Journal of Vascular Surgery

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Financial Analysis of Fenestrated Endovascular Aortic Aneurysm Repair at a High-Volume Medical Center

September 1, 2018 - 00:00
The objective of this study was to examine hospital finances and physician reimbursement associated with fenestrated endovascular aneurysm repair (FEVAR) for complex aortic disease at a high-volume aortic center. Costs and reimbursement for FEVAR were compared with those for open repair, and their trends were analyzed over time.

Lower Extremity Revascularization in the Medicare Population: The Ongoing Rise of Office-Based Atherectomy

September 1, 2018 - 00:00
Peripheral artery disease is a growing health care burden, with rising costs related to use of lower extremity revascularization (LER). We sought to examine recent trends in procedure volumes by level of disease, provider specialty, and encounter setting.

Lower Extremity Revascularization in the Medicare Population: The Ongoing Rise of Office-Based Atherectomy

September 1, 2018 - 00:00
Peripheral artery disease is a growing health care burden, with rising costs related to use of lower extremity revascularization (LER). We sought to examine recent trends in procedure volumes by level of disease, provider specialty, and encounter setting.

Cost-Effectiveness of Repeated Interventions on Failing Arteriovenous Fistulas: When Is It Time to Start Over?

September 1, 2018 - 00:00
Arteriovenous fistulas (AVFs) used for hemodialysis commonly undergo multiple percutaneous and open interventions to maintain function patency, but it is unclear whether this strategy is cost-effective. The aim of this study was to evaluate the cost-effectiveness of performing repeated interventions vs starting a new AVF.

Cost-Effectiveness of Repeated Interventions on Failing Arteriovenous Fistulas: When Is It Time to Start Over?

September 1, 2018 - 00:00
Arteriovenous fistulas (AVFs) used for hemodialysis commonly undergo multiple percutaneous and open interventions to maintain function patency, but it is unclear whether this strategy is cost-effective. The aim of this study was to evaluate the cost-effectiveness of performing repeated interventions vs starting a new AVF.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR). It is associated with shorter recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and the economic impact of P-EVAR has important implications for resource allocation. The objective of our study was to determine the differences in cost between P-EVAR and S-EVAR.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR). It is associated with shorter recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and the economic impact of P-EVAR has important implications for resource allocation. The objective of our study was to determine the differences in cost between P-EVAR and S-EVAR.

Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas: Analysis Based on Duplex Ultrasound Simulation

September 1, 2018 - 00:00
Volume flow measurements obtained by duplex ultrasound (DU) are recommended for monitoring arteriovenous dialysis access fistulas (DAFs) and assessing maturation. We developed a DU simulator and used it to assess the accuracy of volume flow measurements.

Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas: Analysis Based on Duplex Ultrasound Simulation

September 1, 2018 - 00:00
Volume flow measurements obtained by duplex ultrasound (DU) are recommended for monitoring arteriovenous dialysis access fistulas (DAFs) and assessing maturation. We developed a DU simulator and used it to assess the accuracy of volume flow measurements.

Lower Extremity Revascularization With Transmetatarsal Amputation Improves Healing and Reduces Major Amputation

September 1, 2018 - 00:00
A transmetatarsal amputation (TMA) allows patients with forefoot wounds to maintain ambulatory function and preserves a sensate heel and ankle. However, healing after TMA is often compromised in older patients by peripheral artery disease (PAD). The aim of this study was to investigate the effect of lower extremity revascularization (LER) on TMA healing and prevention of major amputation.

Lower Extremity Revascularization With Transmetatarsal Amputation Improves Healing and Reduces Major Amputation

September 1, 2018 - 00:00
A transmetatarsal amputation (TMA) allows patients with forefoot wounds to maintain ambulatory function and preserves a sensate heel and ankle. However, healing after TMA is often compromised in older patients by peripheral artery disease (PAD). The aim of this study was to investigate the effect of lower extremity revascularization (LER) on TMA healing and prevention of major amputation.

Lessons Learned From the Largest Cohort of Type III Endoleaks With the Endologix AFX Stent Graft

September 1, 2018 - 00:00
Our institution has noted a continual rise in the incidence of late graft failure by type III endoleak (T3EL) with early-generation AFX (Endologix, Irvine, Calif) endografts. We also noted repeated T3ELs in these patients treated with bridging AFX grafts. Previous authors noted a much lower incidence of T3EL (0%-5%) but high aneurysm-related mortality (18%) when repairing T3ELs with bridging grafts. Failure rates may be due to significant aortic remodeling in this population.

