Journal of Vascular Surgery

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Area Deprivation Index Score Is Associated With Lower Rates of Long-Term Follow-up After Upper Extremity Vascular Injuries

September 1, 2018 - 00:00
The Area Deprivation Index (ADI) has recently been shown to be a key determinant of several health care outcomes in both medical and surgical fields. We sought to analyze rates of long-term follow-up and outcomes in patients with upper extremity vascular injuries who were admitted during a 5-year period to a level I trauma center based in a university hospital setting.

Outcomes Associated With Postoperative Glycemic Control After Carotid Procedures

September 1, 2018 - 00:00
There are limited data evaluating the impact of postoperative hyperglycemia (POH) in patients undergoing vascular procedures. This study evaluated the relationship between POH and outcomes after carotid artery stenting (CAS) and carotid endarterectomy (CEA).

Retrograde Stenting of Brachiocephalic Artery With Juxtaposed Left Common Carotid Artery

September 1, 2018 - 00:00
The patient is a 68-year-old woman who presented with amaurosis fugax of the right eye. She had prior right carotid endarterectomy. Computed tomography angiography showed >85% stenosis of the right brachiocephalic trunk. The left common carotid artery was juxtaposed, and there was a concern that primary stenting of the brachiocephalic trunk could lead to ostial stenosis or occlusion of the left common carotid artery. We performed cervical cutdown to access the right common carotid artery. Bilateral common femoral artery access was obtained for access to the left common carotid artery and placement of a pigtail catheter for angiography.

Clopidogrel Use Is Not Associated With Increased Complications After Carotid Endarterectomy

September 1, 2018 - 00:00
The objective of this study was to evaluate the use of clopidogrel at the time of carotid endarterectomy (CEA) and its association with postoperative complications.

Results of Carotid Endarterectomy in Patients With Contralateral Internal Carotid Artery Occlusion From the Society for Vascular Surgery Vascular Quality Initiative

September 1, 2018 - 00:00
Carotid endarterectomy (CEA) is among the most commonly performed vascular procedures. Some have suggested worse outcomes with contralateral internal carotid artery (ICA) occlusion (cICAoccl). We compared patients with vs without cICAoccl using the Society for Vascular Surgery Vascular Quality Initiative database.

Intravascular Ultrasound-Guided Catheter-Directed Mechanical Thrombectomy in a Pregnant Woman With Iliofemoral Acute Deep Venous Thrombosis

September 1, 2018 - 00:00
Pregnancy induces a transient hypercoagulable state, increasing the risk for venous thromboembolism. Early thrombus removal over anticoagulation alone reduces post-thrombotic syndrome, especially in those with acute iliofemoral deep venous thrombosis (DVT). However, pregnancy is a relative contraindication because of radiation exposure of the fetus and increased risk of bleeding with tissue plasminogen activator (tPA). This case report demonstrates successful treatment of acute iliofemoral DVT in a pregnant woman using intravascular ultrasound (IVUS)-guided catheter thrombectomy without fluoroscopy or tPA.

Trends in Management and Outcomes of Vascular Emergencies in the United States

September 1, 2018 - 00:00
The objective of this study was to evaluate trends in frequency, mortality, and treatment paradigms for nontraumatic vascular emergencies (VEs) in the United States.

Survey of Vascular Surgery Trainees Suggests Standardized Vascular Laboratory Curriculum During Training May Be Valuable

September 1, 2018 - 00:00
Although the Registered Physician in Vascular Interpretation (RPVI) examination is required for vascular surgery board certification, no standardized noninvasive vascular laboratory (NIVL) curriculum for vascular surgery trainees exists. The purpose of this study was to investigate the NIVL experience of trainees to understand what helps them feel well prepared.

Creation of an Affordable Pulsatile Cadaver-Based Abdominal Aortic Surgery Training Model

September 1, 2018 - 00:00
Developing competence in open aortic surgery is increasingly challenging in vascular surgery training programs. Whereas static cadaver models provide an opportunity for dissection and exposure, the lack of pulsatility limits aortic surgery skill set acquisition. We developed an affordable pulsatile cadaver simulation model to improve training in open abdominal aortic surgery with the primary objective of determining whether it incorporated the fidelity required to teach critical techniques.

Complete Endovascular Arch Reconstruction With a Multibranch Device for the Management of Aortic Arch Aneurysm

September 1, 2018 - 00:00
Open surgical repair through median sternotomy remains the standard of care for aortic arch aneurysms; however, such operative approach is associated with significant morbidity and mortality. New endovascular technology now allows us to treat those patients who are poor candidates for open surgical repair.

