The 2011 annual VEITH Symposium was held from November 16-20 in New York City. The features below highlight just some of the studies that emerged from the meeting.
» Novel Device for Clampless, Bloodless Vascular Surgery
» Analyzing Treatments for Asymptomatic Carotid Stenosis
» An Ultrasound Technique for Acute PE?
» Surgical Bypass Beneficial for Blocked Femoral Artery Vessels
» Endoprosthetic AAA Device Helps in EVAR
The Particulars: Surgeons traditionally place clamps on either side of an anastomosis to keep the area clear of blood while performing the procedure. Traditional clamps, however, can injure delicate vessels. A“clampless” device may help surgeons keep the area clear of blood during anastomosis.
Data Breakdown: In a small study, 92% of anastomoses were completed using LeGoo (Pluromed), a water-soluble, low-viscosity gel that forms a plug and conforms to vascular geometry. It allows for suturing directly through the gel and does not need to be removed after anastomosis. After being injected proximally and distally, LeGoo conformed to the luminal contour to prevent bleeding in the anastomotic site. It then dissolved on its own within 20 minutes.
Take Home Pearls: An injectable gel appears to keep surgery sites clear of blood for surgeons performing anastomosis. It does not appear to harm delicate surrounding vessels.
Analyzing Treatments for Asymptomatic Carotid Stenosis [back to top]
The Particulars: Previous research has demonstrated that surgery appears to be associated with greater benefits than medication for moderate and severe asymptomatic carotid stenosis. Whether this research is still relevant is unknown.
Data Breakdown: In recent studies, the reported risk of ipsilateral stroke with current medical interventions alone for asymptomatic carotid stenosis has been recorded as three times lower than that reported with endarterectomy in other analyses. Improvements in surgical intervention have decreased the rate to about 0.9%. This is double the rate of ipsilateral stroke that is currently being seen with medical interventions.
Take Home Pearls: Rates of ipsilateral stroke appear to be lower for patients with asymptomatic carotid stenosis who receive current medical intervention than for those who receiving stents or surgery. More research is needed to clearly assess long-term outcomes of interventions for patients with moderate and severe asymptomatic carotid stenosis.
An Ultrasound Technique for Acute PE? [back to top]
The Particulars: More than 600,000 Americans have a pulmonary embolism (PE) every year, almost half of whom develop pulmonary hypertension or die. The intravenous delivery of high doses of clot-dissolving agents over 2 hours is known to cause bleeding. Other strategies for treatment are needed for these individuals.
Data Breakdown: A retrospective analysis was conducted of intermediate- and high-risk PE patients treated with ultrasound-accelerated thrombolysis (USAT). This procedure is used to deliver low doses of clot-dissolving agents directly into the clot. In all patients in the analysis, right ventricular dysfunction and clot burden appeared to decrease significantly. All patients who underwent USAT were discharged from the hospital with no systemic bleeding complication.
Take Home Pearls: Using USAT in intermediate- and high-risk PE patients appears to rapidly reduce right ventricular dilation and clot burden. USAT also appears to be associated with no systemic bleeding complications.
Surgical Bypass Beneficial for Blocked Femoral Artery Vessels [back to top]
The Particulars: Research and debate continues over the best methods to treat vascular occlusions in the femoral artery.
Data Breakdown: The THRUPASS study compared superficial femoral artery lesion treatment with endoluminal polytetrafluoroethylene (PTFE) thrupass to that with surgical PTFE bypass. Researchers found a significant patency difference that favored surgical bypass (95% vs 44%).
Take Home Pearl: PTFE bypass appears to be the preferred treatment of patients with superficial femoral artery occlusions.
Endoprosthetic AAA Device Helps in EVAR [back to top]
The Particulars: Several treatments have emerged in recent years for endovascular aneurysm repair (EVAR). A variety of endografts for EVAR have been shown to last for a long time. Long-term results with the procedure, however, are needed.
Data Breakdown: In a study, researchers evaluated the durability of the Gore Excluder AAA endoprosthesis device (W.L. Gore and Associates, Inc.) in 201 EVAR procedures and followed patients for 11 years. Technical success was achieved in all cases, and no operative deaths were reported. During follow-up of 198 patients who survived 30 days, 11 type 1 and type 2 endoleaks occurred. Four patients with initial sac shrinkage developed slow aneurismal growth with an endoleak, and two debilitated patients had late graft infection and eventually died.
Take Home Pearl: Both the short- and long-term results of EVAR performed using the Gore Excluder AAA endoprosthesis device appear to be good with regards to safety and efficacy.
For more information on these studies and others that were presented at the 2011 VEITHsymposium, go to www.veithsymposium.org.