Lessons Learned From the Largest Cohort of Type III Endoleaks With the Endologix AFX Stent Graft

September 1, 2018 - 00:00
Our institution has noted a continual rise in the incidence of late graft failure by type III endoleak (T3EL) with early-generation AFX (Endologix, Irvine, Calif) endografts. We also noted repeated T3ELs in these patients treated with bridging AFX grafts. Previous authors noted a much lower incidence of T3EL (0%-5%) but high aneurysm-related mortality (18%) when repairing T3ELs with bridging grafts. Failure rates may be due to significant aortic remodeling in this population.

Anatomic Suitability for Standard, “Off-the-Shelf” Thoracic Single Side-Branched Endograft in Patients With Type B Aortic Dissection

September 1, 2018 - 00:00
Treatment of type B aortic dissections with thoracic endovascular aortic repair (TEVAR) has been adopted in many centers with the goal of covering the proximal entry tear. Coverage of the left subclavian artery is commonly required to achieve a dissection-free proximal seal zone. A novel thoracic single side-branched (TSSB) endograft offers a potential off-the-shelf option to achieve total endovascular incorporation of the left subclavian artery during zone 2 TEVAR. The aim of this study was to determine what percentage of patients with type B aortic dissection who require zone 2 TEVAR meet the anatomic requirements for this device.

Anatomic Suitability for Standard, “Off-the-Shelf” Thoracic Single Side-Branched Endograft in Patients With Type B Aortic Dissection

September 1, 2018 - 00:00
Treatment of type B aortic dissections with thoracic endovascular aortic repair (TEVAR) has been adopted in many centers with the goal of covering the proximal entry tear. Coverage of the left subclavian artery is commonly required to achieve a dissection-free proximal seal zone. A novel thoracic single side-branched (TSSB) endograft offers a potential off-the-shelf option to achieve total endovascular incorporation of the left subclavian artery during zone 2 TEVAR. The aim of this study was to determine what percentage of patients with type B aortic dissection who require zone 2 TEVAR meet the anatomic requirements for this device.

Duplex Ultrasound Is a Clinically Useful Modality for Surveillance of Renal Branch Grafts After Fenestrated Endovascular Aneurysm Repair

September 1, 2018 - 00:00
The use of duplex ultrasound for surveillance after fenestrated endovascular aneurysm repair (FEVAR) is not well studied. Our objective was to further characterize normal and abnormal duplex ultrasound findings in renal branch grafts after FEVAR.

Duplex Ultrasound Is a Clinically Useful Modality for Surveillance of Renal Branch Grafts After Fenestrated Endovascular Aneurysm Repair

September 1, 2018 - 00:00
The use of duplex ultrasound for surveillance after fenestrated endovascular aneurysm repair (FEVAR) is not well studied. Our objective was to further characterize normal and abnormal duplex ultrasound findings in renal branch grafts after FEVAR.

Disease-Based Observation Cohort Study of Patients with Thoracoabdominal Aortic Aneurysm

September 1, 2018 - 00:00
Current understanding of thoracoabdominal aortic aneurysms (TAAAs) is limited to case series and administrative data describing patients selected to undergo surgical repair. Little is known about the overall cohort of patients with TAAA, specifically those not selected for repair. The purpose of this study was to describe a disease-based cohort of patients with TAAA.

Disease-Based Observation Cohort Study of Patients with Thoracoabdominal Aortic Aneurysm

September 1, 2018 - 00:00
Current understanding of thoracoabdominal aortic aneurysms (TAAAs) is limited to case series and administrative data describing patients selected to undergo surgical repair. Little is known about the overall cohort of patients with TAAA, specifically those not selected for repair. The purpose of this study was to describe a disease-based cohort of patients with TAAA.

Comparison of Bovine Carotid Xenograft Versus Expanded Polytetrafluoroethylene Grafts for Forearm Loop Hemodialysis Access

September 1, 2018 - 00:00
Forearm loop grafts are a useful option for dialysis access in patients without suitable forearm veins. Bovine carotid artery (BCA) and expanded polytetrafluoroethylene (ePTFE) grafts are commonly used for this purpose, but no data exist to support the use of one over the other in the forearm loop conformation.