes the anti-inflammatory and microvascular perfusion protection properties of carbon monoxide (CO) but the downside of exogenously inhaled CO due to its increased carboxyhemoglobin generation. With the availability of transitional metal carbonyls, CO-releasing molecules that can be delivered intravascularly without carboxyhemoglobin production, a potential therapeutic option became available to test. Such agents do appear to protect myocardium during reperfusion and reduce the overall inflammatory response in other animal models. This study demonstrates a similar protective effect in a skeletal muscle model with improved microvascular perfusion, inhibition of inflammation, and attenuation of cellular damage on skeletal muscle when a CO-releasing molecule is delivered at the time of reperfusion. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Systemic application of carbon monoxide-releasing molecule 3 protects skeletal muscle from ischemia-reperfusion injuryJournal of Vascular SurgeryVol. 66Issue 6PreviewIschemia-reperfusion (IR) is a limb- and life-threatening complication of acute limb ischemia and musculoskeletal trauma. Carbon monoxide-releasing molecules (CORMs) have recently been shown to protect microvascular perfusion and to reduce inflammation and injury in various ischemic animal models. The purpose of this study was to examine the effects of water-soluble CORM-3 on the extent of IR-induced muscle injury. Full-Text PDF Open Archive

Recent trends in publications of US vascular surgery program directors.

Objective In order to examine the academic productivity of US vascular surgery program directors, the number of vascular publications listed in PubMed from 2001 to 2015 for US vascular surgery program directors was reviewed. We suggest that this can be used as a benchmark for academic productivity. Methods The names of the program directors were taken from the Accreditation Council for Graduate Medical Education (ACGME) website at two time points: December 2009 (Independent Programs) and December 2015 (Independent + Integrated). This was used to query PubMed, which listed 5196 publications: 3284 from 2001 to 2009 and 1912 from 2010 to 2015. Results There were 104 program directors (2001-2009) and 114 program directors (2010-2015) with average number of publications in PubMed per program director as 3.68/year (SD ± 2.31) and 2.80/year (SD ± 2.73), respectively ( P = .01). From 2001 to 2009, 1215 (37%) and in 2010 to 2015, 860 (45%) of the publications were from Journal of vascular surgery. The top third produced 67% and 69% of publications in the two time-points. No statistical difference was ascertained regionally: northeast, southeast, midwest and west ( P = .46). The numbers of publications/year decreased by 17% compared to first 10 years. From 2001 to 2009, there were no programs with no publications which increased to five and three with no Journal of Vascular Surgery publications which increased to 21 in 2010-2015. The independent and integrated program directors published average of 2.85 (SD ± 2.69) and 3.47 (SD ± 3.1) total publications; 1.25 (SD ± 1.4) and 3.47 (SD ± 1.7) Journal of Vascular Surgery papers/year, respectively ( P = .28, P = .23). Changes in the study subject were noted by percentage of total publications: endovascular lower extremity arterial (4.7% to 8.9%), Thoracic Endovascular Aortic Repair (TEVAR) (4.5% to 9.9%), Arterio-Venous (AV) access (0.0% to 3.0%), basic science (14.7% to 6.8%), open thoracic (3.0% to 0.6%). Conclusion There seems to be a significant decline in the number of publications over the last 15 years. Yet, the subject of the publications has progressed from Open to TEVAR with an increase in endovascular publications. However, basic science publications reduced by half.

Journal of Vascular Surgery: Venous and Lymphatic Disorders – November 2017 Audiovisual Summary

