Marcelo Fiorelli Alexandrino da Silva, Felipe Soares Oliveira Portela, Andressa Cristina Sposato Louzada, Marcelo Passos Teivelis, Edson Amaro Junior, Nelson Wolosker
INTRODUCION: During the COVID-19 pandemic, there was a dramatic increase in healthcare demand. Resources were redirected to care patients with COVID-19. Therefore, surgical treatments were affected, including those of vascular diseases. There are no studies evaluating the whole impact of the COVID-19 pandemic, considering all types of vascular procedures, both elective and urgent, in a large country. The aim of the present study was to analyze the impact on all types of vascular procedures performed in Brazilian public hospitals during the COVID-19 pandemic...
September 15, 2023: Annals of Vascular Surgery
Bahaa Nasr, Mateo Villa, Didier Benoit, Dimitris Visvikis, Julien Bert
OBJECTIVES: Endovascular treatment is continuously gaining ground in vascular surgery procedures. However, current patient radiation dose estimation does not take into account the exact patient morphology and organs' composition. Monte Carlo (MC) simulation can accurately estimate the dose by recreating the irradiation process generated during x-ray-guided interventions. This study aimed to validate the MC simulation models by comparing simulated and measured dose distributions in endovascular aortic aneurysm repair (EVAR) procedures...
September 15, 2023: Annals of Vascular Surgery
Jonathan R Krebs, Brian Fazzone, Erik M Anderson, Walker Ueland, John R Spratt, Martin R Back, Zain Shahid, Thomas S Huber, Gilbert R Upchurch, Michol A Cooper
OBJECTIVES: Endovascular repair of thoracoabdominal aortic aneurysms (TAAA) and juxtarenal aortic aneurysms (JAA) with fenestrated and/or branched endografts (B/FEVAR) has become common. Physician modified endografts (PMEGs) for patients presenting with symptomatic or contained ruptures has made B/FEVAR a feasible option in nonelective settings. The purpose of this study was to describe our 10-year institutional experience with endovascular interventions for TAAA in elective and nonelective cases to evaluate differences in outcomes and the clinical risk factors associated with nonelective presentation...
September 13, 2023: Annals of Vascular Surgery
Brian Luong, Christina M Brown, Misty D Humphries, Steven Maximus, Mimmie Kwong
OBJECTIVES: Objective measures of perfusion such as an ankle brachial index (ABI) and toe pressure remain important in prognosticating wound healing. However, the use of ABI is limited in patients with incompressible vessels and toe pressure may not be comparable across patients. While a toe arm index (TAI) may be of value in this setting, its role as clinical indicator of perfusion for healing in patients with lower extremity wounds has not been well established. METHODS: A retrospective review was performed of all vascular patients with lower extremity wounds that underwent peripheral vascular intervention between 2014-2019...
August 31, 2023: Annals of Vascular Surgery
Spencer J Lucas, Kristopher B Johnson, Ryan Rykhus, Kirby Hora, Angela VandenHull, Kari Bates, Joni Sengos, Patrick W Kelly
OBJECTIVE: Spinal cord ischemia (SCI) continues to be a devastating complication after repair of thoracoabdominal aortic aneurysms (TAAAs). The objective of this review is to present our single-center outcomes after the implementation of a standardized neuroprotective protocol following branched endovascular aortic repair. METHODS: A standardized neuroprotective protocol including preoperative steroids, acetazolamide, intraoperative hemodynamic parameters, and postoperative treatment goals was initiated in November 2019...
August 31, 2023: Annals of Vascular Surgery
Daniel J Lehane, Joshua T Geiger, Zachary R Zottola, Karina A Newhall, Doran S Mix, Adam J Doyle, Michael C Stoner
OBJECTIVES: There are limited analyses of survival and postoperative outcomes in chronic mesenteric ischemia (CMI) utilizing data from large cohorts. Current guidelines recommend open repair (OR) for younger, healthier patients when long-term benefits outweigh increased perioperative risks or for poor endovascular repair (ER) candidates. This study investigates whether long-term survival, reintervention, and value differ between these treatment modalities. METHODS: A retrospective cohort analysis was performed on data extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payer database containing demographics, diagnoses, treatments, and charges...
August 31, 2023: Annals of Vascular Surgery
Ryan P Hall, Monica Majumdar, Sasha Suarez Ferreira, Ivy Lee, Tiffany Bellomo, Samuel Jessula, Amanda Kirshkaln, Kathryn Nuzzolo, Nikolaos Zacharias, Anahita Dua
OBJECTIVE: The role of thrombin in vascular pathology is a focus of investigation. The incorporation of direct Factor-Xa inhibition into practice patterns is based on its theoretical dual-pathway attenuation of both thrombin generation and platelet aggregation. However, quantification of the effect of direct anti-Xa medications on platelet function is not established. Thromboelastography with Platelet Mapping (TEG-PM) leverages dual-pathway metrics to provide comprehensive coagulation profiles...
