The current position of precuffed expanded polytetrafluoroethylene bypass grafts in peripheral vascular surgery.

OBJECTIVE: Long-term results of precuffed expanded polytetrafluoroethylene (ePTFE) grafts used for peripheral bypass surgery are lacking. The aim of this study was to obtain the long-term outcomes of precuffed ePTFE grafts compared with autologous saphenous vein (ASV) grafts used in patients with peripheral arterial disease (PAD). METHODS: A single-institution retrospective study of precuffed ePTFE and ASV graft performances in patients with PAD was undertaken between January 2004 and December 2012. Five-year primary patency, secondary patency, and limb salvage rates were determined by Kaplan-Meier analyses. RESULTS: A total of 467 bypass grafts were included in this study (169 precuffed ePTFE grafts and 298 ASV grafts). Secondary patency rates of ePTFE vs ASV at 1 and 5 years, respectively, were as follows: for 134 supragenicular femoropopliteal bypasses, 60% and 27% vs 89% and 85% (P < .05); for 190 infragenicular femoropopliteal bypasses, 40% and 25% vs 86% and 79% (P < .05); and for 84 femorocrural bypasses, 30% and 14% vs 50% and 50% (P < .05). Five-year limb salvage rates of ePTFE vs ASV for supragenicular femoropopliteal bypasses were 82% vs 94% (P = .16); for infragenicular femoropopliteal bypasses, 41% vs 92% (P < .05); and for femorocrural bypasses, 43% vs 64% (P = .06). CONCLUSIONS: ASV bypasses are still the first-choice conduit in peripheral bypass surgery performed in patients with PAD. Precuffed ePTFE bypasses are acceptable alternatives in the absence of adequate autologous vein.

[A 15-year old boy with abdominal pain]. / Een jongen met pijn links onder in de buik.

A 15-year-old boy came to the emergency department with abdominal pain in the left lower quadrant. The medical history included surgery for malrotation of bowel in two of his brothers. A CT-abdomen showed malrotation of the colon with a left-sided appendicitis and polysplenia. An emergency laparoscopic appendectomy was performed. Recovery was uneventful.

A novel finding: the effect of nurse practitioners on the relation to quality of life, anxiety, and depressive symptoms in vascular surgery.

BACKGROUND: An increasing number of vascular surgery units expand their team with nurse practitioners (NPs) to optimize patient care. There are no previously performed studies which assessed the influence of NPs on patients' quality of life (QoL), anxiety, and depressive symptom levels. The transition in care from surgeon to NP in the vascular surgery unit of our hospital facilitated the comparison of both groups. METHODS: A prospective study was undertaken to analyze the effect of NPs on QoL, anxiety, and depressive symptom scores. Two groups were analyzed: a group of patients treated by a vascular surgeon alone (surgeon group) and a group of patients treated by a NP supervised by a vascular surgeon (NP group). Patients completed the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires both before and after intervention. RESULTS: Two hundred fourteen patients were included in our study. Within groups, there was a significant increase in physical QoL, with 5.2 points in the surgeon group and 4.4 points in the NP group. There was a significant decrease in anxiety scores (-3.8 points in the surgeon group and -5.4 points in the NP group). No differences were found for depressive symptoms. Between groups, no differences were found. CONCLUSIONS: The same improvements were found for QoL and anxiety scores in both groups. Vascular NPs are therefore competent to explain procedures and guide patients through vascular interventions.

First experience of a novel femorocrural expanded polytetrafluoroethylene bypass graft.

BACKGROUND: This study aims to evaluate early results of a precuffed expanded polytetrafluoroethylene (ePTFE) Distaflo® Mini-Cuff Bypass Graft versus autologous saphenous vein (ASV) grafting in patients with peripheral arterial obstructive disease (PAOD). METHODS: This retrospective single-center study analyzed 42 patients who received a femorocrural bypass graft because of PAOD using an ASV graft (n = 28) or Distaflo Mini-Cuff graft (n = 14). RESULTS: Primary patency rates in the ASV and Distaflo Mini-Cuff groups were 81% and 69%, respectively, after 6 months. Secondary patency rates were 81% and 35%, respectively, after 12 months. The limb salvage rate was 81% in the ASV group vs 65% and 35%, respectively, in the Distaflo Mini-Cuff group after 6 months and 1 year. CONCLUSIONS: The ePTFE Distaflo Mini-Cuff is an option for revascularization in the absence of a suitable ASV. However, the performance of this novel graft is not better than that of current ePTFE bypass grafts.

Midterm follow-up of quality of life following peripheral bypass surgery.

BACKGROUND: Peripheral bypass surgery is an important treatment option for patients with peripheral arterial disease. Short-term results of quality of life (QoL) after peripheral bypass surgery showed an increase in QoL at 3 months. Little is known about QoL at more than 2 years of follow-up. This study was performed to analyze QoL at midterm follow-up, and overall survival after peripheral bypass surgery. METHODS: This study was part of a randomized control trial in which intermittent pneumatic compression was compared with compression stockings in the treatment of edema after bypass surgery. Patients completed a QoL questionnaire before surgery, 14 days and 3 months postoperatively, and at least 2 years after the original operation. A survival analysis was performed to calculate survival for patients who received both autologous and polytetrafluoroethylene (PTFE) bypass grafts. RESULTS: The original study consisted of 93 patients, and QoL midterm follow-up was achieved for 42. QoL scores at midterm follow-up were comparable to the preoperative baseline scores for both the autologous and the PTFE groups. Three-year survival rates were 75% and 54%, respectively. CONCLUSION: Although peripheral bypass surgery significantly increased QoL 3 months after surgery, midterm follow-up showed a return to baseline scores. No significant difference was found in survival between patients in the autologous and PTFE groups.

The registration of surgical site infections: a comparison of two different methods in vascular surgery.

BACKGROUND: Registration of complications of treatment is an important instrument for measuring the quality of health care. Reliable registration depends on definitions, the case-finding method that is used, and the registration method itself. We conducted a comparative study of two different methods of registration for the surveillance of surgical site infections (SSIs) in a single hospital. METHODS: The study included all patients in both the surgical database and the microbiology and infection-prevention database of the hospital who underwent surgery on the abdominal aorta or peripheral vascular procedures from March 1, 2009 to March 1, 2010. The surgical database included positive scores for SSI in cases of positive wound swabs, the need for incision drainage, or the need for antibiotic treatment. The microbiology and infection-prevention database used criteria from the U.S. Centers for Disease Control and Prevention (CDC), and based positive scores on redness, heat, swelling, or pain in the area of a surgical incision within 30 d after a procedure, and on a positive swab, drainage from an incision, or the presence of pus following a diagnostic puncture. RESULTS: The surgical complication database included 218 patients, of whom 20 (9.2%) had a SSI. The microbiology and infection-prevention database included 236 patients, of whom 33 (14%) had a SSI. The databases were merged and all infections were ascertained by an expert team. The surgical database had a sensitivity of 57% for SSIs, whereas the microbiology and infection-prevention database had a sensitivity of 93% (p<0.05). CONCLUSION: Physicians provided less reliable scores for SSI than did trained infection-control practitioners. This raises questions about the comparability of rates of SSI in different institutions as a means for judging the quality of hospital care.

Anastomoses in the common femoral artery, vascular clips or sutures? A feasibility study.

BACKGROUND: The Vessel Closure System (VCS) is commercially available since 1997. This clip system has proven to be successful for vascular anastomoses in access surgery. There is little experience with the VCS in peripheral vascular surgery. METHODS: A trial was conducted for patients with peripheral arterial disease, who required either a femoral artery endarterectomy or a peripheral bypass procedure. Patients were randomized into two groups: a VCS group, in which the proximal anastomoses were made using VCS clips; and a control group, in which both proximal and distal anastomoses were performed using Prolene sutures. Outcomes assessed were the speed of anastomosis and patency. Adverse events were monitored. RESULTS: In the VCS group, 12 patients underwent anastomoses using VCS clips. In the control group, 12 patients underwent vascular reconstruction using sutures. In the VCS group, the mean speed of anastomosis was 1.9 mm/min, whereas the mean speed in the control group was 2.5 mm/min; this was not significantly different (P = 0.096). After a follow-up of 12 months, there was no difference in patency. In the VSC group, two serious adverse events occurred, which required emergency surgery. CONCLUSION: Anastomosis in the femoral artery using VCS clips is not faster than that using running Prolene sutures, and in our small sample, two serious adverse events in the VCS group were observed. These results do not support the further use of vascular clips in peripheral vascular surgery.

Evaluation of Staphylococcus aureus nasal carriage screening before vascular surgery.

INTRODUCTION: Staphylococcus aureus is the most important pathogen in the development of surgical site infections (SSI). Patients who carry S. aureus in the nose are at increased risk for the development of SSI in cardiothoracic and orthopedic surgery. In these populations it has been shown that the risk for SSI can be substantially reduced by eradicating S. aureus carriage. For vascular surgery the relation between nasal carriage and surgical site infections has not been clearly investigated. For this reason we performed this study to analyze the relation between S. aureus nasal carriage and SSI in our vascular surgery population. METHODS: A prospective cohort study was undertaken, including all patients undergoing vascular surgery between January first 2010 and December 31th 2010. Before surgery patients were screened for S. aureus nasal carriage using a PCR technique. The presence of SSI was recorded based on criteria of the CDC. RESULTS: Screening was performed in 224. Of those, 55 (24.5%) were positive, 159 (71.0%) were negative and 10 (4.5%) were inconclusive. In the screened vascular population 4 S. aureus SSI occurred in the 55 carriers compared with 6 in 159 non-carriers (p=0.24). A stratified analysis revealed a 10-fold increased risk in nasal carriers undergoing central reconstruction surgery (3 S. aureus SSI in 20 procedures versus 1 in 65 procedures in non-carriers, p=0.039). DISCUSSION: In patients undergoing central reconstruction surgery nasals carriers are at increased risk for the development of S. aureus SSI. These patients will probably benefit from perioperative treatment to eradicate nasal carriage.