Electrical carotid baroreceptor stimulation

Summary: The Barostim neoTM system is a novel implantable device that activates the carotid baroreflex. It decreases the sympathetic activity and inhibits the renin system, which results in reduced blood pressure and heart rate. In patients with resistant hypertension, electrically activation of the baroreflex leads to an average decrease in systolic blood pressure of 38, 36, 40 and 53mmHg at 1, 2, 3 and 4 years, respectively. Additionally, cardiac remodelling with reduced left ventricular mass and posterior wall thickness has been observed in long-term studies. In a limited number of patients with heart failure, baroreflex activation therapy leads to a decrease in muscle sympathetic nerve activity and to improved quality of life and functional capacities. The implantation procedure is safe and associated with risks comparable with those of other active implantable devices. Barostim neo is currently available in several European countries

Management of floating thrombus in the aortic arch

OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients

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

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

peer reviewe

Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis.

OBJECTIVES To assess sex specific differences in 30 day mortality, length of hospital stay, and adverse neurological events following repair of intact degenerative descending thoracic aortic aneurysms (TAAs), by either thoracic endovascular (TEVAR) or open repair. METHODS MEDLINE, Embase, and CENTRAL databases were searched from 2005 to 2019, using ProQuest Dialog. The reviews were registered in PROSPERO (CRD42017020026) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was 30 day mortality; secondary outcomes were length of hospital stay and adverse neurological events. Forest plots with random effects meta-analysis to provide odds ratios (OR) were used for primary assessment. RESULTS For TEVAR, seven studies were identified, including 2758 women and 4674 men; of these studies six were eligible for the primary outcome of 30 day mortality, including 1756 women and 2619 men. There were 94/1756 deaths in women and 82/2619 deaths in men, yielding a pooled 30 day mortality of 5% (95% confidence interval [CI] 3-7) in women and 3% (95% CI 2-4) in men (OR 1.75, 95% CI 1.29-2.38). Length of hospital stay was longer in women, with a standardised mean difference of 0.3 days (95% CI 0.14-0.47; six studies): meta-regression analysis did not identify the slightly older age of women as significant factor in these differences. Stroke rate was not different between the sexes. For open repair only a single study, with national coverage, was identified: this study reported similar 30 day mortality in men and women. CONCLUSIONS In the management of intact degenerative descending TAAs, 30 day mortality after TEVAR appears to be much higher in women than men with no reasons for this difference identified. However, for open repair there is a lack of contemporary evidence owing to insufficient recent data

Randomized controlled comparison of cross-sectional survey approaches to optimize follow-up completeness in clinical studies.

INTRODUCTION In outcome research, incomplete follow-up is a major, yet potentially correctable source of bias. Cross-sectional surveys may theoretically increase completeness of follow-up, but low response rates are reported typically. We investigated whether a pre-notification letter improved patient availability for follow-up phone interviews and thereby improved cross-sectional survey yield. METHODS A consecutive series of vascular patients was randomly divided into a trial and a validation population. The trial population was then randomized 1:1 to one of two cross-sectional contact strategies: Strategy 1 consisted of direct contact attempts by up to 12 systematically timed phone calls, whereas Strategy 2 used a personalized pre-notification letter to arrange for scheduled phone call interviews. Response rates, average time and efforts needed per patient and overall survey duration were compared. Subsequently, trial findings were externally validated in the validation population. RESULTS Of 728 consecutive patients, 370 were allocated to the trial population. Trial patients contacted by strategy 1 (n = 183) had a similar profile when compared to trial patients contacted by strategy 2 (n = 187). Follow-up periods following surgery (54.3 versus 53.6 months) and all-cause mortality rates (21.3% versus 18.7%) were comparable between the trial groups. Cross-sectional information on survival outcomes was almost complete after both contact strategies (99.5% versus 98.9%, P = 1.0). In 144/187 strategy 2 patients (77%) interviews were scheduled successfully necessitating significantly less contact attempts (median of 1.3 versus 2.3 per patient, P<0.0001). However, invested time per patient was similar between the groups (median of 10.1 versus 9.6 minutes), and survey strategy 1 completed earlier (median time to contact 4 versus 11 days, P<0.0001). Therefore, strategy 1 was validated in the validation population (n = 358): a low lost to follow-up rate below 1% (P = 1.0) was reconfirmed necessitating an average of 2.3 contact attempts per patient. CONCLUSIONS Both contact strategies were equally successful in contacting almost all patients cross-sectionally. If systematically timed, direct phone calls were less complicated to organize and faster completed. Given the low time and effort per patient, outcome studies should invest in systematic follow-up surveys to minimize attrition bias

Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm

In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA)