Conclusion: Aspirin resistance can be treated by increasing the aspirin dose or adding omega-3 fatty acids. Summary: There is a wide interindividual variability in aspirin response (Circulation 2002;105:1650-5). The prevalence of aspirin resistance or low response is estimated to be <1% to 45%. Aspirin resistance is associated with an odds ratio of almost 4 for development of cardiovascular events (BMJ 2008;336:195-8). It is unclear whether increasing the dose in patients with aspirin resistance will provide adequate antiplatelet effects or if an alternative strategy, such as adding additional substances that would inhibit the cyclooxygenase (COX)-1 pathway, would be effective. Omega-3 fatty acids, components of dietary fish oil, lead to replacement of n-6 fatty acids, such as arachidonic acid (AA), by n-3 fatty acids in cell membranes. This leads to an increase in eicosapentaenoic acid (EPA). EPA competes with AA as a substrate of the COX-1 pathway, leading to inhibition of collagen-induced platelet aggregation and mild prolongation of bleeding time (Am J Clin Nutr 1997;65:1687-98s). The authors sought to determine whether addition of omega-3 fatty acids or increases in aspirin dose improves response to low-dose aspirin among aspirin-resistant patients. There were 485 patients with stable coronary artery disease treated with 75 to 162 mg of aspirin daily for at least 1 week screened for aspirin response with the VerifyNow Aspirin Assay. Aspirin resistance was defined by ≥2 of 3 criteria; VerifyNow score >550, 0.5 mg/mL AA-induced aggregation ≥20%, and 10 μmol/L adenosine diphosphate (ADP)-induced aggregation ≥70%. Thirty patients (6.2%) were aspirin-resistant and were randomized to receive either low-dose aspirin plus omega-3 fatty acids or aspirin at 325 mg/d. Patients were retested for aspirin activity 30 days later. After treatment, there were significant reductions in VerfiyNow scores and in AA-induced and ADP-induced platelet aggregation. Thromboxane B2 was also reduced in both groups (39.6% decrease in the aspirin group and 56.8% reduction in the omega-3 fatty acid group). After treatment, 12 patients (80%) who received omega-3 fatty acid and 11 (73%) who received aspirin at 325-mg doses were no longer aspirin-resistant.

Objectives: The aim of this study is to investigate whether variation in mortality at hospital level reflects differences in quality of care of peripheral vascular surgery patients.

Heterotopic ossification (HO) is the formation of bone outside the skeletal system, including old incisions. Although a well-known complication after orthopaedic surgery, it is still considered an uncommon phenomenon after vascular surgery. Recent data, however, show that up to 25% of all patients develop HO after midline abdominal surgery. In this article, we present the case of a symptomatic HO, 7 years after an aortobiiliac prosthetic reconstruction for an abdominal aortic aneurysm. Furthermore, we review current insights into the aetiology and show bone morphogenetic proteins to play a crucial role. Treatment options are also reviewed, but lacking any supportive evidence for other therapies, surgical excision with primary closure is the treatment of choice.

Background: Thrombotic stroke following carotid endarterectomy (CEA) is preceded by high-grade embolisation (detected using transcranial Doppler (TCD)) and can be prevented by incremental doses of Dextran. However, this strategy is labour intensive and Dextran manufacture has now ceased. A randomised trial has suggested that a single 75 mg dose of Clopidogrel (administered the night before surgery in addition to daily 75 mg Aspirin) significantly reduces post-CEA embolisation. We hypothesized that this model of dual antiplatelet therapy might significantly reduce the need for adjuvant Dextran therapy.

Objectives: Single centre series have suggested that endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) may reduce mortality versus open surgery. This has not been substantiated in the only randomized controlled trial, leading to suggestion that anatomical suitability for rEVAR may independently improve prognosis of rAAA. Our aim was to assess the outcome of open rAAA repair in patients dependant on their suitability for rEVAR on pre-operative computed tomography (CT) assessment.

Objective: The aim of study was to assess how the ultrastructure of the wall of aortic aneurysms, sac and neck influences aortic wall distensibility and proximal dilatation 2 years after open repair.

