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Source: European Journal of Vascular and Endovascular Surgery
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Total 289 results found since Jan 2013.
Beta-blocker Use and Clinical Outcomes after Primary Vascular Surgery: A Nationwide Propensity Score-Matched Study
Conclusion: Beta-blocker use after primary vascular surgery was associated with a lower risk of major amputation but an increased risk of hospitalisation with MI and stroke. No associations were found between beta-blocker use and all-cause mortality or the risk of recurrent vascular surgery. However, our results are not sufficient to alter the indication for beta-blocker use among symptomatic peripheral arterial disease patients.
Source: European Journal of Vascular and Endovascular Surgery - May 8, 2013 Category: Surgery Authors: A. Høgh, J.S. Lindholt, H. Nielsen, L.P. Jensen, S.P. Johnsen Tags: Peripheral Arterial Disease Source Type: research
CREST: The Twilight Zone Between (Mis)Interpretation and Deception
What is the main message of Parakesvas and co-authors almost three years after publication of the “carotid revascularization endarterectomy versus stent trial” (CREST) main results? Was CREST a bad trial? Without hesitation, the answer should be “No”. CREST was designed in the late 1990s and started in 2000. At the time, there had been no adequate randomized comparison of carotid endarterectomy (CEA) and protected carotid angioplasty (CAS). The reason for CREST was self-evident: compare protected CAS and CEA in low-surgical-risk but symptomatic patients. It was the first trial implementing a lead-in-phase to guide ...
Source: European Journal of Vascular and Endovascular Surgery - May 6, 2013 Category: Surgery Authors: G.J. de Borst, J.-B. Ricco Tags: Invited Commentary Source Type: research
Critique of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): Flaws in CREST and its Interpretation
The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) has been used to support the equivalence of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the treatment of carotid stenosis in both symptomatic and asymptomatic patients. This inclusion of two different forms of the disease decreased the power and significance of the CREST results and weakened the trial. Other flaws in CREST were the equal weighting of mostly minor myocardial infarctions (MIs) with strokes and death in the peri-procedural, composite ‘end’ point, but not in the 4-year, long-term ‘end’ point. Although CAS w...
Source: European Journal of Vascular and Endovascular Surgery - April 22, 2013 Category: Surgery Authors: K.I. Paraskevas, D.P. Mikhailidis, C.D. Liapis, F.J. Veith Tags: Carotid Disease Source Type: research
Does Standardised Post-CEA Blood Pressure Control Make Cerebral Monitoring for Hyperperfusion Irrelevant?
Identification of patients at risk for developing cerebral hyperperfusion syndrome (HS) following carotid endarterectomy (CEA) is essential, as treatment in the early phase can potentially prevent life-threatening symptoms. Previous studies have shown the ability of perioperative transcranial Doppler (TCD) to more accurately predict occurrence of HS and associated intracranial haemorrhage (ICH) or stroke. Based on these studies, Newman et al. retrospectively analysed 1450 CEA patients with accessible TCD window. The authors were unable to demonstrate that increases in middle cerebral artery velocity predicted risk of suff...
Source: European Journal of Vascular and Endovascular Surgery - April 22, 2013 Category: Surgery Authors: G.J. de Borst, F.L. Moll Tags: Invited Commentary Source Type: research
Role of Carotid Endarterectomy Following Intravenous Thrombolysis
These Danish surgeons report outstanding 30-day outcomes for carotid endarterectomy (CEA) in the management of symptomatic carotid stenosis. Their review is focused on 22 CEAs performed after thrombolysis for cerebral ischemic attacks. The hypothetical question asked is whether post-lytic candidates for CEA differ from those with symptomatic extracranial carotid stenoses who did not qualify for lysis. Is risk of CEA increased following lysis for acute stroke?
Source: European Journal of Vascular and Endovascular Surgery - April 22, 2013 Category: Surgery Authors: F. Padberg Tags: Invited Commentary Source Type: research
Distinction between Acute and Chronic Type B Aortic Dissection: Is there a Sub-acute Phase?
Conclusions: TEVAR was performed with low early mortality and few neurological complications. A significant proportion of patients presented with acute complications>14 days after onset of symptoms, indicative of a sub-acute phase in the transition between acute and chronic dissection, questioning the relevance of the current definition.
Source: European Journal of Vascular and Endovascular Surgery - April 22, 2013 Category: Surgery Authors: J. Steuer, M. Björck, D. Mayer, A. Wanhainen, T. Pfammatter, M. Lachat Tags: Aneurysms Source Type: research
Carotid Endarterectomy after Intravenous Thrombolysis for Acute Cerebral Ischaemic Attack: Is It Safe?
Conclusion: Our experience indicates that CEA performed after IVT for acute cerebral ischaemic attack is safe, confirming existing but sparse publications. However, our series is small and our study possesses a number of limitations. Thus, our results cannot necessarily be transferred to other units, who instead should perform similar studies, preferably together.
Source: European Journal of Vascular and Endovascular Surgery - April 12, 2013 Category: Surgery Authors: L.K. Rathenborg, L.P. Jensen, N. Baekgaard, T.V. Schroeder Tags: Carotid Disease Source Type: research
Optical Coherence Tomography after Carotid Stenting: Rate of Stent Malapposition, Plaque Prolapse and Fibrous Cap Rupture According to Stent Design
This study aims to evaluate the rate of stent malapposition, plaque prolapse and fibrous cap rupture detected by optical coherence tomography (OCT) imaging according to carotid stent design.Design: It was a prospective single-centre study.Materials and methods: Forty consecutive patients undergoing protected carotid artery stenting (CAS) and high-definition OCT image acquisition were enrolled in the study. OCT frames were analysed off-line, in a dedicated core laboratory by two independent physicians. Cross-sectional OCT images within the stented segment of the internal carotid artery were evaluated at 1-mm intervals for t...
