|ANTHOLOGIES IN VASCULAR SURGERY-10
|Year : 2022 | Volume
| Issue : 2 | Page : 207-208
Anthologies in vascular surgery-10
|Date of Web Publication||13-Jun-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthologies in vascular surgery-10. Indian J Vasc Endovasc Surg 2022;9:207-8
Compiler & Reviewer: Dr.P.Ilaya kumar, Chennai.
| Carotids|| |
1. Good results of transcarotid artery revascularization are mainly due to flow reversal
Juan c. Parodi, MD, FACS (Hons), Buenes Aires,Argentina.
Department of surgery, University of Buenes Aires. J Vasc surg 2021:73:743-4.
The article highlights the fact that Transcarotid artery revascularization(TCAR) has better outcomes compared to Transfemoral carotid artery stenting(TFAS) and attributes it mainly to “flow reversal” rather than the Trans-cervical approach, the author further outlines the various types of devices his team used for “flow reversal” even before the Gore Flow reversal system became available with subtle modifications like using the CCA as an input and the IJV as the outflow(rather than the Femoral vein).They used the Mo.Ma device and the ArteriA system for flow reversal and used them in selected cases only,like in Type III arch,Intimal surface irregularities or arch ulcers,interesting inputs form the master of EVAR.
| Aorta|| |
2. Cohort study examining the association between Abdominal aortic size and major adverse cardio-vascular events in patients with aortic and peripheral occlusive and aneurysmal disease
Jonathan Golledge, Ramesh Velu et al., Queensland research centre for peripheral vascular disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. Eur J Vasc Endovasc Surg(2021) 62,960-968.
The predictive value of abdominal aortic diameter in patients with established vascular disease is unknown ,this study aimed to examine whether there was an independent association between abdominal aortic diameter,size index and height index and risk of major adverse events in patients referred for various types of Aortic and Peripheral Occlusive and Aneurysmal Disease(APOAD).
A total of 1752 patients with a APOADs were recruited prospectively from 2002 to 2020,maximum abdominal aortic diameter,aortic size index(aortic diameter in relation to body surface area) and aortic height index(aortic diameter relative to height) as measured by ultrasound at the time of recruitement and followed up for a period of approximately 4.6 years,outcome events including major adverse cardio-vascular events(MACE),peripheral artery surgery,Abdominal aortic aneurysms(AAA) events(rupture or repair) and all cause mortality was analysed. The association between aortic size and events was assessed using cox proportional hazard analysis and the ability of aortic size to improve risk of events classification was assessed using Net reclassification Index(NRI).
The study found that larger aortic diameter was associated with an increased risk of MACE (Hazard ratio (HR)1.17,95%C.I(1.05-1.31),for peripheral arterial surgery(HR) 2.05,95% CI( 2.77-3.26) and all cause mortality(HR) 1.20,95%(1.08-1.32).The findings were similar for aortic size and aortic height indices and according to NRI except for MACE all 3 aortic size measures had a significant improvement of classification of risk of peripheral artery surgery and AAA events.
And thus aortic size index and not aortic diameter or aortic height index significantly improved the classification of all cause mortality risk.The paper concludes that large abdominal aortic diameter,size index and height index are independently associated with an increased risk of major adverse events in patients with established PAD.
| Peripheral|| |
3. Comparison of femoro-popliteal balloon angioplasty for chronic limb-threatening ischeamia in the BASIL trial and in a contemporary series
Lewis Meecham MBBCH and Andrew W. Bradbury M.D, University of Birmingham, Birmingham, U.K. J vasc surg 2021:74:1948-55.
There is a general shift to an endo-vascular first strategy in the management of chronic Limb threatening ischeamia, however this may not be appropriate as found out by the authors ,who compared important clinical outcomes following Femoro-popliteal plain balloon angioplasty(FP-PBA) with selective use of bare metal stents(BMS) in a contemporary series(CS) of patients in their unit between 2009-2014 with those observed in the Bypass VS Angioplasty in severe ischeamia of the leg(BASIL-1)treated in 1999-2004. Baseline and clinical outcome data(amputation free survival(AFS),overall survival(OS),limb salvage,freedom from major adverse limb events were obtained retrospectively and also from BASIL-1 case record forms.The study found worse AFS and OS in the contemporary series of patients compared to the BASIL trial.This study had some limitations in that it is a retrospective non-randomized study,WIFI(Wound Ischeamia,Foot infection)scoring system did not exist at the time of study and Paclitaxal DCB's,DES or atherectomy devices were not used.
The authors concluded through their data that despite advances in endovascular technologies and skills overall outcomes do not support a shift to an endo-vascular first strategy for treating CLTI,Vein Bypass should still be considered the gold standard treatment till the results of the BASIL-3 and the BEST-CLI trial results are out.
4. Effects of Statin theraphy and dose on cardio-vascular and limb outcomes in peripheral arterial disease: A systematic review and meta-analysis
Samiek Sofat et al., Eur J Vasc Endovasc Surg(2021)62,450-461.
Various guidelines recommend statin theraphy in patients with peripheral arterial disease(PAD) and the NICE guidelines do recommend “High Intensity statins” a total of 22 observational cohort studies and 2 randomized control trials from January 1957 until February 2020 measuring statin use and outcomes as per the PRISMA criteria. Outcomes include all cause mortality(ACM),cardio-vascular mortality(CVM),major adverse cardiac events(MACE) and amputation.
The study found that statin theraphy VS No statin theraphy was significantly protective for ACM,MACE and amputation.High dose statins was significantly protective against ACM but less so in preventing MACE and amputations were less with high dose statins.The paper concludes that high dose statins provide significant improvement in patient outcomes especially in ACM and amputations and recommends larger PAD specific trials with even newer drugs like the PCSK9 inhibitors.
| Venous|| |
5. European Society for vascular surgery(ESVS)2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs
Marianne G. De Maeseneer et al.
The European Society for Vascular Surgery(ESVS)has updated it's 2015 guidelines and deals mainly with CVD of the lower limbs,pathology of the superficial,perforating and deep veins of the lower limbs as well as to abdominal and pelvic venous pathology also.It deals extensively with management of superficial venous and perforator incompetence and on endovenous non-thermal ablation as well.Deep venous pathology,management of venous ulcers,aneurysms of the deep veins ,popliteal entrapment syndrome,pelvic venous pathology and also special patient characteristics together with future prospective and information to lay public are also included.The Gudelines writing committee(GWC) were selected by the ESVS to represent clinicians involved in the treatment of CVD including vascular surgeons,vascular physicians,interventional Radiologists and a Gynaecologist-obstetrician as well.
Overall there are 94 recommendations many upgrades and downgrades too with 65 new recommendations as well . The guidelines however do not cover superficial and deep vein thrombosis(DVT),congenital venous malformations and Venous tumors. The European Society of Cardiology(ESC) system was used to grade evidence(A,Bor C) and strength of each recommendation to be class I,IIa,IIb or III. A must read for all vascular specialists.
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