Notes

Albendazole Nanocrystal-Based Dissolving Microneedles using Enhanced Pharmacokinetic Overall performance with regard to Superior Management of Cystic Echinococcosis.
Covered stents (CS) to treat superficial femoral artery (SFA) occlusive disease have become more common. However, concerns about patients presenting with acute limb ischemia (ALI) after failure due to coverage of important collaterals have been raised. Herein, we determine if CS are associated with ALI after failure.

Vascular Quality Initiative peripheral vascular intervention and infrainguinal bypass datasets were queried from 2010 to 2020 for patients who underwent SFA stenting with a bare metal stent (BMS) or CS and who also had a subsequent ipsilateral SFA endovascular reintervention or bypass recorded in the Vascular Quality Initiative. The initial SFA stenting procedure will be referred to as the index procedure and the subsequent procedure will be referred to as the reintervention. Patients with aneurysmal pathology, prior infrainguinal bypass, and ALI at the index procedure were excluded. Patients with pre-index inflow/outflow procedures were not excluded. The primary outcome was ALI at reinterven with a CS more often used bypass, pharmacologic thrombolysis, and mechanical thrombolysis. CS at the index procedure was a predictor of ALI at reintervention (odds ratio, 1.87; 95% confidence interval, 1.31-2.65; P= .001) while controlling for age, time difference between procedures, body mass index, chronic obstructive pulmonary disorder, preoperative anticoagulation and antiplatelet, prior carotid intervention and major amputation, index procedure fluoroscopy time and treatment length, and pre-index ankle-brachial index.

In patients undergoing reintervention for failed SFA stents, CS are more likely to present with ALI than those with failed SFA BMS.
In patients undergoing reintervention for failed SFA stents, CS are more likely to present with ALI than those with failed SFA BMS.
Fenestrated/branched endovascular aneurysm repair (F/BEVAR) is a minimally invasive alternative for patients at high risk of open repair of complex aortic aneurysms. Nearly all investigative study protocols evaluating F/BEVAR have required a predicted life expectancy of >2years for study inclusion. However, accurate risk models for predicting 2-year survival in this patient population are lacking. We sought to identify the preoperative predictors of 2-year survival for patients undergoing F/BEVAR.

The prospectively collected data for all consecutive F/BEVAR procedures, performed in an institutional review board-approved registry and/or a physician-sponsored investigational device exemption (IDE) trial (IDE no. G130210), were reviewed (November 2010 to February 2019). We assessed 44 preoperative patient characteristics, including comorbidities, preoperative functional status, aneurysm morphologies, and repair techniques. Preoperative functional status was defined as totally dependent (any impairment in onal status was the strongest predictor of 2-year mortality, with totally dependent patients experiencing poor survival. The traditional risk factors were not independently significant, perhaps reflecting the high prevalence of severe chronic illness in these high-risk patients participating in an IDE trial. For the independent patients, the 2-year F/BEVAR survival rate was 89%, equivalent to patient survival after infrarenal EVAR. Therefore, for independent patients, it would be reasonable to expand the indication for F/BEVAR to low-risk patients.
To investigate the effect of aortic angulation on the early and midterm outcomes of fenestrated-branched endovascular aneurysm repair for thoracoabdominal aortic aneurysms (TAAA) or pararenal aortic aneurysms (PRAA).

We retrospectively reviewed the data of consecutive patients enrolled in a prospective nonrandomized physician-sponsored investigational device exemption study (2013-2018). The infrarenal, suprarenal, and supraceliac aortic angles were measured on three-dimensional reconstructions of the preoperative computed tomography angiogram; a 45° cutoff was used for the analysis. Endpoints were technical success, freedom from endograft-related complications (defined by type IA/IB/IIIA/IIIB/IIID endoleaks, and limb thrombosis); and freedom from target vessel instability (defined by branch-related death, occlusion, rupture or reintervention for stenosis, endoleak, or disconnection). Cox proportional hazard multivariable regression analyses were preformed to assess impact of covariates.

There were 298 ptions. However, increased aortic angulation was associated with longer operative and fluoroscopy times. The suprarenal aortic angle was the most important determinant of more target vessel events, independent of stent design or which bridging stent was selected.
Creation of good long-term arteriovenous access is essential in patients requiring hemodialysis for end stage renal failure. However, arteriovenous grafts or fistulae can be complicated by infection which may require emergency surgery. For infections that involve the brachial artery anastomosis, or if total graft explantation is indicated, brachial artery repair or reconstruction is often required. An alternative management strategy would be brachial artery ligation (BAL). We performed a systematic review to evaluate the outcomes of BAL that has been performed for infected arteriovenous grafts or fistulae.

A thorough literature search was conducted using various electronic databases. We included articles that reported outcomes of BAL performed for infected arteriovenous grafts or fistulae. The primary outcome was the incidence of upper limb ischemia after BAL. Secondary outcomes were the need for urgent revascularization, upper limb amputation and postoperative neurological deficit after BAL.

