Annals of Vascular Surgery

BACKGROUND: Venous compression syndromes are clinical conditions in which the large veins are compressed by other anatomical structures. Laboratory simulations may help us better understand the hemodynamics in venous compressions by creating situations similar to those seen in vivo. The aim of this study is to produce a model of the caval bifurcation using a polymer with distensibility similar to the human vena cava. METHODS: Fragments of the inferior vena cava were collected from 13 deceased kidney donors (aged 15-37 years) and tested for deformation (strain) when subjected to distension at 50 N/cm2 ...

OBJECTIVE: Microaggressions are statements or actions taken in a discriminatory manner. Microaggressions can be subtle or explicit, intentional, or unintentional, but regardless of the type of microaggressions, it is important to identify and address them, as they have been shown to be linked to physician burnout and add to levels of depression, anxiety, and stress. In this study, we evaluated prevalence, quality, and impacts of gender-based microaggressions on surgeons and surgical trainees using simulation-based education...

OBJECTIVE: Among patients with peripheral artery disease (PAD), depression is diagnosed in 17-25% and negatively impacts wound healing, quality of life, and survival. We hypothesized that depression is underdiagnosed in patients with PAD. Additionally, given the associations between depression and mortality in PAD patients, there is an increased need to investigate the strength of this relationship. The present analysis includes two studies to address the following aims: 1) Investigation of the prevalence of concomitant PAD and depression in a cohort from the Southeastern United States, and 2) Examination of the association between depression and all-cause mortality in a cohort of Canadian patients with PAD...

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OBJECTIVES: Median arcuate ligament syndrome (MALS) is an uncommon diagnosis that is often associated with variable clinical presentation and inconsistent response to treatment. Due to the nature of MALS, the optimal treatment modality and predictors of outcomes remain unclear. METHODS: A retrospective review was performed of all median arcuate ligament release (MALR) procedures at a single academic institution between 2000-2020. Variables examined included patient demographics, symptom characteristics, operative technique (open, robotic, laparoscopic), patient symptoms prior to release, symptom relief within 1 year, and recurrence of symptoms between release and last clinical follow-up...

BACKGROUND: The aim of study was to assess the safety and effectiveness of 3 different commercial iliac branch devices (IBDs): the Zenith Branch Iliac Endovascular Graft; the Gore Excluder Iliac Branch System and the E-liac Stent Graft System for the treatment of aorto-iliac or iliac aneurysms. METHODS: From January 2017 to February 2020, a retrospective reviewed was conducted on a total of 96 patients. Primary endpoint was IBD instability rate at 24-months. Secondary endpoints included onset of any endoleaks, buttock claudication, IBD-related reintervention and all-death rates, post-operative acute kidney and changes in maximum diameter from baseline of the aortic aneurysmal sac...

OBJECTIVE: To provide a summary of the current state of research in English medical literature on circulating miRNAs, as biomarkers for AAA. Additionally, for the most commonly mentioned circulating miRNAs in the literature, to attempt a documentation of the biological mechanisms underlying their role in AAA development. METHODS: A literature search was undertaken in the MEDLINE database. Only reports that involved peripheral blood samples (whole blood, plasma, serum) were included...

AIMS: Carotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following non-disabling ischaemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3). METHODS: An observational cohort study was performed, and data was collected from 1013 CEA cases over fifteen years. Patient demographics, co-morbidities and post-operative outcomes were compared between preoperative mRS<3 (Group one) and mRS≥3 (Group two)...

OBJECTIVE: To assess the incidence, clinical patterns, and outcomes of graft limb occlusion (GLO) following endovascular aneurysm repair (EVAR). METHODS: A retrospective study of patients undergoing EVAR from 2002-2017 at two mid-sized suburban teaching hospitals. The ipsilateral and contralateral aorto-common iliac artery angle (A-CIA) and common iliac-external iliac artery angle (CIA-EIA) was determined. The diameter of the EIA, graft extension to the EIA, and prior CIA stenting was recorded...

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute and chronic thoracic aorta diseases. We analysed long-term outcomes and risk factors of TEVAR procedures according to the aortic pathology. METHODS: Demographics, indications, technical details, and outcomes of patients undergoing TEVAR procedures in our institutions were prospectively collected and retrospectively analyzed. Overall survival was determined using Kaplan-Meier methods while Log-rank tests were used to compare the survival between groups...

OBJECTIVE: Depending on the size and location of the tumor, carotid body tumor (CBT) resection can come with various complications, mostly intraoperative bleeding, and cranial nerve injuries. In the present study, we aim to evaluate two fairly new variables, tumor volume, and distance to the base of the skull (DTBOS), with operative complications of carotid body tumor (CBT) resection. METHOD: Patients who underwent carotid body tumor surgery in Namazi hospital from 2015 to 2019 were studied using standard databases...

