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Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 123-125

Anthologies in Vascular Surgery-9

Date of Web Publication23-Mar-2022

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0820.340517

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How to cite this article:
. Anthologies in Vascular Surgery-9. Indian J Vasc Endovasc Surg 2022;9:123-5

How to cite this URL:
. Anthologies in Vascular Surgery-9. Indian J Vasc Endovasc Surg [serial online] 2022 [cited 2022 May 28];9:123-5. Available from:

Compiler & Reviewer: Dr.P.Ilaya kumar, Chennai.

  Carotids Top

1. A systematic review and meta-analysis of peri-procedural outcomes in patients undergoing carotid interventions following thrombolysis

Starvos K.Kakkos et al, Department of vascular surgery, University

hospital of Patros, Patros, Greece. Eur J vasc Endovasc Surg (2021) 62,340-349.

This is a systematic review and meta-analysis of 25 studies which evaluated the peri-procedural outcomes in patients undergoing both carotid endarterectomy (CEA) and carotid artery stenting (CAS) after thrombolytic theraphy (TT) for acute stroke. About 10% to 20% of patients treated with TT, will have an underlying 50% -90% ipsilateral ICA stenosis and are candidates for CEA or CAS, the ESVS 2017 guidelines recommend that CEA should be performed preferably within 7 to 14 days after symptom onset to prevent recurrent stroke. However there is an increased risk of heamorrhagic stroke or neck hematoma formation, if intervention is done soon after TT. There is no proper consensus on the optimal timing of carotid interventions following TT. The aim of this study was to determine whether performing CEA or CAS after TT was associated with increased procedural risks, and if there is any association with timing of these interventions after TT. Twenty-five studies were selected with n = 147,810 patients from Medline, Scopus and Cochrane databases, Data of 2557 patients were studied, of which n = 2076 pts underwent CEA and n = 481 pts underwent CAS following TT. After CEA, the peri-procedural stroke/death rate was 5.2% and intra-cranial haemorrhage (ICH) was 3.4%. After CAS, the peri-procedural stroke/death rate was 14.9% and ICH was 5.5%. Using meta-regression analysis peri-operative stroke/death rate was 13.0% when CEA was performed 3 days after TT and 10.6% if done 4 days after TT and peri-procedural risks falling to the currently acceptable 6% only if done 6-7 days after TT. The paper concludes that peri-procedural ICH and hematoma are significantly high in pts undergoing CEA immediately following TT, while peri-operative stroke/death and ICH were significantly higher after CAS and recommends to defer CEA for at least 6-7 days after thrombolytic theraphy.

  Aorta and Major Branches Top

2. Risk factors, Dynamics and clinical consequences of Aortic neck dilatation after standard Endo-vascular aneurysm repair

Nelson F.G. Oliveira et al., Dept of vascular surgery, Erasmus University medical centre, Rotterdam, The Netherlands. Eur J vasc Endovasc Surg (2021) 62,26-35.

Aortic Neck Dilatation (AND) occurs after aneurysm Endo-vascular repair (EVAR) with self-expanding stent grafts (SESs), sometimes even exceeding the stentgraft's diameter leading to type I A endo-leak and eventual aneurysm rupure. This study analyses the dynamics, risk factors and the clinical relevance of AND after EVAR with standard SESs. A total of 460 EVAR patients treated from 2000 to 2015, were included with a median follow-up of 5.2 years, CT-imaging follow-up of 3.3 years. The study found that upto 50% of the study population presenting with >10% dilatation at the end of the study period. The study found that the rate of AND decreased over time due to the reduction in the radial force of the oversized SES. The Excluder graft compared to the Endurant graft had decreased risk of neck dilatation, however the neck related events were equal in both devices. The study also suggests that baseline neck diameter >30 mm is a risk factor for excessive neck dilatation and suggests longer proximal seal lengths and for low risk patients open repair to be a preferable option. The role of supra-renal fixating stents remain uncertain as they generate more radial force than the infra-renal grafts. The study concluded that endo-graft oversizing and radial force along with initial neck diameter of >30 mm contributes significantly to increasing AND, highlighting the need for lifelong image surveillance in these patients.

  Peripheral Top

3. Long term outcomes of endovascular theraphy for failing Distal Bypass vein grafts

Taira Kobayashi et al., Dept of cardio-vascular surgery, J A Hiroshima General hospital, Hiroshima, Japan. Eur J Vasc Endovasc Surg (2021) 61,121-127.

