Courtesy of Dr. Carlos Fava. The real incidence of peripheral artery (PAD) disease in TAVR remains unclear. Different reports still estimate it is between 10 and 46%, but they have shown it has a negative impact in evolution. 51,685 TAVR patients were analyzed. 12,740 of these patients presented PAD (24.6%). PAD patients tended to be…
Patients: What They Really Want to Know about Their Disease
When we decide that 30-day mortality to repair an abdominal aortic aneurysm (AAA) is at least twice as high with conventional surgery compared against endovascular treatment, many of us think choosing a strategy is far from hard, and recent stats show exactly that. However, are we sure our patient agrees with us, or at least…
¿Metformin to Treat Abdominal Aortic Aneurysms?
Currently, there are no drugs to treat abdominal aortic aneurysms (AAA) outside those indicated as secondary prevention drugs. What this study shows is that diabetic patients treated with metformin had lower AAA incidence than diabetic patients treated without metformin, and even lower incidence than non- diabetic patients, as if metformin per se were a…
Descending Thoracic Aortic Aneurysms: Is There a New Plan A?
The last available evidence suggests that open surgery should be the preferred treatment for intact descending thoracic aortic aneurysms. However, this study recently published in J Am Coll Cardiol, seems to have steered the wheel. In this study, open surgery was associated to increased early mortality and lower late mortality. Despite this long-term benefit, mean…
Surveillance after EVAR: When and How Long
It has been suggested that surveillance after endovascular abdominal aorta aneurysm repair (EVAR) should be for life, seeing as on one hand we are not sure how long these devices last (and they keep coming out), and on the other hand, there could be late complications, such as type 2 leaks. This is why the…
Safety in Abdominal Aortic Aneurysm Surveillance Programs
Abdominal Aortic Aneurysm (AAA) rupture rate in the UK justifies the current surveillance programs and bring ease to some physicians that at some point have cast a shadow on their efficacy. This study also endorses reference thresholds to intervene patients. In 2009, the UK National Health Service (NHS) implemented a AAA national surveillance scheme where…
Vascular Surgeons of the Future in the Endovascular Era
The use of endovascular aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms is widely spread, due to its minimally invasive approach, rapid recovery, and better short-term survival. Approximately 60% of all infrarenal abdominal aortic aneurysms (AAAs) repairs in Europe and 85% in the United States are by EVAR. A decade ago, we believed…
HIV and Peripheral Artery Disease: Acknowledging the Association
The role of human immunodeficiency virus (HIV) in the development of vascular disease (specifically peripheral artery disease) remains unclear. Is the virus per se the direct cause of this disease or is it a consequence of dyslipidemia, one of the adverse effects of antiretrovirals? This study looked into the effect of HIV infection on peripheral…
Frailty and Critical Limb ischemia: Facing a New Challenge
Courtesy of Dr. Carlos Fava. Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility. When it happens in frail patients, it presents a challenge. This population is on the rise and there is…
Cost-Effectiveness of Frenestrated or Branched Endoprostheses vs. Open Surgery
Fenestrated of branched endoprostheses are appealing options for the repair of anatomically-complex aortic aneurysms. Their use is limited by their cost (which is high for everyone, everywhere) and also by the lack of a head-to-head study showing best results than open surgery. This work offers results at 2 years for these devices, including an economic assessment…
Are Abdominal Aortic Aneurysm Screening Programs Overstated?
With the remarkable drop in tobacco use across the world, also dropped mortality associated to abdominal aorta aneurysm rupture (AAA). All AAA screening programs have been designed decades ago, when the risk was higher. This is why we might need to rethink these programs, or at least design new randomized controlled studies to pave the…