Journal of Vascular Surgery

BACKGROUND: The volume-outcomes relationship is cross-cutting among open abdominal aortic operations, where higher-volume surgeons have better perioperative outcomes. However, there has been minimal focus on low-volume surgeons and how to improve their outcomes. This study sought to identify if there are any differences in outcomes among low-volume surgeons for open abdominal aortic surgeries by different hospital settings. METHODS: We used the 2012-2019 Vascular Quality Initiative registry to identify all patients who underwent open abdominal aortic surgery for aneurysmal or aorto-iliac occlusive disease by a low-volume surgeon (<7 operations annually)...

OBJECTIVES: Race-related disparities in outcomes associated with cardiovascular disease are well documented. Arteriovenous fistula maturation can be a challenge in establishing functional access in the end-stage renal disease population requiring hemodialysis. We sought to investigate the incidence of adjunctive procedures required to establish fistula maturation and evaluate the association with demographic factors including patient race. METHODS: This study was a single institution retrospective review of patients undergoing first-time arteriovenous fistula creation for hemodialysis from January 1, 2007 to December 31, 2021...

OBJECTIVE: This single-centre retrospective cohort study was aimed to analyse the early and long-term results of endovascular treatment for true visceral artery aneurysms. Moreover, a comparison with the results of our previously published historical series of open surgical procedures was performed. MATERIALS AND METHODS: From January 2008 to December 2021, 78 consecutive patients were treated at our institution for true visceral artery aneurysms. All demographic data, procedural details, perioperative outcomes, and follow-up data were prospectively collected from a dedicated database...

INTRODUCTION: As medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents' and fellows' operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs...

OBJECTIVE: Optimizing medical management and risk factor modification are underutilized strategies in patients with chronic limb threatening ischemia (CLTI), despite evidence of improved outcomes. The Vascular Quality Initiative (VQI) registry is a tool to improve quality of vascular care. In this study, we used the VQI to evaluate trends in medical management in CLTI patients undergoing peripheral vascular interventions (PVI), and the impact of changes in management on overall survival (OS), amputation-free survival (AFS) and limb salvage (LS)...

OBJECTIVES: The treatment for chronic limb-threatening ischemia (CLTI) has changed dramatically in the last few decades with a shift towards an endovascular-first approach and aggressive revascularization to achieve limb salvage. As the size of the CLTI population and intervention rates increase, patients will continue to experience technical failure (TF). Here, we describe the natural history of patients after TF of endovascular intervention for CLTI. METHODS: We conducted a retrospective cohort study of patients with CLTI that attempted endovascular intervention or bypass at our multidisciplinary limb salvage center from 2013 to 2019...

INTRODUCTION: To investigate the long-term outcomes after endovascular aneurysm repair (EVAR), in a real-world setting using the EndurantTM endograft (EG). METHODS: 184 EVAR candidates treated with the EndurantTM family EGs in a single vascular center were prospectively enrolled from January 2009 to December 2016. Kaplan-Meir estimates of long-term standardized primary and secondary outcome measures were performed Per protocol, subgroup comparison analysis was performed in 3 groups: patients treated within instructions for use (in-IFU) vs patients treated outside-IFU, EVAR in patients receiving Endurant proximal diameter 32 or 36 mm EG vs those receiving <32 mm diameter EG and EVAR with various EndurantTM EG versions...

OBJECTIVES: The Society for Vascular Surgery (SVS) clinical practice guidelines recommend best medical therapy(BMT) as first-line therapy before offering revascularization to patients with intermittent claudication(IC). Notably, atherectomy and tibial-level interventions are generally discouraged for management of IC; however, high regional market competition may incentivize physicians to treat patients outside the scope of guideline-directed therapy. Therefore, we sought to determine the association between regional market competition and endovascular treatment of patients with IC...

BACKGROUND: Enhanced recovery pathways (ERP) aim to lower perioperative stress to facilitate recovery. Limited fasting combined with carbohydrate loading is a common ERP element. The effect of limited fasting has not been elucidated in patients with diabetes (DM). Given the known deleterious effects of poor glycemic control in the perioperative period, such as increased rates of surgical site infection (SSI), the associations of preoperative limited fasting with perioperative glycemic control and early outcomes after lower extremity bypass were investigated...

OBJECTIVE: Lack of insurance has been independently associated with an increased risk of in-hospital mortality after abdominal aortic aneurysm repair, possibly due to worse control of comorbidities and delays in diagnosis and treatment. Medicaid expansion has improved insurance rates and access to care, potentially benefitting these patients. We sought to assess the association between Medicaid expansion and outcomes after abdominal aortic aneurysm repair. METHODS: A retrospective analysis of Healthcare Cost and Utilization Project State Inpatient Databases data from 14 states between 2012-2018 was conducted...

