Journal of Vascular Surgery

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PC180. Superficial Femoral Artery Balloon Angioplasty Stent Implantation-Outcome Stratified by Type of Follow-up Evaluation: Arterial Duplex Imaging versus Ankle-Brachial Index Only

June 1, 2018 - 00:00
Endovascular therapy with transluminal angioplasty with stent deployment has become a commonly performed intervention in the management of superficial femoral artery (SFA) occlusive disease. In-stent stenosis occurs in approximately 16% to 32% of patients at one-year follow-up and can lead to stent occlusion and symptom recurrence. Arterial duplex stent imaging (ADSI) of the stented segment can be diagnostic for recurrent stenosis, however, its uniform application and benefit is controversial. With this study we aim to determine whether follow-up with ADSI yielded a better outcome than those with Doppler and ankle-brachial index (ABI) follow-up alone.

PC178. Derivation and Validation of Thoracic Sarcopenia Assessment in Patients Undergoing Thoracic Endovascular Aortic Repair

June 1, 2018 - 00:00
Sarcopenia, as assessed by computed tomographic (CT) based measurements of muscle mass, is an objective and patient-specific indicator of frailty, which is an important predictor of operative morbidity and mortality. However, studies to date have primarily focused on psoas-defined sarcopenia, which may not be available or valid among patients with thoracic aortic disease. Using psoas sarcopenia as the reference for sarcopenia, the purpose of this study was to validate thoracic level measurements of sarcopenia as a novel method to assess frailty among patients undergoing thoracic endovascular aortic repair (TEVAR).

PC176. Delayed Renal Artery Revascularization Can Be Associated With Complete Renal Recovery and Freedom From Dialysis

June 1, 2018 - 00:00
Acute renal ischemia can progress to irreversible loss of renal function if untreated and is considered time sensitive. Increased duration of warm ischemic time is associated with diminished long-term renal recovery. The usefulness of delayed renal artery revascularization (>48 hours) in patients with acute renal failure leading to dialysis dependence is controversial.

PC174. Predictors of Endovascular Intervention for Arteriovenous Fistula Malfunction: A Retrospective Analysis

June 1, 2018 - 00:00
End-stage renal disease in a growing endemic with hemodialysis being the most common treatment modality. Arteriovenous fistulas (AVFs) remain the optimal choice for vascular access for hemodialysis. Some AVFs require primary intervention following creation to maintain functionally. No consensus currently exists regarding the clinical or diagnostic criteria necessitating invasive procedures. The aim of our study is to evaluate the factors predicting the need for primary intervention on AVFs.

PC172. Endovascular Options in Splenic Artery Aneurysms

June 1, 2018 - 00:00
Splenic artery aneurysms (SAA) represent 50% to 75% of all visceral aneurysms, with an estimated prevalence of 0.1% to 2.0% and a poorly defined natural history. Endovascular treatment, although desirable, is frequently hostile, owing to both the artery's tortuosity and variable location of the aneurysms along it, which determine bad navigability and sealing conditions. Proper endovascular technique selection according to the baseline anatomy is therefore essential for a successful exclusion.

PC170. National Review of Vascular Surgery in Marfan Syndrome and Ehlers-Danlos Syndrome

June 1, 2018 - 00:00
Marfan Syndrome (MFS) and Ehlers-Danlos Syndrome (EDS) represent two connective tissue vascular diseases requiring unique consideration in their vascular surgical (VS) care. A comprehensive national review encompassing all hospitalizations for the MFS and EDS patient population is lacking.

PC168. Cost-Effectiveness Analysis of Open Surgical Repair versus Fenestrated Endovascular Repair of Pararenal Aneurysms

June 1, 2018 - 00:00
With advances in endovascular technology pararenal abdominal aortic aneurysms (pAAA) may be treated with fenestrated endovascular aneurysm repair (FEVAR). Although the length of hospital stay is shorter compared with open surgical repair (OSR) reintervention rates and need for ongoing surveillance may lead to long-term higher costs. The goal of this study was to evaluate the long-term cost-effectiveness of FEVAR and OSR for elective pAAA repair.

PC166. Variation in Postoperative Opioid Prescribing After Common Vascular Procedures

June 1, 2018 - 00:00
Over-prescription of postoperative opioid medication is a major contributor to the current opioid abuse epidemic in the United States. Current research into prescribing practices has suggested patients be limited to seven days or <200 oral morphine equivalents (OME) following surgical procedures. Our aim was to identify patterns of postoperative opioid prescribing for common vascular procedures.

PC164. Evaluation of Incomplete Lower Extremity Duplex Venous Ultrasound Examinations

June 1, 2018 - 00:00
Deep venous thrombosis (DVT) positive lower extremity venous duplex ultrasound (LEVDUS) examination is an indication for anticoagulation. Incomplete examinations that fail to examine all LE veins in patients not otherwise indicated for anticoagulation may be followed by a repeat examination to exclude missed/progressing DVT. This study examined the frequency of follow-up LEVDUS following incomplete LEVDUS and compared the incidence of positive DVT between initial complete LEVDUS and follow-up LEVDUS after an initial incomplete examination to determine if improving rates of follow-up LEVDUS following an incomplete examination is a reasonable target for quality improvement.

PC162. Outcomes of Below-Knee Amputation for Lower Extremity Infection: One-Stage versus Two-Stage Operative Approach

June 1, 2018 - 00:00
Below-knee amputation (BKA) for lower extremity infection may be performed as a single operation, or as a two-stage procedure with guillotine amputation and subsequent formalization. BKA failure owing to recurrent infection or necrosis is associated with significant morbidity; however, it is unclear whether the potential benefits of staging outweigh the risk of an additional operation. Here, we compare the effectiveness of two-stage BKA to single-stage BKA for lower extremity infection.

