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Concept: Vascular surgery


-This project by the International Consortium of Vascular Registries, a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.

Concepts: Medicine, Aortic aneurysm, Aneurysm, Aortic dissection, Abdominal aortic aneurysm, Aneurysm of sinus of Valsalva, General surgery, Vascular surgery


Important data from two large, randomized trials comparing early and late outcomes after carotid endarterectomy and carotid-artery stenting have now been published in the Journal.(1),(2) In common with every other large, multicenter, randomized trial to date, the Asymptomatic Carotid Trial (ACT I) and the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) showed that after the perioperative period, there was no difference in the rate of late ipsilateral stroke after endarterectomy or stenting. In ACT I, which included asymptomatic patients who were deemed to be at average risk, the 5-year rate of ipsilateral stroke (excluding the perioperative period) was . . .

Concepts: Medical terms, Randomized controlled trial, Asymptomatic, Vascular surgery, Carotid endarterectomy


Purpose: To describe a bailout technique for in situ fenestration of an inadvertently covered internal iliac artery (IIA) associated with endovascular repair of an abdominal aortic aneurysm (AAA). Technique: The procedure is demonstrated in a 76-year-old patient who underwent elective repair of a 5-cm infrarenal AAA using an Excluder endovascular graft 2 years following thoracic aortic stent-graft repair of a chronic type B aortic dissection. A completion angiogram demonstrated unintentional coverage of the left IIA. The iliac limb of the stent-graft was not able to be displaced away from the ostium, so to preserve IIA perfusion in a patient with prior thoracic aortic stent-grafting, a bailout technique was performed using an Outback re-entry device to successfully fenestrate the polytetrafluoroethylene graft material. An iCast balloon-expandable stent was placed across the fenestration creating a patent side branch to maintain patency. Six-year follow-up demonstrates a stable repair. Conclusion: In situ fenestration of a stent-graft overlying the internal iliac artery can be a useful bailout technique when other options are unsuccessful.

Concepts: Aortic aneurysm, Aneurysm, Aortic dissection, Aorta, External iliac artery, Abdominal aortic aneurysm, Internal iliac artery, Vascular surgery



BACKGROUND: Endovenous Laser Ablation (EVLA) is one of the most accepted treatment options for varicose veins. The aim of this study was to investigate the efficacy and safety of the new radial fiber slim (ELVeS-radial-slim kit™) for the 1470 nm diode laser in perforator veins with a 1 month follow-up. METHODS: Our prospective observational cohort study comprised 69 perforating veins in 55 patients. Ninety percent of all patients were in the CEAP-stage C3-C6. The radial fiber slim was used to occlude the perforating vein and the great or small saphenous vein in the same procedure. The primary efficacy endpoint of the study was ultrasonographically proven elimination of venous reflux in the perforating vein after at least one month. Secondary efficacy and further safety end points after one month were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis (DVT), clinical pulmonary embolism (PE), or superficial vein thrombosis (SVT) as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia. RESULTS: Follow-up could be completed in all patients. In all treated perforating varicose veins, occlusion with elimination of reflux could be demonstrated immediately after the procedure. After one month 95.6% of the treated veins were still occluded (67/69). During follow-up, we did not diagnose any DVT, PE or SVT in the area related to the treated perforating vein. No patient died. One patient reported paresthesia distally of the puncture site. CONCLUSION: Endovenous laser treatment of varicose perforating veins with 1470 nm diode laser using the radial fiber slim is effective and safe with low recanalization rates during 1-month follow-up.

Concepts: Vein, Great saphenous vein, Deep vein thrombosis, Deep vein, Vascular surgery, Varicose veins, Sclerotherapy, Superficial vein


BACKGROUND: Varicose veins are a common entity presenting a worldwide distribution. Although they are usually benign, sometimes are proved to be a threatening condition. Massive hemorrhage is an unusual complication of this common venous pathology that demands immediate medical intervention. CASE PRESENTATION: We present a case of a 66-year-old woman found dead in her house surrounded by a large quantity of blood. Autopsy revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein, signs of exsanguinations and liver cirrhosis. Toxicological analysis was negative. CONCLUSION: Massive hemorrhage from a ruptured varicosity is a severe medical emergency. Awareness of the risk of massive hemorrhage may provoke preventive treatment to be undertaken so as terminal loss of consciousness and a subsequent unattended death to be averted.

Concepts: Death, Blood, Artery, Vein, Hepatic portal vein, Vascular surgery, Varicose veins, Sclerotherapy


This study analyzed the effect of statins on clinical outcomes after carotid endarterectomy (CEA) and the rate of restenosis.

Concepts: Endarterectomy, Vascular surgery, Carotid endarterectomy




Because of recent advances in best medical treatment (BMT), it is currently unclear whether any additional surgical or endovascular interventions confer additional benefit, in terms of preventing late ipsilateral carotid territory ischemic stroke in asymptomatic patients with significant carotid stenoses. The aim was to compare the stroke-preventive effects of BMT alone, with that of BMT in combination with carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with high grade asymptomatic extracranial carotid artery stenosis.

Concepts: Medicine, Atherosclerosis, Stroke, Transient ischemic attack, Common carotid artery, Neurosurgery, Vascular surgery, Carotid endarterectomy