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Endovascular treatment of penetrating ulcers of paraceliac aorta using fenestrated endograft
No full textCommentary: How Old Is Too Old for EVAR?
No full textThe study from Mwipatayi et al1 in the October 2020 issue of the JEVT is important for a variety of reasons. First of all,
it reports an interesting subanalysis of the prospective, observational, single-arm ENGAGE registry, which involves
almost 80 centers worldwide and represents a clear image of the real-world performance of a modern endovascular solution for most abdominal aortic aneurysms (AAA). The value of this paper takes on even greater importance
if one considers that it deals with one of the main clinical dilemmas of the contemporary vascular surgeon, which is
the treatment decision process in patients >80 years old. In,fact, the mean age of the general population is onstantly
increasing; in Europe, for example, from 2008 to 2018 the overall life expectancy increased by 2 years.2 The revalence
of asymptomatic AAAs is significantly higher in older
people, and it exceeds 8% in male smokers >80 years old.3
This has led to a significant, steady increase in patients >80
years old submitted to endovascular aneurysm repair
(EVAR) in some studies4; however, current guidelines do
not specifically address the indication to repair according to
age. The only age specification available in both the Society
for Vascular Surgery and European Society for Vascular
Surgery guidelines refers to life expectancy; thus, we are
faced with a clinical scenario and no specific indications.
Consistent with previous reports on this subject, the
Engage registry study shows that all-cause mortality in
the octogenarian population submitted to EVAR is higher
than in younger patients; however, aneurysm-related mortality
is not significantly different in the two groups. As a
matter of fact, it is evident from previous works that the
natural history of octogenarians submitted to EVAR is
dependent on their preoperative conditions. Some authors
have found a significantly higher overall mortality in octogenarians
submitted to EVAR compared with younger
patients5; however, this may be the effect of a higher number
of risk factors in this population, as shown by other
authors. For example, in the paper by Crespy et al,6 the two
populations have similar clinical characteristics, and the
3-year survival is comparable in the groups.
Pini et al4 have shown that an American Society of
Anesthesiologists (ASA) score of IV is an independent predictor
of 30-day mortality in octogenarians undergoing
EVAR; however, the most important finding of that study is
that several factors other than ASA IV, such as peripheral
artery disease, chronic obstructive pulmonary disease, and
chronic renal disease, play significant roles in midterm survival.
The outcomes reported by Mwipatayi and colleagues1
are consistent with these findings, since several factors
were found to predict all-cause mortality. It is also interesting
to observe that quality of life has an important role in
late survival. This is an aspect that deserves an increasing
degree of attention when dealing with aneurysm, as already
anticipated in a study from our group.7
Overall, the finding that all-cause mortality is greater in
>80-year-old people cannot be easily dismissed, and the
indication to repair should be very carefully considered in
this group, with particular caution in octogenarians with
multiple comorbidities. With judicious selection of patients
to be treated, the follow-up can be specifically tailored to
avoid unnecessary imaging surveillance in these patients
Fenestrated endograft for recurrent paravisceral aortic pseudoaneurysm after thoracoabdominal aortic endograft
No full textEndograft infection as a late EVAR complication in patients with aortic pseudoaneurysm and previous urological procedures. A report of two cases
No full textEndograft infection is a rare endovascular aortic repair (EVAR) complication with high mortality and morbidity. We report two cases of endograft infection occurred in patients with previous urological procedures who underwent to EVAR for aortic-iliac pseudoaneurysm. The infections were treated with a surgical conversion through arterial homograft. In both cases an homograft complication occurred and it was treated by a new endograft implantation (re-EVAR) and lifetime antibiotic therapy. After 21 months of follow-up both patients are alive and free from aortic complications. In this paper we suggest the correlation between endograft infection and previous urological surgery
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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