Welcome to the November issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders. We are highlighting several papers that we believe you will especially want to read, but we also encourage you to read the entire issue of JVS-VL. The Editors' Choice for this issue is a paper by Marston and other investigators from the HP802-247 Study Group entitled “Baseline factors affecting closure of venous leg ulcers”. Three separate, but nearly identical, randomized trials investigated a novel topical cell therapy for venous leg ulcers. Although the cell therapy did not facilitate wound healing, the authors used the pooled data from the control arm of the study, which used standard compression therapy, to determine the factors in a venous leg ulcer that predicted wound healing. The study found that the size of the wound, location of the wound on the leg, and the duration of the leg ulcer were all predictors of wound healing when standard compression with a four-layer compression dressing was used. In addition, women were more likely than men to heal their venous leg ulcers. These data help clinicians predict the time anticipated for venous leg ulcer wound healing based on the characteristics of the wound. One of the most challenging deep venous problems is chronic cerebrovascular venous insufficiency due to outflow obstruction. Giaquinta and coauthors from Italy and the United Kingdom in their paper entitled “Factors influencing the hemodynamic response to balloon angioplasty in the treatment of outflow anomalies of the internal jugular veins” investigated technical factors that affected initial success and long-term patency of internal jugular balloon angioplasty. They performed nearly 800 procedures and studied the characteristics most associated with success. They found that younger patients with transverse venous defects and high-flow predilatation were most likely to respond to balloon angioplasty and remain patent, while those with hypoplasia or longitudinal defects were less likely to respond well to percutaneous transluminal angioplasty. The authors recommended using anatomic characteristics and patient age when selecting patients for balloon angioplasty of the internal jugular vein. The CME paper for this issue is “Contemporary outcomes of elective iliocaval and infrainguinal venous intervention for post-thrombotic chronic venous occlusive disease” by Rollo and co-authors from UCLA. They reviewed their experience using an aggressive interventional approach to patients with chronic venous occlusions, treating 31 patients with endovascular approaches, including lysis, supra-, and infrainguinal angioplasty and stenting, as well as removal of previously placed vena caval filters. They showed a high initial recanalization success, a significant improvement in CEAP score postprocedure, a patency at 1 year of ∼70%, and improvement in symptoms and swelling in most patients. Several stents were extended below the inguinal ligament with good patency. The authors recommend attempting to remove all vena caval filters to improve patency, and extending the stent below the inguinal ligament, when needed to treat all stenotic disease to obtain the best patency. The final paper highlighted today is “Superimposition of elastic and nonelastic compression bandages” by Chassagne and coauthors from France. They investigated the pressure of superimposed bandages and compared them to the pressure applied by single-component bandages. Six different bandages, composed of one elastic bandage, one nonelastic bandage, or both, were applied in a spiral pattern on both legs of 25 patients at risk of venous thrombosis. Pressure was measured on the leg in the supine, sitting, and standing positions. The two single bandages applied similar pressure in the supine position, but their superimposition showed different pressure levels, with a similar static stiffness index depending on the order in which the bandage components were applied on the leg. They concluded that the order of bandage application has a significant impact on interface pressure, but there was a poor correlation between the pressure applied by each bandage component and the pressure resulting from their superimposition. We hope you enjoy these and the other papers in this issue of the JVS-VL. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkZjY1MzhlYmYzMmIzZTkwOTE5MDQ0MjZkYmExN2I4MiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NDczMjI3fQ.l4wf6nMuwDiwJ3ud7MYvoGw-qTjOY6QKG1BuV8UvtcUzogRH16z10-OTDzIrqFT7BhNZMz_i19uqpA5ylYzCov8589sSViInfM9QrUDS7ORZBqQxUvNZRSwGSG-tq4eKLItAwTBowSa7RIr8I3AKWUCkYaGc2U_zFIwymrI-yxEcC9u28I11_RAH7jJtgM_3yvYZFk-o8IHPH0BhdOOM75rb7Z1gZYw2a_d9MaNGqcyDaKh1bQN64ptjUqEQHFYloZfG7Oq3Wt_XwIH1xjdj8MnviTSoSFK5pTcEEHMHSNgBFO5yehwzrv7ULfXAaIDVUiv1izIVshhvzCc_4_NdGA Download .mp4 (89.84 MB) Help with .mp4 files Video

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Selected Abstracts from the November Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the November Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Invited commentary

