scholarly journals Review of 20 years of vascular surgery research in Australasia: Defining future directions

2019 ◽  
Vol 7 ◽  
pp. 205031211987106
Author(s):  
Judy Wang ◽  
Jasamine Coles-Black ◽  
Matija Radojcic ◽  
Jason Chuen ◽  
Philip Smart
Keyword(s):  
New Zealand ◽  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Case Series ◽  
Arterial Disease ◽  
Future Research ◽  
Hybrid Surgery ◽  
Peripheral Arterial ◽  
High Level ◽  
Over Time

Objectives: High-quality research is fundamental to the advancement of surgical practice. Currently, there is no quantitative assessment of the research output of vascular surgeons in Australia and New Zealand. By conducting this bibliometric analysis, we aim to provide an objective representation of the trends in vascular surgery and guide future research. Methods: A list of all current vascular surgeons in Australia and New Zealand was compiled from the Royal Australasian College of Surgeons ‘Find a Surgeon’ website tool and correlated with the Australia and New Zealand Society for Vascular Surgery database. A Scopus search of each surgeon’s author profile over the last 20 years was conducted. Results: In total, 2120 articles were published by 208 Australasian vascular surgeons between 1998 and July 2018, with an overall increase in publications over time. Audits or case series were the most published type of study and only 8% of the publications were of high-level evidence. The most popular topics were thoracoabdominal aortic pathologies (24%), followed by peripheral arterial disease (15%). Chronological analysis illustrates an increasing volume of peripheral arterial disease research over time and there is a clear trend towards more endovascular and hybrid surgery publications. The top 10 (5%) highest publishing authors by h-index account for 41% of all publications and 49% of all citations and are also responsible for producing significantly more high-level evidence research. Conclusion: Australasian vascular surgeons have made a significant contribution to medical research. However, the majority of these articles are of low-level evidence. In this time, there has been an increasing number of publications on endovascular and hybrid surgery in keeping with the trend in clinical practice. These areas, as well as research regarding peripheral arterial disease, show potential for high-evidence research in the future.

scholarly journals P6: ANTIPLATELET AND ANTICOAGULANT USE IN RANDOMISED TRIALS OF PATIENTS UNDERGOING ENDOVASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
MI Qureshi ◽  
HL Li ◽  
GK Ambler ◽  
KHF Wong ◽  
S Dawson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Arterial Intervention ◽  
Arterial Disease ◽  
Endovascular Intervention ◽  
Randomised Trials ◽  
Peripheral Arterial ◽  
High Level

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

Underrepresentation of Vascular Surgery In Twitter-based Clinical Discussions On The Management Of Peripheral Arterial Disease

2020 ◽  
Vol 63 ◽  
pp. 24-25
Author(s):  
Reid A. Ravin ◽  
Daniel K. Han ◽  
Kassandra Carrion ◽  
Nicole Ilonzo ◽  
Peter L. Faries
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Arterial Disease ◽  
Peripheral Arterial

How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease

2017 ◽  
Vol 40 ◽  
pp. 85-93 ◽  
Author(s):  
Martina Thiney ◽  
Nellie Della Schiava ◽  
Patrick Feugier ◽  
Patrick Lermusiaux ◽  
Jacques Ninet ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Vascular Surgery ◽  
Medical Treatment ◽  
Arterial Disease ◽  
Peripheral Arterial ◽  
Surgery Department

P6172Management of silent myocardial ischemia in patients with peripheral arterial disease needing surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Erglis ◽  
G Latkovskis ◽  
D Krievins ◽  
S Jegere ◽  
I Kumsars ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Vascular Surgery ◽  
Multidisciplinary Team ◽  
Coronary Stenosis ◽  
Coronary Revascularization ◽  
Arterial Disease ◽  
Silent Myocardial Ischemia ◽  
Team Approach ◽  
Fractional Flow ◽  
Peripheral Arterial

