Background and objectives: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis but have a considerable failure rate. This study investigated whether routine preoperative vascular ultrasound results in better AVF outcome than physical examination.Design, setting, participants, & measurements: Patients with end-stage kidney disease referred for permanent access formation were assessed by independent examiners using physical examination and ultrasound. After random allocation, the ultrasound report was disclosed to the surgeon for patients in the ultrasound group but not for the clinical group. End points were AVF failure and survival rates, analyzed by intention to treat and by use for hemodialysis.Results: AVFs were made in 208 of 218 randomized patients. Clinical and ultrasound groups were similar in terms of patient characteristics, allocation to individual surgeons, and proportion of forearm AVFs. The ultrasound group had a significantly lower rate of immediate failure (4% versus 11%, P ‫؍‬ 0.028) and, among failed AVFs, less thrombosis (38% versus 67%, P ‫؍‬ 0.029). Primary AVF survival at 1 year was not statistically different (ultrasound ‫؍‬ 65%, clinical ‫؍‬ 56%, P ‫؍‬ 0.081). Assisted primary AVF survival at 1 year was significantly better for the ultrasound group (80% versus 65%, P ‫؍‬ 0.012). The number of patients requiring preoperative ultrasound to prevent one AVF failure was 12.Conclusions: Routine preoperative vascular ultrasound in addition to clinical assessment improves AVF outcomes in terms of patency and use for dialysis. National Research Register, United Kingdom, trial number N0046131432.

The highly significant association between LDL cholesterol and small aneurysms suggests that LDL, possibly acting via inflammatory mediated matrix degeneration, could be an initiating factor in the development of AAA. The ability of statin therapy to prevent AAA formation requires further investigation.

Objective: The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. Background: Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. Methods: We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. Results: Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138–642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. Conclusions: Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.

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