PC160. Risk Score for Non-Home Discharge After Lower Extremity Bypass

June 1, 2018 - 00:00
Patients undergoing bypass for lower extremity ischemia (LEI) require intensive health care resource use. Prior study has demonstrated that these patients frequently require rehab or skilled nursing homes following surgical intervention, yet little study has evaluated whether it is possible to predict non-home discharge (NHD) in this patient population. Early preoperative identification of those at high risk for NHD may help improve preoperative counselling and hospital efficiency in providing appropriate resources to those who need it.

PC158. The Impact of Achieving a Normal Ankle-Brachial Index on Patency and Limb Salvage After Lower Extremity Bypass

June 1, 2018 - 00:00
The ideal result of infrainguinal bypass (IBP) with in-line flow to the foot should be a normal hemodynamic result indicated by a palpable pulse/normal ankle-brachial index (ABI). The results of intervention can vary depending on inflow and outflow of the bypass and the quality and type of conduit chosen. The object of this study is to identify outcome depending on the hemodynamic result after IBP.

PC156. Initial Open versus Endovascular Treatment and Subsequent Limb Loss After Primary Minor Amputation

June 1, 2018 - 00:00
Studies of major amputation after initial minor amputation are limited with rates of subsequent major amputation ranging from 14% to 34% with a limited understanding for associated comorbidities and time to subsequent amputation. We sought to determine major amputation rates for patients that undergo initial minor amputation and determine which factors are associated with limb preservation with open vs endovascular treatment.

PC154. Pharmacology for Peripheral Arterial Disease in The Netherlands: Patient Journey and Platelet Aggregation Inhibitor Prescription

June 1, 2018 - 00:00
Pharmacologic treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control, and cholesterol optimization. Guidelines provide class I recommendations on APT prescription; nevertheless, there is a lack of data on the actual treatment of patients with PAD. Our study provides insight into the use of APT among patients in primary and secondary care with newly diagnosed PAD in The Netherlands, based on real-world information.

PC152. Risk Associated With Female Gender for More Advanced Peripheral Arterial Disease at Time of Femoropopliteal Bypass Remains Constant from 2003 to 2015

June 1, 2018 - 00:00
Peripheral arterial disease (PAD) is estimated to affect 15% to 30% of the female U.S. population by 80 years of age. Women with PAD have different incidences of traditional modifiable risk factors as compared with men and are suspected to be underdiagnosed owing to atypical presentation, poor screening and an underappreciation of the prevalence of PAD in women. Additionally, women have faster functional decline as part of the natural course of their disease. For these reasons, we used the national Vascular Quality Initiative (VQI) database of femoropopliteal bypasses to identify non-mortality-related outcomes with female gender bias and to track gender attributable risk over time.

PC150. A Comprehensive Quality Improvement Initiative to Reduce Surgical Site Infections Following Peripheral Vascular Surgery

June 1, 2018 - 00:00
Surgical site infections (SSIs) are one of the leading causes of thirty-day readmissions following vascular surgery, add to patient morbidity, and increase cost. The reported incidence of SSIs following vascular surgery ranges from 2% to 30% and is higher than many other "clean" procedures. The rate of SSIs following lower extremity vascular surgery at our institution was well above the national benchmark of 7% to 10%. This prompted development and implementation of a comprehensive quality improvement initiative (QII) initiative to reduce SSIs.

PC146. Chronic Antiplatelet or Anticoagulant Therapy Does Not Increase Graft Failure After Split Thickness Skin Grafting

June 1, 2018 - 00:00
Split-thickness skin grafting is a common and effective tool for lower extremity wound coverage among patients with peripheral vascular disease. However, many patients with lower extremity wounds also present with cardiovascular disease which mandates chronic antiplatelet or anticoagulant therapy. This may discourage some surgeons from using split thickness skin grafting in the management of lower extremity wounds. Additionally, some surgeons may advocate temporary cessation of chronic antiplatelet therapy to reduce the risk of hematoma formation and improve skin graft take which puts the patient at significant cardiovascular risk.

PC142. Long-Term Increased Quality of Life With Receipt of a Prosthesis Following Vascular/Diabetic Lower Limb Amputation: A Cross-Sectional Study

June 1, 2018 - 00:00
A primary goal following lower limb amputation is to maximize patient quality of life (QoL) and satisfaction (SAT) with health. For those individuals that are candidates for prostheses, mobility (MOB) is also considered a primary goal. The role of the prosthesis in improving QoL and SAT is not well known. The purpose of this study was to examine the QoL, SAT, and MOB in a cross-sectional analysis of individuals with lower limb amputation owing to diabetes/vascular disease at various periods post amputation with and without a prosthesis.

PC140. Clinical Outcomes of Surgical Revascularization for Patients With Threatened Limb Attributed to Pure Isolated Infrapopliteal Lesions

June 1, 2018 - 00:00
The aim of this study was to elucidate the efficacy of bypass surgery in patients with threatened limb owing to pure isolated infrapopliteal lesions in terms of clinical outcomes categorized Wound Ischemia Foot Infection (WIfI) classification.

PC138. A Matched Case-Control Comparison Between Heparin-Bonded Expanded Polytetrafluroethilene Graft and Autologous Saphenous Vein in Femorotibial Bypasses Performed for Critical Limb Ischemia

June 1, 2018 - 00:00
To compare early and late results of heparin-bonded expanded polytetrafluroethilene (He-ePTFE) graft and autologous saphenous vein (ASV) femorotibial bypasses performed for critical limb ischemia (CLI) in a retrospective multicenter registry-based case-control study.