European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
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Eur J Vasc Endovasc Surg · Jun 2013
Comparative StudyUptake of abdominal aortic aneurysm screening. A cohort study.
Abdominal aortic aneurysms (AAA) are responsible for 1.4% of UK deaths. Deprivation is a risk factor for AAA. Screening reduces AAA related mortality and is cost effective if uptake remains high. The Highland aneurysm screening programme (HASP) began in 2001 offering screening to men in a sparsely populated area. The aim was to identify whether uptake varies with deprivation or rurality, in the context of an established programme. ⋯ HASP has a high uptake even in the most deprived and rural populations, demonstrating that programme design has overcome any potential rural disadvantage. A gradient of uptake associated with deprivation remains, although even the most deprived have an uptake of almost 80%.
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Eur J Vasc Endovasc Surg · Jun 2013
ReviewCritique of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): flaws in CREST and its interpretation.
The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) has been used to support the equivalence of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the treatment of carotid stenosis in both symptomatic and asymptomatic patients. This inclusion of two different forms of the disease decreased the power and significance of the CREST results and weakened the trial. Other flaws in CREST were the equal weighting of mostly minor myocardial infarctions (MIs) with strokes and death in the peri-procedural, composite 'end' point, but not in the 4-year, long-term 'end' point. ⋯ The 4-year MI rate, however, was not a component of the primary 'end' point. Additionally, although the initial CREST report indicated that there was no difference in the outcomes of CAS and CEA according to symptomatic status or sex, subsequent subgroup analyses showed that CAS was associated with significantly higher stroke and death rates than CEA in symptomatic patients, in females and in individuals ≥ 65 years of age. The present article will examine these and other flaws and the details of CREST's results derived from the trial's preplanned subanalyses to show why the claims that CREST demonstrates equivalence of the two therapeutic procedures are unjustified.
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Eur J Vasc Endovasc Surg · Jun 2013
The single-centre experience of the supra-arch chimney technique in endovascular repair of type B aortic dissections.
We summarised the data performed at our centre to evaluate the feasibility of the chimney technique in type B aortic dissections (ADs) with supra-aortic vessel involvement. ⋯ In repairs for type B ADs, the chimney technique provides a minimally invasive way of preserving flow to the arch branches combined with a favourable mid-term outcome. The bare stents seemed to be related to a higher probability of the immediate type I endoleaks. A balloon-expandable stent should be regarded as the first choice due to its greater radial strength.
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Eur J Vasc Endovasc Surg · Jun 2013
Changes in middle cerebral artery velocity after carotid endarterectomy do not identify patients at high-risk of suffering intracranial haemorrhage or stroke due to hyperperfusion syndrome.
To determine if significant increases in middle cerebral artery velocity (MCAV) or pulsatility index (PI) during and immediately after carotid endarterectomy (CEA) were predictive of patients suffering a stroke due to the hyperperfusion syndrome (HS) or intracerebral haemorrhage (ICH). ⋯ We were unable to demonstrate that significant increases in MCAV and PI were able to predict patients at increased risk of suffering a post-operative stroke due to HS or ICH. The provision of written guidance for managing PEH in Group 2 patients was associated with virtual abolition of ICH/HS.
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Eur J Vasc Endovasc Surg · Jun 2013
Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms.
This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression. ⋯ Ip l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.