INTRODUCTION: Recent studies have demonstrated increased postoperative patency with the use of routine completion angiography for bypass using venous conduit. Compared to vein conduits however, prosthetic conduits are less plagued by technical issues such as unlysed valves or arteriovenous fistulae. The effect of routine completion angiography on bypass patency in prosthetic bypasses has yet to be compared to the more traditional selective use of completion imaging. METHODS: A retrospective review of all infrainguinal bypass procedures using prosthetic conduit completed at a single hospital system from 2001 to 2018 was performed...

INTRODUCTION: The widespread introduction of minimally invasive endovascular techniques in cardiovascular surgery has necessitated a transition in the psychomotor skillset of trainees and surgeons. Simulation has previously been used in surgical training; however, there is limited high quality evidence regarding the role of simulation-based training on the acquisition of endovascular skills. This systematic review aimed to systematically appraise the currently available evidence regarding endovascular high-fidelity simulation interventions, to describe the overarching strategies used, the learning outcomes addressed, the choice of assessment methodology, and the impact of education on learner performance...

OBJECTIVES: To retrospectively evaluate the feasibility and effectiveness of the endovascular treatment of patients with abdominal aortic aneurysm (AAA) and chronic kidney disease (CKD) without the need for using iodinated contrast media (ICM) throughout the diagnostic, therapeutic and follow-up pathway. METHODS: A retrospective review of prospectively collected data concerning 251 consecutive patients presenting an abdominal aortic or aorto-iliac aneurysm who underwent endovascular aneurysm repair (EVAR) from January 2019 to November 2022 at our academic institution was performed in order to identify patients with feasible anatomy with respect to manufacturers' instructions for use (IFU) and with CKD...

BACKGROUND: Iliac artery tortuosity is an important anatomical factor that influences the endovascular repair of aortic artery aneurysms (EVAR). The influencing factors of the iliac artery tortuosity index (TI) have not been well studied. TI of iliac arteries and related factors in Chinese patients with and without AAA were studied in this study. SUBJECTS AND METHODS: One hundred and ten consecutive patients with AAA and 59 patients without AAA were included. For patients with AAA, the diameter of the AAA was 51...

BACKGROUND: Type II endoleaks (ELII) are the most common complication following endovascular aneurysm repair (EVAR). Persistent type II endoleaks require continual surveillance and have been shown to increase the risk of Type I and III endoleaks, sac growth, need for intervention, conversion to open or even rupture directly or indirectly. These are often difficult to treat following EVAR and there are limited data regarding the effectiveness of prophylactic treatment of ELII. The aim of this study is to report midterm outcomes of prophylactic perigraft arterial sac embolization (pPASE) performed in patients undergoing EVAR...

OBJECTIVES: Infra-inguinal vascular injuries (IIVI) are emergencies involving both functional and vital prognosis. The choice between saving the limb or doing a first-line amputation is difficult even for an experienced surgeon. The aims of this work are to analyze early outcomes in our center and to identify predictive factors for amputation. M METHODS: Between 2010 and 2017, we reviewed retrospectively patients with IIVI. The main criteria for judgement were: primary, secondary and overall amputation...

BACKGROUND: The ankle-brachial pressure index (ABI) and toe-brachial pressure index (TBI) are commonly used diagnostic tools for peripheral artery disease (PAD) that are unreliable in the presence of calcified vessels.In this study, we aimed to demonstrate the utility of lower extremity calcium score (LECS) in addition to ABI and TBI in measuring disease burden and predicting the risk of amputation in patients with PAD. METHODS/RESULTS: Patients who were evaluated in the vascular surgery clinic at Emory University for PAD and who underwent non-contrast CT of the aorta and lower extremities were included in the study...

OBJECTIVES: Recent studies have shown a trend supporting endovascular revascularization (ER) in the treatment of chronic mesenteric ischemia (CMI). However, few studies have compared the cost effectiveness of ER and open revascularization (OR) for this indication. The purpose of this study is to conduct a cost-effectiveness analysis comparing open versus endovascular revascularization for CMI. METHODS: We built a Markov model with Monte Carlo microsimulation using transition probabilities and utilities from existing literature for CMI patients undergoing OR versus ER...

OBJECTIVES: We sought to investigate the midterm results of kissing self-expanding covered stents (SECSs) for the reconstruction of aortic bifurcation in complex aortoiliac occlusive disease. MATERIALS AND METHODS: Data of consecutive patients who had undergone endovascular treatment for aortoiliac occlusive disease were screened. Only patients with TransAtlantic Inter-Society Consensus (TASC) class C and D lesions treated by bilateral iliac kissing stents were included...