Editor's Choice Articles
Editor's Choice – A Cost Effectiveness Analysis of Outpatient versus Inpatient Hospitalisation for Lower Extremity Arterial Disease Endovascular Revascularisation in France: A Randomised Controlled TrialThe AMBUVASC trial evaluated the cost effectiveness of outpatient vs. inpatient hospitalisation for endovascular repair of lower extremity arterial disease (LEAD).
Editor's Choice – Regional Versus General Anaesthesia in Peripheral Vascular Surgery: a Propensity Score Matched Nationwide Cohort Study of 17 359 Procedures in DenmarkCardiopulmonary comorbidity is common in vascular surgery. General anaesthesia (GA) may impair perfusion and induce respiratory depression. Regional anaesthesia (RA), including neuraxial or peripheral nerve blocks, may therefore be associated with a better outcome.
Editor's Choice – Percutaneous Access Does Not Confer Superior Clinical Outcomes Over Cutdown Access for Endovascular Aneurysm Repair: Meta-Analysis and Trial Sequential Analysis of Randomised Controlled TrialsTo investigate whether a percutaneous approach has better clinical outcomes than surgical access for standard endovascular repair of abdominal aortic aneurysms.
Editor's Choice – Comprehensive Literature Review of Radiation Levels During Endovascular Aortic Repair in Cathlabs and Operating TheatresOccupational exposure is a growing concern among the endovascular specialist community. Several types of imaging equipment are available, such as mobile C arms or hybrid rooms, and some have been shown to deliver higher levels of radiation. A literature review was conducted to identify studies reporting dose data during standard (EVAR) and complex abdominal aortic endovascular repair (fenestrated/branched EVAR [F/BEVAR]).
Editor's Choice – Hospital Incidence, Treatment, and In Hospital Mortality Following Open and Endovascular Surgery for Thoraco-abdominal Aortic Aneurysms in Germany from 2005 to 2014: Secondary Data Analysis of the Nationwide German DRG MicrodataHospital incidence, treatment modality, and in hospital mortality after surgery are reported for thoraco-abdominal aortic aneurysms (TAAAs) treated by endovascular or open means in Germany from 2005 to 2014.
Editor's Choice – Direct vs. Indirect Angiosomal Revascularisation of Infrapopliteal Arteries, an Updated Systematic Review and Meta-analysisThe importance of the angiosome concept in tibial artery revascularisation remains controversial. The aim of this review was to assess the outcomes of direct revascularisation (revascularisation to the angiosome of tissue loss; DR) versus indirect revascularisation (IR) in infrapopliteal arteries.
Editor's Choice – Systematic Review and Meta-Analysis of the Outcome of Treatment for Type II Endoleak Following Endovascular Aneurysm RepairThe efficacy and need for secondary interventions for type II endoleaks following endovascular abdominal aortic aneurysm repair (EVAR) remain controversial. This systematic review aimed at investigating the clinical outcomes of different type II endoleak treatments in patients with a persistent type II endoleak after EVAR.
Editor's Choice – A Comparison of Clinical Outcomes Between Primary Bypass and Secondary Bypass After Failed Plain Balloon Angioplasty in the Bypass versus Angioplasty for Severe Ischaemia of the Limb (BASIL) TrialChronic limb threatening ischaemia (CLTI) is a growing global health problem. The UK NIHR HTA funded BASIL trial is still the only randomised controlled trial to have compared a “bypass surgery first” with a “plain balloon angioplasty (PBA) first” strategy for the management of CLTI. In patients who were likely to survive for 2 years and had a suitable vein, primary bypass (PB) was associated with better clinical outcomes. Furthermore, PBA was associated with a high technical and clinical failure rate and many went on to have secondary bypass (SB).
Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised TrialThe aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology.
Editor's Choice – An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational StudiesA 2011 meta-analysis comparing eversion (eCEA) with conventional (cCEA) carotid endarterectomy in 16,251 patients concluded that eCEA was associated with lower rates of peri-operative stroke and late occlusion compared with cCEA. However, randomised controlled trials (RCTs) showed no difference in outcomes. Since then, the literature contains outcome data on 49,500 patients undergoing eCEA or cCEA. An updated meta-analysis was performed to establish whether eCEA confers significant benefit over cCEA.
Editor's Choice – Renal complications after EVAR with suprarenal versus infrarenal fixation among all users and routine usersPrevious studies comparing endografts with suprarenal and infrarenal fixation for endovascular abdominal aortic aneurysm repair (EVAR) have found conflicting results and did not account for differences in patient selection. This study aims to evaluate the differences in outcomes among surgeons who routinely use either suprarenal or infrarenal fixation, as well as all surgeons in the Vascular Study Group of New England (VSGNE).
Editor's Choice – Very Urgent Carotid Endarterectomy is Associated with an Increased Procedural Risk: The Carotid Alarm StudyThe aim of the Carotid Alarm Study was to compare the procedural risk of carotid endarterectomy (CEA) performed within 48 hours with that after 48 hours to 14 days following an ipsilateral cerebrovascular ischaemic event.
Mapping the Workload Associated with Intact Abdominal Aortic AneurysmEpidemiology is the study of health related states or events (including disorders such as abdominal aortic aneurysm (AAA)), to find out how and why the disorder occurs in different groups of people. Given this definition, what does the paper from Swedvasc in this issue of the journal tell us about AAA?1 It tells us that despite the excellent Swedish AAA screening programme,2 aneurysm repairs are not increasing at the anticipated rate. Why not?
Editor's Choice – Inequalities in Abdominal Aortic Aneurysm Screening in England: Effects of Social Deprivation and EthnicityPopulation screening for abdominal aortic aneurysm (AAA) in men is currently ongoing in several countries. The aim was to examine the effects of deprivation and ethnicity on uptake of screening for abdominal aortic aneurysm (AAA) and prevalence of AAA.
Editor's Choice – Mid-term Outcomes of Endovenous Laser Ablation in Patients with Active and Healed Venous Ulcers: A Follow-up StudyThe aim of this study was to assess the mid-term ulcer recurrence rate in patients with healed or active venous ulcers treated with endovenous laser ablation (EVLA) for incompetent superficial axial veins and to search for possible risk factors for non-healing and recurrence.
Editor's Choice – Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical WorkloadThe epidemiology and management of abdominal aortic aneurysms (AAAs) has changed drastically in the past decades, with implementation of nationwide screening programs, introduction of endovascular repair (EVAR), and reduced prevalence of the disease. This report aims to assess recent trends in AAA repair epidemiology in Sweden in this context.
Editor's Choice – Comparison of Renal Outcomes in Patients Treated by Zenith® Fenestrated and Zenith® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal TrialsFenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined.
Haemostatic Gauze Emerging From The Neck Incision Five Months after Carotid EndarterectomyA 71 year old male was re-operated on 48 hours after a right carotid endarterectomy (with Dacron patch) for evacuation of a neck haematoma. Meticulous haemostasis, placement of absorbable haemostatic gauze (SIDA-CEL, Sidapharm, Thessaloniki, Greece; estimated absorption time 21–28 days) and drain, was undertaken. Broad spectrum antibiotics were administered for 5 days. Five months later, signs of wound infection and two areas of skin dehiscence appeared with foreign material in one of them. Computed tomography revealed only superficial involvement (red arrow).
Editor's Choice – Factors Associated with Long-Term Outcome in 191 Patients with Ilio-Femoral DVT Treated With Catheter-Directed ThrombolysisTo identify factors associated with long-term treatment success after catheter-directed thrombolysis (CDT) for acute deep venous thrombosis (DVT) involving the ilio-femoral vein.
Editor's Choice – Dual Antiplatelet Therapy Improves Outcome in Diabetic Patients Undergoing Endovascular Femoropopliteal Stenting for Critical Limb IschaemiaThe purpose of this study was to analyse the effect of dual antiplatelet therapy (DAPT) compared to aspirin on outcome after endovascular interventions in patients with CLI.
Editor's Choice – Durability of Endovascular Repair in Blunt Traumatic Thoracic Aortic Injury: Long-Term Outcome from Four Tertiary Referral CentersTo analyze the early and long-term survival and re-intervention rate in patients undergoing TEVAR for blunt traumatic thoracic aortic injury.
Editor's Choice – Thirty day Outcomes and Costs of Fenestrated and Branched Stent Grafts versus Open Repair for Complex Aortic AneurysmsTo compare 30 day outcomes and costs of fenestrated and branched stent grafts (f/b EVAR) and open surgery (OSR) for the treatment of complex abdominal aortic aneurysms (AAA) and thoraco-abdominal aortic aneurysms (TAAA).
A Periscope-Based Parallel Endografting Approach Can Successfully Exclude an Aneurysm of the Left Subclavian Artery OriginAn 86-year-old female presented with a 3-cm saccular aneurysm at the left subclavian artery (LSA) origin, effectively providing only one landing zone for endografting. This was successfully excluded under regional anaesthesia using a thoracic stent-graft (38 × 77 mm TX2, Cook Aortic Intervention) with a heparin-bonded endoprosthesis (10 × 150 mm Viabahn, Gore Medical) deployed in periscope configuration. Both remain patent 8 months later, with LSA aneurysm exclusion and no endoleakage. Such endovascular techniques avoid the morbidity of open bypass surgery and waiting times for a customised/fenestrated device, and provide an alternative for aneurysms of the aortic arch outflow where only single landing zones are available.
Editor's Choice – ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac AneurysmsECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus) is a prospective multicentre randomized controlled trial including consecutive patients with ruptured aorto-iliac aneurysms (rAIA) eligible for treatment by either endovascular (EVAR) or open surgical repair (OSR). Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aorto-iliac rupture.
Editor's Choice – Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)Anterior Accessory Saphenous Vein