Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

The worldwide results of the RESTORE II registry show the safety and effectiveness of RELAY and RELAY NBS stent grafts for elective endovascular thoracic aortic repair. Compared with the RESTORE registry, the device presents a lower rate of perioperative complications.

Background Academic interaction with mentors has almost become minimal due to the current pandemic of COVID-19. The objective of this study is to introduce how a group of vascular surgery residencies joined forces to improve surgical education in times of COVID-19. Methods On May 2020, a group of Hispanic American vascular residency programs created webinar sessions of arterial and venous clinical cases among vascular residents across Latin America and Europe. Participants were surveyed via email. Questions were about the perceived quality and utility of the webinars; answers were stratified into negative (disagree), neutral, and positive (agree). Results There have been 60 sessions and 118 clinical cases presented. The survey was answered by 106 participants, 82 males (78.8%) and 24 women (23.0%). Fifty-four (51.9%) were board-certified vascular surgeons, 49 (47.1%) vascular surgery residents, and 2 (1.9%) general surgery residents. Mean age of the participants was 41.5 years (range: 25–74 years). Mean years of vascular surgery practice or experience were 11.2 years (range: 0–45 years). The residency programs involved in this project were from 13 different countries. Most answers received were positive for both perceived quality and utility of the webinars. Conclusion Globalization and technology provide an opportunity for international education, with the goal of building well-rounded and academic vascular surgeons. This group is just the beginning of a large collaborative group among Hispanic American countries, hoping that more residency programs will join, with the aim of breaking borders in the education of vascular surgery.

A 55-year-old man, diagnosed with descending aortic ulcer through regular health examination, was implanted with a Gore Conformable TAG (W. L. Gore & Associates, Flagstaff, Ariz) at the suprarenal aorta, with celiac trunk covered.Results: During 4-month follow-up, the patient had no complaints, and no graft migration was shown by computed tomography angiography (CTA) examination, yet superior mesenteric artery occlusion was observed. During 10-month follow-up, the patient presented with abdominal back pain, general fatigue, and fever. CTA examination showed abnormal density around the graft, which was assumed to be a graft infection with periaortic tissue compatible with an inflammatory reaction. After invalid treatment for infection, positron emission tomography-computed tomography was performed and showed avid fluorodeoxyglucose uptake at the descending aorta, retroperitoneum, right lung, pancreas, spleen, left kidney, mesenteric glands, and left whirl bone. Computed tomography-guided biopsy confirmed it as epithelioid angiosarcoma. On review of the CTA study, no sign of malignant tumor was found on the preoperative images; however, left renal metastases were seen on the 4-month postoperative images.Conclusions: There may have been an association between angiosarcoma and artificial graft observed in animal experiments or rare cases before. However, this is the first case of epithelioid angiosarcoma after Conformable TAG aortic endograft placement. In addition, the rapid onset of the tumor also confused us as to whether the cause of the descending aortic ulcer was arteriosclerosis or epithelioid angiosarcoma and whether the epithelioid angiosarcoma was primary or secondary to the artificial graft.