Objectives: To test the hypothesis that vein graft intimal hyperplasia can be significantly suppressed by a single intra-operative transfection of the graft with a decoy oligonucleotide (ODN) binding the transcription factor Egr-1.

Objectives: The aim of this study was to determine the mid-term patency and the clinical outcome after stenting of chronic occluded caval and iliofemoral venous segments. Design: Observational study.

Objectives: There have been few randomised studies comparing Radiofrequency Ablation(RFA) with other endovenous techniques. The primary aim of this study was to determine whether RFA of the great saphenous vein (GSV) was associated with less pain and bruising than endovenous laser ablation (EVLA).

Objective: The SAPPHIRE trial established that carotid artery stenting (CAS) is not inferior to carotid endarterectomy (CEA) for patients at high surgical risk. The CREST trial has shown CEA has a lower stroke rate than CAS, at the expense of higher cardiac complications. The objective of this study was to evaluate the nationwide performance of CAS and CEA in both high-risk (HR) and low-physiologic-risk (LR) patients, outside of the clinical trial setting.

Objective: The utilization of selective cerebral shunting during carotid endarterectomy (CEA) has been predicated on surrogate measures such as contralateral carotid occlusion, back-pressure measurements, and the patient's motor and cognitive function with regional anesthesia or recent stroke. This study analyzed the need for shunting in CEA where comprehensive electroencephalography (EEG) monitoring with somatosensory evoked potentials (SSEP) was the sole determinant of the necessity of a shunt.

Background: Despite the absence of clinically evident neurologic symptoms, subclinical microemboli during carotid interventions are common. Characterizing the typical locations of these lesions is an important step in identifying neural systems vulnerable to disruption. The purpose of this study was to examine the distribution of microemboli after carotid interventions using a novel imaging analysis program.

Background: Aberrant origin of right subclavian arteries represents the most common of the aortic arch anomalies. This variant has few published series to guide management. Our goal was to review treatment options and results for these potentially complex reconstructions.

Objective: Although the influence of initial TASC II classification has been clearly shown to influence the primary patency of infrainguinal stenting procedures, its effect on outcomes once stent failure has occurred is less well documented. It is the objective of this paper to determine whether clinical outcomes and implications of anatomic stent failure vary according to initial TASC II classification

Objective: We postulate that catheter-directed intraoperative thrombolysis in conjunction with laser atherectomy is a safe and effective treatment of TASC C and D critical limb ischemia.

Objective: American Chest Physician (ACP) guidelines stratify DVT risk in trauma patients based on injury pattern and medical prophylaxis. Screening is recommended only for the highest risk groups. Many screening studies for DVT have not investigated calf vein DVT (CVDVT) and did not exclusively target critically ill patients. Given new ACP guidelines recommending treatment of calf vein DVT, we investigated the efficacy of duplex ultrasound (DUS) screening of critically ill trauma patients for all lower extremity DVTs, including CVDVT, regardless of injury pattern, risk factors, or medical prophylaxis.

Objectives: Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy.

Objective: Neurogenic thoracic outlet syndrome (nTOS) encompasses a wide spectrum of disabling symptoms that are often vague and difficult to diagnose and treat. We developed and prospectively analyzed a treatment algorithm for nTOS utilizing objective disability criteria, TOS-specific physical therapy, radiographic evaluation of the thoracic outlet, and selective surgical decompression.

Objective: Thoracic outlet decompression is an effective and durable treatment for venous thoracic outlet syndrome (VTOS), but there is no consensus regarding the optimal operative approach. Transaxillary, supraclavicular, or paraclavicular approaches are most commonly used, based largely on surgeon preference. However, unlike other forms of thoracic outlet syndrome, the pathology in VTOS is centered in the anteriorly located costoclavicular space. Therefore, we have adopted a focused infraclavicular approach with intraoperative venography that provides excellent access to the axillosubclavian veins and the costoclavicular space for effective treatment of VTOS patients.

Objective: Surging interest in the 0+5 integrated vascular surgery (VS) residency and successful recruitment of the top students in medical school requires early exposure to the field. We sought to determine the impact of a high-fidelity simulation-based preclinical endovascular skills course on medical student performance and ultimate career specialty choices.