Abstract:
BACKGROUND:Significant national variation exists in defining the degree of stenosis that requires intervention in patients with asymptomatic carotid artery stenosis (ACAS). We aimed to evaluate the risk of perioperative and 2-year stroke and death in ACAS patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) for severe versus very severe stenosis in a contemporary population. METHODS:All patients undergoing CEA or transfemoral CAS for ACAS in the Vascular Quality Initiative (2005-2017) were included. Degree of stenosis was defined as the highest recorded on any imaging method. Univariable and multivariate logistic regression analyses were performed to assess risk of stroke, stroke/death, and major adverse cardiac events (MACE) at 30 days; and Cox proportional hazard, life tables, and Kaplan-Meier estimates were implemented to evaluate ipsilateral stroke and stroke/death at 2 years postoperatively in patients undergoing CEA versus CAS for severe (60-79%) and very severe (≥80%) stenosis adjusting for baseline characteristics. RESULTS:A total of 53,337 ACAS patients were examined (severe stenosis = 17,586; 33.%), of which 11.5% (n = 6,127) underwent CAS. The crude incidence of 30-day stroke/death was significantly higher for CAS versus CEA in the very severe stenosis group (2.0% vs. 1.2%, P < 0.001), but not in the severe stenosis group (1.7% vs. 1.3%, P = 0.17). MACE was not significantly different for CAS versus CEA in either group (P ≥ 0.64). On multivariable analysis, CAS was associated with a persistently higher risk of 30-day stroke or death compared to CEA in patients with very severe stenosis (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.26-2.13). The 30-day composite stroke/death risk for patients undergoing CEA was similar for severe versus very severe stenosis (OR 1.07, 95% CI 0.89-1.28), but there was a trend toward higher risk of perioperative stroke in the severe stenosis group (OR 1.23, 95% CI 0.97-1.56). Two-year outcomes were similar; the crude annualized incidence rates of stroke and stroke/death were higher for CAS versus CEA in both the severe (stroke: incidence rate ratio [IRR] 1.62, 95% CI 1.00-2.55; stroke/death: IRR 1.53, 95% CI 1.11-1.64) and very severe stenosis (stroke: IRR 1.97, 95% CI 1.44-2.65; stroke/death: IRR 1.51, 95% CI 1.34-1.68) groups (all, P ≤ 0.04). On multivariable Cox proportional hazards analysis, CAS was associated with a higher risk of stroke or death compared to CEA in patients with both severe (hazard ratio [HR] 1.40, 95% CI 1.15-1.70) and very severe stenosis (HR 1.62, 95% CI 1.37-1.90). CONCLUSIONS:More than one-third of patients undergoing carotid revascularization for ACAS had 60-79% stenosis. Having lower degree of stenosis is not protective against stroke and death for either CEA or CAS at either 30 days or 2 years postoperatively. We believe that optimal medical management should be the first line in stroke prevention for asymptomatic patients with severe (60-79%) carotid stenosis.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Hicks CW,Nejim B,Aridi HD,Black JH 3rd,Malas MBdoi
10.1016/j.avsg.2018.10.001subject
Has Abstractpub_date
2019-01-01 00:00:00pages
1-11eissn
0890-5096issn
1615-5947pii
S0890-5096(18)30796-9journal_volume
54pub_type
杂志文章abstract::Marjolin's ulcer is an aggressive form of squamous cell carcinoma that develops over time from chronic wounds and scars, including burns and chronic venous stasis ulcers. The incidence of malignant transformation is low, resulting in a delay in diagnosis and increased morbidity and mortality in these patients. We repo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2013.06.002
更新日期:2013-11-01 00:00:00
abstract::The complex interactions occurring at the blood/material interface of implanted blood-contacting biomaterials largely determine the clinical efficacy of small diameter vascular grafts. Physical characteristics of the material such as chemical composition, electrical charge, surface texture, elastic modulus, and porosi...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02042699
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.042
更新日期:2020-12-30 00:00:00
abstract:BACKGROUND:Sex-related differences in outcomes have been identified in patients with peripheral artery disease (PAD). We hypothesized that women with PAD would have equivalent inpatient mortality with men after vascular intervention. METHODS:Patients with a primary diagnosis of critical limb ischemia (CLI) or lifestyl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.01.006
更新日期:2019-07-01 00:00:00
abstract::Twenty-four patients who underwent surgery for pararenal aortic aneurysms between January 1992 and April 1997 are reviewed. Eighteen patients had primary atherosclerotic aneurysms, three patients had symptomatic infected aneurysms, two patients had an aneurysm proximal to a prior aortic repair, and one patient had a p...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900164
