No abstract

1365 men, 247 women) and were of fair quality. The overall pooled nonintervention rates were higher in women (34%) than men (19%; OR, 2.27; 95% CI, 1.21-4.23). The review of 30-day mortality included nine studies (52,018 men, 11,076 women). The overall pooled estimate for EVAR was higher in women (2.3%) than in men (1.4%; OR, 1.67; 95% CI, 1.38-2.04). The overall estimate for open repair also was higher in women (5.4%) than in men (2.8%; OR, 1.76; 95% CI, 1.35-2.30). The data for the women demonstrated no or only slight heterogeneity, but the heterogeneity of the men's data was more pronounced. Confounding factors such as age, aneurysm diameter, and comorbidities did not seem to alter the difference in mortality noted.Comments: This study demonstrates a difference in terms of gender when dealing with abdominal aortic aneurysms. The proportion of women meeting EVAR criteria for repair is less at the initial investigation, women are relegated to noninterventional treatment at a higher rate, and when treated by open or EVAR, have a higher mortality. This study is not designed to provide the "why" of these findings, but smaller aortic size, difference in cardiovascular risk management, and other technical considerations are potentially factors in the worse outcomes noted. We might need to modify our threshold for diagnosis and intervention in women. The poor prognosis with open operation compared with the endovascular approach might suggest a need for grafts of smaller size and potentially of design unique to the gender.

Thrombosis is the most important access-related complication. Several declotting procedures have been suggested falling mainly into two categories; thrombolysis-dependent and thrombectomy-dependent. Areas covered: Seventeen studies after 2001 have been published on percutaneous treatment of thrombosed vascular access. Authors performed a systematic review of these studies together with a parametric meta-analysis of data available investigating clinical success, postintervention assisted primary patency (PAPP) and independent factors that could influence outcome measures. Expert commentary: A shift to thrombectomy-dependent procedures is observed with a view to diminishing complications from the use of thrombolytic agents. Arteriovenous fistulas provide significantly better PAPP, while newer studies show improved, non-significant results compared with older ones. The role of improvement of devices for subsequent angioplasty is of equal importance, if not more, for improved declotting results.

Isolated popliteal lesions requiring treatment appear in nearly 1% of patients with PAD. Balloon angioplasty and bail-out stenting resulted in acceptable long-term clinical outcomes. Treatment of occlusions was correlated with increased restenosis rate.

In this retrospective analysis, Lutonix PCB proved to be safe and effective in treating restenosis in dysfunctional dialysis access with results comparable to the literature available. Larger studies are needed to prove abovementioned results.