Journal of vascular surgery
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Randomized Controlled Trial Comparative Study
Randomized comparison of ePTFE/nitinol self-expanding stent graft vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease.
A randomized prospective study comparing the treatment of superficial femoral artery occlusive disease percutaneously with an expanded polytetrafluoroethylene (ePTFE)/nitinol self-expanding stent graft (stent-graft) vs surgical femoral to above knee popliteal artery bypass with synthetic graft material. ⋯ Management of superficial femoral artery occlusive disease with percutaneous stent-grafts exhibits similar primary patency at 24-month follow-up when compared with conventional femoral-popliteal artery bypass grafting with synthetic conduit. This treatment method may offer an alternative to treatment of the superficial femoral artery segment for revascularization when prosthetic bypass is being considered or when autologous conduit is unavailable.
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The diameter of an abdominal aortic aneurysm (AAA) is the single most important factor in deciding whether to repair an aneurysm or to monitor it conservatively. Open surgical repair does not appear to be beneficial until the diameter of the aneurysm is >5.5 cm. Prospective clinical trials, however, confirmed a lower risk of operative mortality after endovascular aneurysm repair (EVAR) than after open surgical repair. ⋯ PIVOTAL has an enrollment goal of up to 1025 patients with a 4- to 5-cm AAA, randomly assigning patients to EVAR or surveillance. The primary end points of PIVOTAL are aneurysm rupture and AAA-related death at up to 36 months after randomization. When complete, the results of PIVOTAL should provide objective evidence to guide the use of EVAR for small AAAs.
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Multicenter Study Comparative Study
Risk-adjusted 30-day outcomes of carotid stenting and endarterectomy: results from the SVS Vascular Registry.
As the first operational societal registry of carotid procedures, the Outcomes Committee of the Society for Vascular Surgery (SVS) developed the Vascular Registry (VR) in response to the Centers for Medicare and Medicaid Services' (CMS) National Coverage Decision on carotid artery stenting (CAS). Although CMS requires data submission only on CAS, the VR collects similar data on carotid endarterectomy (CEA) to allow comparison of outcomes, as well as potential for expansion to other procedures. ⋯ Following best possible risk adjustment of these unmatched groups, symptomatic and asymptomatic CAS patients had significantly higher 30-day postprocedure incidence of death/stroke/MI when compared with CEA patients. The initial 1.5 years of data collection provide proof of concept that a specialty society based VR can succeed in meeting regulatory and scientific goals. With continued enrollment and follow-up, analysis of SVS-VR will supplement randomized trials by providing real-world comparisons of CAS and CEA with sufficient numbers to serve as an outcome assessment tool of important patient subsets and across the spectrum of peripheral vascular procedures.
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Comparative Study
Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair.
Use of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) monitoring during thoracic and thoracoabdominal aortic surgery is controversial. This study evaluated the intraoperative use of SSEP and MEP during thoracoabdominal repair and assessed their role in decreasing the risk of spinal cord ischemia and paralysis. ⋯ SSEP and MEP monitoring were highly correlated only when intraoperative changes were irreversible. Reversible changes were not significantly associated with immediate neurologic deficit. Irreversible changes were significantly associated with immediate neurologic deficit, and the findings were identical for SSEP and MEP in this variable, indicating that the more complex MEP measures do not add further information to that obtained from SSEP. Normal SSEP and MEP findings had a strong negative predictive value, indicating that patients without signal loss are unlikely to awake with neurologic deficit.
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Case Reports
Recurrent refractory arterial thromboembolism associated with the Janus kinase 2 V617F mutation.
We report two patients with peripheral vascular disease requiring multiple bilateral radiologic and surgical interventions, and whose disease was unresponsive to conventional anticoagulation and antiplatelet therapy. Although thrombocytosis was only intermittent, analysis of the Janus kinase 2 (JAK2) gene revealed a V617F mutation, thus confirming the presence of an underlying occult myeloproliferative disorder. We propose that JAK2 mutation analysis be considered in patients with recurrent, unexplained arterial events to identify those with occult myeloproliferative disorders.