Journal of Vascular Surgery

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PC094. Two-Stage Brachiobasilic Arteriovenous Fistula Creation Is Cost Effective

June 1, 2018 - 00:00
There are two established strategies for creating brachiobasilic arteriovenous fistula (BB-AVF), a one-stage and two-stage approach. Although the comparative effectiveness of one-stage versus two-stage BB-AVF have been studied by multiple single center studies, a small randomized controlled trial and two meta-analyses, neither strategy has been shown to be superior with regards to durability, patency, or complications. This study was designed to evaluate the relative cost effectiveness of these different BB-AVF strategies.

PC092. Patient-Reported Outcomes in Patients With End-Stage Renal Disease: Is Quality of Life Affected When Catheters Are Used for Hemodialysis versus Arteriovenous Fistulas?

June 1, 2018 - 00:00
Patients with end-stage renal disease (ESRD) often require tunneled dialysis catheters (TDC) for hemodialysis, but the impact of TDCs on patient quality of life is unclear. The purpose of this study was to evaluate patient-reported outcome (PRO) measures for depression and physical function among patients with ESRD undergoing TDC as compared with arteriovenous fistulas (AVF).

PC090. Risk Score for Groin Access Complication in Ultrasound-Guided Percutaneous Aortic Procedures

June 1, 2018 - 00:00
Ultrasound-guided access for percutaneous endovascular aortic procedures has been increasingly used. We developed a prediction model to risk stratify patients for access site complications following ultrasound-guided percutaneous approach.

PC088. Impact of Baseline Vascular Disease Burden on Outcomes of Thoracoabdominal Aortic Repair Involving Visceral Segment

June 1, 2018 - 00:00
Thoracoabdominal aneurysm (TAAA) extent 4 aneurysms share a common region of the visceral aorta with extents 2 and 3, with 3, extending proximally to the sixth intercostal space and two further to the left subclavian artery. We sought to determine how proximal extension affects outcome risk incrementally to the extent 4 visceral segment. Risk factor adjustment was performed to separate these effects from underlying disease and surgical risk factors.

PC086. The Prognostic Implications of Diagnosing Frailty and Sarcopenia in Vascular Surgery Practice

June 1, 2018 - 00:00
Frailty and sarcopenia are two related but independent conditions commonly diagnosed in older patients that can be used to predict an individual's ability to tolerate the stress of major vascular surgery. For surgical decision making, however, it is also important to know the prognostic implications associated with these conditions and estimate whether patients will live long enough to benefit from elective procedures. The objective of this study was to assess long-term survival among nonsurgical patients diagnosed with frailty and sarcopenia within an outpatient vascular surgery clinic setting.

PC084. Serious Complications From Embolosclerotherapy of Upper Extremity High- and Low-Flow Vascular Malformations From a Specialist Single Center

June 1, 2018 - 00:00
Minimally invasive, embolosclerotherapy (EST) for upper extremity vascular malformations (VMs) carries significant risk of serious complications, such as ischemia, infarction, amputation, nerve injury, contracture, and ulceration, with as high as 61% rates for hand treatments most recently reported. Despite improved care in specialist centers, up-to-date estimates of complication risk for audit and informed consent are scarce; recent literature focuses on high-flow VMs (HFVM) with a paucity of data for low-flow VMs (LFVM).

PC082. Emergent Axillary-Femoral Bypasses Are Associated With Even Higher 30-Day Mortality and Complication Rates

June 1, 2018 - 00:00
The differences in outcomes between emergent axillary-femoral bypasses and elective axillary-femoral bypasses are not well-defined. This study compares the outcomes of emergent and elective axillary-femoral bypasses and determines the predictors of mortality for Emergent axillary-femoral bypasses.

PC080. The Effect of Smoking Cessation Timing Before Elective Open Abdominal Aortic Aneurysm Repair and Lower Extremity Bypass

June 1, 2018 - 00:00
Smoking has been associated with poor postoperative outcomes across a wide range of vascular surgery procedures. The effect of quitting smoking before elective operations is unclear. Our goal was to assess the effect of timing of smoking cessation before open vascular surgery operations on perioperative outcomes

PC078. Rising Incidence of Femoral Pseudoaneurysm After Cardiac Catheterization Results in Significant Increases in Hospital Cost and Length of Stay

June 1, 2018 - 00:00
Femoral pseudoaneurysm (FPA) is the most common complication associated with percutaneous coronary interventions. The purpose of this study is to identify the risk factors associated with FPA after cardiac catheterization, and the impact of FPA on total hospital cost and duration of stay.

PC076. Thoracic Sarcopenia Is a Specific Predictor of Late Mortality After Thoracic Endovascular Aortic Repair in Patients With Chronic Aortic Disease

June 1, 2018 - 00:00
Frailty, characterized by physiologic depletion, predicts postoperative morbidity and mortality in vascular surgery patients. Sarcopenia, defined by computed tomography (CT) measurements of muscle mass, is a valuable method for objectively staging frailty preoperatively. However, prior analyses have focused on psoas sarcopenia, which has not been validated in patients with chronic thoracic aortic disease. We hypothesized that thoracic sarcopenia is common in this patient population, and is more accurate than psoas sarcopenia in predicting long-term survival after thoracic endovascular aortic repair (TEVAR).