更新日期:1998-07-01 00:00:00
abstract::Resistance to activated protein C (RAPC) is a newly recognized hypercoagulable state that was first described in 1993. It has become apparent that RAPC is even more common than deficiencies in protein C, protein S, or antithrombin III (AT-III) and affects an estimated 5% of the general population. The majority of pati...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02000762
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Aortic sac hygroma and concealed endoleaks (EL) after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm needs particular attention with aggressive management as they are associated with rapid sac expansion and rupture risk. However, they can be erroneously reported as type IV or V EL with supi...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.039
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:IVCFs are usually placed under fluoroscopic guidance in dedicated angiography suites. Bedside placement of inferior vena cava filters (IVCF) is possible in patients not suitable for transportation, but data regarding their use are limited. The objective of this study is to compare utilization, procedural out...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.06.013
更新日期:2017-02-01 00:00:00
abstract::Carotid-jugular fistula is an abnormal connection between the carotid artery and/or its branches and jugular vein. It can develop either because of trauma or spontaneous causes. Traumatic fistula may occur after head injuries and can range from minor falls to severe penetrating wounds. Traumatic fistula may also resul...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.12.030
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:MicroRNAs (miRNAs or miRs) have been highlighted to be involved in abdominal aortic aneurysm (AAA) with the emergence of recent miRNA microarray profiling studies. miR-516a-5p has been shown to be significantly overexpressed in vascular smooth muscle cells (VSMCs) from human AAA tissues from our previous mic...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.10.062
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:The aim of this study was to detail our experience in the management of skin necrosis/ulceration over hemodialysis vascular accesses. METHODS:We collected demographics and operative data about patients undergoing surgery for skin necrosis over native or prosthetic vascular accesses. The different procedural...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.030
更新日期:2020-12-28 00:00:00
abstract:BACKGROUND:We report the outcomes of a single-center experience with endovascular aneurysm repair (EVAR) in nonagenarians. METHODS:Via a retrospective medical records review, we identified all patients > or = 90 years old who underwent EVAR at a single university teaching hospital during a 5-year period (January 2004 ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.10.009
更新日期:2010-05-01 00:00:00
abstract::Vasculitis is an heterogeneous group of syndromes, which shares inflammation of blood vessel wall as the main feature. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a necrotizing vasculitis, with few or no immune deposits, predominantly affecting small vessels (i.e., capillaries, venules, ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2018.05.060
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Carotid revascularization for asymptomatic carotid artery stenosis (ACAS) has become increasingly controversial in the past few decades as the best medical therapy has improved. The aim of this study was to assess and define contemporary trends in the rate of carotid revascularization procedures for ACAS in ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.08.118
更新日期:2020-09-03 00:00:00
abstract:OBJECTIVES:To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS:This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2021.01.054
更新日期:2021-01-22 00:00:00
abstract::We retrospectively reviewed our experience with subintimal angioplasty for chronic limb ischemia. Hospital records and films of all subintimal angioplasty procedures performed between October 2002 and December 2004 were reviewed and analyzed for demographic data, clinical data, and comorbid condition status. Thirty-ni...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9105-0
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Percutaneous endovascular aortic repairs (pEVARs) are associated with access site complications. Two-device technique using 2 Perclose devices has been well established. Combined Perclose and Angioseal technique has been described as well. We sought to determine whether a hybrid Perclose and Angioseal closur...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.06.008
