Journal of Vascular Surgery

BACKGROUND: Women and underrepresented minorities (URMs) who are at an increased risk of presenting with severe peripheral artery disease (PAD) and have different responses to treatment compared to non-Hispanic white males yet are underrepresented in PAD research. METHODS: ELEGANCE is a global, prospective, multi-center, post-market registry of PAD patients treated with drug-eluting devices (DEDs) that aims to enroll at least 40% women and 40% URMs. The study design incorporates strategies to increase enrollment of women and URMs...

OBJECTIVE: Late primary care provider (PCP) or nephrologist evaluation of patients with progressive kidney disease may be associated with increased morbidity and mortality. Among patients undergoing initial arteriovenous (AV) access creation, we aimed to study the relationship of recent PCP and nephrologist evaluations with perioperative morbidity and mortality. METHODS: We performed a retrospective review of patients from 2014-2022 who underwent initial AV access creation at an urban, safety-net hospital...

INTRODUCTION: Recent myocardial infarction (MI) represents a real challenge in patients requiring any vascular procedure. There is currently a lack of data on the effect of preoperative MI on the outcomes of carotid revascularization methodology (carotid enterectomy (CEA), transfemoral carotid artery stenting (TFCAS), or transcarotid artery revascularization (TCAR)). This study looks to identify modality-specific outcomes for patients with recent MI undergoing carotid revascularization...

OBJECTIVES: Despite the significant number of trauma patients treated at level 2 trauma centers (L2TC) in the United States, most of the literature describing vascular trauma is from level 1 trauma centers (L1TC). Currently, trauma center designation criteria do not require vascular surgery as a necessary component service. METHODS: A retrospective chart review was performed for all trauma patients with a vascular surgery consultation (VSC) seen at our L2TC between 2013 and 2018...

No abstract text is available yet for this article.

BACKGROUND/OBJECTIVE: The aim of this study was to assess the association between the proximity to the tertiary care hospital and the severity of peripheral arterial disease at the time of lower extremity bypass (LEB) in a rural-urban mix region. METHODS: Patients undergoing LEB from 2010-2020 at Penn State Milton S. Hershey Medical Center were reviewed and stratified into two study groups based on a median distance from hospital i.e., Group I: ≥34 miles and Group II: <34 miles...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: Type II endoleak is the most frequent complication after endovascular abdominal aneurysm repair. Polytetrafluoroethylene and polyester are the two most commonly used graft materials in EVAR-devices. Biological properties of the material might influence the appearance and persistence of type II endoleak. Therefore, the aim of this study was to evaluate potential differences in the prevalence of Type II endoleak after EVAR between polytetrafluoroethylene and polyester endografts in patients electively treated for an infrarenal AAA...

OBJECTIVES: Complex endovascular juxta-, para- and suprarenal abdominal aortic aneurysm repair (comEVAR) is frequently accomplished with commercially available fenestrated (FEVAR) devices or off-label use of aortoiliac devices with parallel branch stents (chEVAR). We sought to evaluate the implantable vascular device costs incurred with these procedures as compared to standard Medicare reimbursement to determine the financial viability of comEVAR in the modern era. METHODS: Five geographically distinct institutions with high-volume, complex aortic centers were included...

OBJECTIVE: To identify disparities in sociodemographic factors that are associated with major lower limb amputation in patients with PAD. METHODS: A systematic review of literature was performed to identify studies that reported major lower limb amputation rates in patients with PAD among different sociodemographic groups. Data that compared amputation rates on the basis of sex, race, ethnicity, income, insurance, geography, and hospital type were collected and described...

OBJECTIVE: Many patients with chronic limb threating ischemia (CLTI) have additional comorbidities requiring systemic immunosuppression. Few studies have analyzed whether these medications may inhibit graft integration and effectiveness, or conversely, whether they may prevent inflammation and/or restenosis. Therefore, our study aim was to examine the effect of systemic immunosuppression versus no immunosuppression on outcomes following any first-time lower extremity revascularization for CLTI...

Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999...

OBJECTIVE: Sex disparities in outcomes after carotid revascularization have long been a concern, with several studies demonstrating increased post-operative death and stroke for female patients after either carotid endarterectomy (CEA) or transfemoral stenting (TF-CAS). Adverse events after TF-CAS are higher in female patients, particularly in symptomatic cases. Our objective was to investigate outcomes after transcarotid revascularization (TCAR) stratified by patient sex hypothesizing that the results would be similar between males and females...

INTRODUCTION: Abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm in men and 5 cm in women. Since AAA is more common among the elderly, we sought to evaluate contemporary practices of elective AAA repair and two-year postoperative outcomes in octogenarians. METHODS: We identified octogenarians undergoing elective AAA repair in the Vascular Quality Initiative from 2012-2019. We included patients undergoing endovascular (EVAR) and open (OAR) aortic repair...

INTRODUCTION: A preoperative supervised exercise programme (SEP) improves cardiorespiratory fitness and perioperative outcomes for patients undergoing elective abdominal aortic aneurysm (AAA) repair. The aim of this study was to assess the effect of a preoperative SEP on long-term survival of these patients. A secondary aim was to consider long-term changes in cardiorespiratory fitness and quality of life. METHODS: Patients scheduled for open or endovascular AAA repair were previously randomized to either a 6-week preoperative SEP or standard management and a significant improvement in a composite outcome of cardiac, pulmonary, and renal complications was seen following SEP...

OBJECTIVES: Guidelines recommend open surgical (OR) over endovascular revascularization (ER) for the treatment of chronic mesenteric ischemia (CMI) for younger, healthier patients. However, little is known about the long-term costs of these recommendations with respect to patients' overall life expectancy. This study investigated whether 5-year value differs between these treatment modalities. METHODS: Patient data were extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payor database containing demographics, diagnoses, treatments, and charges...

OBJECTIVE: There is increasing evidence that depression is a risk factor for worse outcomes in patients with peripheral artery disease (PAD). The association of depression in patients with chronic limb threatening ischemia (CLTI) is not well described, nor is the impact of medical treatment for depression in this patient population. The objective of this study was to investigate the prevalence of depression in CLTI patients, its association on major amputation and all-cause mortality, and whether medical antidepressant treatment is associated with improvement in these outcomes in patients with depression...

OBJECTIVE: Superficial femoral artery stenting is a common treatment for peripheral artery disease. It is effective in the short term, however in-stent restenosis limits long term success. Surveillance with duplex ultrasound can identify patients who develop in-stent restenosis leading to early reintervention, but data to support this practice is sparce. The purpose of this study was to evaluate whether surveillance and subsequent reintervention improves outcomes in patients with SFA stents...

BACKGROUND: Carotid web (CaWeb) is a rare form of fibromuscular dysplasia that can produce embolic stroke. Misdiagnosis of symptomatic CaWeb as "cryptogenic stroke" or "embolic stroke of unknown source" is common and can lead to recurrent, catastrophic neurologic events. Reports of CaWeb in the literature are scarce, and their natural history is poorly understood. Appropriate management remains controversial. METHODS: CaWeb was defined as a single, shelf-like, linear projection in the posterolateral carotid bulb causing a filling defect on computed tomography angiography (CTA) or cerebral angiography...