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Eur J Vasc Endovasc Surg [journal]
- Commentary on 'Ultrasound-guided Intralesional Diode Laser Treatment of Congenital Extratruncular Venous Malformations: Mid-term Results'. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):565.
- Compression Therapy Versus Surgery in the Treatment of Patients with Varicose Veins: A RCT. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Mar 24.
Superficial venous reflux and varicose veins are common. The aim of this randomized controlled trial was to assess effectiveness of compression therapy compared with surgery for superficial venous reflux.153 patients with CEAP class C2-C3 and superficial venous reflux were randomized to receive either conservative treatment (compression stockings) (n = 77) or surgery (n = 76). Clinical examination including duplex ultrasound (DUS) was performed at entry and 1 and 2 years after randomization (compression group) or surgery (surgery group). Venous Clinical Severity Score without compression stockings (VCSS-S), Venous Segmental Disease Score (VSDS), Venous Disability Score (VDS), and health-related quality of life (HRQoL) were assessed at entry and at the follow-ups. Data were analysed on an intention-to-treat basis and according to the actual treatment performed.At 2 years, 70/76 patients in the surgery group and 11/77 patients in the compression group had been operated on. VCSS-S decreased from 4.6 to 3.5 in the compression group (p < .01) and from 4.8 to 0.6 in the surgery group (p < .001). VSDS decreased from 7.7 to 7.0 in the compression group and from 8.2 to 0.9 in the surgery group (p < .0001). HRQoL did not change in the compression group, but improved significantly in the surgery group.The surgical elimination of non-complicated superficial venous reflux is an effective treatment when compared with providing compression stockings only.
- European Journal of Vascular and Endovascular Surgery in the Era of Social Media. [EDITORIAL]
- Eur J Vasc Endovasc Surg 2014 Mar 24.
- Invasive Treatment for Infrainguinal Claudication Has Satisfactory 1 Year Outcome in Three out of Four Patients: A Population-based Analysis from Swedvasc. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Mar 21.
In spite of recommendations advocating conservative best medical treatment, many patients with infrainguinal intermittent claudication (IC) are treated by invasive open and endovascular methods. This study aims to evaluate the incidence and 1-year results of all such treatments during 2009 in Sweden.The design was a one-year follow-up through the Swedish Vascular Registry (Swedvasc) of all 775 patients from the Swedish population of 10 million inhabitants in whom 843 invasive infrainguinal procedures (796 index procedures and 47 secondary procedures) were performed for IC in 2009. Index procedures were open surgery in 290 (37%) patients, bilateral in nine cases, giving a total of 299 limbs, endovascular treatment in 447 (58%) patients, bilateral in 10, giving a total of 457 limbs, and hybrid treatment in 38 (5%) patients, bilateral in two cases, giving a total of 40 limbs. Data were analysed both with regard to the number of patients (775) and the number of procedures (843). Clinical outcome was calculated from patient-reported leg function (unchanged, improved, deteriorated) and whether amputation had been necessary or death had occurred. Patent reconstruction at 1 year was also counted as improvement.Improvement at 1 year was seen in 567 (73.2%) patients, (225 [77.6%] in the open surgery group, 320 [71.6%] in the endovascular treatment group, and 22 [57.9%] in the hybrid treatment group). No significant difference was found between the open surgery and endovascular treatment groups comprising 737/775 patients (p = .350). Hybrid treatment gave significantly worse results (p = .046). Fifty-seven (7.3%) patients reported unchanged limb function and 32 (4.1%) patients reported deterioration. Within 30 days two patients died and one patient underwent amputation. Within 1 year 10 patients underwent 11 amputations: five (1.7%) in the open surgery group, three (0.6%) in the endovascular treatment group, and two (7.5%) in the hybrid treatment group; one underwent bilateral amputation (p = .07). Twenty-two patients died: 10 (3.4%) in the open surgery group, 12 (2.7%) in the endovascular treatment group and none in the hybrid treatment group (p = .465).Reported improvement at 1 year was 73.2% in patients invasively treated for infrainguinal IC. Patients reporting an unchanged or deteriorated clinical state are a considerable clinical challenge. Further studies to determine whether or not invasive treatment of infrainguinal IC is appropriate are justified.
- Randomized Trials for Endovascular Treatment of Infrainguinal Arterial Disease: Systematic Review and Meta-analysis (Part 1: Above the Knee). [REVIEW]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):524-535.
