23 research outputs found
Letter by Ng et al regarding article, risk of early carotid endarterectomy for symptomatic carotid stenosis
No full text10.1161/STROKEAHA.110.605410Stroke424e359-SJCC
Thoracic stent graft versus surgery for traumatic thoracic transection
No full text10.1002/14651858.CD006642Cochrane Database of Systematic Reviews3
Commentary: Global differences in endovascular treatment of chronic aortic dissections:a comparison of physicians in the United States, Europe, and Asia
No full textThe entire concept of treating “acute” aortic dissections endovascularly makes good sense to me because the intimal flap is extremely mobile and flexible. It is a very dynamic situation, with extremely fragile and diseased aortic wall that makes it almost impossible to treat this pathology via an open approach. Closing of the entry tear with an endograft has a reasonable chance of resulting in thrombosis of the false lumen, which will likely prevent further acute complications (rapid dilatation, rupture, organ ischemia) and aneurysm formation in the long run.This is all completely different in the case of a “chronic” dissection, in which a firm intimal flap (lamella) is present, and the aortic wall is relatively firm, making open repair a lot easier than in the case of acute dissection. Studies with dynamic cine computed tomographic angiography on patients with chronic dissections clearly show the immobility and stiffness of the lamella. All surgeons with experience in treating chronic dissections by open graft implantation realize this quality of the lamella: it is so robust that it is very unlikely (impossible?) that any stent-graft will ever be capable of pushing it toward the false lumen to close it off.In my mind, chronic dissections can be treated via an endovascular approach only when there are normal, good-quality sealing zones proximally and distally, basically treating it like a normal aortic aneurysm. This is usually not the case in chronic dissections; often, an adequate proximal landing zone is present, but distally, the stent-graft must land in the true lumen. This leaves open a giant fenestration distally, which results in continuous flow in the false lumen originating from the distal attachment, making it extremely unlikely that the pressure on the still perfused false lumen will be any different than before stent-grafting. Basically, even though the stent-graft has been implanted, there is continued pressurization of the outside aortic wall, with all the associated potential for complications remaining.Some investigators explain the concept of stent-grafting for chronic dissections with the distal end landing in a dissected area by hypothesizing that it may work exactly the same as with acute dissections: by closing of the entry tear, the flow in the still perfused false lumen may change as a result of different pressure gradients. In my mind, this is very unlikely and will be difficult to prove without the use of large, randomized studies
Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients
No full textBackgroundThe number of elderly (≥65 years) end-stage renal disease (ESRD) patients on hemodialysis is rapidly increasing. Vascular access outcomes remain contradictory and understudied across different elderly populations. We hypothesized age might influence primary autogenous fistula use and outcomes in a predominantly diabetic multiethnic Asian ESRD population.MethodsDemographic and clinical factors affecting fistula patency and maturation were retrospectively compared among patients with incident ESRD aged <65 and ≥65 years at a single center. Fistula patency was estimated by Kaplan-Meier curves with log-rank test comparison.ResultsWe analyzed 280 primary fistulas (59% radiocephalic, 33% brachiocephalic, and 8% brachiobasilic) in this cohort consisting of 31.8% aged ≥65 years, 50% Chinese, 39% Malay, 42% women, and 70% diabetic. One- and 2-year primary and secondary patency in patients aged <65 vs ≥65 years were comparable: 41.3% vs 36.7% and 28.7% vs 24.4% (P = .547) and 57.7% vs 56.8% and 47.1% vs 47.2% (P = .990). On multivariate analysis, only non-Chinese, dialysis initiation with tunneled catheters, and surgical/endovascular interventions affected fistula survival hazard ratios (HR): 0.622 (95% confidence interval [CI], 0.43-1.00), 0.549 (95% CI, 0.297-0.841), and 2.503 (95% CI, 1.695-3.697), respectively. Nonmaturation and intervention rates were also similar at 56.7% vs 61.8% and 34% vs 32.2% at 3 and 6 months and 0.31 vs 0.36 per access year, respectively (P > .05). Females and tunneled catheters were the only risk factors for nonmaturation (HR, 1.568; 95% CI, 1.148-1.608, and HR, 1.623; 95% CI, 1.400-1.881, respectively).ConclusionsA primary fistula strategy in incident elderly ESRD is feasible and does not result in inferior outcomes. Age should therefore not be a determinant for primary fistula creation
Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients
No full text10.1016/j.jvs.2012.01.063JOURNAL OF VASCULAR SURGERY562433-439United State
Corrigendum to “Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischaemia” [Eur J Vasc Endovasc Surg 58 (1S) (2019) 1–109>] (European Journal of Vascular & Endovascular Surgery (2019) 58(1S) (S1–S109.e33), (S1078588419303806), (10.1016/j.ejvs.2019.05.006))
No full textThe authors regret that the name of one of the co-author has been incorrectly spelt. Dr. Mauro Garguilo should have been spelt as “Mauro Gargiulo”. The authors would like to apologise for any inconvenience caused
Validation of the new venous severity scoring system in varicose vein surgery
No full textAbstractObjectivesWe performed this observational study to validate the three components of a new venous severity scoring (VSS) system, ie, venous clinical severity score (VCSS), venous segmental disease score (VSDS), and venous disability score (VDS), and to evaluate VCSS, VDS, and CEAP clinical class and score in quantifying outcome of varicose vein surgery.Patients and methodsThe study included 45 patients who underwent superficial venous surgery in 48 legs with primary varicose veins. Venous color duplex scanning, clinical examination, and a questionnaire were used preoperatively and at 6 weeks and 6 months postoperatively to assign VSS and CEAP clinical class and score.ResultsCEAP clinical score, VCSS, and VDS demonstrated a linear association with CEAP clinical class (P < .001, P < .001, P = .002, respectively). Good correlation among all severity scores was found, particularly between CEAP clinical score and VCSS (r = 0.94; P < .001). CEAP clinical score was also highly correlated with CEAP clinical class (r = 0.84; P < .001) and VDS (r = 0.70; P < .001). Similarly, VCSS correlated with CEAP clinical class (r = 0.83; P < .001) and also VDS (r = 0.72; P < .001). The anatomic severity marker VSDS demonstrated a weak correlation with clinical severity indicators VCSS (r = 0.29; P = .048) and VDS (r = 0.31; P = .03) but not with age, gender, or CEAP clinical class and score. Six months after surgery the median (interquartile range) percent change in VCSS (73%; range, 50%-100%) and CEAP clinical score (70%; range, 50%-100%) were both significantly greater (P < .001) than the corresponding change in CEAP clinical class (17%; range, 0%-50%). In legs with high VDS at baseline, median (interquartile range) percent change in VDS was 100% (range, 50%-100%), significantly greater (P < .001) than the corresponding change in CEAP clinical class (0%; range, 0%-17%).ConclusionsVenous severity scores are significantly higher in advanced venous disease, demonstrating correlation with anatomic extent. Both venous clinical severity scores, VCSS and CEAP clinical score, are equally sensitive and significantly better for measuring changes in response to superficial venous surgery than is the already in use CEAP clinical class. VDS demonstrated comparable and even better performance. Although the assignment of CEAP clinical class might be adequate for daily clinical purposes, venous severity scoring systems should be used in clinical studies to quantify venous outcome
