BackgroundThe treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse e ects of anticoagulation. ObjectivesTo assess the e ects of di erent treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. Selection criteriaRandomised controlled trials (RCTs) for the treatment of distal DVT. Data collection and analysisTwo review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-e ect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. Main resultsWe identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for di erent time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatmentAnticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compared with participants receiving no anticoagulation (RR 0.34, 95% CI 0.15 to 0.77; 5 studies, 496 participants; I 2 = 3%; high-certainty evidence), and reduced the risk of Treatment of distal deep vein thrombosis (Review)

BackgroundThe treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse e ects of anticoagulation. ObjectivesTo assess the e ects of di erent treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. Selection criteriaRandomised controlled trials (RCTs) for the treatment of distal DVT. Data collection and analysisTwo review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-e ect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. Main resultsWe identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for di erent time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatmentAnticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compared with participants receiving no anticoagulation (RR 0.34, 95% CI 0.15 to 0.77; 5 studies, 496 participants; I 2 = 3%; high-certainty evidence), and reduced the risk of Treatment of distal deep vein thrombosis (Review)

Most RCCs in renal transplant recipients are low-stage, low-grade tumors with a favorable prognosis. Their diagnosis is usually incidental. RCC development in the native kidney of renal transplant recipients is an early event, frequently observed within 4 to 5 years after transplantation. The different natural history of these tumors is still undefined. Further research is needed to determine whether these differences are due to particular molecular pathways or to biases in relation to the mode of diagnosis.

RPH is a relatively uncommon but potentially fatal complication after renal transplantation, and its non-specific symptoms may lead to misdiagnosis. Physician awareness, prompt diagnosis, and early surgical intervention are critical. In addition, meticulous surgical technique during transplantation may help avoid this complication.

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Aggressive angiomyxoma is a rare mesenchymal tumor occurring usually in women of reproductive age in pelvic-perineum region. These myofibroblastic tumors rarely affect men and non-pelvic-perineum anatomical sites. There are few literature references for aggressive angiomyxoma in men. We describe a case of a 57-year old male with aggressive angiomyxoma of the scrotum and its management.

Background The COrona Virus Disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorise the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. Methods An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15th to October 15th 2020. Results 856 records from 84 different countries could be included. Most participants attended several online activities (>4: n=461, 54%; 2-4: n=300, 35%; 1: n=95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n=440, 51.4%), followed by the reputation of the presenter or the panel (n=178, 20.8%), but not necessarily receiving accreditation or certification (n=52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n=432, 50.5%), no protected/allocated time (n=488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n=25, 2.9%). Conclusions During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.

Background: Acetylsalicylic acid, clopidogrel and cilostazol are well-established agents inhibiting the normal function of platelets with known advantages and limitations. The development of novel antiplatelet agents aims to provide equal or superior outcomes for patients and simultaneously minimize side effects. Objective: The aim of this manuscript is to review the latest data on the use of novel antiplatelet agents in vascular patients. Method: Based on our 2016 review, a further search in the English medical literature has yielded a number of publications on cangrelor, prasugrel, ticagrelor, vorapaxar and a number of other – still experimental – agents (Ir- 6, UBO-QIC, W1, revacept and YM-254890). Results: Recently published data have not altered the use and indications of cangrelor, prasugrel and vorapaxar; all of them now approved by both FDA and EMA. The EUCLID trial has recently provided valuable data on the clinical use of ticagrelor, although results regarding vascular patients and administration of ticagrelor are still under scrutiny. Vorapaxar remains the only novel antiplatelet that is approved for PAD. Randomized control trials that focus on vascular patients are necessary to establish the safety and efficacy of these novel agents. Despite their positive initial results, most novel experimental antiplatelets are still in early development, thus in preclinical or early clinical phases of their trials. Research on three novel antiplatelets is currently discontinued (atopaxar, darexaban and elinogrel). Conclusion: Vorapaxar remains the only novel antiplatelet that is approved for PAD. Other novel antiplatelets demonstrate positive results, but further studies focused on vascular patients are necessary. Novel experimental antiplatelets are still in the early phases of the clinical and preclinical studies.