To evaluate 1 to 36 month follow-up outcomes of different endovascular treatment strategies in above-the-knee (ATK) arterial segments in patients with intermittent claudication (IC) and critical limb ischemia (CLI).Studies indexed in Medline and Embase from 1980 to November 2013 of randomized controlled trials comparing balloon angioplasty (PTA) or drug-eluting balloon (DEB) with optional bailout stenting, or primary stenting using a bare stent (BS) or drug-eluting stent (DES) to one another were included. Methodological quality of each trial was assessed using the Cochrane Collaboration tool, and quality of evidence was assessed using the GRADE system. Outcomes assessed were quality of life, walking capacity evaluated by treadmill or questionnaire, change in Rutherford classification, target lesion revascularization (TLR), bypass, binary restenosis, late lumen loss, stenosis grade, amputation, death, major adverse cardiac events, or event-free survival with follow-up periods of at least 1 month.Twenty-three trials including 3314 patients in total were identified. Eighty-five per cent patients had IC and 15% CLI. Fifteen trials showed no systematic benefit of BS over PTA. One trial comparing DES and PTA reported no significant differences in walking capacity or Rutherford classification. Four trials showed a beneficial effect on TLR rate, but not on Rutherford classification of DEB compared with PTA. In four trials DES did not systematically perform better than BS.In general, performing PTA with optional bailout stenting for ATK lesions is the preferred strategy in patients with IC. For CLI, more studies are needed for recommending an optimal treatment strategy.
- Ultrasound-guided Intralesional Diode Laser Treatment of Congenital Extratruncular Venous Malformations: Mid-term Results. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):558-64.
Over the short term, endovenous laser ablation (EVLA) has been found to be safe and effective for endovenous ablation in extratruncular venous malformations (EVMs). We report our experiences in percutaneous ultrasound (US)-guided treatment of congenital EVMs with respect to effectiveness and safety over the mid-term.This was a retrospective analysis of a collected database of consecutive US-guided intralesional diode laser treatments of congenital EVMs (2007-2013). A consecutive series of 164 patients (86 women/girls [53%] and 78 men/boys [46%], aged 1.5-68.0 years [mean age 20.78 years]) were treated using EVLA for congenital EVMs at our institution. All of the patients were symptomatic. The primary outcomes for assessing safety were mortality and morbidity, including laser-related adverse events, thrombotic events, and important nerve or vessel injuries, and so on. Effectiveness was assessed according to reduction of the mass, the absence of pain, and technical success.One hundred and ninety procedures were undertaken in 164 patients, achieving a 100% immediate technical success rate. Most complications were minor and improved quickly, except in one patient, who suffered a peroneal nerve injury. Spot skin burn injuries occurred in one procedure (0.53%). Paresthesia in the treated area was noted after 15 procedures (7.89%). For complaints related to swelling, cosmetic outcomes, and pain, the clinical success rates were 65.71%, 68.97% and 97.74%, respectively. After a mean follow-up of 23.91 months, no patient suffering from pain, hemorrhage, or limited range of motion had returned with recurrent symptoms after initial successful treatment (resolved). Recurrence rates in patients with heavy sensation, swelling, and deformity were 6.89% (two of 29), 7.41% (two of 27), and 11.11% (one of nine), respectively. One hundred and twelve (59.00%) treated lesion areas were classified as "excellent", 59 lesions (31.00%) were "good", and 19 lesions (10.00%) were "fair" using duplex US imaging at the final follow-up visit.EVLA is a minimally invasive treatment with the advantages of safety, effectiveness, and simplicity in ameliorating symptoms associated with EVMs in appropriately selected patients.
- Editor's Choice - Hybrid Treatment of Thoracic, Thoracoabdominal, and Abdominal Aortic Aneurysms: A Multicenter Retrospective Study. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):470-8.
The aim of this study was to assess the results of hybrid techniques for the treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms based on multicenter results and the various series regarding hybrid procedures reported in the literature.The results of 76 hybrid procedures performed in 19 French university hospital centers between November 2001 and October 2011 were collected. There were 50 men and 26 women, mean age 68.2 (35-86) years. All patients were considered at high risk (ASA ≥ 3) for conventional surgery. Aneurysms involved the thoracic, abdominal, and thoracoabdominal aorta in five, 14, and 57 cases respectively. There were 11 emergent repairs. The revascularization of four visceral arteries was performed in 38 cases. Between one and three visceral arteries were revascularized in the other cases. Visceral artery debranching and stent graft deployment were performed in a one-stage procedure in 53 cases and in a two-stage procedure in 23 cases.There were 26 (34.2%) postoperative deaths. Nine of the survivors developed paraplegia, of which one resolved completely. Bowel ischemia occurred in 13 cases (17.1%), and one patient was treated by a superior mesenteric artery bypass. Four patients required long-term hemodialysis. Postoperative computed tomography scan showed a type II endoleak in two patients.Morbidity and mortality in this study were greater than previously reported. Candidates for hybrid aortic repair should be carefully selected.
- Healthcare Quality Indicators of Peripheral Artery Disease Based on Systematic Reviews. [JOURNAL ARTICLE]
- Eur J Vasc Endovasc Surg 2014 Mar 17.
Peripheral artery disease (PAD) is a major health problem whose clinical management includes multiple options regarding risk factor control, diagnosis, and medical and surgical treatment. The aim was to generate indicators based on systematic reviews to evaluate the quality of healthcare provided in PAD.Electronic searches were run for systematic reviews in The Cochrane Library (Issue 6, 2011), MEDLINE, EMBASE, and other databases (up to June 2011). Conclusive systematic reviews of high methodological quality were selected to formulate clinical recommendations. Indicators were derived from clinical recommendations with moderate to very high strength of evidence as assessed by the GRADE system.From 1,804 reviews initially identified, 29 conclusive and high-quality systematic reviews were selected and nine clinical recommendations were formulated with a moderate to very high strength of recommendation. Six indicators were finally generated: four on pharmacological interventions, antiplatelet agents, naftidrofuryl, cilostazol, and statins; and two lifestyle interventions, exercise and tobacco cessation. No indicators were derived for diagnostic tests or surgical techniques. Most indicators targeted patients with intermittent claudication.These quality indicators will help clinicians to assess the appropriateness of healthcare provided in PAD. The development of evidence-based indicators in PAD is limited by the lack of methodological quality of the research in this disease, the inconclusiveness of the evidence on diagnostic and surgical techniques, and the dynamic nature of the vascular diseases field.
- Randomized Trials for Endovascular Treatment of Infrainguinal Arterial Disease: Systematic Review and Meta-analysis (Part 2: Below the Knee). [REVIEW]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):536-544.
To evaluate 1 to 48 month follow-up outcomes of different endovascular treatment strategies in below-the-knee (BTK) arterial segments in critical limb ischemia (CLI) patients.Medline and Embase were searched (last searched on 5 November 2013) for studies of randomized controlled trials comparing either balloon angioplasty (PTA) or drug-eluting balloon (DEB) with optional bailout stenting, or primary stenting using a bare stent (BS) or drug-eluting stent (DES) to one another. Methodological quality of each trial was assessed using a Cochrane Collaboration's tool, and quality of evidence was assessed using the GRADE system. Outcomes assessed were wound healing, quality of life, change in Rutherford classification, amputation, death, target lesion revascularization (TLR), bypass, binary restenosis, late lumen loss, stenosis grade, and event-free survival with follow-up periods of at least 1 month.Twelve trials including 1145 patients were identified, with 90% of patients having CLI. Six BS versus PTA and two DES versus PTA trials showed low-quality evidence of equal efficacy. One trial, comparing DEB with PTA, showed moderate-quality evidence of improved wound healing (RR 1.28; 95% CI: 1.05 to 1.56; p = .01), improvement in Rutherford classification (RR 1.32; 95% CI: 1.08 to 1.60; p = .008), and lower TLR (RR 0.41; 95% CI 0.23 to 0.74; p = .002) and binary restenosis (RR 0.36; 95% CI 0.24 to 0.54; p < .0001) in diabetic patients after 12 months. Amputation and death rate did not differ significantly. For DES versus BS, most trials showed equal efficacy between strategies.Based on low- to moderate-quality evidence, PTA with optional bailout stenting using BS should remain the preferred strategy in treating CLI patients with BTK arterial lesions. Before other strategies can be implemented, larger and high-quality RCTs assessing clinically relevant outcomes are needed.
- Graft durability and fatigue after in situ fenestration of endovascular stent grafts using radiofrequency puncture and balloon dilatation. [Journal Article]
- Eur J Vasc Endovasc Surg 2014 May; 47(5):501-8.
In situ fenestration of endovascular stent grafts is a technique that is becoming more common, as it has the advantages of decreased cost, increased availability, and more anatomic configuration than other methods of branch revascularization. However, a significant concern is the short- and long-term durability of the stent graft fabric during and after fenestration.This study utilizes the textiles analysis techniques of macro- and microscopic imaging, tear strength testing, burst strength testing, and accelerated cyclic fatigue testing on the fabrics of the Cook Zenith, Medtronic Talent, and Medtronic Endurant stent grafts (three polyester grafts), as well as two different expanded polytetrafluoroethylene (ePTFE) membranes. Specimens were punctured using radiofrequency, and serially dilated with angioplasty balloons (3, 5, and 7 mm). For each type of fabric, three groups were analyzed: control, radiofrequency (RF) puncture only, and balloon dilated.A total of 110 specimens were analyzed, with 80 of them having been fenestrated. The Zenith fabric had the greatest strength after fenestration, but was limited by the inability to fully dilate the fenestration with the conventional balloons, which only achieved 26-29% of their nominal balloon diameter. While the Talent and Endurant grafts could be dilated with balloons, the orifices were markedly elliptical not circular. After accelerated fatigue testing, there was an increase in the size of fenestrations of the Talent fabric. There was no increase in fenestration size for the Endurant fabric, Zenith fabric, or the ePTFE fabrics, after fatigue testing.While the Zenith fabric was the strongest both before and after fenestration, it requires further study with cutting balloons to achieve full-sized fenestrations. All fenestrations remained stable during fatigue testing except for the Talent fabric. This study serves as the baseline for future studies that will include stent grafts, branch stents, and cutting balloons.