Abstract：
:In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid. Even though the two most recent papers comparing carotid endarterectomy with CAS reported that the long-term risk (after first deducting periprocedural risks) is similar to that with medical therapy (approximately 0.5% per year), when the periprocedural risks are considered (approximately 3% with stenting v 1.5% with CAS), most patients would be better treated with intensive medical therapy. Furthermore, it must be recognized that the low risks observed in clinical trials with highly selected surgeons and interventionalists are much lower than in real-world practice. It is therefore necessary to have ways to identify, among patients with asymptomatic carotid stenosis, the few (approximately 10% to 15%) who could benefit from intervention. Indicators of vulnerable plaque, such as ulceration, juxtaluminal lucent plaque, intraplaque hemorrhage on magnetic resonance imaging, and plaque inflammation on positron emission tomography/computed tomography are in development for that purpose. The best-validated approach is detection of microemboli on transcranial Doppler. A prospective single-center study of 468 patients showed that microemboli identified high-risk asymptomatic stenosis; this was validated by a prospective multicenter international study in 467 patients. Increased risk with microemboli persisted in the era of lower risks with intensive medical therapy. Patients with asymptomatic carotid stenosis should not be offered CAS or carotid endarterectomy without first being identified as high risk; percent stenosis does not do so. Currently, the best way to improve the risk to benefit ratio for intervention is transcranial Doppler embolus detection.
journal_name
Semin Vasc Surgjournal_title
Seminars in vascular surgeryauthors
Spence JDdoi
10.1053/j.semvascsurg.2017.04.011subject
Has Abstractpub_date
2017-03-01 00:00:00pages
62-66issue
1eissn
0895-7967issn
1558-4518pii
S0895-7967(17)30012-1journal_volume
30pub_type
杂志文章,评审abstract：:The relative merits of aortomonoiliac and bifurcated stent-graft configurations depend on the patient's arterial anatomy and clinical status. Aortomonoiliac stent-grafts are simple to make, simple to insert, and versatile. They are most useful when the iliac artery anatomy is severely distorted and the patient is old,...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章
doi：
更新日期：1999-09-01 00:00:00
abstract：:Prophylaxis for venous thromboembolism is an area that has received intense study in certain conditions, but less than adequate coverage in other areas. In considering who needs prophylaxis, patients are categorized into levels of risk. Clinical venous thromboembolism can be correlated to these levels of risk. Methods...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：2000-09-01 00:00:00
abstract：:Radiotherapy (XRT) plays a prominent role in the therapy of a variety of malignancies. Improved survival for malignancies treated with XRT has produced a growing subset of patients who present several years later with arterial occlusive disease in the irradiated field. Establishing a presumptive diagnosis of radiation...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1016/s0895-7967(03)00026-7
更新日期：2003-09-01 00:00:00
abstract：:The evolution of vascular surgery during the past five decades has established what was once controversial to be mandate, what was never dreamed of as debatable, and the vast body of knowledge yet to be unraveled--but requiring clinical application--as currently controversial. Controversy results when dissimilar thera...