Source: European Journal of Vascular and Endovascular Surgery - April 12, 2013 Category: Surgery Authors: G. de Donato, F. Setacci, P. Sirignano, G. Galzerano, A. Cappelli, C. Setacci Tags: Carotid Disease Source Type: research
Changes in Middle Cerebral Artery Velocity after Carotid Endarterectomy do not Identify Patients at High-risk of Suffering Intracranial Haemorrhage or Stroke due to Hyperperfusion Syndrome
Conclusion: We were unable to demonstrate that significant increases in MCAV and PI were able to predict patients at increased risk of suffering a post-operative stroke due to HS or ICH. The provision of written guidance for managing PEH in Group 2 patients was associated with virtual abolition of ICH/HS.
Source: European Journal of Vascular and Endovascular Surgery - March 29, 2013 Category: Surgery Authors: J.E. Newman, M. Ali, R. Sharpe, M.J. Bown, R.D. Sayers, A.R. Naylor Tags: Carotid Disease Source Type: research
Safety of Carotid Stenting (CAS) is Based on Institutional Training More than Individual Experience in Large-volume Centres
Background: Operator training is a key factor for the safety of carotid stenting (CAS). Whether institutional practice is associated with improved individual operator outcomes is debated.Objective: To evaluate the effect of the institutional experience on outcomes of new trainees with CAS, a retrospective analysis of a prospectively held database was performed.Methods: The overall study period, 2004–2012, was divided into two sequential time frames: 2004–April 2006 (leaders-team phase) and May 2006–2012 (expanded team phase). In the first frame, a single leader-operators team that first approached CAS and passed the ...
Source: European Journal of Vascular and Endovascular Surgery - March 7, 2013 Category: Surgery Authors: G. Parlani, P. De Rango, F. Verzini, E. Cieri, G. Simonte, A. Casalino, A. Manzone, P. Cao Tags: Carotid Disease Source Type: research
Part One: For the Motion. Completion Angiography Should be Used Routinely Following Carotid Endarterectomy
The principle tenet for all surgeons who perform carotid endarterectomy (CEA) should be a commitment to increase the safety of surgery, but there is no agreement on whether the routine use of intraoperative completion imaging should be performed to confirm the technical adequacy of CEA. This divergence is partially due to the positive outcome of CEA in patients without the use of completion imaging and to the fact that some postoperative strokes are unrelated to the surgical technique. But does a careful technique with the use of intra-operative magnification eliminate the need to further examine the adequacy of the surgic...
Source: European Journal of Vascular and Endovascular Surgery - March 4, 2013 Category: Surgery Authors: J.-B. Ricco, F. Schneider, G. Illuminati Tags: Trans-Atlantic Debate Source Type: research
Part Two: Against the Motion. Completion Angiography is Unnecessary Following Carotid Endarterectomy
Stroke as a result of carotid endarterectomy (CEA) is usually attributed to technical complications. Accordingly, some surgeons have instituted a policy of routine completion imaging (RCI). Based on variously defined findings these surgeons will re-explore with the intention of correcting the abnormality. It would seem self evident that this approach would lead to elimination of all technical defects and result in an almost negligible incidence of postoperative stroke.
Source: European Journal of Vascular and Endovascular Surgery - March 4, 2013 Category: Surgery Authors: R.H. Samson Tags: Trans-Atlantic Debate Source Type: research
Comparison of Open and Endovascular Treatments of Post-carotid Endarterectomy Restenosis
Conclusions: despite the selection limits and bias of this study, in our experience open and endovascular surgery provided similar perioperative results in the management of post-CEA restenosis. Long term outcomes are similar, too, despite a slight increase in secondary restenosis and recurrent reinterventions among open surgery patients, warranting further studies and analysis.
Source: European Journal of Vascular and Endovascular Surgery - February 22, 2013 Category: Surgery Authors: W. Dorigo, R. Pulli, A. Fargion, G. Pratesi, D. Angiletta, I. Aletto, A. Alessi Innocenti, C. Pratesi Tags: Carotid Disease Source Type: research
Nationwide Experience of Cardio- and Cerebrovascular Complications During Infrainguinal Endovascular Intervention for Peripheral Arterial Disease and Acute Limb Ischaemia
Conclusions: In this population-based study we found a low risk of cardiac complications, but catheter-administered thrombolytic therapy entailed a non-negligible risk of major stroke.
Source: European Journal of Vascular and Endovascular Surgery - January 21, 2013 Category: Surgery Authors: J. Nordanstig, K. Smidfelt, M. Langenskiöld, B. Kragsterman Tags: Peripheral Arterial Disease Source Type: research
Selected Abstracts from the February Issue of the Journal of Vascular Surgery
Carlos H. Timaran, Vito A. Mantese, Mahmoud Malas, O. William Brown, Brajesh K. Lal, Wesley S. Moore, Jenifer H. Voeks, Thomas G. Brott Objective: Outcomes in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) did not differ between carotid artery stenting (CAS) and carotid endarterectomy (CEA) for the composite primary end point of stroke, myocardial infarction (MI), or death during the periprocedural period or ipsilateral stroke within 4 years. Rigorous credentialing and training of interventionists, including vascular surgeons, were required for the randomization phase of CREST. Because the lead...
Source: European Journal of Vascular and Endovascular Surgery - January 18, 2013 Category: Surgery Tags: JVS Abstracts Source Type: research
