European Journal of Vascular & Endovascular Surgery - Articles in Press

An Expanded Series of Distal Bypass Using the Distal Vein Patch Technique to Improve Prosthetic Graft Performance in Critical Limb Ischemia - Corrected Proof

R.F. Neville, M. Lidsky, A. Capone, J. Babrowicz, R. Rahbar, A.N. Sidawy — 2012-05-17

Abstract: Objectives: The endovascular first approach has led to increasing complexity for surgical bypass especially in those patients without autogenous conduit. The use of vein interposed at the distal anastomosis has been reported to improve the results of prosthetic grafts. This series expands our initial experience with the distal vein patch technique (DVP) reporting a larger cohort with enhanced follow-up.Design: A retrospective review of prospectively collected data was performed for distal bypasses from July 1995 to November 2008.Materials/Methods: 1296 tibial bypasses were performed with 270 using the DVP technique. Patient demographics included; 49% diabetes, 20% chronic renal failure, 33% prior failed bypass. Indications for revascularization were claudication (9.3%), rest pain (27.8%), gangrene (22.2%), and non-healing ulceration (40.7%). Lack of vein for the bypass conduit resulted from previous failed grafts (55%), coronary bypass (18%), poor quality vein (23%), or prior vein stripping (8%). Follow-up ranged from 1 to 48 months with graft surveillance by pulse exam, ABI, and Duplex ultrasound. Primary patency and limb salvage ± SE were determined by Kaplan–Meier life-table analysis using Rutherford criteria.Results: Bypasses originated from the external iliac (29%), CFA (55%), SFA (13%), popliteal (1%), and prior grafts (2%). Recipient arteries were below knee popliteal (6%), anterior tibial (25%), posterior tibial (30%), and peroneal (39%). Perioperative graft failure occurred in 13 cases with a total of 41 graft failures leading to 39 major amputations. Primary graft patency from one to four years was 79.8%, 75.6% 65.9%, and 51.2%. Corresponding limb salvage rates were 80.6%, 78.0%, 75.7%, and 67.5%.Conclusion: Although not addressed by a randomized trial, we believe this expanded series is a more accurate reflection of expected results confirming that the DVP bypass leads to reasonable long-term results for those challenging patients that require prosthetic distal bypass for lower extremity revascularization.

Disease Specific Biomarkers of Abdominal Aortic Aneurysms Detected by Surface Enhanced Laser Desorption Ionization Time of Flight Mass Spectrometry - Corrected Proof

2012-05-17

Abstract: Introduction: Biomarkers have the potential to improve the clinical management of patients with AAA.Report: A prospective, proteomics discovery study was undertaken to compare patients with AAA (n = 20) to matched screened controls (n = 19) for plasma protein expression. Surface-Enhanced-Laser-Desorption-Ionization Time of Flight Mass Spectrometry (SELDI ToF MS) coupled with Artificial Neural Networks (ANN) analysis identified six protein related diagnostic biomarker ions with a combined AUC of 0.89.Discussion: This study discovered a signature plasma protein profile for patients with AAA and demonstrated that mass spectrometric based research for disease specific biomarker of AAA is feasible.

Corrigendum to ‘Inferior Mesenteric Artery Aneurysm with Occlusion of the Superior Mesenteric Artery, Coeliac Trunk and Right Renal Artery’ [Eur J Vasc Endovasc Surg 35 (2008) 312–313] - Corrected Proof

K.L.D. Mandeville, C. Bicknell, S. Narula, S. Renton — 2012-05-17

The authors regret that the patient upon whose case this report is based was erroneously described in the case report as being a heavy smoker. The patient in question was in fact a lifelong non-smoker and the authors regret any assertion to the contrary.

Failure of Sweat Gland Curettage to Relieve Axillary Hyperhidrosis: A Salutary Lesson - Corrected Proof

S.J. Chapman, M.J. Gough — 2012-05-14

Introduction: Several treatment options are available for primary hyperhidrosis. Selection for individual patients is influenced by symptom severity, success rates and the relative risk of compensatory hyperhidrosis.

Endovascular Retrieval of Fragmented Central Venous Access Device Catheters: A Management Protocol Based on Catheter Location - Corrected Proof

S.-F. Ko, C.-K. Sun, C.-T. Kung, S.-H. Ng, C.-C. Huang — 2012-05-14

Introduction: Fragmented central venous access device (CVAD) catheters can be retrieved percutaneously but a pertinent approach for catheters in various locations has not been addressed.

Multi-center Experience of 164 Consecutive Hemodialysis Reliable Outflow [HeRO] Graft Implants for Hemodialysis Treatment - Corrected Proof

2012-05-14

Abstract: Objective: To report a multi-center experience with the novel Hemodialysis Reliable Outflow (HeRO) vascular access graft.Materials and methods: Four centers conducted a retrospective review of end stage renal disease patients who received the HeRO device from implant to last available follow-up. Data is available on 164 patients with an accumulated 2092.1 HeRO implant months.Results: At 6 months, HeRO primary and secondary patency is 60% and 90.8%, respectively and at 12 months, 48.8% and 90.8%, respectively. At 24 months, HeRO had a primary patency of 42.9% and secondary patency was 86.7%. Interventions to maintain or re-establish patency have been required in 71.3% of patients (117/164) resulting in an intervention rate of 1.5/year. Access related infections have been reported in 4.3% patients resulting in a rate of 0.14/1000 implant days.Conclusions: In our experience the HeRO device has performed comparably to standard AVGs and has proven superior to TDCs in terms of patency, intervention, and infection rates when compared to the peer-reviewed literature. As an alternative to catheter dependence as a means for hemodialysis access, this graft could reduce the morbidity and mortality associated with TDCs and have a profound impact on the costs associated with catheter related infections and interventions.

Commentary on ‘The Impact of Decreasing Abdominal Aortic Aneurysm Prevalence on a Local Aneurysm Screening Programme, Darwood RJ, et al.’ - Corrected Proof

J.J. Earnshaw — 2012-05-14

This manuscript describes a theoretical model of a future local screening programme. It could, however, apply to anywhere in England at the moment. The NHS AAA Screening Programme (NAAASP) is currently implementing in England, with similar national programmes on the way in Scotland, Wales and Northern Ireland.

Hemodynamic Changes after Eversion Carotid Endarterectomy: A Reason for Concern? - Corrected Proof

P. De Rango — 2012-05-14

Eversion and reimplantation of internal carotid artery (ICA) was the latest technique introduced to perform carotid endarterectomy (CEA) different from the conventional CEA (cCEA) based on patch or primary closure. The two main preliminary concerns that initially prevented the extensive implementation of eversion CEA (eCEA), related to 1. the potential of leaving behind an unsafe carotid distal endpoint and 2. injuring cranial nerves (due to the peculiar extensive ICA dissection required with eCEA), were rapidly overcome as familiarity with the technique increased. Since the nineties eCEA has been extensively used as a comparable valid alternative to cCEA. Nevertheless a third relevant, still ongoing, distinctive issue between the two techniques relies on the differential effect after removal of the carotid atheroma with and without preservation of carotid sinus nerve during cCEA and eCEA respectively. Baroreflex sensitivity is suggested to increase after cCEA due to improved vessel compliance after plaque removal. Oppositely, the destruction of baroreceptor apparatus (carotid sinus nerve) during ICA dissection and transection required with eCEA, may likely result in decreased baroreceptor sensitivity and increased postoperative blood pressure values as suggested by Demirel et al. in this issue of EJVES. With a prospective study Demirel et al. compared 37 eCEA and 27 cCEA for hemodynamic changes and showed that eCEA was associated with significantly increased systolic (p = 0.01), diastolic (p = 0.008) and mean (p = 0.03) blood pressure, and higher heart rate (p = 0.03) values on postoperative day 1 when compared to cCEA. Furthermore, baroreflex sensitivity increased after cCEA but dropped significantly after eCEA with changes persisting on the third postoperative day even tough there was a trend toward recovery.