journal_title：Seminars in vascular surgery
pub_type： 历史文章,杂志文章
doi：
更新日期：1999-03-01 00:00:00
abstract：:Vascular surgeons well versed in peritoneal dialysis applications understand the importance of this modality among the limited options afforded to patients in renal failure. Peritoneal and hemodialysis strategies are interdependent and should be considered in concert. Careful assessment often shows that patients with ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：1997-09-01 00:00:00
abstract：:Venous invasion is a common characteristic of renal cell carcinoma, manifesting as tumor thrombus with possible extension into the renal vein and, in extensive cases, the thrombus can reach from the renal vein to the right atrium. Currently, cytoreductive nephrectomy and tumor thrombectomy are the foundations for impr...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2014.06.015
更新日期：2013-12-01 00:00:00
abstract：:Renal artery stenting remains an important adjuvant treatment for true-resistant hypertension, although recent disappointing randomized trials highlight the importance of careful patient selection. Safe and successful renal interventions begin with critical core knowledge regarding renal artery anatomy and understandi...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2014.06.002
更新日期：2013-12-01 00:00:00
abstract：:The controversies that surround the technical aspects of transabdominal reconstruction for aortoiliac occlusive disease, and more specifically ABF, have provided lively debates during the golden era of vascular surgery. It seems almost a pity that, with the resolution of many of these issues, what has become one of th...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：1994-03-01 00:00:00
abstract：:Recent advances in endovascular technologies have made catheter-based interventions a preferred treatment strategy in patients with intermittent claudication or ischemic rest pain of the lower extremity. Although the current body of literature is inundated with clinical reports favoring countless endovascular devices ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2010.05.001
更新日期：2010-09-01 00:00:00
abstract：:Duplex ultrasound testing has evolved to be a clinically useful modality for the evaluation of chronic mesenteric ischemia (CMI) due to visceral artery origin atherosclerosis. Patients with known or suspected CMI can be scanned to identify stenosis or occlusion of the celiac, superior mesenteric, and inferior mesenter...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2013.11.005
更新日期：2013-06-01 00:00:00
abstract：:In vascular surgery, the gold standard for evaluation of the lower-extremity arterial tree has long been contrast arteriography (CA). Associated risks of CA are well-documented and include severe allergic reactions, arterial injury and/or hemorrhage, and contrast-induced nephropathy. Increasingly, less-invasive techni...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2007.02.005
更新日期：2007-03-01 00:00:00
abstract：:While carotid angioplasty and stenting has been clearly established as a minimally invasive alternative to endarterectomy for patients with carotid occlusive disease, its indications continue to evolve, being refined as more controlled data of large studies are being accumulated. The purpose of this article is to revi...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2008.03.003
更新日期：2008-06-01 00:00:00
abstract：:Popliteal artery aneurysms are the most common peripheral aneurysm. They are associated with concomitant contralateral popliteal aneurysms and abdominal aortic aneurysms. Patients with unrecognized aneurysms may present with acute limb ischemia and potential for limb loss. Use of preoperative lytic therapy to improve ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2005.09.009
更新日期：2005-12-01 00:00:00
abstract：:Constructing vascular access for hemodialysis causes changes in blood flow to the extremity, which can lead to distal ischemia. Ischemic steal syndrome is manifested by pain; weakness; pallor; and, in severe cases, ulceration and tissue loss. Severe ischemia, requiring reintervention, has an incidence of 4%, although ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2007.07.009
更新日期：2007-09-01 00:00:00
abstract：:Aortoiliac occlusive disease is a significant cause of lower extremity ischemic symptoms. Over the past two decades, most patients have been treated with a variety of surgical procedures, including aortofemoral and extra-anatomic bypasses. Most recently, percutaneous balloon angioplasty and stents have been successful...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：1997-12-01 00:00:00
abstract：:The increasing availability of and vascular surgeons' familiarity with digital cine-fluoroscopy in the operating room has been facilitated by the advent and growing popularity of endovascular aortoiliac aneurysm repair and other endovascular techniques that are being incorporated into vascular surgical practice. Digit...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2003.08.006
更新日期：2003-12-01 00:00:00
abstract：:Nutcracker syndrome is one of the abdominal venous entrapments, caused by compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. Occasionally a retro-aortic left renal vein is compressed between the aorta and the vertebral body (posterior nutcracker syndrome). The renal vein...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2013.04.006
