|Year : 2022 | Volume
| Issue : 4 | Page : 337-338
|Date of Web Publication||8-Nov-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Anthology-11. Indian J Vasc Endovasc Surg 2022;9:337-8
Compiler & Reviewer: Dr. P.Ilaya kumar, Chennai.
| Carotids|| |
1. Timing of carotid intervention in symptomatic carotid artery stenosis: A Systematic Review and Meta-analysis
Andreia Coelho, A.Ross Naylor et al.
Department of Angiology and Vascular Surgery Centre Hospitalor Universitono do Porto, Portugal.
https://doi.org/10.1016/j.ejvs.2021.08.021. Eur J Vasc Endovasc Surg(2022)63,3-23.
This is a systematic review and meta-analysis aimed to analyse the timing of carotid endarterectomy(CEA) and carotid artery stenting(CAS) after the index event and 30-day outcomes in various periods within 14 days of symptom onset. The end-points analysed include procedural stroke and/or death, including delay from the index event and the technique used (CEA vs CAS). Around 71 studies were analysed with 232,952 symptomatic patients undergoing CEA/CAS in different time frames (<2/3-14/< 7 days vs 8-14 days). Results showed that CAS compared with CEA was associated with a higher 30-day stroke(OR 0.70:95%CI 0.58-0.85) rate, Increased mortality CEA vs 3-14 days had a 30-day stroke rate of 1.4% vs 1.8% (No statistical significance). Early CAS had no difference in stroke rate but increased mortality rate(OR 2.76%). Previous ESVS 2017 guidelines advised CEA within 14 days of the index event, another SR showed recurrent stroke rate can vary from 6% within 7 days and up to 26% within 14 days of the index event. The authors conclude that CEA is safer than trans-femoral CAS if done within 2-7 days of symptoms onset(TCAR data is not available for CAS <14 days) and the ideal timing for performing CAS is not yet defined.
| Aorta|| |
2. Fifteen years of single centre experience with in-situ reconstruction for infected native aortic aneurysms
Xavier Berard M.D,Ph.d et al.
Department of vascular surgery, Bordeaux university hospital, Bordeaux, France.
https://doi.org/10.1016/j.jvs.2021.08.094. J vas Surg 2022:75:950-61
This is a single centre, retrospective observational study which evaluated the survival and freedom from re-infections for patients with infected native aortic aneurysms(INAA)treated with insitu revascularization(ISR) by open surgical repair(OSR) vs Endovascular aneurysm repair(EVAR)and to identify the prediction of outcome. A total of 65 patients were included, the most common location was infra-renal(60.0%)54 patients underwent OSR with ISR and 8 patients underwent EVAR as a definitive procedure and 3 patients underwent EVAR before ISR. The approach was by mid-line laparotomy followed by reconstruction, and aortic-aortic/prosthetic bypass(Silver and Triclosan Dacron graft). The 30-day mortality rate was 6.2% and 10% with a median follow-up of 33.5 months. The 1 year/5 year survival rates were 79% and 67.4%. The freedom from re-infection rates was 92.5%. The in-hospital mortality increased with 1)Uncontrolled sepsis 2)rapidly expanding aneurysms 3)Fusiform aneurysms and increased reinfection with longer operating times. The use of prescribed diagnostic criteria, selective use of ISR and OSR, combined with targeted anti-microbial therapy and proper follow-up will help to treat this complex entity.
3. Long-term outcomes associated with open vs Endovascular Abdominal Aortic Aneurysm Repair in medicare -matched Database
Kevin Yei,B S, Asma Mathlouthi MD et al. doi:10.1001/jamanetworkopen.2022.12081.
This is a cohort study of 32,760 abdominal aortic aneurysm repairs in a medicare-matched database which compared the long-term outcomes of endovascular(EVAR) vs open surgical repair of abdominal aortic aneurysm(OSR). Patients undergoing first-time elective endovascular or open abdominal aortic aneurysm repair from 2003 to 2018 were propensity-matched. The primary long-term outcome of interest was 6-yr all-cause mortality, rupture and re-intervention. Secondary outcomes include 30 -day mortality and perioperative complications. Out of the total 32,760 patients, 28,281 patients underwent endovascular repair and 479 patients underwent open repair. The study noted 1) OSR patients had lower 6-yr mortality compared with EVAR (35.6% vs 41.2%).HR ,0.83:95%CI 0.74-0.94;P=.002).2)Open repair had significantly lower rates of ruptures (6 years)5.8% vs8.3% (EVAR) HR,0.76%:95%CI.0.60-0.97;p<.001. and re-intervention,11.6% vs 16%;HR 0.67;95%CI 0.55-0.80;p<.001. However Open repair had higher rates of 30-day mortality (OR,3.56;95%CI 2.41-5.26,p<.001 and morbidity compared with EVAR. The authors concluded that overall mortality after elective AAA repair(Ruptured AAA not taken up in this study)was higher with EVAR than OSR despite reduced 30-day mortality and morbidity after EVAR and was associated with significantly higher rates of long-term rupture and re-interventions and emphasised the need for careful patient selection and long time follow-up.
| Peripheral Arteries|| |
4. Pedal arterial calcification score is associated with the risk of major amputation in chronic limb-threatening ischemia
Iris H.Liv BA et al..
Department of Surgery, University of California, San Francisco.
https://doi.org/10.1016/j.jvs.2021.07.235. J Vasc Surg 2022:75:270-8.
This is a single-centre, retrospective cohort study, which looks at a new scoring system based on pedal vessel calcification for assessing the risk of amputation in pts with CLTI. The Medial arterial calcification(MAC) uses a minimum two-view plain foot radiograph following successful infra-inguinal revascularization with 1 point each for calcification of >2cm in Dorsalis pedis, Plantar and metatarsal arteries and >1cm in Hallux and non-Hallux digital arteries. A MAC score of 5:HR,4.9:95%CI 1.19-13.1,p,.001 has a higher risk of major amputation. Male sex, DM, ESRD and the GLASS(Global Anatomical Staging System)Pedal score were independently associated with a high MAC score. The authors conclude that the MAC score along with the WIfi staging system can help improve outcomes stratification and treatment planning in patients with CLTI.
| Venous|| |
5. No Benefit in wearing compression stockings after Endovenous Thermal Ablation of Varicose veins.A Systematic Review and meta-Analysis
Huanvui HU et al,
Department of vascular surgery and National clinical research centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
https://doi.org/10.1016/j.ejvs.2021.09.034. Eur j vasc Endovasc surg(2022)63,103-111.
This is a meta-analysis of seven RCTs done to investigate whether compression stockings are necessary after endo-venous Thermal Ablation of varicose veins(EVTA). A total of seven RCTs consisting of 1,146 patients were included. Wearing compression stockings was co-related with lower postoperative pain scores however there was no significant improvement in 1)Quality of life 2)Incidence of complications 3)time to return to work4) or Target vein occlusion rates. The authors concluded that after EVTA wearing of compression stockings was not associated with a better outcome except for mild pain relief, so wearing compression stockings after EVTA may not be necessary as per this study.
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