Dr Harris and colleagues argue that services for vascular acute care surgery (VACS) should be established in tertiary referral centers for nonelective care. Further, they speculate that additional training and advanced certification of vascular surgeons and VACS program accreditation may be required in the future. Their analyses likely overestimate the burden of emergency vascular care. The Health Services Cost Review Commission inpatient data set they reviewed provided minimal information about the nature of patients' vascular conditions and procedures. As expected, urgent or emergency hospitalization was associated with greater resource utilization and poorer outcomes. The analysis, however, could not determine whether vascular disease or injury was the reason for admission or whether vascular procedures were needed during hospitalization to address complications or comorbidities. Vascular diagnoses were not specified, nor was the urgency of procedures performed. Many nonelective hospital admissions for vascular diagnoses are not true emergencies. Emergency Department cases may become “acute” because of lack of insurance, inadequate primary care, or because of a primary care provider's choice to first send the patient to the Emergency Department for management. All board-certified vascular surgeons, regardless of their training pathway, should be competent to handle most nonelective problems, including thromboembolectomy, vascular access procedures, angiography, inferior vena cava filter placements, amputations, treatment of pseudoaneurysms, and the like. These procedures should not require transfer to an acute vascular care center. Complex care is already regionalized to larger centers. There are 5564 United States hospitals,1American Hospital Association AHA Hospital Statistics. Fast facts on US hospitals.http://www.aha.org/research/rc/stat-studies/fast-facts.shtmlGoogle Scholar but only 3767 vascular surgeons.2American Board of Surgery Statistics and pass rates.http://www.absurgery.org/default.jsp?statsummaryGoogle Scholar The need for triage and transfer should be considered the norm. Although there can be problems with access to care and timeliness of transfer, it is unlikely that establishing VACS teams at regional centers will be the answer. Interestingly, our group at a medium-sized academic medical center (a level 1 trauma center) instituted an acute vascular surgery care service. We found the change unhelpful. After a 1-year trial, we reverted to our traditional coverage model. We still handle ruptured aneurysms, acute limb ischemia, and other complex vascular problems, but without a service dedicated to acute problems. Implementation a VACS service may make sense where most of the work is urgent or an emergency. That does not mean it is right for most programs. Management of clinical services needs to be based on referral patterns, local resources, and institutional priorities, not national directives. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Defining the burden, scope, and future of vascular acute care surgeryJournal of Vascular SurgeryVol. 66Issue 5PreviewThe paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. Full-Text PDF Open Archive

Invited commentary

Infections after placement of a prosthetic graft, for either aortic or peripheral arterial reconstruction, are feared and potentially devastating complications. These infections can have significant morbidity and can also lead to subsequent infections. In this issue of the Journal of Vascular Surgery, Fariñas et al report their experience with postoperative infectious complications after placement of prosthetic grafts for both lower extremity and aortic reconstruction. Their all-cause infection rate was 27.2%. The majority of infections were surgical site infections, and only two graft infections were noted. The authors identified preoperative active lower extremity soft tissue infection as an independent risk factor for infectious complications after both aortic and lower extremity operations. Although active lower extremity infection may not be able to be resolved for patients with advanced critical limb ischemia or those who undergo emergent aortic surgery, efforts should be undertaken to treat soft tissue infection before elective aortic aneurysm repair. Prolonged mechanical ventilation was noted to be a predictor for infectious complications after aortic surgery, once again emphasizing the importance of expeditious extubation in the immediate postoperative period, although it is unclear whether this is a marker of overall illness. There are several lessons to be learned from this analysis. Studies of postoperative infectious complications should not combine very different procedures together as “vascular surgery procedures.” To correctly identify high-risk patients and to set in place systems for improvement, each specific type of intervention and indication needs to be closely examined. Leg bypass and aortic surgery are very different from one another with regard to a number of issues. For example, postoperative nasogastric tubes are often used after aortic procedures and seldom after leg bypass. Prolonged intubation with postoperative tracheostomy placement is less of an issue for lower extremity bypass as it is for major open abdominal surgery. Finally, for aortic surgery, an operation performed for aneurysmal disease is very different from one executed to treat occlusive disease, and a ruptured aneurysm is much different from an elective aneurysm repair. To decrease these rates of postoperative infections, risks identification and interventions should be tailored for specific scenarios. Studies need to be optimally designed to answer the questions that they set up to ask. Future prospective work is needed as granular details are needed, including surgical and preparation technique. Risks factors identified in this study, such as poor glucose control, anemia, and prolonged ventilation, can also be analyzed and teased out to see if they are really factors that predict a poor outcome or merely markers for ill and sick patients with more advanced disease. As such, risk reduction methods should focus specifically on each procedure and indication. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Risk factors and outcomes for nosocomial infection after prosthetic vascular graftsJournal of Vascular SurgeryVol. 66Issue 5PreviewThe objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). Full-Text PDF Open Archive

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Selected Abstracts from the October Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the October Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Journal of Vascular Surgery: Venous and Lymphatic Disorders – September 2017 Audiovisual Summary

Journal of Vascular Surgery: Venous and Lymphatic Disorders – September 2017 Audiovisual Summary

Selected Abstracts from the September Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the September Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the August Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the August Issue of the Journal of Vascular Surgery: Editors: Peter Gloviczki and Peter F. Lawrence

Journal of Vascular Surgery: Venous and Lymphatic Disorders – July 2017 Audiovisual Summary

