Journal of Vascular Surgery

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Updated: 13 hours 22 min ago

Risk Factors and Outcomes Associated With Infected Lower Extremity Prosthetic Bypasses and Patches

October 1, 2017 - 00:00
Prosthetic grafts are often used as alternative conduits in patients with peripheral vascular disease who do not have adequate autologous vein for bypass. However, prosthetic grafts carry increased risk of infection and associated increased morbidity and mortality. The goal of this study was to identify potential risk factors and subsequent outcomes associated with lower extremity prosthetic graft infections.

Contemporary Results of Surgical Management of Peripheral Mycotic Aneurysms

October 1, 2017 - 00:00
Mycotic aneurysms of the extremities occur infrequently but can cause severe life and limb complications. Traditional treatment typically includes débridement and revascularization, although ligation may be well tolerated in some patients. We reviewed our experience with these aneurysms treated with these two modalities.

The Society for Vascular Surgery Wound, Ischemia, and foot Infection Classification Predicts Wound Healing Better Than Angiosome-Directed Perfusion in Neuroischemic Diabetic Foot Wounds

October 1, 2017 - 00:00
Previous studies have shown conflicting results in the wound healing outcomes based on angiosome-directed perfusion, but none have adjusted for wound characteristics. We have previously shown that the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification correlates with wound healing in neuroischemic diabetic foot ulcers (DFUs) treated by a multidisciplinary team. The aim of this study was to compare WIfI classification vs angiosome-directed perfusion as a predictor of wound healing in patients presenting with DFU and peripheral arterial disease (PAD).

Upper Extremity Endovascular Interventions for Symptomatic Vascular Access-Induced Steal Syndrome

October 1, 2017 - 00:00
Critical hand ischemia due to vascular access-induced steal syndrome (VASS) continues to be a significant problem. The aim of this study was to examine the outcomes of endovascular interventions in the upper extremity of patients presenting with VASS.

Postanesthesia Ultrasound-Guided Venous Mapping Increases Fistula Placement Rates Without Compromising Fistula Maturation Rates

October 1, 2017 - 00:00
This study aimed to investigate the impact of introducing postanesthesia ultrasound (PAUS) on the type of vascular access chosen for hemodialysis in patients without previous accesses.

Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins

October 1, 2017 - 00:00
Radiofrequency ablation (RFA) has become the primary modality of treating perforator vein insufficiency. Previous studies have shown a closure rate of 60% to 80% in incompetent perforator veins (IPVs) with RFA. The purpose of the study was to determine utility of redo RFA for symptomatic recanalized perforators and to predict factors associated with recanalization.

Presentation and Management of Inferior Vena Cava Thrombosis

October 1, 2017 - 00:00
Inferior vena cava thrombosis (IVCT), although rare, has a potential for significant morbidity and mortality. IVCT is often a result of IVC filter thrombosis, but it can also occur de novo. Whereas anticoagulation remains standard of care, endovascular techniques to restore IVC patency have become key adjunctive therapies in recent years. This study examines a single-center experience with diagnosis and management of IVCT.

Experience With Vein Stent Placement for Proximal Venous Outflow Obstruction at One Center

October 1, 2017 - 00:00
Venous stenting in patients with chronic proximal venous outflow obstruction (PVOO) has recently emerged as a valuable therapeutic strategy. This report summarizes our experience, focusing on patient selection, technical approaches, and outcomes.

Implications of Early Failure of Isolated Tibial Interventions

October 1, 2017 - 00:00
Infrapopliteal disease is documented in 50% of patients presenting with rest pain and tissue loss, and tibial interventions for critical limb ischemia are frequent. The implications of early (≤30 days) failure of an isolated tibial intervention are still unclear. The aim of this study was to examine the patient-centered outcomes of failed isolated tibial intervention.

Metformin Is Associated With Improved Survival and Decreased Cardiac Events With No Impact on Patency and Limb Salvage After Revascularization for Chronic Limb Ischemia

October 1, 2017 - 00:00
The incidence of cardiovascular and limb-specific adverse outcomes is higher in peripheral arterial disease (PAD) patients with diabetes. Metformin is the first-line drug therapy for type 2 diabetes and is associated with fewer adverse cardiovascular events. However, the effect of metformin on limb-specific outcomes is unclear. The objective of this study was to assess the effect of metformin on outcomes after intervention for PAD.

Reimbursement, Particularly Atherectomy, Appears to Be a Principal Driver for Intervention for Lower Extremity Occlusive Disease, Particularly in Office-Based Laboratories

October 1, 2017 - 00:00
The purpose of this study was to examine the ongoing trend of migration of endovascular procedures being done for lower extremity occlusive disease from the hospital to office-based laboratories (OBLs) since our previous analysis reported a year ago. We also analyzed the 12-month downstream use of repeated atherectomy after the incident procedure.