The Impact of Decreasing Abdominal Aortic Aneurysm Prevalence on a Local Aneurysm Screening Programme - Corrected Proof

R.J. Darwood, M.J. Brooks — 2012-05-11

Abstract: Objectives: The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP), based on the Multicentre Aneurysm Screening Study (MASS) trial (2002), is being introduced across the UK. Recent studies have demonstrated a decline in prevalence of abdominal aortic aneurysm (AAA). The aim of this study was to examine the effect of this on screening workload.Methods: A model was developed to predict screening and surgical workload for a screening centre (Bristol – population 1,123,203). Workload was compared using data from MASS with data from the “Early Implementers” (EI) of NAAASP.Results: Modelling for 2011/2012 using EI data predicted significantly fewer men diagnosed with an AAA compared to MASS data [84 (EI) versus 198 (MASS) p < 0.0001] and fewer referrals to a vascular surgeon for AAA repair [10 (EI) versus 30 (MASS) p = 0.0002). This difference became more marked with time (2015/16: 90 (EI) versus 212 (MASS) men diagnosed with an AAA (p < 0.0001) and 29 (EI) versus 71 (MASS) referred to a vascular surgeon (p < 0.0001)). From 2015/16 there was also a significant reduction in the predicted number of ultrasound scans.Conclusions: Modelling screening activity based on contemporary epidemiological data demonstrates a significant reduction in workload compared to MASS data. This has implications for workforce planning, the introduction of new screening centres and the future of NAAASP.

ADSORB: A Study on the Efficacy of Endovascular Grafting in Uncomplicated Acute Dissection of the Descending Aorta - Corrected Proof

J. Brunkwall, J. Lammer, E. Verhoeven, P. Taylor — 2012-05-10

Abstract: Acute dissection of the descending thoracic aorta carries a 30-day mortality of around 10% with best medical treatment (BMT). In addition, about 25% will develop an aneurysm during the following 4–5 years.This is the first ever randomised trial on acute dissections comparing BMT with BMT and stent grafting of the proximal tear in patients having an uncomplicated acute dissection of the descending aorta. The commonly used temporal definition of acute dissection being within 14 days of onset of symptoms is applied.A total of 61 patients will be randomised and followed at regular intervals (1, 3, 6, 12, 18, 24, 30 and 36 months) after acute dissection. Thrombosis of the false lumen, aortic enlargement and rupture are the primary end points.The study will examine whether aortic remodelling occurs after stent grafting in acute type B dissections, and its effect on aneurysm formation, rupture and re-intervention.

Eversion Carotid Endarterectomy is Associated with Decreased Baroreceptor Sensitivity Compared to the Conventional Technique - Corrected Proof

S. Demirel, L. Macek, H. Bruijnen, M. Hakimi, D. Böckler, N. Attigah — 2012-05-10

Abstract: Objective: Impairment of baroreceptor sensitivity (BRS) has been shown to be associated with blood pressure instability after carotid endarterectomy (CEA). The aim of this study was to determine whether there is a difference in postoperative BRS changes following eversion CEA (E-CEA) and conventional CEA (C-CEA).Methods: Sixty-four patients undergoing E-CEA (n = 37) and C-CEA (n = 27) were prospectively studied. Non-invasive measurements of mean arterial pressure (MAP), cardiac output (CO) and total peripheral resistance (TPR) were perioperatively obtained over three 10-min periods. Baroreflex gain was calculated as the sequential cross-correlation between heart rate and beat-to-beat systolic blood pressure.Results: Compared with changes observed after C-CEA, E-CEA was associated with an increase in systolic pressure (SP) (P = 0.01), diastolic pressure (DP) (P = 0.008), MAP (P = 0.002) and heart rate (HR) (P = 0.03) on postoperative day 1 (POD-1). BRS decreased after E-CEA from 6.33 to 4.71 ms mmHg−1 on POD-1 (P = 0.001) and to 5.26 ms mmHg−1 on POD-3 (P = 0.0004). By contrast, BRS increased after C-CEA from 4.59 to 6.13 ms mmHg−1 on POD-1 (P = 0.002) and to 6.27 ms mmHg−1 on POD-3 (P < 0.0001).Conclusion: E-CEA and C-CEA have different effects on BRS. This is associated with an altered haemodynamic behaviour after E-CEA and C-CEA, respectively. These findings are likely the result of carotid sinus nerve interruption during E-CEA and preservation with C-CEA.

Ultrasound-guided Locoregional Anaesthesia for Carotid Endarterectomy: A Prospective Observational Study - Corrected Proof

R. Martusevicius, F. Swiatek, L.G. Joergensen, H.B. Nielsen — 2012-05-04

Abstract: Introduction: Ultrasound guidance is increasingly used for invasive anaesthetic procedures to improve efficacy, facilitate performance and reduce risk of complications. Herein, we present a simple approach to ultrasound-guided locoregional anaesthesia for patients undergoing eversion carotid endarterectomy.Methods: At the level of the base of the carotid bifurcation, the needle was inserted at the lateral border of the sternocleidomastoid muscle and, guided by ultrasound, advanced 0.5–1 cm posterolateral to the carotid artery, where ropivacaine (7.5 mg ml−1) was injected. During retraction of the needle, additional local anaesthetic was administered beneath the sternocleidomastoid muscle and, finally, subcutaneous infiltration along the surgical incision line was performed.The primary study end point was the amount of additional ropivacaine (7.5 mg ml−1) provided intra-operatively. Secondary measures included the occurrence of puncture-related complications and the adverse effects to locoregional anaesthesia.Results: Sixty consecutive patients admitted for primary carotid endarterectomy were prospectively included. The volume of administered ropivacaine for locoregional anaesthesia and subsequent intra-operative supplementation was 31.7 ± 3.5 and 1.9 ± 2.5 ml, respectively. There were no conversions to general anaesthesia. Intravascular or subarachnoid injection of local anaesthetic did not occur, and symptoms of local anaesthetic systemic toxicity did not present. Related to the blockade, hoarseness (72%), Horner syndrome (37%), cough (20%), facial palsy (13%) and dysphagia (12%) were observed and resolved on the first postoperative day.Conclusions: This observational study demonstrates that the described ultrasound-guided locoregional anaesthesia is suitable for eversion carotid endarterectomy and the amount of supplemental anaesthetic during the surgery is low.

Extravascular Injection of Sclerotic Agents does not Affect Vessels in the Rat: Experimental Implications for Percutaneous Sclerotherapy of Arteriovenous Malformations - Corrected Proof

D. Sato, M. Kurita, M. Ozaki, N. Kaji, A. Takushima, K. Harii — 2012-04-30

Abstract: Objectives: Sclerotherapy is useful for the treatment of arteriovenous vascular malformations. However, intravascular administration of sclerotic agents into small arteriovenous niduses is often difficult. Extravascular administration of sclerotic agents causes reduction of vascular flow on Doppler echo during clinical sclerotherapy. Therefore, we aimed to investigate whether the extravascular injection of sclerotic agents affects tiny vessels.Design: Animal study.Materials: The effect of extravascular injection of sclerotic agents on vessels was investigated using rat femoral and superficial inferior epigastric vessels.Methods: After surgical exposure of vessels, absolute ethanol, 5% ethanolamine oleate and 3% polidocanol were injected into perivascular surrounding tissues, and their effect on vessels was evaluated after 14 days using histology and coloured silicone rubber injection.Results: The integrity of the vascular lumen, endothelial cells and vascular patency were not affected by injection of sclerotic agents.Conclusions: Attenuation of vascular flow of an arteriovenous shunt after extravascular injection of sclerotic agents is transient and/or trivial and does not cause disruption of vessels. Therefore, sclerotic agents should be delivered to obtain sufficient destruction of arteriovenous malformation lesions and blood flow.

Response to Commentary on ‘Factors Influencing Wound Healing of Critical Ischaemic Foot after Bypass Surgery: Is the Angiosome Important in Selecting Bypass Target Artery?’ - Corrected Proof

N. Azuma — 2012-04-30

We would like to thank the authors of the letter for their pertinent comments on our manuscript. We fully agree that CLI treatment cannot be accomplished by surgery alone and recognise the importance of postoperative care, including wound management and medication. In our manuscript, we emphasise that healing ischaemic wounds is not easy, even after successful revascularization, because of the impaired wound healing ability and impaired immune system of compromised patients, such as those with diabetes or end-stage renal disease (ESRD).

Commentary on ‘ADSORB: A Study on the Efficacy of Endovascular Grafting in Uncomplicated Acute Dissection of the Descending Aorta’ - Corrected Proof

M.T. Voûte, F. Bastos Gonçalves, H.J.M. Verhagen — 2012-04-30

We would like to congratulate the ADSORB trialists with the initiative of the much awaited trial on management of acute type B aortic dissections. Many of us in the vascular community are looking forward to hearing the answers ADSORB set out to provide. The trial design printed in this Journal is well written, but it does raise a few methodological questions.

Commentary on ‘A Scoring System (DISTAL) for Predicting Failure of Snuffbox Arteriovenous Fistulas’ - Corrected Proof

L.M. Harris — 2012-04-30

Snuffbox fistulas are uncommonly performed by most access surgeons. There are only 8 reports in the literature, by search of HUBNET, over the last 30 years referencing this access, despite relatively good results reported in all series. The fistula first initiative and updated 2006 K-DOQI guidelines do not even mention snuffbox fistulas as an alternative access site. The UK Renal Association guidelines strongly recommend the use of arteriovenous fistula over graft, however, do not discuss any specific access sites. Dr Twine and colleagues suggest that approximately 50% of their patients would be potentially suitable for snuffbox fistulas, and undertook such a fistula in about 25% of their patients. They present a scoring system to assess failure of snuffbox fistulas.

Antegradly Performed TEVAR - Corrected Proof

O. Gokalp, L. Yilik, S. Gur, T. Gunes, A. Gurbuz — 2012-04-30

We congratulate the authors for their work on the incidence of stroke in thoracic endovascular aortic replacement (TEVAR) due to arcus aorta aneursyms. We wonder if TEVAR,performed in 32 patients in whom zone 0 was intervened, was performed in the same sitting with surgical intervention to ascending aorta. We would like to know how TEVAR was performed if TEVAR was carried out in the same session. That's because if TEVAR is performed in the same session as surgical procedure it can be done antegradely from ascending aorta rather than the retrograde technique in which femoral artery is utilized. In this technique a 8-mm graft is anastomosed to ascending aorta or the graft interposed to ascending aorta. TEVAR is performed antegradely with this 8-mm graft. Performing this procedure by antegrade route provides such advantages as avoiding complications likely to develop in the iliofemoral artery used as the site of access during the procedure and ensuring sufficient length in order for the endograft deployment systems to reach the landing zones. Moreover, presence of shorter carrier systems in the antegrade approach will cause delivery of less rotational power, thus providing maximum precision in the placement of the graft. Another advantage is that antegrade approach permits manual manipulations of the endograft in order to fit it to a desired position in the aortic arch, thanks to the open sternum. Apart from that, there appears to be a risk of entering the false lumen in the femoral or iliac arteries upon using the retrograde route especially in dissection cases. Under the light of this knowledge we feel that it is essential to keep in mind that TEVAR can be antegradely done too, particularly in cases with thoracic aorta aneursyms where sternum is opened.

Strengths and Limits of Risk Stratification Models in Vascular Surgery - Corrected Proof

P. Kolh — 2012-04-30

As older patients with significant comorbidities are increasingly undergoing elective open or endovascular repair to prevent abdominal aortic aneurysm (AAA) rupture, accurate preoperative stratification of the operative risk is of major importance. In fact, AAA surgery is associated with variable postoperative mortality and morbidity rates, related to the invasive nature of surgery, the frequent existence of severe comorbidities, the experience of surgeons and anaesthesiologists caring for the patients, and the hospital procedural volume. The prognostic weight of each of these factors remains controversial and difficult to measure although numerous operative risk scores have been developed, mostly to assess the impact of comorbidities on short-term results. The widespread use of these risk scores has been hampered by their complexity, lack of validation in larges studies or low accuracy.

Risk Factors and Possible Mechanisms of Intravenous Port Catheter Migration - Corrected Proof

2012-04-23

Abstract: Objective: To identify the risk factors for catheter migration and demonstrate possible mechanisms of this migration.Design: Retrospective study.Setting: Chang Gung Memorial Hospital, a tertiary medical centre in Taiwan.Patients: Patients who underwent implantation of intravenous ports via the superior vena cava (SVC).Interventions: Procedures involving catheter placement and re-intervention for catheter migration.Main outcome measures: The anatomic location of the catheter tip was confirmed by plain chest X-rays (postero-anterior view). From these plain radiographs, the distance (in cm) between the carina and catheter tip and the angle (in degrees) between the locking nut and catheter were measured.Methods: A total of 1542 procedures related to intravenous port implantation were retrospectively reviewed but only procedures involving implantation via the SVC were included in the analysis. The study group was composed of 31 interventions because of catheter migration, while the control group consisted of 1475 implantation and re-intervention procedures except those involving catheter migrations.Results: Shallow catheter-tip location (p < 0.0001) and the presence of lung cancer (p = 0.006) were risk factors for catheter migration.Conclusions: Shallow catheter-tip location and the presence of lung cancer are risk factors for catheter migration. Strategies that ensure low catheter-tip location and avoid increased thoracic pressure may be useful preventive measures.

A Case of Iatrogenic Ilio-iliac Arteriovenous Fistula Initially Mistaken for Deep Venous Thrombosis - Corrected Proof

X. Liu, M. Lu, H. Shi, M. Jiang — 2012-04-23

Deep venous thrombosis (DVT) and associated complications cause significant morbidity and mortality in orthopedic surgery. Typical DVT symptoms, such as swelling, pain and discoloration in the affected extremities are often unreliable for diagnosis. Here we report a rare case of iatrogenic ilio-iliac arteriovenous fistula (AVF) due to lumbar discectomy, which was initially misdiagnosed as DVT, resulting in unnecessary implantation of a permanent inferior vena cava filter. Endovascular treatment is an attractive treatment option for such an AVF. We recommend a thorough physical and ultrasonography for patients presenting with DVT-like symptoms, especially following lumbar spinal surgery, to prevent overlooking underlying AVF.

Corrected Proof

M. Vega de Ceniga — 2012-04-23

What would I expect from a book about complications in vascular surgery? I would look forward to reading about early and late complications, about both intraoperative management and decision making when facing complications outside the operating room, about well-known procedure complications and rare honest blunders. This book includes all of the above.

Risk Stratification Scores in Elective Open Abdominal Aortic Aneurysm Repair: Are They Suitable for Preoperative Decision Making? - Corrected Proof

G.J. Bryce, C.J. Payne, S.C. Gibson, D.B. Kingsmore, D.S. Byrne, C. Delles — 2012-04-23

Abstract: Objectives: Risk indices help quantify the risk of cardiovascular events and death prior to making decisions about prophylactic AAA repair. This paper aims to study the predictive capabilities of 5 validated indices.Design and methods: A prospective observational multi-centre cohort study from August 2005 to September 2007 in Glasgow recruited 106 consecutive patients undergoing elective open AAA repair. The Glasgow Aneurysm Score (GAS), Vascular physiology only Physiological and Operative Severity Score for enUmeration of Mortality (V(p)-POSSUM), Vascular Biochemical and Haematological Outcome Model (VBHOM), Revised Cardiac Risk Index (RCRI) and Preoperative Risk Score of the Estimation of Physiological Ability and Surgical Stress Score (PRS of E-PASS) were calculated. Indices were compared using receiver operating characteristic (ROC) analysis and area under the curve (AUC) estimates. End points were all-cause mortality, Major Adverse Cardiac Events (MACE) and cardiac death.Results: GAS, VBHOM and RCRI did not predict outcome. V(p)-POSSUM predicted MACE (AUC = 0.681), cardiac death (AUC = 0.762) and all-cause mortality (AUC = 0.780), as did E-PASS (AUC = 0.682, 0.821, 0.703 for MACE, cardiac death and all-cause mortality respectively).Conclusion: Whilst V(p)-POSSUM and E-PASS predicted outcome, the less complex RCRI and GAS performed poorly which questions the utility of decision making based on these surgical risk indices.