PC074. Unplanned Readmissions After Endovascular Aortic Repair: An Analysis Using the Nationwide Readmissions Database

June 1, 2018 - 00:00
Total readmission rates of abdominal aortic aneurysm repair are greater after endovascular aortic repair (EVAR) than with open repair. Unplanned readmissions are associated with increased patient morbidity and cost. As the number of EVAR procedures increases, it becomes imperative to identify and mitigate risk factors associated with unplanned hospital readmissions. Using the Nationwide Readmissions Database, we analyzed and examined patient predictors for hospital readmission within 30 days of EVAR.

PC072. The Impact of Stent Geometry on Outcomes of Carotid Artery Stenting

June 1, 2018 - 00:00
Carotid artery stenting (CAS) is now a well-established minimally invasive procedure for treatment of carotid stenosis. Whereas the atherosclerotic plaque is completely removed in carotid endarterectomy, CAS is designed to cover and stabilize the plaque with the stent struts. Two stent designs with respect to geometric arrangement of cells are most commonly used (open and closed cell). Prior studies, including a small randomized controlled trial, have shown similar outcomes between the two designs; however, the current evidence from a large multi-institutional database is lacking.

PC070. Preoperative Silent Brain Infarcts Have a Significant Impact on Both Carotid Endarterectomy and Stenting

June 1, 2018 - 00:00
The presence of silent cerebral infarcts (SCIs) in patients submitted to carotid revascularization has been extensively studied in patients undergoing carotid endarterectomy (CEA); however, few data exist about their influence in those undergoing carotid artery stenting (CAS). The aim of our study was to assess the different impact of SCIs on CAS and CEA.

PC068. Factors Associated With Microembolization After Carotid Intervention

June 1, 2018 - 00:00
Microembolization after carotid artery stenting (CAS) and carotid endarterectomy (CEA) has been documented and may confer risk for neurocognitive impairment. Patients undergoing stenting are known to be at higher risk for microemoblization. In this prospective cohort study, we compared the microembolization rates for patients undergoing CAS and CEA and patient and perioperative characteristics that may be associated with microembolization.

PC066. A Multi-Institutional Analysis of Contemporary Outcomes After Transcarotid Artery Revascularization versus Carotid Endarterectomy

June 1, 2018 - 00:00
Transcarotid artery revascularization (TCAR) provides an attractive alternative to carotid endarterectomy (CEA) and transfemoral stenting for high-risk patients by using a direct carotid approach with cerebral blood flow reversal for embolic protection. The purpose of this study was to compare outcomes from patients with carotid artery stenoses treated by TCAR versus a matched control group undergoing CEA.

PC064. The Effect of Three-dimensional Image Fusion on Radiation Exposure, Contrast Dose, and Procedural Times During Carotid Artery Stenting

June 1, 2018 - 00:00
Three-dimensional (3D) image fusion is associated with lower radiation exposure, contrast dose, and operative time during endovascular abdominal aortic aneurysm repair. However, its impact on cerebrovascular intervention is unknown. Therefore, we evaluated the use of this technology during carotid artery stenting (CAS).

PC062. Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

June 1, 2018 - 00:00
Statins are commonly used for the primary and secondary prevention of cardiovascular events; however, statins are underused in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease, and examine the association between statin therapy and clinical outcomes among an elderly population after carotid artery revascularization.

PC060. Does Anesthesia Technique Modify the Risk of Routine and Selective Shunting During Carotid Endarterectomy?

June 1, 2018 - 00:00
Prior research has shown a higher risk of stroke/death with selective shunting during carotid endarterectomy (CEA) compared with routine shunting, which was mainly attributable to the surgeons inexperience. In this study, we aim to evaluate whether the anesthetic choice and intraoperative neuromonitoring method modify the risk of in-hospital stroke/death with each shunting approach.

PC058. The Natural History of Asymptomatic, Severe Internal Carotid Artery Stenosis: Comparing Medical Management versus Endarterectomy

June 1, 2018 - 00:00
Conclusions from landmark trials investigating medical versus surgical management of asymptomatic carotid occlusive disease may not be supported with the advancement of statin therapy for lipid management. We set out to evaluate the current understanding of the natural history of asymptomatic, severe internal carotid artery (ICA) stenosis through an analysis of our own results, which, in turn, will optimize our practice patterns and improve patient outcomes.

PC056. Hidden Readmissions After Carotid Endarterectomy and Stenting: A National Analysis

June 1, 2018 - 00:00
The unplanned readmission rate after carotid procedures is approximately 6%, but most prior studies are limited to only index hospital readmission. Up to one in three postoperative readmissions occur at a different hospital and are missed by current metrics. There are no national studies examining readmission after carotid endarterectomy and carotid artery stenting (CAS), including to different hospitals. The purpose of this study was to compare unplanned readmission incidence and risk factors between carotid endarterectomy and CAS, including readmissions to any hospital, in a nationally representative sample.