N-Terminal Proteomics Reveals Distinct Protein Degradation Patterns in Different Types of Human Atherosclerotic Plaques.

Atherosclerotic plaque rupture is a major cause of cardiovascular events. Plaque destabilization is associated with extracellular matrix (ECM) modification involving proteases which generate protein fragments with new N-termini. We hypothesized that rupture-prone plaques would contain elevated fragment levels, and their sequences would allow identification of active proteases and target proteins.

Relationship Between Intraluminal Thrombus Volume and Circulating ADAMTS-13 Activity in Abdominal Aortic Aneurysms.

Introduction: Abdominal aortic aneurysms (AAAs) with intraluminal thrombus (ILT) are suggested to be more prone to rupture than AAAs without. Prior studies indicate that the von Willebrand factor (vWf) plays a role in the formation of ILT since a positive correlation between ILT volume and vWf has been shown. vWf mediates the tethering of platelets at sites of endothelial injury, and the protease ADAMTS-13 cleaves larger forms of vWf, thus counteracting the thrombosis cascade and maintaining haemostatic balance.

Automated 3D ultrasound bridges the gap between novices and experts in diameter assessment of abdominal aortic aneurysms.

Background: The current management of abdominal aortic aneurysm (AAA) hinges upon assessing diameter using ultrasound (US). Diameter reproducibility with conventional two-dimensional ultrasound (2D-US) is challenging and requires experienced operators. A novel automatic three-dimensional ultrasound (3D-US) system enables on-cart software-assisted diameter estimation (3D-SAUS), potentially facilitating more precise diameter measurements than 2D-US.

Hypoxia inducible factor 1-alpha in the pathogenesis of abdominal aortic aneurysms in vivo: A narrative review.

Abdominal aortic aneurysms (AAAs) are relatively common, primarily among older men, and, in the case of rupture, are associated with high mortality. Although procedure-related morbidity and mortality have improved with the advent of endovascular repair, noninvasive treatment and improved assessment of AAA rupture risk should still be sought. Several cellular pathways seem contributory to the histopathologic changes that drive AAA growth and rupture.

Proteomic analysis of the extracellular matrix of human atherosclerotic plaques shows marked changes between plaque types.

Cardiovascular disease is the leading cause of death, with atherosclerosis the major underlying cause. While often asymptomatic for decades, atherosclerotic plaque destabilization and rupture can arise suddenly and cause acute arterial occlusion or peripheral embolization resulting in myocardial infarction, stroke and lower limb ischaemia. As extracellular matrix (ECM) remodelling is associated with plaque instability, we hypothesized that the ECM composition would differ between plaques.

3-D Contrast-Enhanced Fusion Ultrasound for Accurate Volume Assessment of Vessel Lumen and Plaque in Carotid Artery Disease as Compared With Computed Tomography Angiography.

Objective: Three-dimensional contrast-enhanced fusion ultrasound (CEFUS) of atherosclerotic carotid arteries provides spatial visualization of the vessel lumen, creating a lumenography. As in 3-D computed tomography angiography (CTA), 3-D CEFUS outlines the contrast-filled lumen. Plaque and vessel contours are distinguished in 3-D CEFUS, allowing plaque volume quantification as a valid estimate of carotid plaque burden.

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In Denmark, around 4,500 people are diagnosed with colorectal cancer (CRC) annually. This review investigates that while the efficacy of immunotherapy in CRC is still being studied, immunotherapy is currently only indicated in the treatment of mismatch-repair deficient (dMMR) metastatic CRC, which accounts for 10-15% of patients. Recent studies indicate high rates of pathologic response in dMMR CRC treated with pre-operative immunotherapy while large-scale studies on novel immunotherapy combinations are ongoing.

Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment.

Objective: Endovascular aortic repair (EVAR) is being used increasingly for the treatment of infrarenal abdominal aortic aneurysms. Improvement in educational strategies is required to teach future vascular surgeons EVAR skills, but a comprehensive, pre-defined e-learning and simulation curriculum remains to be developed and tested. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), an assessment tool for simulation based education (SBE) in EVAR, has previously been designed to assess EVAR skills, and a pass limit defining mastery level has been set.

Systematic Review and Meta-Analysis of the Incidence of Rupture, Repair, and Death of Small and Large Abdominal Aortic Aneurysms under Surveillance.

