Journal of Vascular Surgery

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Updated: 4 hours 28 min ago

Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis

July 1, 2017 - 00:00
Do asymptomatic restenoses > 70% after carotid endarterectomy (CEA) and carotid stenting (CAS) increase the risk of late ipsilateral stroke?

Supra-aortic interventions for endovascular exclusion of the entire aortic arch

July 1, 2017 - 00:00
Our aim was to analyze the outcomes of endovascular exclusion of the entire aortic arch (proximal landing in zone 0, distal landing in zone III or beyond, after Ishimaru) in which complete surgical debranching of the supra-aortic vessels (I), endovascular supra-aortic revascularization (chimney, fenestrated, or branched grafts) with partial surgical debranching (II), or total endovascular supra-aortic revascularization (III) was additionally performed.

MIPS: Clinical practice improvement activities

July 1, 2017 - 00:00
The Quality Payment Program (QPP), established by the Medicare Access and Children's Health Improvement Program (CHIP) Reauthorization Act (MACRA), represents a drastic shift in Medicare reimbursement from volume-based incentives to pay for performance. Under the QPP, providers who bill Medicare must participate in an Advanced Alternative Payment Model (APM) or the Merit-based Incentive Payment System (MIPS) in 2017 to avoid a 4% Medicare reimbursement penalty in 2019. As there are no vascular APMs in 2017, the majority of vascular providers will be participating in MIPS.

Endovascular treatment for claudication still awaits long-term results

July 1, 2017 - 00:00
Ever since the advent of the endovascular revolution, there has been a drive to prove endovascular revascularization to be as good as or better than its surgical counterpart. Countless manuscripts have been published on this topic, and yet we are still far from an evidence-based consensus of what type of revascularization works best for whom. Ohki and colleagues1 “threw down another gauntlet” by evaluating short-term outcomes in a cohort of mostly claudicants with long superficial femoral artery (SFA) lesions treated with self-expanding stent grafts.

Muscle strength and control characteristics are altered by peripheral artery disease

July 1, 2017 - 00:00
Peripheral artery disease (PAD), a common manifestation of atherosclerosis, is characterized by lower leg ischemia and myopathy in association with leg dysfunction. Patients with PAD have impaired gait from the first step they take with consistent defects in the movement around the ankle joint, especially in plantar flexion. Our goal was to develop muscle strength profiles to better understand the problems in motor control responsible for the walking impairment in patients with PAD.

Invited commentary

July 1, 2017 - 00:00
The successful use of fenestrated endografts for the treatment of complex aortic aneurysms was first published nearly 2 decades ago, in 1999.1,2 Now, we are in the midst of a rapid evolution of technical advances in endovascular catheter-based treatments for aortic aneurysms. Endografts designed with scallops, fenestrations, and branches allow for stent grafts to be placed across visceral arteries and great arteries of the arch, while preserving flow to the critical end organs supplied by these arteries.

Invited commentary

July 1, 2017 - 00:00
I want to congratulate Dr Behzad Farivar and colleagues on a well-written manuscript that analyzes the National Surgical Quality Improvement Program (NSQIP) database and focuses attention on the implications of concomitant hypogastric artery embolization and endovascular repair of infrarenal aortoiliac aneurysms.

Percutaneous treatment of adult aortic coarctation with multiple intrathoracic aneurysms

July 1, 2017 - 00:00
The following “vascular images” depict an adult type aortic coarctation (AoC) (A) associated with eight intrathoracic aneurysms originating from thoracic collaterals. Of these aneurysms, three appear particularly large and indicate initial thrombosis (B/Cover).

Discussion

June 23, 2017 - 00:00
Dr Matthew S. Edwards (Winston-Salem, NC). Dr Wooster and colleagues, thank you for a very nice presentation on a complex topic and thank you to the program committee for the opportunity to provide comments and initiate discussion of this work.

Outcomes of concomitant renal reconstruction during open paravisceral aortic aneurysm repair

June 23, 2017 - 00:00
The objective of this study was to review the outcomes of renal artery revascularizations during open aortic aneurysm repair.

