Journal of Vascular Surgery

Syndicate content
Journal of Vascular Surgery RSS feed.
Updated: 6 hours 22 sec ago

Constructing cost measures for critical limb ischemia

May 1, 2018 - 00:00
Episode-based cost measures are a method of measuring costs incurred by a provider in the Quality Payment Program (QPP). Episode-based cost measures utilize a specific condition/treatment to serve as the basis, or “trigger,” for the cost episode.1 The “episode” can include time periods before and after the triggering event and includes the costs related to that specific condition/treatment incurred during that time. The Centers for Medicare and Medicaid Services (CMS) engaged clinical subcommittees composed largely of relevant providers to develop eight initial episode-based cost measures.

Reply

May 1, 2018 - 00:00
We thank Dr Galyfos and Dr Filis for their interest in our publication addressing cardiac risk estimation in vascular surgery and for their important remarks. First, we agree that each specific procedure has a particular impact on cardiac risk, that this could interfere with the accuracy of the risk scores, and that procedure-specific models, such as those developed by Bertges et al,1 may perform better. However, in a recent study, Moses et al compared and validated the Revised Cardiac Risk Index, the risk calculator of the American College of Surgeons National Surgical Quality Improvement Program, and the Vascular Study Group of New England Cardiac Risk Index in a retrospective database of 856 patients.

Regarding “Prediction of major cardiac events after vascular surgery”

May 1, 2018 - 00:00
We have read with great interest the study by Gualandro et al,1 in which the authors have tried to evaluate well-established cardiac indices in patients undergoing vascular surgery procedures. However, some points need to be addressed.

Regarding “Preoperative inflammatory status predicts primary patency after femoropopliteal stent implantation”

May 1, 2018 - 00:00
This letter was written in regard to the recently published study by Nakazawa et al1 entitled “Preoperative inflammatory status as a predictor of primary patency after femoropopliteal stent implantation” in the Journal of Vascular Surgery. In their study, the authors evaluated the impact of preoperative inflammatory status on patency of femoropopliteal stenting for peripheral arterial disease. We would like to emphasize some points to clarify the findings of this article in reference to some confounding factors.

Reply

May 1, 2018 - 00:00
We want to thank Zhu et al for the thoughtful letter to the Editor in regard to our recently published article entitled “Preoperative inflammatory status as a predictor of primary patency after femoropopliteal stent implantation” in the Journal of Vascular Surgery. We appreciate the opportunity to clarify and respond to their comments.

Correction

May 1, 2018 - 00:00
In the January 2018 issue of the Journal of Vascular Surgery, for the article titled “Unusual mesenteric revascularization” (J Vasc Surg 2018;67:319), the editorial office failed to relay corrections made during the revision process to the Publisher. The following text was omitted from the published version:

Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery

May 1, 2018 - 00:00
The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training.

Measuring the worth of a vascular surgeon: Making it personal through a career of service

May 1, 2018 - 00:00
As I stand before you all, I am profoundly humbled to have served as your President this past year. Unlike my typical presentations over the past 20-plus years, my Presidential address this morning will not be a data-driven academic exposé. With your indulgence, I will take you on an abbreviated journey and share events that I hope will resonate with each of you. Clearly, these events had an impact on me, and I will try my best not to preach too much. This talk is not about science.

Reply

May 1, 2018 - 00:00
We have read with interest the well-written letter to the Editor regarding our publication “Controversies and evidence for cardiovascular disease in the diverse Hispanic population.” Dr Hinojosa and colleagues correctly identify the difficulties in obtaining accurate information on the diverse Hispanic population. The basis of our review was not limited to the English literature but also included articles that were translated to English originally published in Spanish.

Aneurysms don't have borders

May 1, 2018 - 00:00
My first real conversation with Roy Greenberg was a telephone interview for the Aortic Fellowship at the Cleveland Clinic. That cold day in January is etched indelibly in my personal history, and as I sat at my desk looking out over a snowy field in Hamilton, Ontario, Canada, we discussed what seemed like the most important things in the world at the time: surgery for thoracoabdominal disease, the design of fenestrated devices, and the goals I had for the fellowship. I loved working in Canada, so when the opportunity to move to Cleveland for training presented itself, I was eager to ensure it was as short and efficient as possible—I couldn't bear the thought of leaving my beautiful country and the patients I felt responsible to treat.