BACKGROUND: An increased prevalence of thoracic aortic aneurysm (TAA) has been demonstrated in patients with SRC; patients with SRC has a less elastic aortic wall than those without SRC. The purpose of this study was to evaluate aneurysm sac shrinkage after thoracic endovascular aortic repair (TEVAR) for true TAA in patients with and without SRC. METHODS: One hundred-three patients with true aneurysms of the thoracic aorta undergoing TEVAR at our university hospital from November 2013 to December 2021 were included in this study...

OBJECTIVE: A common measure to lower the risk for spinal cord ischemia (SCI) during complex endovascular aortic repair (cEVAR) is prophylactic cerebrospinal fluid drainage (CSFD). This method has caused controversy due to drain related complications. Spinal drains are usually pressure-directed. The objective of this study was to evaluate the risk of CSFD related complications and SCI within the context of an automated volume-directed drain protocol. METHODS: Retrospective single-center study of all cEVARs with CSFD at a tertiary vascular center January 2014 - December 2020...

BACKGROUND: Patients undergoing peripheral vascular intervention (PVI) (i.e., endovascular revascularization) for symptomatic lower extremity peripheral artery disease remain at high risk for major adverse limb and cardiovascular events. High-quality evidence demonstrates the addition of a low dose oral Factor Xa inhibitor to single antiplatelet therapy, termed dual pathway inhibition (DPI), reduces the incidence of major adverse events in this population. OBJECTIVE: This study aims to describe the longitudinal trends in Factor Xa inhibitor initiation after PVI, identify patient and procedural characteristics associated with Factor Xa inhibitor use, and describe temporal trends in antithrombic therapy post-PVI before vs...

BACKGROUND: Patients with chronic limb threatening ischemia (CLTI) experience high annual mortality and would benefit from timely palliative care intervention. We sought to better characterize use of palliative care among CLTI patients in the Medicare population. METHODS: Using Medicare data from 2017-2018, we identified patients with CLTI, defined as two or more encounters with a CLTI diagnosis code. Palliative care evaluations were identified using ICD-10-CM Z51...

OBJECTIVE: Society for Vascular Surgery (SVS) recommendations for managing intimal (grade 1) blunt thoracic aortic injuries (BTAI) include observation and medical management. University of Washington (UW) revised criteria suggest that intimal injuries with ≥1 cm flap should be upgraded to a moderate injury and treatment be considered. We sought to evaluate and compare SVS and UW criteria for BTAI and determine how discordance in grading affected treatment and outcome. METHODS: We reviewed all patients admitted with BTAI from 1/1/2011 to 3/31/2022...

INTRODUCTION: We assessed the feasibility of integrating palliative care consultation into the routine management of patients with chronic limb threatening ischemia (CLTI). Additionally, we sought to describe patient reported outcomes from the palliative care and vascular literature in patients with chronic limb threatening ischemia receiving a palliative care consultation at our institution. METHODS: This was a single institution, prospective, observational study that aimed to assess feasibility of incorporating palliative care consultation into the management of patients admitted to our tertiary academic medical center with chronic limb threatening ischemia by looking at utilization of palliative care before and after implementation of a protocol-based palliative care referral system...

OBJECTIVES: Mistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment. METHODS: This is a cross-sectional study of United States vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders...

BACKGROUND: Peripheral artery disease (PAD) is associated with worse survival following abdominal aortic aneurysm (AAA) repair. However, little is known about the impact of PAD and sex on outcomes following open infrarenal AAA repair (OAR). METHODS: All elective open infrarenal AAA cases were queried from the Society for Vascular Surgery Vascular Quality Initiative from 2003 to 2022. PAD was defined as history of non-cardiac arterial bypass, non-coronary percutaneous vascular intervention (PVI), or non-traumatic major amputation...

OBJECTIVE: Endovascular popliteal artery aneurysm (PAA) repair has acceptable outcomes compared with open repair for elective therapy. Endovascular repair for urgent PAA causing acute limb ischemia (ALI) has not been well-studied. This project compares outcomes of urgent endovascular and open repair of PAA with ALI. METHODS: The Vascular Quality Initiative database for peripheral vascular interventions (PVIs) and infrainguinal bypass were reviewed for PAAs with ALI from 2010 to 2021...

INTRODUCTION: Type 2 endoleak (T2EL) is the most common adverse finding on post-operative surveillance after endovascular aortic aneurysm repair (EVAR). A low rate of aneurysm related-mortality with T2EL has been established. However, the optimal management strategy and the efficacy of reintervention remains controversial. This study used data from the Vascular Quality Initiative linked to Medicare claims (VQI-Medicare) to evaluate T2LE in a real-world cohort. METHODS: This retrospective review of EVAR procedures in VQI-Medicare included patients undergoing their first EVAR procedure between 2015 and 2017...