Long-Term Results of Carotid Artery Stenting in Veterans With Prior Head and Neck Cancer

October 1, 2017 - 00:00
Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical irradiation or neck dissection are considered “high risk” for carotid endarterectomy. This is a well-established indication for carotid artery stenting (CAS). The long-term outcomes of CAS in this population, however, are not so well established. The purpose of this study was to review the long-term results of CAS in veteran patients with a prior history of treatment for head and neck cancer.

Long-Term Comparative Effectiveness of Carotid Stenting Versus Carotid Endarterectomy in a Large Tertiary Care Vascular Surgery Practice

October 1, 2017 - 00:00
Carotid interventional trials have strict inclusion and exclusion criteria that make translation of their results to the real-world population challenging. In routine clinical practice, the role of clinical decision-making is difficult to evaluate. We designed this trial to compare the effectiveness of carotid artery stenting (CAS) vs carotid endarterectomy (CEA) in a real-world setting.

EndoAnchors Use With Infrarenal Versus Suprarenal Stent Grafts—Results From ANCHOR Global Registry

October 1, 2017 - 00:00
EndoAnchors (Medtronic, Santa Rosa, Calif) have shown safety and efficacy in maintaining proximal seal and in treatment of type I endoleaks. The Aneurysm Treatment Using the Heli-FX Aortic Securement System Global Registry (ANCHOR) data captured use of a variety of endografts with infrarenal (IR) and suprarenal (SR) fixation; approximately 75% of patients were considered to have one or more markers for hostile aortic neck anatomy. The outcomes of the EndoAnchor endovascular aneurysm repair (EVAR) with IR and SR stent grafts were analyzed.

Patient and Operating Room Staff Radiation Doses During Fenestrated/Branched Endovascular Aneurysm Repair Using Premanufactured Devices

October 1, 2017 - 00:00
Fenestrated/branched endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices.

Favorable Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Patients With Acute Uncomplicated Type B Aortic Dissection

October 1, 2017 - 00:00
Standard nonoperative medical therapy for uncomplicated type B dissection has been questioned by recent studies demonstrating improved outcomes in those treated with thoracic endovascular aortic repair (TEVAR). This study assessed long-term survival after acute uncomplicated type B dissection comparing medical therapy (MED), open repair (OPEN), and TEVAR.

Iliac Branch Devices Do Not Decrease Ischemic Colitis Compared With Hypogastric Artery Embolization in Endovascular Abdominal Aneurysm Repair

October 1, 2017 - 00:00
Before the availability of iliac branch devices (IBDs), hypogastric artery embolization (HAE) was routinely performed to prevent type Ib endoleak in endovascular repair of abdominal aortic aneurysms with associated common iliac aneurysms. This, however, can result in poor pelvic perfusion leading to ischemic colitis, buttock claudication, and sexual dysfunction. This study investigated whether IBD is superior to HAE in 30-day outcomes of patients with elective endovascular aneurysm repair (EVAR) using the multicenter prospectively collected American College of Surgeons National Surgical Quality Improvement Program database.

Endovascular Abdominal Aortic Aneurysm Repair With Large-Diameter Devices (35 and 36 mm) Is Associated With Acceptable Risk of Device Failure

October 1, 2017 - 00:00
Endovascular aneurysm repair (EVAR) using smaller diameter (<28 mm) devices is associated with infrequent device migration and type Ia endoleaks. Large-diameter (35 and 36 mm) devices are typically reserved for patients treated emergently or with limited open surgical options. We sought to determine whether these devices were associated with a high incidence of type Ia endoleaks, device migration, aneurysm-related mortality, or need for early reintervention.

Comparative Study of Clinical Outcome of Endovascular Aneurysm Repair in Large-Diameter Aortic Necks (>31 mm) Versus Smaller Neck: Word of Caution

October 1, 2017 - 00:00
A significant number of patients with large aortic neck diameters have undergone endovascular aneurysm repair. This study compares clinical outcomes in patients with large (>31 mm) vs small aortic neck diameters (≤28 and ≤31 mm).

Regarding “Google Maps offers a new way to evaluate claudication”

October 1, 2017 - 00:00
We read with great interest the paper “Google Maps offers a new way to evaluate claudication” from Khambati et al.1 We do agree that Google Maps proposes a readily available GPS-based mapping tool that could be considered an accessible method of evaluating claudication. We are convinced that GPS-based determination of walking is of great interest in claudication.2,3 Nevertheless, one reason that we previously used an autonomous GPS data logger with no real-time transmission and local data analysis was related to potential privacy and security issues.