Editor's choice : European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia

A

Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular & Endovascular Surgery 59/3 (2020) 339-384]

peer reviewe

Always Contact a Vascular Interventional Specialist Before Amputating a Patient with Critical Limb Ischemia

Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 ± 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options

Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections.

peer reviewe

Elective surgery of abdominal aortic aneurysms in octogenarians: a systematic review

Abdominal aortic aneurysm (AAA) is an age-related disease. In an aging population, the prevalence of AAA is likely to increase. Open AAA repair in patients aged >80 years is often not considered because of their advanced age as such or because of comorbidities. In addition, little is known about the natural history in such patients or survival after successful repair. We performed a systematic review of the literature to determine peri-operative and late survival after AAA repair in octogenarians The Medline, Embase, and Cochrane databases were searched to identify all studies reporting on octogenarians undergoing AAA repair published between January 1966 and June 2006. Two independent observers assessed the methodologic quality of the included studies and the data extraction. Outcomes were rates of perioperative mortality, complications, and long-term survival after open or endovascular repair (EVAR). Summary estimates with 95% confidence interval (CI) were calculated using a random effects model. Thirty-nine articles were included. The median aneurysm size was 6.7 cm in the conventional AAA repair group of 1534 patients. The perioperative mortality was 0% to 33%, with a pooled mortality of 7.5% (95% CI, 6.2% to 9.0%). The median 5-year survival rate for this group was 60% (range, 14% to 86%). In the 1045 patients treated with EVAR, the median aneurysm size was 5.9 cm. Their pooled perioperative mortality varied from 0% to 6%, with a pooled mortality of 4.6% (95% CI, 3.4 to 6.0%). We could not derive 5-year survival rates from articles describing endovascular repair of AAA. The mortality rate after open or endovascular AAA repair in carefully selected octogenarians seems acceptable but is higher than the mortality rate in younger patients. Long-term survival rates were acceptable, but small sample size, selection, and publication bias must be taken into account. Finally, selection criteria for successful surgery with low mortality and morbidity rates cannot be derived from the literatur

Fracture of a covered stent used for pseudoaneurysm exclusion in a prosthetic femoro-infrapopliteal bypass

PURPOSE: To present a case of fracture in a stent-graft used for exclusion of a pseudoaneurysm in a prosthetic femoro-infrapopliteal bypass. CASE REPORT: A Hemobahn stent-graft was inserted into a Dacron femoro-infrapopliteal bypass to avoid repeat surgery for a recurrent distal anastomotic pseudoaneurysm that had been excluded 2 years earlier by a Dacron interposition graft in a 69-year-old woman. Three months after stent-graft implantation, the patient complained of pain around the left knee; plain radiography showed stent fractures at 2 sites coinciding with the proximal and distal anastomoses of the interposition graft, and ultrasonography detected a new pseudoaneurysm at the distal anastomosis. The stent-graft was explanted and the pseudoaneurysm excluded with a new interposition graft. CONCLUSION: Although some stents have high flexibility and radial strength that make them suitable for use in periarticular vessels, interventionists should take into account the possibility of stent fracture when weighing the treatment option