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Eur J Vasc Endovasc Surg [journal]
- Part One: For the Motion. Evidence Supports Reducing the Threshold Diameter to 5 cm for Elective Interventions in Women With Abdominal Aortic Aneurysms. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 Dec; 48(6):611-4.
- Commentary on: "White Matter Damage of the Brain is Associated With Poor Outcomes in Vascular Surgery Patients with Claudication: A Pilot Study". [Journal Article]
- Eur J Vasc Endovasc Surg 2014 Dec; 48(6):694.
- Commentary on 'Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study'. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 Dec; 48(6):657-8.
- Predictors of Failure of Closure in Percutaneous EVAR Using the Prostar XL Percutaneous Vascular Surgery Device. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Nov 22.
To identify predictors of failure in percutaneous endovascular aneurysm repair (P-EVAR) using the Prostar XL Percutaneous Vascular Surgery Device (Abbot Vascular, Santa Clara, CA, USA) and the need for conversion to conventional femoral cutdown (O-EVAR).Consecutive patients who underwent P-EVAR with the Prostar XL device between January 2009 and April 2012 were included in this series. Patients with a circular calcified common femoral artery (CFA) on computed tomography angiography were operated using O-EVAR and were therefore excluded. To identify predictors of success of closure in P-EVAR, artery characteristics, sheath size used, and comorbidities were analyzed in a univariate logistic regression model.Percutaneous access was achieved in 154 femoral access sites with conversion to O-EVAR was needed in 10 (6.5%). Significant predictors of conversion included sheath size (continuous, relative risk [RR] 1.50, p < .03) and the ratio between sheath size and CFA diameter >0.75 (RR 8.93, p < .01). Variables such as calcification quantity scores, CFA diameter, body mass index, and comorbidities were not significant.The data demonstrate that sheath size, in particular, combined with CFA diameter predicts failure of closure in P-EVAR using the Prostar XL device. This ratio can be utilized to help in decision making with regard to the EVAR approach. A ratio of >0.75 would favor a primary open groin approach.
- Overexpression of MicroRNA-145 Promotes Ascending Aortic Aneurysm Media Remodeling through TGF-β1. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Nov 25.
In this study the role of microRNA-145 expression in ascending aortic aneurysm wall media remodeling was examined.Aortic wall samples were obtained from 10 patients who had undergone surgery for ascending aortic aneurysm. Control aortic tissue samples were obtained from 10 patients who had undergone coronary artery bypass graft. The levels of microRNA-145 were analyzed using real time quantitative reverse transcriptase polymerase chain reaction, and western blots were used to determine the expressions of osteopontin (OPN) and collagen. In vitro cultures of vascular smooth muscle cells (VSMCs) were established from both patient groups. The VSMCs were transfected with either microRNA-145 mimics or microRNA-145 inhibitors to determine the effect of microRNA-145 on the expression of OPN and collagen. Furthermore, cells were co-transfected with microRNA-145 mimics and TGF-β1 siRNA to investigate whether TGF-β1 is involved in the process that microRNA-145 increases the expression of OPN and collagen.Aortic microRNA-145, OPN and collagen III was increased in ascending aortic aneurysm patients compared with controls (p < .05). VSMCs transfected with microRNA-145 mimics increased the expression of both OPN (average of 1.59-fold, p < .05) and collagen III (mean of 1.71-fold, p < .05). Cells transfected with microRNA-145 inhibitors decreased expression of both OPN and collagen III compared with negative controls. In addition, the inhibition of TGF-β1 decreased the positive effect of microRNA-145 on the expression of OPN and collagen III.The increased expression of microRNA-145 promotes media remodeling through TGF-β1 in the aortic aneurysm wall.
- Re: "Type II Endoleak: Conservative Management Is a Safe Strategy" [LETTER]
- Eur J Vasc Endovasc Surg 2014 Nov 4.
- Re: 'Type II Endoleak: Conservative Management Is a Safe Strategy' [LETTER]
- Eur J Vasc Endovasc Surg 2014 Nov 4.
- Variability of Origin of Splanchnic and Renal Vessels From the Thoracoabdominal Aorta. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Nov 10.