Endovascular Elephant Trunk Completion for Distal Arch-Proximal Thoracic Aortic Aneurysms

September 1, 2018 - 00:00
Aneurysms involving the distal arch-proximal thoracic aorta can be difficult to treat because of their location. A hybrid approach with endovascular elephant trunk (ET) completion is a hybrid technique that combines surgical creation of a proximal ET in conjunction with distal thoracic endograft placement. We report our single-center experience with endovascular ET completion during a 10-year period.

Parallel Stent Graft Approaches in Zone 0 and Zone 1 Aortic Arch Aneurysmal Diseases

September 1, 2018 - 00:00
Parallel snorkel endografting is well acknowledged in complex aortic endovascular procedures but has not seen widespread use in proximal aortic arch procedures (zones 0 and 1) because of presumed superiority of total intrathoracic debranching approaches and exaggerated concerns about stroke risk. Our recent experience compelled us to reconsider this approach as a valid option in these conditions.

Benefit of Arterial Duplex Ultrasound Stent Imaging After Superficial Femoral Artery Stent Implantation: Impact of Surveillance Method on Postprocedural Outcome

September 1, 2018 - 00:00
In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex ultrasound stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation (SI), whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up.

Popliteal Artery Aneurysm Repair With Minimally Invasive Endoscopic Vein Harvest Yields Outstanding Wound Healing Outcomes With Fast-Tracked Hospitalization

September 1, 2018 - 00:00
There is growing literature showing that minimally invasive vein harvest (MIVH) is safe, with good patency rates and decreased wound complications, in treating infrainguinal occlusive disease. Our institution has performed MIVH since 2003 with a dedicated team of providers specializing in endoscopic vein harvest. The purpose of this study was to specifically evaluate major outcomes of MIVH as an adjunct to the standard, open operative repair of popliteal artery aneurysms.

In Search of the Right Tool: Using a Standardized Risk Calculator to Predict Groin Wound Infection

September 1, 2018 - 00:00
Surgical site infection (SSI), particularly involving groin exposure during lower extremity revascularization, remains a challenge for vascular surgeons. Groin SSI is associated with limb loss, increased mortality, and cost of care. A useful tool to the vascular surgeon would be a standardized risk calculator that can help identify patients at risk and potentially prevent future complications. In this study, we test the Penn Groin Assessment Scale and a prediction model developed at Duke University in our population of patients.

Outcomes of Drug-Coated Balloons in Patients With Critical Limb Ischemia

September 1, 2018 - 00:00
The drug-coated balloon (DCB) is widely employed in treatment of peripheral arterial disease. Treatment outcomes of DCB in patients with critical limb ischemia (CLI) are still lacking. The objective of this study was to compare and to assess clinical outcomes of DCB treatment vs standard angioplasty and stenting (SAS) in patients with CLI.

Old Tradition of Prophylactic Fasciotomy Could Be Avoided

September 1, 2018 - 00:00
Compartment syndrome is one of the true emergencies in vascular and orthopedic surgery. Surgical treatment of this condition is mandated to prevent nerve and eventually further function loss. Traditional teaching and practice of prophylactic fasciotomy after revascularization in acute ischemia are still performed after certain criteria are met. Patients with longer ischemia time and concomitant artery and vein injury will get fasciotomy. Fasciotomy is a relatively morbid and debilitating procedure that may cause disability and permanent damage to nerves and limb function.

Early Findings With Vacuum-Assisted Thrombectomy for Acute Limb Ischemia

September 1, 2018 - 00:00
Interventional strategies for acute limb ischemia continue to evolve. Most studies have focused on the comparison between thrombolytic therapy and surgical revascularization. However, limited data exist on the use of novel vacuum-assisted thrombectomy (VAT) devices. The purpose of this study was to evaluate the outcomes of patients who have undergone VAT at our institution.

Variables Predicting Surgical Site Infection in Femoropopliteal Bypass in the Time of Endovascular Therapy: A Retrospective Analysis of the National Surgical Quality Improvement Program Database

September 1, 2018 - 00:00
Peripheral arterial disease (PAD) affects nearly 8.5 million patients in the United States according to the Centers for Disease Control and Prevention. Although lifestyle modification and medical management can delay the rate of disease progression, approximately 5% of patients with PAD will eventually require revascularization. The most common complication of lower extremity bypass is surgical site infection (SSI), which can lead to prolonged hospital stays, additional procedures, and additive patient and hospital costs.

Premature Peripheral Arterial Disease Is Associated With Worse Outcomes in Patients Undergoing Infrainguinal Bypass and Endovascular Intervention

September 1, 2018 - 00:00
Few data exist to accurately describe the difference in characteristics, management, and outcomes of patients with premature peripheral arterial disease (PPAD), defined as patients <50 years old at the time of intervention. Our goal was to use Vascular Quality Initiative (VQI) data to investigate differences between PPAD patients and non-PPAD patients who had lower extremity vascular interventions.