This work supports previous observations on the mortality benefit of regional (and even local) anesthesia in patients who undergo elective endovascular aneurysm repair for the treatment of infrarenal abdominal aortic aneurysms. These benefits also translated into a shorter hospital stay, but not into less pulmonary complications, which is what previous studies had suggested. Minimally invasive…
Virtual ACC 2020 | COMPASS Sub-Analysis: Diabetes Increases the Benefit of Rivaroxaban Combined with AAS
In patients with stable coronary or peripheral artery disease, diabetes increases the benefit of combining low doses of rivaroxaban and aspirin vs. aspirin alone. This analysis was pre-specified in the COMPASS protocol and was presented virtually for the ACC 2020 and simultaneously published in Circulation. Patients with diabetes, showed numerically greater reduction in terms of…
EVAR with No Complications in Octogenarians: Survival Rate Identical to that of Healthy Octogenarians
This analysis reports (for the first time in the literature) that after the endovascular aortic aneurysm repair (EVAR) in octogenarians, survival rate is the same as that of their healthy counterparts. This is true provided the procedure does not present complications. If any, mortality results twice as high in this group. Using propensity score, researchers…
New European Guidelines on the Management of Lower Limb Acute Ischemia
Clinical practice guidelines are usually tedious and, frankly, while a lot of people make an enormous effort to write them, they are ultimately read in full by just a few. These new European Guidelines on the Management of Lower Limb Acute Ischemia represent a special team effort, since they include physicians, cardiologists, surgeons, and interventionists,…
Medical vs. Endovascular Treatment in Uncomplicated Type B Aortic Dissection
Under much debate, the treatment of uncomplicated type B aortic dissection is still uncertain. Several studies with methodological limitations have shown that endovascular treatment plus optimal medical treatment might be beneficial, compared with medical treatment alone. This meta-analysis sought to define more clearly the treatment strategy in patients with acute and subacute uncomplicated type B…
The Real Impact of Peripheral Artery Disease in TAVR
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…