Journal of Vascular Surgery

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Risk Prediction Tools to Improve Patient Selection for Carotid Endarterectomy Among Patients With Asymptomatic Carotid Stenosis

May 1, 2019 - 00:00
This cohort study was conducted between January 1, 2005, and December 31, 2009.

Safety of Men with Small and Medium Abdominal Aortic Aneurysms Under Surveillance in the National Health Service Screening Programme

May 1, 2019 - 00:00
A retrospective review of the National Health Service Abdominal Aortic Aneurysm Screening Programme was conducted in men older than 65 years in England between 2009 and 2017.

Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

May 1, 2019 - 00:00
A systemic review and meta-analysis analyzed randomized controlled trials using PubMed (MEDLINE), Embase (Excerpta Medica Database), Allied and Complementary Medicine Database, Scopus, Cochrane Central Register of Controlled Trials, archived online content, public filings of regulatory bodies, and published abstracts from international vascular meetings through August 2018.

Field testing and refining the hemodialysis access creation episode-based cost measure

May 1, 2019 - 00:00
The Quality Payment Program, established by the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA), requires Medicare providers to participate in the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model to avoid a 7% penalty in 2021 reimbursements. In reporting year 2019, the Cost category will account for 15% of the final MIPS score.

Hybrid repair of concurrent popliteal artery and tibioperoneal trunk aneurysms

May 1, 2019 - 00:00
A 63-year-old asymptomatic man with a family history of peripheral artery aneurysms presented with prominent pulsation in his right popliteal artery. He did not have any history of distal thromboembolic events. He denied any history of trauma or operations on his leg. He denied any fevers or shaking chills. His white blood cell count was in normal range with normal differential count. His past medical history was significant for a 5.4-cm left internal iliac aneurysm that was treated with coil embolization and covered stent graft across the origin of the internal iliac artery a year earlier.

Patient selection for transcarotid artery (stent) revascularization

May 1, 2019 - 00:00
The article entitled “Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting” in this issue of the Journal of Vascular Surgery1 is an important study in that it represents the initial report of anatomic eligibility for transcarotid artery revascularization (TCAR) in a “real-world” practice cohort whose only unifying characteristic was the performance of a carotid intervention and the availability of a carotid computed tomography angiography (CTA) image for retrospective review.

Reply

May 1, 2019 - 00:00
We thank Bellini et al for their comments on our study.1 We fully agree with the critical statements about the measurement of the activated clotting time (ACT). We also acknowledge that ACT is the only bedside test available 24 hours a day in many hospitals. Furthermore, current guidelines recommend the use of ACT to monitor unfractionated heparin (UFH) therapy during vascular interventions.2 Nevertheless, many laboratories are now transitioning to monitor actual heparin activity by chromogenic anti-activated factor X (anti-Xa) assay, which is considered the reference method for monitoring heparin therapy.

Activated clotting time monitoring in vascular surgery: so bad, no bad

May 1, 2019 - 00:00
We read with great interest your recent publication by Dieplinger et al1 in the Journal of Vascular Surgery. Unfractionated heparin (UFH) is usually employed in arterial vascular surgery, generally at lower doses compared with those in cardiac surgery (50-100 IU/kg); the goal is a balance between the need of anticoagulation to avoid thrombosis and, on the other hand, limiting bleeding and surgical revision.2 Much evidence supports its use also in endovascular procedures. Even if data in literature show a lower incidence of complications, thromboembolic and cardiologic events still continue to occur even when endovascular techniques are applied.

Comparison of specialties participating in the BEST-CLI trial to specialists treating peripheral arterial disease nationally

May 1, 2019 - 00:00
The Best Endovascular vs Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial compares open surgery and endovascular therapy for the treatment of critical limb ischemia (CLI). This report describes the types and proportion of investigators participating in BEST-CLI and determines how these compare with those specialists treating peripheral artery disease (PAD) outside of the trial.

Invited commentary

May 1, 2019 - 00:00
The last 20 years have brought dramatic changes in our approach to aortic dissections. Advances have come not only in devices but also in imaging, medical therapy, and even our fundamental understanding of the anatomic pathology. But it is really the stent graft devices, and their promise of lower morbidity and mortality, that have emboldened us to more aggressively treat type B dissections.

Why do we write?

May 1, 2019 - 00:00
A warm cup of coffee next to one's laptop, late in the evening. The marked-up draft with treasured comments from a mentor or colleague. The pride that swells when your name—or even better, your resident's name—graces the lead article in this month's JVS. The reasons that surgeons find writing to be rewarding vary broadly.

National criteria for academic appointment in vascular surgery

May 1, 2019 - 00:00
Advancement in academic medicine is multifactorial. Our objectives were to characterize academic appointments in vascular surgery and to investigate what factors, particularly publications, influenced academic appointment.

Vascular surgery residents spend one fifth of their time on electronic health records after duty hours

May 1, 2019 - 00:00
Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities.

Comparison of dynamic changes in aortic diameter during the cardiac cycle measured by computed tomography angiography and transthoracic echocardiography

May 1, 2019 - 00:00
This study aimed to examine the relationship between dynamic changes in aortic diameter and corresponding measurement methods.

Vascular repair after firearm injury is associated with increased morbidity and mortality

May 1, 2019 - 00:00
Firearm injuries have high morbidity and mortality. Presentation of injuries requiring concurrent vascular repair and its outcomes are unclear. Our study's objective was to characterize the injury details and to assess the associated mortality and morbidity after vascular repair.

Duty hours are frequently inaccurate

May 1, 2019 - 00:00
For all its well-publicized deficiencies, the electronic medical record (EMR) is exquisitely capable of precisely tracking the activities of users. With dispassionate objectivity, the EMR knows where you are when you sign in, which patient records you access, and what orders you give and notes you write. Dr Aziz and colleagues have tested the feasibility of using the EMR to quantify off-duty access to the EMR by vascular surgery residents in an integrated training program. The results are important for two interconnected findings: (1) approximately 20% of vascular surgery residents' access to the EMR occurs during off-duty hours, or so-called pajama time; and (2) self-reporting of duty hours appears to be a flawed process.

Invited commentary

May 1, 2019 - 00:00
All of the published prospective randomized controlled trials (RCTs) comparing carotid artery stenting (CAS, presumably from the transfemoral approach) with carotid endarterectomy (CEA) have made the uniform observation that “older patients” had fewer end points (death and stroke) with CEA compared with CAS. These findings have been criticized by some as not necessarily reflecting everyday clinical practice (often erroneously referred to as “real world”) because the strict inclusion and exclusion parameters necessary for a well-defined clinical trial may exclude patients otherwise undergoing treatment in daily clinical practice.

Invited commentary

May 1, 2019 - 00:00
The science of vascular simulation remains in its infancy. Even as our simulators become more advanced, the technology they replicate evolves faster, confounding our efforts. We have no large-scale multicenter, randomized clinical trials on which to hang our hats. Therefore, as each new relevant investigation is published, we must look closely to see what pearls can be harvested. The “gold standard” remains to provide a link between simulation use and patient outcomes—a very lofty goal, and one much easier to demonstrate with endovascular simulation rather than open.

Association between the choice of anesthesia and in-hospital outcomes after carotid artery stenting

May 1, 2019 - 00:00
Several prior studies have shown lower risk of myocardial infarction (MI) in carotid artery stenting (CAS) compared with carotid endarterectomy. This is likely because the majority of endarterectomies are performed under general anesthesia (GA), whereas CAS is mainly performed under local anesthesia (LA). Performing CAS under GA may reverse its minimally invasive benefits. The aim of this study was to compare the safety profile of CAS-GA with that of CAS-LA.

Age modifies the efficacy and safety of carotid artery revascularization procedures

May 1, 2019 - 00:00
Several randomized clinical trials have shown that carotid artery endarterectomy (CEA) is safer than carotid artery stenting (CAS) in the elderly. However, those studies were limited by their strict inclusion criteria that might make their findings inapplicable to real-world practice. Therefore, the aim of this study was to evaluate the association of age with the efficacy of CEA and CAS in a population-based registry.