Regarding “Controversies and evidence for cardiovascular disease in the diverse Hispanic population”

May 1, 2018 - 00:00
We read with great interest the recent study published by Shaw et al1 consisting of a systematic search of the literature to identify English-language publications with the terms “cardiovascular disease,” “prevalence,” “vascular,” and “Hispanic,” with additional searches including countries such as Mexico, Cuba, and Puerto Rico and geographic regions such as Latin America, and we congratulate the valuable effort.

Reply

May 1, 2018 - 00:00
We would like to thank Drs Hanis and Mansori for their interest in our recently published paper entitled “Prediction of 6-minute walk performance in patients with peripheral artery disease.”1 This letter is in response to their letter, which offers two suggestions regarding alternative design and statistical analysis approaches.

Regarding “Prediction of 6-minute walk performance in patients with peripheral artery disease”

May 1, 2018 - 00:00
We read with much interest the article by Chen et al1 entitled “Prediction of 6-minute walk performance in patients with peripheral artery disease” that was published in the Journal of Vascular Surgery in October 2017. The aim of this research was to develop a statistical model to predict 6-minute walk test (6MWT) gait speed from 4-meter walk test results and clinical characteristics among patients with peripheral artery disease. Finally, the authors mentioned that the variables of slower 4-meter walking speed, lower ankle-brachial index, and presence of dyspnea all predict slower 6MWT gait speed, which corresponds to shorter 6MWT distance.

Reply

May 1, 2018 - 00:00
We appreciate the opportunity to emphasize the value of lifelong limb preservation (LLP) as a valuable patient-centered outcome measure. Dr Kuo et al raise several questions, all of which revolve around the “legitimacy” of not censoring death as an outcome in our life-table analysis. This conceptual stumbling block arises from the specific nature of limb salvage procedures and the context within which they are performed. The purpose of lower extremity revascularization is not to prolong life but to avoid amputation and disability in the final few years of life.

Regarding “Lifelong limb preservation: A patient-centered description of lower extremity arterial reconstruction outcomes”

May 1, 2018 - 00:00
We are interested in the concept of lifelong preservation (LLP) that Shean et al1 proposed recently. To apply survival analysis to quantifying the benefits of intervention on critical limb ischemia, we have to explicitly define risk set, failure (event), and censoring.2-6

Reply

May 1, 2018 - 00:00
Drs Krzanowski and Partyka are to be congratulated on their single-center retrospective experience highlighting outstanding outcomes in a high-volume center of excellence. While we agree that additional prospective randomized trials are needed to definitively answer the question of superiority of approach for treatment of critical limb-threatening ischemia (CLI), this comment highlights the value of multicenter data. While a majority of publications and trial data are drawn from high-volume centers of excellence, including recent Society for Vascular Surgery objective performance goals for CLI, these data may not represent outcomes for a majority of patients undergoing procedures for CLI as many patients are not treated at high-volume centers of excellence.

Regarding “Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention”

May 1, 2018 - 00:00
Mehaffey and colleagues' work, “Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention,”1 adds to the growing debate on whether endovascular or open repair is the best management for critical limb ischemia (CLI). The results they report on 30-day outcomes of endovascular treatment, however, do not comport with data we have accrued at our center in southern Poland.2,3 During the last 8 years, we have percutaneously treated 5195 patients with CLI (78% of them with tissue loss).

Management of visceral aortic patch aneurysms after thoracoabdominal repair with open, hybrid, or endovascular approach

May 1, 2018 - 00:00
The objective of this study was to investigate the outcomes of patients with visceral aortic patch (VAP) aneurysms after open repair of thoracoabdominal aortic aneurysm (TAAA) treated with three different approaches: open, hybrid, and endovascular repair.

Early sac shrinkage is a good surrogate marker of durable success after endovascular aneurysm repair in Japanese patients

May 1, 2018 - 00:00
The applicability of early sac shrinkage as a predictor of a low risk of late complications after endovascular aneurysm repair (EVAR) in Asian populations has not been validated. This study aimed to analyze early sac shrinkage and its relationship with late complications in Asian people using a Japanese multicenter database. We also assessed the impact of endoleaks.

Invited commentary

May 1, 2018 - 00:00
Recognizing that some abdominal aortic aneurysm (AAA) endografts have a small offset between the radiopaque markers and the proximal fabric edge that may result in unintended partial renal artery coverage, the authors investigated the hemodynamic effect of this potentially adverse event. It is generally accepted that blood flow-induced low arterial wall shear forces are associated with development of atherosclerosis (wall shear force per unit wall area is wall shear stress, WSS) and that extremely high shear rates may produce thromboembolism with or without local turbulence.