August 30, 2023: Annals of Vascular Surgery
Saranya S Sundaram, Ryan W King, Elizabeth A Genovese, Ravi K Veeraswamy
OBJECTIVES: Duplex ultrasound is frequently used to determine the degree of carotid stenosis. However, axial imaging is typically obtained for operative planning for transcarotid artery revascularization (TCAR). We examined if ultrasound alone is sufficient prior to TCAR. METHODS: Data from the Vascular Quality Initiative TCAR Surveillance Project registry between 2016 and 2021 was obtained. Patients were divided into two groups - those with preoperative ultrasound alone (US) versus those with additional axial imaging (AX)...
August 30, 2023: Annals of Vascular Surgery
Shernaz S Dossabhoy, Sabina M Sorondo, Andrea T Fisher, Vy T Ho, Jordan R Stern, Jason T Lee
OBJECTIVE: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established treatment approach for juxtarenal and short neck infrarenal aortic aneurysms. Recommendations and clinical outcomes are lacking for offering FEVAR in patients with chronic kidney disease (CKD). We aimed to compare short and long-term outcomes for patients with none-to-mild versus moderate-to-severe CKD undergoing FEVAR. METHODS: We retrospectively reviewed consecutive patients undergoing standard FEVAR with Cook devices at a single institution...
August 14, 2023: Annals of Vascular Surgery
Molly Ratner, Clay Wiske, Caron Rockman, Virendra Patel, Jeffrey J Siracuse, Neal Cayne, Karan Garg
BACKGROUND: While prior studies have confirmed the protective effect of diabetes on abdominal aortic aneurysm (AAA) development, much less is known about the effect of diabetes, and in particular insulin dependence, on outcomes following AAA repair. In this study, we aim to evaluate the role of insulin-dependent diabetes on short-term and long-term outcomes following open and endovascular AAA repair. METHODS: The Vascular Implant Surveillance and Interventional Outcomes Network (VISION), a registry linking the Vascular Quality Initiative (VQI) data with Medicare claims, was queried for patients who underwent open or endovascular AAA repair from 2011 to the present...
August 14, 2023: Annals of Vascular Surgery
Rohini J Patel, Agustin Sibona, Mahmoud B Malas, John S Lane, Omar Al-Nouri, Andrew R Barleben
OBJECTIVE: Physician modified endografts (PMEG) and custom manufactured devices (CMD) use branched and fenestrated techniques (F/BEVAR) to repair complex aneurysms. Traditionally many of these are deployed through a combination of upper and lower extremity access. However, with newer steerable sheaths, you can now simulate upper extremity access from a transfemoral approach. Single institution studies have demonstrated increased risks of access site complications and stroke when upper extremity access is used...
August 11, 2023: Annals of Vascular Surgery
Katsuhiro Yamanaka, Ryo Kawabata, Mari Hamaguchi, Shunya Chomei, Taishi Inoue, Shota Hasegawa, Takanori Tsujimoto, Yojiro Koda, Shunsuke Miyahara, Hiroaki Takahashi, Takuya Okada, Masato Yamaguchi, Kenji Okada
BACKGROUND: Although endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is widely used worldwide, the fact that it is associated with increased rates of reintervention has been considered a problem. This study aimed to analyze the outcomes of primary open AAA repair and open conversion with explantation of stent grafts after EVAR. METHODS: In this retrospective study, we enrolled 1,120 patients (open repair, n = 664; EVAR, n = 456) who underwent AAA repair at Kobe University from 1999 to 2019...
August 2, 2023: Annals of Vascular Surgery
Alireza Daryapeyma, Jennifer Pettersson, Linus Blohmé, Elisabeth Franzen Röhl, Erika Bartholdson, Mathias Waldén, Rebecka Hultgren
OBJECTIVES: The aim of this study was to assess the eventual added benefit of anti- granulocyte monoclonal antibodies scintigraphy to the diagnostic imaging of aortic graft infection and its role in evaluation of treatment outcome. METHODS: A population-based, retrospective, register-based analysis was carried out of all patients with infected aortic grafts after treatment for aneurysmal or aortoiliac occlusive disease (AIOD) at Karolinska University Hospital, covering the greater Stockholm area during Nov-2012-Dec-2020...