Abstract Background Patients with peripheral arterial disease (PAD) needing surgery have increased risk for post-operative myocardial infarction (MI)/death due to coexisting coronary artery disease (CAD). Coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing coronary stenosis in patients with suspected CAD but its value in PAD patients is unknown. Purpose To determine the prevalence of silent coronary ischemia in PAD patients undergoing surgery and to assess the value of FFRCT in guiding management of patients with multisite arterial ischemia. Methods Patients admitted for elective carotid, aortic or peripheral vascular surgery with no cardiac history or CAD symptoms were enrolled in a prospective, open-label, ethics committee-approved study and underwent pre-op CTA and FFRCT evaluation with results available to treating physicians. Ischemia-producing coronary stenosis was defined as FFRCT≤0.80 distal to stenosis in >2mm diameter vessels. Patient management was guided by a multidisciplinary team of cardiologists, cardiovascular surgeons and anaesthesiologists. Primary endpoint was major adverse cardiac events (MACE= cardiac death, MI, urgent revasc) at 30 days with follow up at 3,6,12 months. Results Coronary CTA and FFRCT analysis was performed in 179 consecutive patients (age 66±8 years, male 78%, hypertension 79%, diabetes 10%, dyslipidemia 31%, smoking 37%). CTA revealed extensive coronary calcification (Agatston score 995±1004, range 0–4810) and ≥50% stenosis in 64% of patients. Ischemic coronary stenosis (FFRCT≤0.80) was present in 114 patients (64%) with FFRCT ≤0.75 in 97 (54%) and multivessel ischemia in 63 (35%). Clinically indicated vascular surgery was performed as planned in 170/179 patients (95%) with cardiac anaesthesia and close monitoring and postponed in 9 patients for coronary revascularization (3) or medical/other therapy (6). There were no post-op cardiac complications. Elective coronary angiography, performed 1–3 months post surgery in 86 patients with left main, severe or multivessel ischemia, confirmed significant stenosis in each patient with revascularization in 58 patients (53 PCI and 5 CABG) including 8 for LM disease. There have been no cardiovascular deaths; 3 patients have died of lung cancer which was first discovered on CTA. One patient had peri-procedural MI at time of PCI and one had MI and urgent PCI at 6 months. MACE at 30 days=0/179, 3 months = 1/154, 6 months=2/123, 12 months=0/65. Conclusions Patients undergoing elective PAD surgery have a high prevalence (64%) of unsuspected ischemia-producing coronary stenosis. Pre-op diagnosis with CTA- FFRCT can help guide a multidisciplinary team approach with optimum medical management and staged peripheral and coronary revascularization. Favourable early results are promising and suggest the need for prospective controlled studies to define the role of coronary revascularization in PAD patients. Acknowledgement/Funding Heartflow, Inc.; Mikrotikls Ltd

scholarly journals The DRIL procedure for arteriovenous access ischemic steal: a controversial approach

2016 ◽  
Vol 18 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Ingemar Davidson ◽  
Gerald Beathard ◽  
Maurizio Gallieni ◽  
John Ross
Keyword(s):  
Peripheral Arterial Disease ◽  
New Technologies ◽  
Clinical Presentation ◽  
Arterial Disease ◽  
Surgical Risk ◽  
Hand Ischemia ◽  
Arterial Inflow ◽  
Arteriovenous Access ◽  
Peripheral Arterial ◽  
Over Time

The DRIL procedure first described in 1988 has long been considered the preferred treatment for arteriovenous access ischemic steal (AVAIS). At the time it was a brilliant concept and breakthrough. In the last decade, the DRIL procedure has become less used. With the increasing age of the dialysis population, patients developing AVAIS are more likely to be elderly with advanced peripheral arterial disease, making the distal revascularization anastomosis difficult and risky if not impossible to perform. In addition, the distal ligation of the main artery to the arm is something most surgeons are reluctant to do. The occlusion of the arterial bypass over time is not uncommon with recurrence of hand ischemia. The multistep DRIL procedure requires general anesthesia and the need to harvest the saphenous vein for the bypass, add to the surgical risk in patients with multiple co-morbidities. For these reasons, some surgeons prefer to do only the DR (distal re-vascularization) portion of the procedure omitting the IL (interval ligation). Increasing the bypass distance from the original anastomosis, makes this modification similar to the less invasive proximal arterial inflow (PAI) procedure. Conclusions Because of changes in the patient population clinical presentation, most notably forearm atherosclerosis and with new technologies, this editorial addresses the current validity of the DRIL procedure as a safe option in treating AVAIS.

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