Seminars in Vascular Surgery RSS feed: Current Issue. Each issue of Seminars in Vascular Surgery examines the latest thinking on a particular clinical problem and features new diagnostic and operative techniques. The journal allows practitioners to expand their capabilities and to keep pace with the most rapidly evolving areas of surgery. Seminars in Vascular Surgery is indexed/abstracted in: Science Citation Index Expanded (SciSearch®), Current Contents®/Clinical Medicine, and Journal Citation Reports/Science Edition. 2009 Topics , Volume 22 June Dealing with Long-Term Problems after Endovascular and Open Aortic Repair http://www.semvascsurg.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Seminars in Vascular Surgery0895-7967251March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semvascsurg.com/article/PIIS0895796712000269/abstract?rss=yesContents10.1053/S0895-7967(12)00026-9Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-6iihttp://www.semvascsurg.com/article/PIIS0895796712000063/abstract?rss=yesPERIODICALLY, AS EDITOR of this increasingly popular Journal, I run out of topical issue ideas and guest editors to recruit colleagues to address them. This issue represents my usual solution, that is, an issue that I edit myself, and typically it is named “potpourri.” It usually consists of a collection of articles I have read that I think will be interesting to the reader, and I then ask the contributing author to modify the contents to fit the style of Seminars in Vascular Surgery and apply an informal style that is meant for easy reading. This is such an issue and, as such, there is no unifying theme, rather a collection of topics that I think our readers will enjoy.IntroductionRobert B. Rutherford10.1053/j.semvascsurg.2012.03.001Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-611http://www.semvascsurg.com/article/PIIS0895796712000051/abstract?rss=yes Patients with acute iliofemoral deep vein thrombosis suffer the most severe post-thrombotic sequelae. The pathophysiology of the post-thrombotic syndrome is ambulatory venous hypertension, and patients with valve dysfunction and luminal obstruction have the highest ambulatory venous pressures. Treatment designed to reduce or eliminate the post-thrombotic syndrome must necessarily remove thrombus to eliminate obstruction. The technique of contemporary venous thrombectomy follows basic vascular surgical principles and offers patients the opportunity for complete or near complete thrombus extraction. The techniques described herein represent the authors' approach to patients with few alternatives to clear their venous system. The Current Role of Operative Venous Thrombectomy in Deep Vein ThrombosisAnthony J. Comerota10.1053/j.semvascsurg.2012.02.004Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-6212http://www.semvascsurg.com/article/PIIS089579671200004X/abstract?rss=yes The Nationwide Inpatient Sample (NIS) is often used for population-based research comparing the safety of carotid artery stenting (CAS) to that of carotid endarterectomy (CEA) in the United States. At least two findings from the NIS dataset seem questionable, however. First, several NIS studies indicate that >90% of CEAs and CAS procedures are currently being performed for asymptomatic carotid stenosis, which considerably exceeds the prevalence of asymptomatic patients reported elsewhere. Second, these studies also suggest that periprocedural stroke rates for CEA and CAS are collectively lower at hundreds of community hospitals contributing data to the NIS than they were in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), even though the participating surgeons and interventionalists in CREST were vetted on the basis of their previous experience and results. In addition, some unexpectedly low stroke to death ratios are present in NIS studies, implying that not all iatrogenic strokes have been entered into the NIS dataset. These issues might be related to inadequate documentation of preprocedural symptoms and periprocedural strokes in the medical records, leading to subsequent coding errors in the hospital discharge abstracts from which NIS data are extracted. The clinical limitations of the NIS and other administrative datasets have been pointed out in the past, but they appear to be particularly relevant to carotid interventions and must be recognized. Reasons Why Data from the Nationwide Inpatient Sample Can Be Misleading for Carotid Endarterectomy and Carotid StentingNorman R. Hertzer10.1053/j.semvascsurg.2012.02.003Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-61317http://www.semvascsurg.com/article/PIIS0895796712000038/abstract?rss=yes New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance, and during many procedures. Ultrasound has also altered our understanding of the pathophysiology of chronic venous disease. Laser and radiofrequency saphenous ablations are common. Classic techniques, such as sclerotherapy, high ligation, stripping, and phlebectomy, have been improved. Magnetic resonance venography, computed tomographic venography, and intravascular ultrasound have improved diagnostic capabilities. New strategies like ambulatory selective varices ablation under local anesthesia (ASVAL) and conservative hemodynamic treatment for chronic venous insufficiency (CHIVA) raise important questions about how to manage these patients. Treatment of Primary Varicose Veins Has Changed with the Introduction of New TechniquesEric Mowatt-Larssen, Cynthia K. Shortell10.1053/j.semvascsurg.2012.02.002Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-61824http://www.semvascsurg.com/article/PIIS0895796712000099/abstract?rss=yes Multiple medical therapies have been proposed to prevent abdominal aortic aneurysm expansion. Use of these medications, hormones, vitamins, and dietary products is based on their ability to alter the pathophysiology of continued aortic wall growth. In this review, the explanation of how these medications can achieve suppression of abdominal aortic aneurysm is explained in relation to their effect on the various aspects of aortic wall inflammation. Despite the large number of animal and observational studies, there remain very few randomized clinical trials to support use of any of these agents. However, there may be sufficient evidence to suggest that statins, doxycycline, vitamin E, cyclooxygenase-2 inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers can prove beneficial in some individuals. Can Pharmacologic Agents Slow Abdominal Aortic Aneurysm Growth?Russell Samson10.1053/j.semvascsurg.2012.03.004Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-62528http://www.semvascsurg.com/article/PIIS0895796712000087/abstract?rss=yes Surgical revascularization has been the cornerstone of limb salvage for patients with critical limb ischemia due to infrapopliteal arterial atherosclerotic disease. Endovascular procedures such as balloon angioplasty and stenting are gaining popularity for treatment of such patients, although level 1 evidence to support the superiority of endovascular treatment over saphenous vein bypass is still lacking. A review of the literature from the past 2 years reveals that balloon angioplasty of the tibial arteries in patients with critical limb ischemia carried a 1-year primary patency rate between 33% and 37%, a secondary patency rate of 56% to 63%, and a limb-salvage rate of 75% to 100%. Two randomized controlled trials failed to show the superiority of primary infrapopliteal stenting over balloon angioplasty alone. One randomized controlled trial reported the benefit of drug-eluting stents over bare metal stents. Other studies documented good early results after secondary stenting, cryoplasty, and using retrograde access for tibial interventions. In conclusion, balloon angioplasty or stenting, if angioplasty fails, have emerged as reasonable options for limb salvage in patients with critical limb ischemia. More studies are needed to evaluate the role of percutaneous transluminal angioplasty as the primary modality of choice. There is a real need for a new randomized controlled trial to compare tibial angioplasty/stenting with autologous surgical bypass. Endovascular Interventions for Infrapopliteal Arterial Disease: An UpdateMuhammad Ali Rana, Peter Gloviczki10.1053/j.semvascsurg.2012.03.003Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-62934http://www.semvascsurg.com/article/PIIS0895796712000075/abstract?rss=yes Increased intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) are important clinical problems after repair of ruptured abdominal aortic aneurysms and are reviewed here. IAP >20 mm Hg occurs in approximately 50% of patients treated with open abdominal aortic aneurysm repair after rupture, and approximately 20% develop organ failure or dysfunction, fulfilling the criteria for ACS. Patients selected for endovascular aneurysm repair are often more hemodynamically stable, perhaps related to not handling the viscera or more favorable anatomy, resulting in less bleeding and, consequently, decreased risk of developing ACS. Centers that treat most patients with endovascular aneurysm repair tend to have the same proportion of ACS as after open repair. There are no randomized data on these aspects. Early nonsurgical therapy can prevent development of ACS. Medical therapy includes neuromuscular blockade and the combination of positive end-expiratory pressure, albumin, and furosemide. This proactive strategy can reduce the number of decompressive laparotomies, an important detail because treatment of ACS with open abdomen is a morbid procedure. When treatment with an open abdomen is necessary, it is important to choose a temporary abdominal closure that maintains sterile conditions during often prolonged treatment. In addition, it should prevent lateralization of the bowel wall and adhesions between the intestines and the bowel wall. Enteroatmospheric fistulae must be prevented. Many alternative methods have been suggested, but we prefer the combination of vacuum-assisted wound closure with mesh-mediated traction, which will be described. Management of the Tense Abdomen or Difficult Abdominal Closure after Operation for Ruptured Abdominal Aortic AneurysmsMartin Björck10.1053/j.semvascsurg.2012.03.002Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-63538http://www.semvascsurg.com/article/PIIS0895796712000105/abstract?rss=yes Development of endovascular abdominal aortic aneurysms repair (EVAR), now in its 4th decade, has involved at least 16 different devices, not counting major modifications of some, only 4 of which have emerged from clinical trials and gained US Food and Drug Administration approval. The main impetus behind EVAR has been its potential for significantly reducing procedural mortality and morbidity, but it was also expected to speed recovery and reduce costs through decreased use of hospital resources. At the outset, EVAR was touted as a better alternative to OPEN in high-risk patients with large abdominal aortic aneurysms, and to “watchful waiting” (periodic ultrasound surveillance) for those with small abdominal aortic aneurysms. This new technology has evoked a mixed response with enthusiasts and detractors debating its pros and cons. Bias and conflict of interest exist on both sides. This review will attempt to present a balanced review of the development and current status of this controversial competition between EVAR and OPEN, comparing them in terms of the following key considerations: mortality and morbidity, complications, failure modes and durability, and costs. Open Versus Endovascular Stent Graft Repair for Abdominal Aortic Aneurysms: An Historical ViewRobert B. Rutherford10.1053/j.semvascsurg.2012.03.005Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-63948http://www.semvascsurg.com/article/PIIS0895796712000026/abstract?rss=yes Although relatively rare, congenital arteriovenous fistulas and other vascular anomalies present a diagnostic challenge to the clinician. The same noninvasive tests that are used for diagnosing arterial occlusive disease in the extremities will also detect arteriovenous fistulas. These tests include segmental limb pressure measurements, segmental plethysmography, and arterial waveform analysis. Additionally, magnetic resonance imaging can be used to determine the extent of these vascular anomalies and the involvement of muscle skin and bone, all of which have a direct bearing on resectability. This article will examine these diagnostic modalities and explain how they can be used in this setting. Noninvasive Evaluation for Congenital Arteriovenous Fistulas and MalformationsRobert B. Rutherford10.1053/j.semvascsurg.2012.02.001Seminars in Vascular Surgery 25, 1 (2012)2012-03-01Seminars in Vascular Surgery2012-03-01251S0895-7967(11)X0006-64957