To analyze the variability of origin of the celiac trunk (CT), the superior mesenteric artery (SMA), the right renal artery (RRA), and the left renal artery (LRA) in terms of mutual distances, angle from the sagittal aortic axis (clock position), and ostial diameters on computed tomography angiographies (CTAs) in three groups of patients.One hundred and fifty CTAs of 50 patients with a non-dilated thoracoabdominal aorta (group A), 50 with thoracoabdominal aneurysm (B), and 50 with infrarenal aneurysm (C) were reviewed. The measurements performed on CTAs, as well as the patients' age, sex, and body surface area, were analyzed. p values <.05 were considered statistically significant.The clock position of the CT and the SMA, the diameters of all vessels, and the distance of the CT-SMA followed a Gaussian distribution. In contrast, the clock position of the renal vessels did not follow a normal distribution, and nor did the distances of the SMA-RRA, SMA-LRA, RRA-LRA or the distances between the renal arteries and the aortic bifurcation. The same values did not differ significantly among the three groups, with the exception of the distances between the renal arteries and the aortic bifurcation, significantly greater in group C. The clock position of the LRA and the distances of the SMA-LRA, SMA-RRA, RRA-LRA and between both renal arteries and the aortic bifurcation showed a significant correlation with the increase of aortic diameter.The anatomic variability of the origin of both the CT and the SMA in terms of clock position and mutual distances followed a Gaussian distribution, regardless of group. The same applies to the ostial diameters of renal and visceral vessels. In contrast, the origin of the renal vessels had a statistically significant heterogeneity that seemed to be correlated with the increase of aortic diameter in the mesenteric and renal aortic region.
- Risk Factors for Proximal Neck Complications After Endovascular Aneurysm Repair Using the Endurant Stentgraft. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Nov 7.
To assess the incidence and risk factors for proximal aneurysm neck related complications with a late generation device for endovascular abdominal aneurysm repair (EVAR).Data were retrieved from a prospective registry (Endurant Stent Graft Natural Selection Global Postmarket Registry) involving 79 institutions worldwide. The risk factors tested were age, gender, surgical risk profile, proximal neck length (<10 mm), diameter (>30 mm), supra- and infrarenal angulation (>60° and 75°), mural thrombus/calcification (>50%) and taper (>10%), and AAA diameter (>65 mm). Two neck related composite endpoints were used, for intra-operative (type-1a endoleak, conversion, deployment/retrieval complication or unintentional renal coverage) and post-operative (type-1a endoleak or migration) adverse events. Independent risk factors were identified using multivariable backwards modeling.The study included 1263 patients (mean age 73, 10.3% female) from March 2009 to May 2011. Twenty three (1.8%) intra-operative adverse events occurred. Neck length <10 mm (OR 4.9, 95% CI 1.1-22.6) and neck thrombus/calcification >50% (OR 4.8, 95% CI 1.7-13.5) were risk factors for intra-operative events. The planned 1 year follow up visit was reached for the entire cohort, and the 2 year visit for 431 patients. During this time, 99 (7.8%) events occurred. Female gender (HR 1.9, 95% CI 1.1-3.2), aneurysm diameter >65 mm (HR 2.8, 95% CI 1.9-4.2), and neck length <10 mm (HR 2.8, 95% CI 1.1-6.9) were significant post-operative risk factors. Neck angulation, neck taper, large diameter neck, and presence of thrombus/calcification were not predictors of adverse outcome in this study.These results support the adequacy of this device in the face of adverse neck anatomy, and confirm neck length as the most relevant anatomical limitation for EVAR. Additionally, the study confirms the decline in early to mid-term intervention rates with a newer generation device in a large patient sample. Lastly, it suggests that neck related risk factors affect outcome and impact on prognosis in varying degrees.
- Beneficial Effects of Pre-operative Exercise Therapy in Patients with an Abdominal Aortic Aneurysm: A Systematic Review. [REVIEW]
- Eur J Vasc Endovasc Surg 2014 Nov 14.
The impact of post-operative complications in abdominal aortic aneurysm (AAA) surgery is substantial, and increases with age and concomitant co-morbidities. This systematic review focuses on the possible effects of pre-operative exercise therapy (PET) in patients with AAA on post-operative complications, aerobic capacity, physical fitness, and recovery.A systematic search on PET prior to AAA surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database scale. The agreement between the reviewers was assessed with Cohen's kappa.Five studies were included, with a methodological quality ranging from moderate to good. Cohen's kappa was 0.79. Three studies focused on patients with an AAA (without indication for surgical repair) with physical fitness as the outcome measure. One study focused on PET in patients awaiting AAA surgery and one study focused on the effects of PET on post-operative complications, length of stay, and recovery.PET has beneficial effects on various physical fitness variables of patients with an AAA. Whether this leads to less complications or faster recovery remains unclear. In view of the large impact of post-operative complications, it is valuable to explore the possible benefits of a PET program in AAA surgery.