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.09.019
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Current blunt thoracic aortic injury (BTAI) guidelines recommend early repair of traumatic pseudoaneurysms (PSAs) due to risk for subsequent aortic rupture. Recent analyses indicate that early repair is required only in the setting of high-risk features, while delayed repair is safe and associated with lower...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2016.02.021
更新日期:2016-08-01 00:00:00
abstract::With the development of endovascular aneurysm repair, abdominal aortic aneurysms with short infrarenal necks (< or =10 mm, AAASN) are considered juxtarenal aneurysms. Minimally invasive treatment consists of hybrid procedures or fenestrated endografts. We present our experience with direct aortic repair for AAASN perf...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.09.005
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Arterial revascularizations can present significant challenges when vessels are disadvantaged and advances in technology present the surgeon with innovative opportunities. A number of studies have used the GORE® Hybrid Vascular Graft (GHVG), and we have been using this device in arterial revascularizations s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2019.12.002
更新日期:2020-07-01 00:00:00
abstract::This study was undertaken to evaluate the ability of intraoperative duplex scanning during infrainguinal vein bypass to identify technical abnormalities and to determine the relation between intraoperative scan result and early primary graft patency. We retrospectively reviewed of 78 consecutive intraoperative duplex ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900257
更新日期:1999-05-01 00:00:00
abstract::Although transperitoneal surgical repair has been the gold standard for patients with a suspected ruptured abdominal aortic aneurysm (rAAA), the retroperitoneal approach and endovascular aortic repair (EVAR) are increasingly being recommended as preferred approaches due to lower morbidity and mortality. To highlight t...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2006.10.019
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:The acute exacerbations and progressive deterioration seen in thromboangiitis obliterans (TAO) have been related to poor clinical outcomes. Here, we have studied the association of laboratory biomarkers with the acute phase of TAO (AP-TAO). METHODS/RESULTS:We conducted a retrospective case-contro...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.11.020
更新日期:2020-05-01 00:00:00
abstract::A retrospective analysis of 56 patients undergoing ruptured abdominal aortic aneurysm (AAA) repair was performed to find out if cell saver had any impact on postoperative morbidity and mortality. All patients but one were male. The mean age was 68 +/- 8 years (35-85 years). Cell saver was used in 40 patients (CS group...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0123-7
更新日期:2002-07-01 00:00:00
abstract::Synovial hemangioma is a rare benign vascular malformation. We report a case of chronic swelling in the left knee of a 7-year-old boy. An intra-articular tumor of synovial origin could was detected after a magnetic resonance imaging scan. Surgical excision of the mass associated with partial synovectomy was carried ou...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.08.019
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Transcarotid artery revascularization (TCAR) has been shown to have half the rates of transient ischemic attack (TIA), stroke, and death compared with transfemoral carotid artery stenting (TFCAS). Successful outcomes of TFCAS require careful patient selection. The aim of this study was to determine the outco...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.04.016
更新日期:2020-08-01 00:00:00
abstract::We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.061
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:We report 2 cases of patients undergoing endovascular aneurysm repair (EVAR) using reentry devices to recanalize unilateral iliac artery occlusions and complete a bifurcated endovascular repair. METHODS:Patient 1 is a 70-year-old male with an enlarging 6.5-cm abdominal aortic aneurysm (AAA) and disabling le...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.05.008
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:We report endovascular treatment of a patient with an isolated Internal Iliac Artery (IIA) aneurysm who was treated by positioning a novel covered stent that could adapt to different proximal and distal diameters. CASE REPORT:A 68-year-old man who had already had several previous aortic surgeries underwent ...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.10.059
更新日期:2020-04-01 00:00:00