August 1, 2023: Annals of Vascular Surgery
Maryam K Mohammed, Elizabeth A Andraska, Abhisekh Mohapatra, Efthymios D Avgerinos, Michael C Madigan, Karim M Salem
BACKGROUND: Acute aortic occlusion (AAO) is a morbid diagnosis in which mortality correlates with severity of ischemia on presentation. Visceral ischemia (VI) is challenging to diagnose and its presentation as a consequence of AAO is not well-studied. We aim to identify characteristics associated with VI in AAO to facilitate diagnosis. MATERIALS AND METHODS: Patients diagnosed with AAO who underwent revascularization were identified retrospectively from institutional records (2006-2020)...
July 27, 2023: Annals of Vascular Surgery
Tyler Arismendi, Nicholas Schaper, Alec Falkenhain, Konstantinos C Karabetsos, Ali Syed, Rheyana Branch, Marvi Moreno, Cole Pickney, Ikpechukwu Obayi, Spencer J Lucas, Eduardo González, Aaron Graves, Brittany Kauffman, Alexandra Maningat, Tara Zielke, Janice Nam, Michael C Soult, Faisal Aziz, Saideep Bose, Matthew R Smeds
BACKGROUND: Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular techniques. However, despite substantial modifications to the training paradigm, a shortage of vascular surgeons is still projected through 2050. We aimed to gather and analyze fourth-year medical students' knowledge and perceptions of vascular surgery (VS) to further inform strategies for recruiting future vascular surgeons...
July 24, 2023: Annals of Vascular Surgery
Daniel Silverberg, Avner Bar Dayan, Chen Speter, Michal Fish, Moshe Halak
OBJECTIVE: The aim of this single center study was to evaluate the early results of the off the shelf inner branch E-nside endograft in the treatment of complex aortic aneurysms and thoracoabdominal aortic aneurysms. METHODS: We performed a retrospective analysis of a prospectively maintained database of all patients treated with the E-nside endograft at our institution during the years 2021-2023. Parameters evaluated were technical success, early major adverse events, target vessel patency, and the presence of endoleaks...
July 24, 2023: Annals of Vascular Surgery
Clément Benic, Konstantinos Stavroulakis, Mélanie Carret, Kevin Pluchon, Romain Didier, Bahaa Nasr
BACKGROUND: Access-site vascular injury (ASVI) remains a challenge for transfemoral transcatheter aortic valve implantation (TAVI). Although surgery is the gold standard, endovascular therapy gains growing acceptance as primary treatment option for ASVI. The aim of this study was to analyze the safety and efficacy of covered balloon-expandable stents (BXSs) placement for ASVI after transfemoral TAVI. METHODS: All patients treated with a covered BXS between January 2018 and December 2020 for access-site related bleeding complications following femoral TAVI were included in this single center retrospective study...
July 24, 2023: Annals of Vascular Surgery
John Iguidbashian, Zhixin Lun, Kyle Bata, Robert W King, Lauren Gunn-Sandell, Derek Crosby, Kristin Stoebner, David Tharp, C T Lin, Ethan Cumbler, Jennifer Wiler, Jeniann Yi
BACKGROUND: Inefficient clinical workflows can have downstream effects of increased costs, poor resource utilization, and worse patient outcomes. The surgical consultation process can be complex with unclear communication, potentially delaying care for patients requiring time-sensitive intervention in an acute setting. A novel electronic health records (EHR)-based workflow was implemented to improve the consultation process. Post-implementation, we assessed the impact of this initiative in patients requiring vascular surgery consultation...
July 24, 2023: Annals of Vascular Surgery
Scott R Levin, Alik Farber, Elizabeth G King, Alan G Perry, Thomas W Cheng, Jeffrey J Siracuse
BACKGROUND: Functional impairment affects outcomes after a variety of procedures. However, the impact of functional impairment on outcomes of arteriovenous (AV) access creation is unclear. We aimed to evaluate the association of patients' ability to ambulate and perform activities of daily living (ADL) with AV access outcomes. METHODS: We retrospectively reviewed patients undergoing AV access creation at an urban, safety-net hospital from 2014 to 2022. We evaluated associations of impaired ambulatory and assisted ADL status with 90-day readmission, 1-year primary patency, and 5-year mortality...
July 19, 2023: Annals of Vascular Surgery
Satinderjit Locham, Mark D Balceniuk, Matthew Byrne, Timothy Hoang, Doran Mix, Karina Newhall, Adam Doyle, Michael Stoner
OBJECTIVE: Antiplatelet therapies with thromboxane inhibitors and adenosine 5'-diphosphate (ADP) antagonists have been widely used following carotid artery stenting (CAS). However, these therapies may not apply to patients who are intolerant or present acutely. Glycoprotein IIb/IIIa inhibitors (GPI) are a proposed alternative therapy in these patients; however, their use has been limited due to concerns of increased risk for intracranial bleeding. Thus, this study aims to assess the safety profile of GPI in patients undergoing CAS...
July 18, 2023: Annals of Vascular Surgery
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