This is an observational study regarding the patency, wound healing rate and Amputation-free survival of patients undergoing Endo-vascular theraphy (EVT) for failing distal bypass vein grafts done between 2009 and 2019 at a single centre in Japan. A retro-spective analysis of 113 “failing”distal vein grafts (94pts, 113 limbs) after distal bypass done between 2009 and 2019 was taken up. Of the 113 failing grafts based on Duplex ultra-sound criteria, 54 grafts (48%) were detected in asymptomatic patients, 41 grafts (36%) in patients with recurrent ulcer or gangrene and 18 grafts (16%) in patients with rest pain. The failing grafts were treated by low pressure long inflation balloon angioplasty with a mean balloon size of 3.0_+0.8mm, procedural success was 98%(111grafts), During a mean follow-up time of 34 months, EVT was done for a median frequency of 2 times, sometimes upto a maximum of 11 times. The primary and assisted primary patency of EVT revised grafts were 41% and 80% at one year, 34% and 68% at 3 years, 31% and 58% at 5 years respectively. Of the 41 limbs with a recurrent ulcer or gangrene, wound healing was achieved in 34 limbs (85%). Only 8 patients required major amputation and AFS at one year was 96% and 80% at 5 years.

The paper concludes that though surgical revascularization is the standard of care in patients with failing grafts, EVT could be a viable alternative to surgical revascularization in patients with a failing distal bypass graft for CLTI. The study has a few limitations being a single center, retrospective, small volume study with a shorter follow up period and newer technologies like Drug coated balloons were not used in this study (Not approved in Japan yet), The quality of the autogenous veins were also not evaluated.

4. External applicability of the COMPASS and VOYAGER-PAD trials on patients with symptomatic lower extremity artery disease in France-The COPART registry

Francois-Xavier Lapebie et al, Dept of vascular medicine, Toulouse University spital, Toulouse, France. Eur j Vasc Endovasc Surg (2021) 62-439-449. 20210.05.028.

This was a multi-centre retrospective analysis of prospectively collected COPART data, which is a French multi-center registry of patients, hospitalized for symptomatic lower extremity arterial disease (LEAD). This study aimed at examining the external applicability of the COMPASS and the VOYAGER-PAD trials in patients with LEAD in the real world. Of the 2,259 patients evaluated, only 679 Pts (30.1%) were eligible for low dose Riveroxaban plus Aspirin regimen, others were not eligible because of the need for anti-coagulants, dual anti-platlet use, high bleeding risk, malignancy, history of ischeamic/heamorrhagic stroke and severe renal failure. Those patients who are COMPASS and VOYAGER-PAD eligible and ineligible patients were at higher risk of ischeamic events than participants in these trials. The one-year cumulative –incidence was 6.0%(95% C.I 4.3-8.1) in the COMPASS eligible subject VS 3.5%(95% C.I 2.9-4.3%) in the COMPASS control arm for Major adverse cardio-vascular events (MACE) and 27.9%(C.I 19.9%-38.3%) in the VOYAGER-PAD eligible subset VS 6.0%(95% C.I 5.3-6.9) in the VOYAGER-PAD control arm for Major adverse limb events (MALE).

The study concludes that the higher rates of MALE and major amputations in these patients VS those in the VOYAGER-PAD trial and the higher rates of MACE VS those in the COMPASS trial, these patients may certainly have greater benefits from this regimen in the real world scenario, the ineligible patients represent a high risk population who could have benefitted more from this regimen and which may require further research in the future.

  Venous Top

5. Polidocanol plus Glucose versus Glucose alone for the treatment of Telengiectasias: Triple blind Randomised control trial (PG3T)

Matheus Bertanha et al…Department of surgery and orthopaedics of Batucatu medical school, Sao Paulo state University Julio de Mesquita filho, UNESP, Batucatu, SP, Brazil. Eur J vasc Endovasc Surg (2021) 61,128-135. 20200.07.007.

This is a prospective, randomized, triple-blind, controlled, parallel group trial which aimed to compare the effectiveness and safety of two sclerosing agents namely 0.2% Polidocanol + 70% hypertonic glucose and 75% hypertonic glucose alone, in the management of Telengectasias in the lower limbs. A total of 115 patients were included, among whom 98 completed the study. No severe adverse events were reported in both the groups, pigmentation was the most common minor adverse event particularly in those with STS group and in those who did not wear compression stockings after the procedure. The study concluded that the use of 0.2% Polidocanol +70% hypertonic glucose proved to be safe and had better results than using 75% Hypertonic glucose alone. The limitations of this study include ~1. Single center study with insufficient data size. 2. Doesn't compare with pure liquid polidocanol or “Foam sclerotheraphy” and compression was not used post-procedure.


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