Imaging vulnerable plaques by targeting inflammation in atherosclerosis using fluorescent-labeled dual-ligand microparticles of iron oxide and magnetic resonance imaging

June 23, 2017 - 00:00
Identification of patients with high-risk asymptomatic carotid plaques remains an elusive but essential step in stroke prevention. Inflammation is a key process in plaque destabilization and a prelude to clinical sequelae. There are currently no clinical imaging tools to assess the inflammatory activity within plaques. This study characterized inflammation in atherosclerosis using dual-targeted microparticles of iron oxide (DT-MPIO) as a magnetic resonance imaging (MRI) probe.

Discussion

June 23, 2017 - 00:00
Dr W. Charles Sternbergh, III (New Orleans, La). Dr Hicks, Dr Black, and coworkers from Johns Hopkins present a 10-year experience in thoracoabdominal aortic aneurysm repair using branched grafts for the visceral vessels, contrasting patients with and without connective tissue disorders. These are formidable operations with little margin for error; I describe them to my patients as the “Super Bowl” of all vascular operations. Dr Black and his group have built an internationally recognized center of excellence in treating aortic pathology in these challenging patients.

A 10-year institutional experience with open branched graft reconstruction of aortic aneurysms in connective tissue disorders versus degenerative disease

June 23, 2017 - 00:00
Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclusion patch repair of the aorta but is frequently necessary in patients with CTDs or other pathologies because of anatomic reasons. We describe our institutional experience with open branched graft reconstruction of aortic aneurysms and compare outcomes for patients with CTDs vs degenerative pathologies.

Comparison of intravascular ultrasound- and centerline computed tomography-determined aortic diameters during thoracic endovascular aortic repair

June 23, 2017 - 00:00
Accurate sizing of stent grafts during thoracic endovascular aortic repair (TEVAR) is critical for a successful outcome. Centerline measurements using three-dimensional reconstruction of preoperative computed tomography angiography (CTA) is the current standard for stent graft sizing. However, this technique is predicated on an idealized straightened aorta and does not account for the variability in the aortic diameter during the cardiac cycle or the overall status of the patient's volume. Intravascular ultrasound (IVUS) offers real-time cross-sectional imaging of the aorta orthogonal to the support wire, thereby providing an adjunctive method for aortic diameter determination at the time of TEVAR.

Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia

June 21, 2017 - 00:00
It is unclear whether frailty adversely affects treatment outcomes in patients with critical limb ischemia (CLI). The aim of this study was to investigate the influence of frailty on CLI patients after revascularization.

Racial disparities after infrainguinal bypass surgery in hemodialysis patients

June 21, 2017 - 00:00
Peripheral arterial disease poses a significant burden in the hemodialysis (HD)-dependent population. Race is a known modifier of outcomes after surgical treatment of peripheral arterial disease. A comprehensive evaluation of the effect of race on infrainguinal bypass surgery (IBS) outcomes in HD patients is lacking. In this study, we evaluated the effects of race on long-term IBS outcomes in a large, nationally representative cohort of HD patients.

Cryopreserved venous allograft is an acceptable conduit in patients with current or prior angioaccess graft infection

June 21, 2017 - 00:00
The durability of cryopreserved allograft has been previously demonstrated in the setting of infection. The objective of this study was to examine the safety, efficacy, patency, and cost per day of graft patency associated with using cryopreserved allograft (vein and artery) for hemodialysis access in patients with no autogenous tissue for native fistula creation and with arteriovenous graft infection or in patients at high risk for infection.

Trends in open abdominal exposure among vascular surgery trainees

June 21, 2017 - 00:00
This retrospective study evaluates the trends in open abdominal surgery cases among integrated vascular surgery residents compared with their 5 + 2 counterparts.

Smooth muscle cells of human veins show an increased response to injury at valve sites

June 21, 2017 - 00:00
Venous valves are essential but are prone to injury, thrombosis, and fibrosis. We compared the behavior and gene expression of smooth muscle cells (SMCs) in the valve sinus vs nonvalve sites to elucidate biologic differences associated with vein valves.

Prediction of 6-minute walk performance in patients with peripheral artery disease

June 21, 2017 - 00:00
Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive, and repeatable, but whether it accurately predicts endurance performance in the long-distance 6MWT is not known.