A total of five studies with a total of 125 patients were included in our systematic review. BAL was performed for infected arteriovenous grafts or fistulae for all studies. Follow-up period ranged from one to 27 months. The incidence of upper limb ischemia after BAL low. Only a single study reported three patients that developed upper limb ischemia. Two patients required urgent revascularization and one patient required forearm amputation after proximal ligation. All studies reported clearance of infection with no recurrence.results CONCLUSIONS Distal BAL may be performed safely for patients with an infected arteriovenous fistulae or grafts with low risk of upper limb ischemia, postoperative neurological deficit and recurrent infection.

The degree of carotid artery stenosis, calculated using catheter-based angiography and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method, has been shown to predict the stroke risk in several, large, randomized controlled trials. In the present era, patients have been increasingly evaluated using computed tomography (CT) angiography (CTA) before carotid artery revascularization, especially as the use of transcarotid artery revascularization has increased. Interpretation of CTA findings regarding the degree of carotid stenosis has not been standardized, with both NASCET methods and the area stenosis used. We performed a single-institution, blinded, retrospective analysis of CTA studies using both the NASCET method and the CT-derived area stenosis to assess the concordance and discordance between the two methods when evaluating ≥70% and ≥80% stenosis.

The UMass Memorial Medical Center vascular laboratory database was queried for all carotid duplex ultrasound scans performed from 200 carotid revascularization.
The area stenosis CTA calculations of carotid artery stenosis dramatically overestimated the degree of carotid stenosis compared with that calculated using the NASCET method. Given that stroke risk estimates have been determined from trials that used the NASCET method, the area stenosis method likely overestimates the risk of stroke. Therefore, area stenosis calculations could lead to unnecessary carotid revascularization procedures. This model highlights the need for standardized usage of the NASCET method when using CTA as the imaging modality to determine the threshold for carotid revascularization.
Despite advancements, aortofemoral bypass (AFB) remains the most durable option for aortoiliac occlusive disease. Although runoff has been shown to be associated with AFB patency, the association of the Society for Vascular Surgery (SVS) thigh runoff scoring system with patency has not been assessed. Doramapimod clinical trial The aim of the present study was to evaluate the association between the SVS runoff scoring system and limb-based primary patency after AFB.

Institutional data for patients undergoing AFB with preoperative runoff imaging available from 2000 to 2017 were queried. Runoff scores were assigned according to the presence of occlusive disease in the superficial femoral artery and profunda femoris artery (minimum, 1; maximum, 10) as described by the 1997 SVS reporting standards for lower extremity ischemia. Limb-based patency was the primary endpoint. Kaplan-Meier analysis was used to compare the long-term limb-based patency and freedom from reintervention between limbs with runoff scores ≥6 and those withrunoff scord for worse limb outcomes and a greater incidence of operative complications. The SVS score can be determined from preoperative axial imaging studies and serve as a guide in decision-making and operative planning.
The SVS femoral runoff score is an important factor associated with long-term AFB limb patency. Scores of ≥6 portend for worse limb outcomes and a greater incidence of operative complications. The SVS score can be determined from preoperative axial imaging studies and serve as a guide in decision-making and operative planning.
Sex disparities regarding outcomes for women after open and endovascular abdominal aortic aneurysm repair have been well-documented. The purpose of this study was to review whether these disparities were also present at our institution for elective endovascular aneurysm repair (EVAR) and whether specific factors predispose female patients to negative outcomes.

All elective EVARs were identified from our three sites (Florida, Minnesota, and Arizona) from 2000 to 2018. The primary outcome was in-hospital mortality and three-year mortality. Secondary outcomes included complications requiring return to the operating room, length of hospitalization (LOH), intensive care unit (ICU) days, and location of discharge after hospitalization. Multivariable logistic regression models were used to assess for the risk of complications.

There were 1986 EVARs; 1754 (88.3%) were performed in male and 232 (11.7%) in female patients. Female patients were older (79years [interquartile range (IQR), 72-83years] vs 76years [IQRhree-site, single-institution data support sex disparities to the detriment of female patients regarding return to the operating room after EVAR, LOH, ICU days, and discharge to rehabilitation facility. However, we found no differences for in-hospital or 3-year mortality.
Previous studies of the natural history of abdominal aortic aneurysms (AAAs) have been limited by small cohort sizes or heterogeneous analyses of pooled data. By quickly and efficiently extracting imaging data from the health records, natural language processing (NLP) has the potential to substantially improve how we study and care for patients with AAAs. The aim of the present study was to test the ability of an NLP tool to accurately identify the presence or absence of AAAs and detect the maximal abdominal aortic diameter in a large dataset of imaging study reports.

Relevant imaging study reports (n= 230,660) from 2003 to 2017 were obtained for 32,778 patients followed up in a prospective aneurysm surveillance registry within a large, diverse, integrated healthcare system. A commercially available NLP algorithm was used to assess the presence of AAAs, confirm the absence of AAAs, and extract the maximal diameter of the abdominal aorta, if stated. A blinded expert manual review of 18,000 randomly selected imaging reports was used as the reference standard.
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