Hello and welcome to the July issue of the JVS-VL. We have four interesting papers to tell you about, which are featured in this month's JVS-VL. First is a paper by Brownson and colleagues from Yale, “Characteristics of provoked deep vein thrombosis in a tertiary care center”. The authors retrospectively studied 425 patients over an 18-month period at their institution with provoked deep vein thrombosis (DVT) and divided them into those with transient risk factors, such as surgery that resolved in 2 weeks and those with permanent risk factors such as cancer, long-term immobilization, or a hypercoagulable state. They found that those with transient risk factors were younger and had more calf DVT as well as a significantly lower risk of recurrent DVT and death at 7 months. The authors question whether those with transient risk factors who develop DVT should be treated differently and have a shorter period of anticoagulation. The next paper “Clinical characteristics and prognostic features of intravenous leiomyomatosis with inferior vena cava or intracardiac extension” by Zhang and colleagues from Beijing, China is a retrospective analysis of 38 patients with intravenous leiomyomatosis, whose mean age was 44 years. Fifty-eight percent of patients had a history of uterine leiomyoma and 24% had a history of uterine leiomyoma without extension into the deep veins. The most common symptoms were chest tightness, lower limb swelling, palpitation, dizziness, and abdominal distention. Sixty percent underwent one-stage surgery and 40% underwent two-stage surgery and 72% received postoperative antiestrogen hormone therapy. Unfortunately, at a median follow-up of 12 months, 50% showed evidence of recurrence. Postoperative antiestrogen hormone therapy, duration of postoperative hormonal therapy, and heart involvement were not associated with recurrence. The authors conclude that this rare disease requires surgery as the primary treatment, and although the recurrence rate is high, postoperative antiestrogen hormone therapy is not correlated with recurrence. The next paper is the Editors' Choice and is titled “Clinical presentation of women with pelvic source varicose veins in the perineum as first steps in the development of a disease-specific patient assessment tool” by Gibson and coauthors from Bellevue and Seattle, Washington and Boston, Massachusetts. They prospectively studied 72 women with symptomatic pelvic source varicose veins and compared them to 1160 women with saphenous vein incompetence alone. The severity of disease was objectively evaluated using the revised Venous Clinical Severity Score (rVCSS). The study revealed that those with pelvic source varicose veins were younger and thinner than those with saphenous incompetence and also had large infants. The most common symptoms were aching in 68%, throbbing in 47%, and heaviness 35%, and premenopausal women noted that symptoms were worse during menses. Since the VCSS is poorly associated with patient-reported discomfort, it is not good for evaluating pelvic source varicose veins. A disease-specific tool for the evaluation of pelvic source varicose veins is critically needed. The final highlighted paper is by Marston and coauthors from North Carolina and is titled “Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation”. They retrospectively reviewed all open and healed venous ulcer patients treated with laser ablation. Laser ablation of the great saphenous vein, small saphenous vein, or both was performed on 173 limbs. Deep venous insufficiency was present in 31% and concomitant phlebectomy was performed in 34%. At a median follow-up of 25 months, venous ulcers healed after laser ablation in 57% at 3 months, 74% at 6 months, and 78% at 12 months, but ulcers recurred in 9% at 1 year, 20% at 2 years, and 29% at 3 years. Ulcers recurred more often in patients with deep venous insufficiency and in those patients who did not undergo phlebectomy of associated varicose veins at the time of laser ablation. The authors suggest phlebectomy at the time of laser ablation for patients with open or healed venous ulcers and particularly in those with isolated superficial venous insufficiency. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5YmFjY2E4ZWRkYzM5YzMwMGM0YzcxNzAwZWE3MTdjMCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3OTM3OTE2fQ.gSrZb5TQHy5bf-ns-ZZTj19DBn0yNrQw0UuGnDH0RYwFFbVbW7Ke2UL5BFHo4LftO-mQtyCBkLh-w9tmqqKz7UUKR85RBSrnHQ0wPjR4FFUClwLo_LdHtK_No6JZoUAvrF4P9g75SryQ0c1kUYo16aX_kjYgWgS1hpu9rLL_WnHgSBj3w4qNgwArBgKhw4hnkLzsa_LtmHYU8iHTb9kLOWWjyQBUS0rdmC-yV5gzH7cxtMcuLPV5hgFqnV_-jaM9gu3V75SN0QtdroudvJQ4DNlUJESOMfiZRTKDuHhLVHtfgR0MeJ2xiPAqOxmH1by8E7Pd-6s55HwQ0Jc42shRYw Download .mp4 (332.17 MB) Help with .mp4 files Video

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Selected Abstracts from the July Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the July Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence