European Journal of Vascular & Endovascular Surgery

Editorial Board

2012-02-01

The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy

2011-10-05

Abstract: Background: A policy of intra-operative transcranial Doppler (TCD) and completion angioscopy was previously associated with virtual abolition of intra-operative stroke (apparent upon recovery from anaesthesia) following carotid endarterectomy (CEA). The aims of this study were to determine whether the prevalence of technical error has diminished with experience and whether our monitoring/quality control policy was still associated with low rates of intra-operative stroke 20 years after its introduction.Methods: Retrospective review of four consecutive cohorts of 400 patients undergoing CEA between October 1995 and March 2010 (1600 CEAS in total).Results: One hundred four patients (7%) had thrombus removed following angioscopy and prior to flow restoration, while 31 (2.1%) underwent repair of a distal intimal flap. The prevalence of intimal flaps diminished from 4.9% in the first 400 patients to 0.8% in the last 400 patients (p = 0.006). By contrast, the prevalence of retained thrombus did not decline with experience (8.5%, 3.7%, 10.3% and 5.4% for the four consecutive periods). Intra-operative TCD and completion angioscopy was, however, associated with extremely low rates of intra-operative stroke (0.25%, 0.25%, 0.5% and 0.25% during the four study periods).Conclusion: Most intra-operative strokes probably follow embolisation of thrombus following restoration of flow. This can be prevented by angioscopy which has the advantage of being performed prior to flow restoration. Increasing experience was associated with a decline in the detection of intimal flaps, but not in the prevalence of retained thrombus. Even the most experienced of surgeons can still be responsible for inadvertent technical error.

Comments regarding ‘The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy’

M.J. Gough — 2011-11-28

Professor Naylor and his team should be congratulated on both the thoroughness of this audit and the excellent results that they have achieved. The principle ethos for all surgeons who perform carotid endarterectomy (CEA) should be an on-going commitment to increase the safety of surgery. For these authors quality control, both intra- and post-operatively has been the focus of improved outcomes during an extensive experience. So why haven’t we all adopted the methods that Professor Naylor proposes? Is it laziness, overconfidence, lack of resources or a belief that the problem is not as great as the authors lead us to believe?

Patients with Recurrent Ischaemic Events from Carotid Artery Disease have a Large Lipid Core and Low GSM

2011-12-09

Abstract: Objectives: The aim of the current study was to determine whether computerised ultrasound plaque analysis could identify features predictive of an increased risk of early recurrent events after symptom onset.Methods: Between August 2008 and December 2010, 158 consecutive symptomatic patients undergoing carotid endarterectomy (CEA) had their plaques harvested at CEA and then independently scored for markers of histological plaque instability. Duplex ultrasound images recorded prior to CEA were independently assessed using the Iconsoft software.Results: One hundred and fifty eight recently symptomatic patients underwent CEA with 118 (75%) undergoing their operation within 14 days of their most recent clinical event. Twenty (12.7%) suffered a recurrent cerebral ischaemic event following admission to the vascular unit and before undergoing CEA. Using multivariate stepwise analysis; lipid core (OR 4.00, 95% CI 1.07 to 14.83, P = 0.042) and a low GSM (OR 6.21, 95% CI 1.86 to 20.4, P = 0.003) were independently associated with recurrent cerebrovascular events.Conclusion: Within a cohort of patients presenting with recent onset cerebral ischaemic events undergoing CEA, the plaques of patients with recurrent events following admission to hospital had evidence a large lipid core and a low GSM.

Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque

2011-11-10

Abstract: Objective: To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology.Methods: This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification.Results: Of the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients with unstable plaque compared to those with stable plaque (222.4 (174.9–437.5) interquartile range (IQR) 63.5 vs. 211.1 (174.9–270.6) IQR 37.2 ng ml−1; p = 0.02). Moreover, median Lp-PLA2 level were higher in asymptomatic patients with unstable plaque (226.8 ng ml−1 (174.9–437.5) IQR 76.8) vs. stable plaque (206.9 ng ml−1 (174.9–270.6) IQR 33.7; p = 0.16). Logistic regression showed that only the neurological symptoms (OR = 30.9 (3.7–244.6); p < 0.001) and the plasma Lp-PLA2 level (OR = 1.7 (1.1–12.3); p = 0.03) were independently associated with unstable carotid plaque as defined by histology.Conclusions: This study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease.

The Emerging Role of Lipoprotein-associated Phospholipase A2 in Cerebrovascular Disease

S.K. Kakkos, I.A. Tsolakis — 2011-11-28

Previous studies have demonstrated increased serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in cardiovascular and cerebrovascular disease, including incident stroke, and recurrent TIA or stroke. Lp-PLA2 is an enzyme derived from inflammatory leukocytes involved in the metabolism of oxidized LDL by generating mediators (lysophosphatidylcholine and oxidized non-esterified fatty acids) involved in atherosclerotic plaque inflammation and formation of vulnerable (rupture-prone) and unstable (symptomatic) plaques rather than stimulation of atherogenesis. Indeed, enhanced local expression of Lp-PLA2 in symptomatic carotid plaques has been reported. In this issue, Sarlon-Bartoli went one step further by demonstrating increased serum Lp-PLA2 in ulcerated unstable atherosclerotic plaques and also a trend in unstable asymptomatic carotid plaques. These findings have the potential to improve cerebrovascular disease stratification, however, correlation with ultrasonic or MRI markers of plaque instability or the presence of infarction on brain imaging was not performed.

Is the Incidence of Abdominal Aortic Aneurysm Declining in the 21st Century? Mortality and Hospital Admissions for England & Wales and Scotland

A. Anjum, J.T. Powell — 2011-12-19

Abstract: Background: Between 1951 and 1995 there was a steady increase in age-standardised deaths from all aortic aneurysms in men, from 2 to 56 per 100,000 population in England & Wales, supporting an increase in incidence. More recently, evidence from Sweden and elsewhere suggests that now the incidence of abdominal aortic aneurysm (AAA) may be declining.Methods: National statistics for hospital admissions and deaths from AAA, after population age-standardisation, were used to investigate current trends in England & Wales and Scotland.Results: Between 1997 and 2009 there has been a reduction in age-adjusted mortality from AAA from 40.4 to 25.7 per 100,000 population for England & Wales and from 30.1 to 20.8 per 100,000 population in Scotland. The decrease in mortality was more marked for men than women. Mortality decreased more than 2-fold in those <75 years versus 25% only in those >75 years. During this same time period the elective hospital admissions for AAA repair have only increased in the population >75 years.Conclusions: These data suggest that the age at which clinically-relevant aneurysms present has increased by 5–10 years and that incidence of clinically-relevant AAA in men in England & Wales and Scotland is declining rapidly. The reasons for this are unclear.

Assessment of the Accuracy of AortaScan for Detection of Abdominal Aortic Aneurysm (AAA)

A. Abbas, A. Smith, M. Cecelja, M. Waltham — 2011-12-15

Abstract: Background: AortaScan AMI 9700 is a portable 3D ultrasound device that automatically measures the maximum diameter of the abdominal aorta without the need for a trained sonographer. It is designed to rapidly diagnose or exclude an AAA and may have particular use in screening programs. Our objective was to determine its accuracy to detect AAA.Methods: Subjects from our AAA screening and surveillance programs were examined. The aorta was scanned using the AortaScan and computed tomography (CT).Results: Ninety-one subjects underwent imaging (44 AAA on conventional ultrasound surveillance and 47 controls). The largest measurement obtained by AortaScan was compared against the CT-aortic measurement. The mean aortic diameter was 2.8 cm. The CT scan confirmed the diagnosis of AAA in 43 subjects. There was one false positive measurement on conventional ultrasound. AortaScan missed the diagnosis of AAA in eight subjects. There were thirteen false positive measurements. The sensitivity, specificity, positive and negative predictive values were 81%, 72%, 72% and 81% respectively.Conclusion: A device to detect AAA without the need for a trained operator would have potential in a community-based screening programme. The AortaScan, however, lacks adequate sensitivity and significant technical improvement is necessary before it could be considered a replacement for trained screening personnel.

Plasma Levels of Matrix Metalloproteinase-9: A Possible Diagnostic Marker of Successful Endovascular Aneurysm Repair

2011-12-15

Abstract: Objective: The aim of the study was evaluating the diagnostic value of plasma matrix metalloproteinase- (MMP)-2 and -9 and tissue inhibitor of MMP-1 (TIMP-1) for endoleak detection after endovascular aneurysm repair (EVAR).Report: Consecutive EVAR patients (n = 17) with endoleak and matched controls without endoleak (n = 20) were prospectively enrolled. Increased levels of MMP-9 were observed in patients with endoleak (P < 0.001). Regression analysis showed no significant influence of age, sex or abdominal aortic aneurysm (AAA) size. The receiver operating characteristic (ROC) curve of plasma MMP-9 levels showed that a cut-off value of 55.18 ng ml−1 resulted in 100% sensitivity and 96% specificity with an AUC value of 0.988 (P < 0.001) to detect endoleak.Conclusions: Plasma MMP-9 levels appear to discriminate between patients with and without an endoleak with high sensitivity and specificity.

Comments regarding ‘Plasma Levels of Matrix Metalloproteinase-9: A Possible Diagnostic Marker of Successful Endovascular Aneurysm Repair’

R.J. Hinchliffe — 2011-11-28

A more rational approach to the surveillance of patients with endovascular aneurysm repair (EVAR) is urgently needed. Recent publications have questioned the benefit of surveillance and demonstrated that significant heterogeneity of surveillance schedules exists among vascular units. Current imaging modalities reliably identify endoleak and other stent-graft related complications but are costly and some are potentially harmful. A blood test which might predict complications or the need for secondary interventions would be attractive.

Recommendations for Reporting Treatment of Aortic Graft Infections

O.E. Teebken, T. Bisdas, O. Assadian, J.-B. Ricco — 2011-12-12

Abstract: The purpose of these recommendations is to provide a standard format for reporting treatment results and standardised epidemiologic data after aortic vascular graft infection to improve the comparison of clinical outcomes between different therapeutic approaches and different study populations. Analytical reporting standards for patients’ characteristics, type and extent of the disease, type of treatment and study design are described. Adherence to these recommendations will improve clinical relevance, quality and comparability of future studies dealing with aortic vascular graft infections.

What are the Risk Factors for Renal Failure following Open Elective Abdominal Aortic Aneurysm Repair?

S.W. Grant, A.D. Grayson, M.J. Grant, D. Purkayastha, C.N. McCollum — 2011-12-19

Abstract: Objectives: Renal failure following abdominal aortic aneurysm (AAA) repair is a common and significant complication. The objective of this study was to identify risk factors for renal failure following open elective AAA repair.Design: A retrospective analysis of prospectively collected multi-centre data.Materials: Consecutive data on patients undergoing open elective AAA repair were collected between January 2000 and December 2010. Patients with pre-operative serum creatinine >200 μmol/L were excluded.Methods: Renal failure was reported by clinicians and included all patients requiring post-operative renal-replacement therapy. Univariate and multivariate analyses were used to identify renal failure risk factors. A simplified clinical risk score was developed.Results: Post-operative renal failure occurred in 140 (6.0%) of 2347 patients and was associated with age >75 (OR = 1.58, 95%CI 1.11–2.26), symptomatic AAA (OR = 1.77, 95%CI 1.24–2.52), supra/juxta renal AAA (OR = 2.17, 95%CI 1.32–3.57) pre-operative serum creatinine >150 (OR = 2.75, 95%CI 1.69–4.50), treated hypertension (OR = 1.87, 95%CI 1.28–2.74), and respiratory disease (OR = 2.08, 95%CI 1.45–2.97). Patients with post-operative renal failure had significantly higher 30-day mortality (35.0% vs. 4.3%, p < 0.001).Conclusions: Renal failure following open elective AAA repair was associated with an increased risk of mortality. Risk factors for post-operative renal failure were identified and a simple clinical risk score developed to facilitate focussed care strategies for high-risk patients.

Safety, Healing, and Efficacy of Vascular Prostheses Coated with Hydroxypropyl-β-cyclodextrin Polymer: Experimental In Vitro and Animal Studies

E. Jean-Baptiste, N. Blanchemain, B. Martel, C. Neut, H.F. Hildebrand, S. Haulon — 2011-11-30

Abstract: Objectives: Polyester vascular prostheses (PVPs) coated with a polymer of hydroxypropyl-β-cyclodextrin (HPβCD) have been designed to provide an in situ reservoir for the sustained delivery of one or more bioactive molecules. The goal of this study was to assess the efficacy, the safety and the healing properties of these prostheses.Methods: Collagen-sealed PVPs were coated with the HPβCD-based-polymer (PVP-CD) using the pad–dry–cure textile finishing method and loaded with one or two antibiotics. Appropriate control and PVP-CD samples were tested in several in vitro and animal model conditions. The study end points included haemolysis, platelet aggregation, antibacterial efficacy, polymer biodegradation, acute toxicity and chronic tolerance.Results: PVP-CD proved to be compatible with human blood, since it did not induce haemolysis nor influenced ADP-mediated platelet aggregation. Sustained antimicrobial efficacy was achieved up to 7 days against susceptible bacteria when PVP-CDs were loaded with the appropriate drugs. Analysis of harvested PVP-CD from the animal model revealed that the HPβCD-based coating was still present at 1 month but had completely disappeared 6 months after implantation. All grafts were patent, well encapsulated without healing abnormalities. Clinical data, blood-sample analysis and histological examination did not evidence any signs of acute or chronic, local or systemic toxicity in the animal models.Conclusion: PVP-CD was proved safe and demonstrated excellent biocompatibility, healing and degradation properties. Effective antimicrobial activity was achieved with PVP-CD in conditions consistent with a sustained-release mechanism.

Two-year Vascular Hospitalisation Rates and Associated Costs in Patients at Risk of Atherothrombosis in France and Germany: Highest Burden for Peripheral Arterial Disease

2011-10-17

Abstract: Objectives: To obtain Western European perspectives on the economic burden of atherothrombosis in patients with multiple risk factors only (MRF), cerebrovascular disease (CVD), coronary artery disease (CAD), and in the under-evaluated group of patients with peripheral arterial disease (PAD), we examined vascular-related hospitalisation rates and associated costs in France and Germany.Design: The prospective REACH Registry enrolled 4693 patients in France, and 5594 patients in Germany (from December 2003 until June 2004).Methods: For each country, 2-year rates and costs associated with cardiovascular events and vascular-related hospitalisations were examined for patients with MRF, CVD, CAD, and PAD.Results: Two-year hospitalisation costs were highest for patients with PAD (3182.1€ for France; 2724.4€ for Germany) and lowest for the MRF group (749.1€ for France; 503.3€ for Germany). Peripheral revascularizations and amputations were the greatest contributors to costs for all risk groups. Across all PAD subgroups, peripheral procedures constituted approximately half of the 2-year costs.Conclusion: Hospitalisation rates and costs associated with atherothrombotic disease in France and Germany are high, especially so for patients with PAD.

Endofibrosis and Kinking of the Iliac Arteries in Athletes: A Systematic Review

G. Peach, G. Schep, R. Palfreeman, J.D. Beard, M.M. Thompson, R.J. Hinchliffe — 2011-12-21

Abstract: Introduction: Kinking and endofibrosis of the iliac arteries are uncommon and poorly recognized conditions affecting young endurance athletes. Deformation or progressive stenosis of the iliac artery may reduce blood flow to the lower limb and adversely affect performance. The aim of this review was to examine the existing literature relating to these flow-limiting phenomena and identify a clear, unifying strategy for the assessment and management of affected patients.Methods: A systematic review of the literature was performed. A comprehensive search was carried out using Medline, Embase and The Cochrane Database to identify relevant articles published between 1950 and 2011 (last search date 05/08/2011). This search (and additional bibliography review) identified 413 articles, of which 367 were excluded. 46 articles were then studied in detail. Methodological quality of studies was assessed according to Scottish Intercollegiate Guideline Network criteria.Results: Focussed history and examination can successfully identify nearly 80% of patients with iliac flow limitation. However, both provocative exercise tests and detailed imaging are also necessary to identify those in need of intervention and establish most appropriate treatment. Provocative exercise tests and duplex imaging can then be used to confirm flow limitation before detailed assessment of abnormal anatomy with MRA and DSA. These multiple imaging modalities are necessary to identify those most likely to benefit from surgery and clarify whether each patient should undergo arterial release, vessel shortening, endofibrosectomy or interposition grafting.Conclusion: We present a systematic review of the literature together with a proposed algorithm for diagnosis and management of these iliac flow limitations in endurance athletes.

Haemodialysis Access-induced Distal Ischaemia (HAIDI) is Caused by Loco-regional Hypotension but not by Steal

M.R. Scheltinga, C.M.A. Bruijninckx — 2011-11-28

Abstract: Objectives: Some haemodialysis patients with an arteriovenous fistula (AVF) suffer from chronic hand ischaemia (haemodialysis access-induced distal ischaemia, HAIDI). This overview discusses pathophysiological mechanisms of chronic HAIDI with emphasis on the role of steal and loco-regional hypotension.Materials and methods: The literature obtained from Medline and Google using various terms including steal and hand ischaemia was studied for clues on pathophysiology of hand ischaemia in the presence of an AVF.Results: Constructing an arteriovenous anastomosis as in a haemodialysis access leads to augmented blood flows in arm arteries. Due to increased shear stress, these arteries will remodel while hand perfusion pressures are maintained. However, arteries of some dialysis patients with diabetes mellitus and/or severe arteriosclerosis demonstrate insufficient remodelling leading to a gradual loss of perfusion pressures towards the periphery. A blood pressure drop associated with turbulent flow at the arteriovenous anastomosis intensifies the distal hypotension. By contrast, steal (reversal of blood flow) may reflect an upstream arterial stenosis and patent collaterals but its presence has no pathophysiological significance related to hand ischaemia.Conclusion: HAIDI is caused by too low forearm and hand blood pressures. Therapy should focus on attenuating the loss of arterial pressure including optimalisation of inflow arteries and/or ligation of the AVF’s venous side branches. Surgery aimed at access flow reduction or distal revascularisation is only indicated if these measures fail.

An Arteriovenous Fistula Model of Intimal Hyperplasia for Evaluation of a Nitinol U-Clip Anastomosis

2011-11-21

Abstract: Objectives: The aim of this study was to create an ovine arteriovenous fistula (AVF) model which would closely replicate a human forearm fistula and use this to quantify the degree of intimal hyperplasia in those created with the U-Clip compared to a conventional sutured anastomosis.Materials and methods: Twenty AVFs were created in 10 Border Leicester–Merino sheep between the superficial femoral artery and vein of each hind limb. On one side the U-Clip and on the other a continuous polypropylene suture was used to perform the anastomosis. The animals were sacrificed at 2 (n = 3), 4 (n = 4), 6 (n = 3) weeks and histological slices were taken of each AVF in cross section to determine the intimal media area per unit length (IMA/L).Results: Intimal hyperplasia (IH) was observed at all time points with one AVF found occluded with thrombus at the time of harvest. The IMA/L was significantly lower in the U-Clip groups by 24% at 2 weeks, 32% at 4 weeks and 23% at 6 weeks (Two-way ANOVA, p = 0.019, observed power = 0.825, time or side p ≥ 0.766, type p = 0.001; Paired t-test, p < 0.001 between matched anastomotic types). Time taken to perform the anastomosis was similar between the two anastomotic techniques (Polypropylene 14(8–18) vs. U-Clip 15.3(11–23) min; p = 0.47).Conclusion: This ovine AVF model results in IH similar to that seen in a human AVF. The IH that occurs with the U-Clip is less than that of continuous polypropylene suture.

Vascular Anastomotic Clips Revisited

S.K. Kakkos, I.A. Tsolakis — 2011-12-19

Nitinol and titanium vascular anastomotic clips were introduced in access surgery more than a decade ago. Compared to sutured anastomoses, clipped ones are performed faster, with fewer bleeding and infectious complications, while improved maturation, and better primary, and secondary patency of autogenous arteriovenous fistulas (AVFs) and prosthetic grafts have been reported in most studies. Improved outcomes might be the result of reduced neointimal hyperplasia (NIH) as shown in AVF and non-AVF models, improved anastomotic compliance, preservation of endothelial function, minimized endothelial/vessel wall trauma and reduced thrombosis potential, and perhaps bias due to slight differences in technique. Graft flow in clipped and sewn anastomoses has been reported to be the same.

Value of a Planned Compression Ultrasonography after an Isolated Superficial Vein Thrombosis: Results from a Prospective Multicentre Study

2011-12-06

Abstract: Objectives: To assess the efficiency of a systematically planned compression ultrasonography (SP-CUS) to detect venous thrombotic complications (VTCs) in patients with symptomatic isolated superficial vein thrombosis (SVT).Design: Post hoc analysis of a prospective, multicentre, cohort study (POST).Patients: As many as 537 patients with CUS-confirmed isolated SVT undergoing an SP-CUS 8–15 days after the initial CUS.Outcomes: Asymptomatic VTC (extension or recurrence of SVT, deep-vein thrombosis (DVT) of the lower limbs) diagnosed by the SP-CUS and symptomatic thromboembolic complications (VTC and pulmonary embolism (PE)) up to 3 months.Results: VTC was suspected before or on the day of the SP-CUS in 18 patients (3.0%). Among the 519 asymptomatic patients (97%) undergoing SP-CUS, this revealed asymptomatic VTC in 12 patients (2.3%; 4 DVT, 4 SVT recurrences, 4 SVT extensions), none of whom subsequently experienced symptomatic thromboembolic events up to 3 months. Among the 507 patients with a normal SP-CUS, 29 (5.7%) presented symptomatic thromboembolic events during follow-up: 2 PE, 7 DVT, 9 SVT recurrences and 11 SVT extensions.Conclusions: In this study, the SP-CUS detected a few asymptomatic VTC, but failed to identify patients at risk of thromboembolic events during follow-up. Use of an SP-CUS was therefore neither efficient nor cost effective.

Comments regarding Vardoulis O, et al., Impact of Aortic Grafts on Arterial Pressure: A Computational Fluid Dynamics Study. Eur J Vasc Endovasc Surg 2011;42:704–10

V.D. Tzilalis, D. Kamvysis, M.K. Lazarides, H. Boudoulas — 2011-12-08

In this very interesting paper, the authors qualified in a computational fluid dynamics study how central hemodynamics are affected by woven Dacron grafts while inserted in the ascending or descending aorta.

Response to comments regarding Vardoulis O, et al., Impact of Aortic Grafts on Arterial Pressure: A Computational Fluid Dynamics Study. Eur J Vasc Endovasc Surg 2011;42:704–10

O. Vardoulis, E. Coppens, B. Martin, P. Reymond, P. Tozzi, N. Stergiopulos — 2011-12-06

We would like to thank the authors of the letter for their pertinent comments on the hemodynamic effects of aortic grafts. We fully agree with their positions and clinical perspective. We grasp the opportunity to stress once again the fact that the mechanisms by which grafts placed in ascending or descending aorta contribute to pulse pressure augmentation, are quite different. Grafts in the ascending aorta augment principally the amplitude of the forward running waves coming from the ejecting heart, whereas grafts in the descending or thoracic aorta augment the amplitude of the reflected waves.

Letter to Editor Re “Differential Protein Expression in Serum of Abdominal Aortic Aneurysm Patients – A Proteomic Approach”

I.M. Nordon — 2011-12-19

In their paper “Differential expression in serum of abdominal aortic aneurysm patients – A proteomic approach”, Pulinx et al. mined the proteome of patients with AAAs in search of novel biomarkers. They report elevated factor XII and α-1 antitrypsin levels in the serum of patients with progressive aneurysms, but found these proteins to have little ability to predict aneurysm progression above the established marker, AAA diameter.

Response to Letter to Editor re “Differential Protein Expression in Serum of Abdominal Aortic Aneurysm Patients – A Proteomic Approach”

2011-12-22

We would like to thank Dr. Nordon for his interest in and remarks on our manuscript. We fully agree that the translation of proteomics-discovered biomarkers into clinically meaningful assays is difficult. However, our aim was to find differential protein expression related to aneurysm size and progression. These differentially expressed proteins could help to elucidate the mechanisms behind abdominal aortic aneurysm.

Re: Single-centre Prospective Comparison between Contrast-enhanced Ultrasound and Computed Tomography Angiography after EVAR

S. Dindyal, C. Kyriakides — 2011-12-19

We would like to commend you for your work and we were delighted to read your five-year comparison of CEUS and CTA for EVAR surveillance. This is to our knowledge the largest series to compare these two modalities and we are keen advocates of CEUS for EVAR surveillance also having achieved similar results to you in our department. Currently we are using three techniques for our surveillance, we are comparing CTA with duplex ultrasound and also CEUS for selective cases.

Response to Letter to the Editor “Re: Single Centre Prospective Comparison between Contrast Enhanced UltraSound and Computed Tomography Angiography after EVAR”

S. Haulon, P. Perini — 2011-12-07

We are grateful for the comments of Drs. S. Dindyal and C. Kyriakides. They raise several important issues: The experience of the angiologists performing CEUS: In our report all participating angiologists had a minimum of 6 months supervised training and experience prior to inclusion in the dataset. We concur with the Royal London Hospital group – CEUS is a technique that demands training and experience before the results can be considered comparable with CT scanning. With this in mind, we did a preliminary assessment of our early experience with CEUS the year before the current study started.

Selected Abstracts from the February Issue of the Journal of Vascular Surgery

2012-02-01

Nadia Vallejo, Julio A. Rodriguez-Lopez, Paniz Heidari, Grayson Wheatley, David Caparrelli, Venkatesh Ramaiah, Edward B. Diethrich Purpose: Some patients with aortic arch or descending thoracic aorta pathologies are not suited for open repair because of comorbidities that may increase their risk of procedural complications or death. Endovascular approaches may also be difficult when there are inadequate proximal landing zones in the aortic arch. We report our experience using rerouting techniques with bypass, stenting of the branches, or a combination of both to create a landing area in zones 0 and 1 of the aortic arch.

Intra-arterial Foreign Body in Popliteal Artery: A Case Report

C.C.C. Hulsker, J. Kardux, P. Klemm — 2011-11-21

We describe the case of a male patient who presented with an intra-arterial sheath following an endovascular intervention months earlier. The occurrence, complications and retrieval of an unusual intra-arterial foreign body are described.

Extrinsic Compression of the Popliteal Vessels after Knee Arthoplasty: An Interesting Case of Claudication

J. Smith, J. Hopkins, W. Neary — 2011-12-08

A 79-year-old gentleman developed new onset intermittent claudication and ipsilateral deep vein thrombosis 12 years after total knee arthroplasty. Vascular imaging demonstrated a 90–99% popliteal stenosis with three vessels run off and an occlusive thrombosis of the gastrocnemius and soleal veins. Ultrasound scan (USS) confirmed the presence of a benign granulomatous mass secondary to wear of arthroplasty causing extrinsic compression of the popliteal artery. After successful revision arthroplasty and removal of the mass the patient has no vascular symptoms and does not require anticoagulant therapy.

External Carotid Artery to Internal Carotid Artery Transposition with Patch Resection to Treat an Infected Carotid Endarterectomy Dacron Patch: A Novel Technique

N. Bhasin, E. Baker, S.T. Rashid, P.M. Renwick, P.T. McCollum — 2011-11-21

Introduction: Prosthetic patch infection after carotid endarterectomy is a rare but potentially devastating complication. The published literature generally supports patch resection with vein patch closure or venous interposition grafting.

EJVES vol. 43, issue 2 (February 2012) - Chinese Translated Abstracts

2012-02-01

EJVES vol. 43, issue 2 (February 2012) - Spanish Translated Abstracts

2012-02-01

Forthcoming events

2012-02-01