Background: The ultimate goal of treating patients with abdominal aortic aneurysms (AAAs) is to repair them when the risk of rupture exceeds the risk of repair. Small AAAs demonstrate a low rupture risk, and recently, large AAAs just above the threshold (5.5-6.

Abdominal aortic aneurysms volume growth patterns with three-dimensional ultrasound.

Background: Three-dimensional ultrasound (3D-US) and computed tomography (CT) have proven abdominal aortic aneurysm (AAA) volume a more sensitive measure of growth than diameter. This proof-of-concept study aimed to investigate the clinical applicability of two-dimensional ultrasound and 3D-US for AAA diameter and volume growth pattern evaluation.

Methods: AAA patients with at least three follow-ups within a minimum of 24 months were included prospectively and consecutively from the COpenhagen Aneurysms CoHort (COACH).

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This review investigates patients with renovascular disease due to atherosclerotic renal artery stenosis. This group of patients has a very high risk of cardiovascular events. Randomised trials have failed to show that renal artery stenting is more effective than medical therapy alone in most patients but did not enroll patients with high-risk clinical syndromes.

Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey.

Background: Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms.

Single branch arch stent graft combined with laser fenestration in the treatment of a zone two penetrating thoracic aortic ulcer.

We present the case of a 75-year-old man with a symptomatic penetrating aortic ulcer located in zone 2 on the arch inner curve between the left subclavian artery and left carotid artery treated using a single branch thoracic endovascular aortic repair combined with in situ laser fenestration. The patient underwent a successful procedure with no neurologic impairment and was discharged on the second postoperative day. The postoperative follow-up showed a well-excluded penetrating aortic ulcer.

Massed Training is Logistically Superior to Distributed Training in Acquiring Basic Endovascular Skills.

Objective: A "PROficiency based StePwise Endovascular Curricular Training" (PROSPECT) has proven its superiority over traditional training in a randomised controlled trial to acquire basic endovascular skills outside theatre, but real life adherence is low. This study aimed to compare the original distributed training format, where trainees learn at their own pace, with a massed training format offering the same content within a limited time span while exempt from clinical duties. Secondly, long term skills retention was evaluated.

Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe.

Objective: This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery.

Methods: A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs).

Endoleak following endovascular repair of popliteal artery aneurysm: clinical outcome and contrast-enhanced ultrasound detection.

Background: Continued blood flow in the aneurysm sac after repair, also known as endoleak, can occur after both open and endovascular popliteal aneurysm repair (EPAR) with risk for aneurysm sac enlargement. Primary aims were to investigate aneurysm sac growth and the presence and classification of endoleak after EPAR using contrast-enhanced ultrasound (CEUS).

Methods: Cross-sectional study of patients receiving EPAR with expanded polytetrafluorethylene (ePTFE) covered stent-grafts between 1 of January 2009 and 1 of February 2019 at a tertiary referral endovascular center.

One-year volume growth of abdominal aortic aneurysms measured by extended field-of-view ultrasound.

Background: Measurement of volume has the potential to detect subtle growth not recognized in the current surveillance paradigm of abdominal aortic aneurysms (AAAs). Currently available three-dimensional ultrasound allows for estimation of AAA volume, but for most patients, the AAA extends beyond the ultrasound field-of-view and only allows visualization of a partial AAA volume. A new extended field-of-view three-dimensional ultrasound protocol (XFoV US) has been found to improve the proportion of patients with visualization of the full AAA volume.

The use of evidence-based medical therapy in patients with critical limb-threatening ischaemia.

Aims: To describe the practice patterns of evidence-based medical therapy (EBM) and overall mortality in high-risk patients with critical limb-threatening ischaemia (CLTI), compared with patients with myocardial infarction (MI).

Methods And Results: Using Danish registries, we identified patients 40-100 years of age with a first-time hospitalization for CLTI or MI from 2008-2018 and grouped them into CLTI, MI, and CLTI and history of MI (CLTI + MI). We examined the likelihood of filling prescriptions with EBM [i.

Limb graft occlusion after endovascular aneurysm repair with the Cook Zenith Alpha abdominal graft.

Objective: Prior reports of the low profile Zenith Alpha abdominal graft (Cook Medical Inc, Bloomington, IN) have shown impaired limb graft patency to be the primary causes of reintervention. Special notices from the manufacturer have indicated certain instructions for use (IFU) violations as the main reasons for these complications. In the present study, we assessed the incidence of limb graft occlusion (LGO) and analyzed the effects of the detailed anatomic risk factors for LGO highlighted in the IFU and previously reported studies.