A Systematic Review of the Role of Cardiopulmonary Exercise Testing in Vascular Surgery - Corrected Proof

2012-04-23

Abstract: Objective: To perform a systematic review of cardiopulmonary exercise testing (CPET) in the pre-operative evaluation of patients with abdominal aortic aneurysm or peripheral vascular disease requiring surgery.Methods: Review methods and reporting were according to the PRISMA guidelines. Studies were eligible if they reported CPET-derived physiological parameters in patients undergoing abdominal aortic aneurysm repair or lower extremity arterial bypass. Data were extracted regarding patient populations and correlation between CPET and surgical outcomes including mortality, morbidity, critical care bed usage and length of hospital stay.Results: The searches identified 1301 articles. Although 53 abstracts referred to the index vascular procedures, only seven articles met inclusion criteria. There were no data from randomised controlled trials. Data from prospective studies did not comprehensively correlate CPET and surgical outcomes in patients with abdominal aortic aneurysms. There were no studies reporting CPET in patients undergoing lower extremity arterial bypass. Major limitations included small sample sizes, lack of blinding, and an absence of reporting standards.Conclusion: The paucity of robust data precludes routine adoption of CPET in risk stratifying patients undergoing major vascular surgery. The use of CPET should be restricted to clinical trials and experimental registries, reporting to consensus-defined standards.

ADSORB: A Prospective Randomised Study on the Efficacy of Endovascular Grafting vs. Best Medical Treatment in Uncomplicated Acute Dissection of the Descending Aorta - Corrected Proof

R.J. Hinchliffe, M.M. Thompson — 2012-04-23

Many of the arterial lesions that vascular surgeons treat are on the decline, and those that currently are may soon be offered more effective drug therapy. In contrast, dissections of the aorta are increasing and are likely to represent a significant future workload and challenge for vascular surgeons. Traditionally acute Stanford type B dissections of the aorta were managed by a variety of specialists, often cardiologists. Vascular surgeons only became involved where peripheral ischaemia supervened.

A Scoring System (DISTAL) for Predicting Failure of Snuffbox Arteriovenous Fistulas - Corrected Proof

C.P. Twine, M. Haidermota, J.D. Woolgar, C.P. Gibbons, C.G. Davies — 2012-04-18

Abstract: Objectives: A first fistula failing will lead to serious morbidity in a proportion of patients. Snuffbox fistulas have the advantage of proximal vessel preservation, and although several factors have been associated with failure, the relative importance of these factors combined and their clinical applicability is unknown. The aim of this study was to determine the relative importance of risk factors for snuffbox fistula failure and create a simple scoring system to aid fistula placement decision making.Methods: 218 consecutive patients were examined using Cox regression analysis to determine risk factors for failure. Primary patency was used as the endpoint.Results: Diabetes, IHD, Stroke, Two snuffbox procedures, Age > 70 and Less than 2.0 mm vein (DISTAL, maximum score 6) were significant predictors of primary patency failure. There was a clear decrease in primary patency with increasing DISTAL score (log rank χ2 = 30.3, DF = 5, P < 0.001). Performing snuffbox procedures on patients with a score ≤3 would give a 23% reduction in the number of failures within two months for a 12% reduction in the number of patients offered snuffbox procedures.Conclusion: The DISTAL scoring system could give large improvements in primary patency for the snuffbox fistula if the results can be validated in other datasets.

WITHDRAWN: Rationale and Design of a Randomised Controlled Trial Comparing Stent-Protected Angioplasty with Bypass Surgery for Intermittent Claudication: The ABC Study - Corrected Proof

2011-07-27

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.