更新日期：2013-03-01 00:00:00
abstract：:For generations, the use of techniques to defer skin pressure and protect the lower-extremity wound has been a cardinal goal to achieve therapeutic success and healing. Choosing the appropriate postoperative offloading device or shoe is often difficult, as it is challenging to merge optimal mechanical protection with ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2014.10.002
更新日期：2014-03-01 00:00:00
abstract：:Innovation in medicine is often driven by the observations of imaginative physicians who are blessed with insatiable curiosity, coupled with the inability to accept technical boundaries, the status quo of patient care, or the acceptance of procedural morbidity. Few examples illustrate this truism better than the physi...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2018.03.002
更新日期：2018-03-01 00:00:00
abstract：:While open or endovascular techniques for treatment of the superficial femoral artery continue to dominate the care of most patients, there are clearly patients who benefit from a combination of these approaches. Typically these patients require treatment of more than a single level of disease. In these cases, endovas...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2008.11.006
更新日期：2008-12-01 00:00:00
abstract：:The training of vascular surgeons in Canada has evolved over the past decade. Direct entry into a vascular surgery training program after medical school has been offered since 2012. At some institutions, it is the only option for surgery training. The smaller population of Canada and a single-payer health care system ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章
doi：10.1053/j.semvascsurg.2019.01.009
更新日期：2019-01-01 00:00:00
abstract：:Innominate and subclavian artery lesions run a wide spectrum of disease manifestation and treatment options. Since the first surgical treatment, multiple variances have been attempted with the desire to maintain high long-term patency rates while reducing perioperative morbidity and mortality. The advent of endovascul...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2011.04.001
更新日期：2011-03-01 00:00:00
abstract：:The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2019.07.002
更新日期：2019-01-01 00:00:00
abstract：:Although numerically far less than claudicants, patients with critical leg ischemia (CLI) demand a disproportionately large commitment both in medical effort and economically and represent the major workload for vascular surgical units. The incidence and prevalence of CLI is approximately 500 to 1,000/million/year. Th...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：1999-06-01 00:00:00
abstract：:Ischemia-reperfusion injury is a continuing challenge to vascular surgeons. Microvascular factors and mechanisms underlying edema and compartment syndrome provide a useful end point for analysis and planning of therapy. We review the pivotal role of endothelium-leukocyte interactions and of cytokines in the genesis of...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：1998-09-01 00:00:00
abstract：:Acute limb ischemia is one of the most potentially devastating but treatable diseases faced by the vascular surgeon. It is crucial to identify the ischemic process early, as the outcomes of early intervention can lead to limb salvage, whereas late recognition places the patient at risk for limb loss and potential mort...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2008.12.004
更新日期：2009-03-01 00:00:00
abstract：:Chronic venous disease includes a spectrum of clinical presentations ranging from varicose veins through chronic lower extremity pain and edema to venous skin changes and ulceration. Such manifestations may result from primary venous insufficiency or be secondary to other disorders, primarily acute deep venous thrombo...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：
更新日期：2002-03-01 00:00:00
abstract：:The purpose of this article is to describe the development and utilization of a unique paperless medical record system in a large multispeciality group practice setting. The Scott and White integrated health care delivery system provides care over a 34-county area in Central Texas. Since 1988, clinicians at Scott and ...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章
doi：10.1053/svas.2001.21253
更新日期：2001-03-01 00:00:00
abstract：:Tobacco abuse is a highly prevalent modifiable risk factor in vascular surgery patient populations. Despite the known benefits of smoking cessation, quitting smoking is difficult for most patients. Physician advice to stop smoking can help, though more intensive or multifactorial interventions have greater impact. Smo...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2015.10.001
更新日期：2015-06-01 00:00:00
abstract：:The recent endovascular aneurysm repair (EVAR) 1 and 2 and Dutch Randomized Endovascular Aneurysm Management (DREAM) trials addressed management of abdominal aortic aneurysms (AAAs) larger than 5.5 cm in diameter. The DREAM and EVAR 1 trials randomized patients appropriate for open repair between endovascular repair (...
journal_title：Seminars in vascular surgery
pub_type： 杂志文章,评审
doi：10.1053/j.semvascsurg.2006.03.001
更新日期：2006-06-01 00:00:00
