Journal of Vascular Surgery

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Arteriovenous Fistula Remains the Best Hemodialysis Access Choice for Some Elderly Patients

September 1, 2018 - 00:00
The optimal choice of hemodialysis access in elderly patients remains controversial. This study was undertaken to determine hemodialysis-dependent life expectancy by age of the patient at dialysis initiation and to compare this with the durability of the various hemodialysis access options.

Persistent Opioid Use After Vascular Surgery

September 1, 2018 - 00:00
Canada is currently facing an opioid crisis. In 2016, there were 1.3 million Canadians who commenced opioid treatment, and nearly 3000 Canadians suffered an opioid-related death. Our aim was to assess the rate and associated risk factors of prolonged opioid use in postoperative vascular surgery patients with the goal of informing and improving patient care.

Preoperative Anemia Has Sex-Based Differences in Immediate Postoperative Mortality

September 1, 2018 - 00:00
The objective of this study was to assess hemoglobin thresholds to prevent short-term mortality, adverse cardiac events, and immediate postoperative complications.

Vascular Interventions in Head and Neck Cancer Patients: Guidelines for Best Practice

September 1, 2018 - 00:00
Head and neck cancer can involve the surrounding vasculature and require technically challenging vascular interventions. Our aim was to examine patients with vascular interventions and head and neck cancer to determine outcomes and best practice.

Engineering the Educational Experience: Creating a Genuine Clinical Experience for Trainee Learning and Assessment

September 1, 2018 - 00:00
With the move toward competency-based education, providing genuine clinical experiences that allow trainees to learn in a safe and secure environment and assessing these experiences continue to daunt medical educators. Recently, the opportunity to develop an outpatient, ambulatory care clinic (Medical Education Teaching Clinic [METC]) to offer genuine experiences to a variety of trainees arose. To ensure that the experiences maximized quality and value to the trainees while allowing opportunities for assessment in a variety of formats, we created an engineered educational experience (E3).

Improving Critical Discharge Medication Adherence: A Vascular Quality Improvement Initiative

September 1, 2018 - 00:00
Admission to the hospital provides an ideal opportunity to ensure that appropriate morbidity- and mortality-improving medications are prescribed. Antiplatelet (AP) medications (eg, aspirin, clopidogrel) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins; eg, rosuvastatin) have class 1A evidence for patients with peripheral arterial disease. Similarly, perioperative AP medications and statins reduce mortality after vascular surgery. Our objective was to establish a five-component discharge improvement program that results in all eligible patients’ having a statin and AP medication prescribed at discharge.

Are Demographics Affecting Vascular Surgery Volumes? A Province-Wide Perspective

September 1, 2018 - 00:00
The purpose of this study was to evaluate the relationship between population increase, changing age demographics, and the throughput of vascular procedures province-wide from 1993 to 2016.

Inferior Vena Cava Filter Removal After Extended Implantation Periods

September 1, 2018 - 00:00
Retrievable inferior vena cava (IVC) filters are intended for short-term placement, and serious complications have been reported in patients with chronic IVC filters. As a result, national health agencies have encouraged each hospital to assess all retrievable IVC filters for filter removal. The aim of our study was to identify patients with unretrieved chronic IVC filters to document complications and removal techniques.

Nontumescent-Based Versus Tumescent-Based Endovenous Therapies for Patients with Saphenofemoral Reflux and Varicose Veins: A Meta-Analysis

September 1, 2018 - 00:00
Varicose veins and chronic venous insufficiency are increasingly common diagnoses in the adult population. Valvular incompetency at the saphenofemoral junction is the usual cause of the venous insufficiency, leading to a variety of symptoms. Most traditional endovenous procedures (laser and radiofrequency) require injection of tumescent fluid along the saphenous vein, which can be a cause of significant discomfort for the patient. Newer, nontumescent-based therapies have been introduced with similar success rates and less discomfort, leading to high appeal to patients.

Nontumescent-Based Versus Tumescent-Based Endovenous Therapies for Patients with Saphenofemoral Reflux and Varicose Veins: A Meta-Analysis

September 1, 2018 - 00:00
Varicose veins and chronic venous insufficiency are increasingly common diagnoses in the adult population. Valvular incompetency at the saphenofemoral junction is the usual cause of the venous insufficiency, leading to a variety of symptoms. Most traditional endovenous procedures (laser and radiofrequency) require injection of tumescent fluid along the saphenous vein, which can be a cause of significant discomfort for the patient. Newer, nontumescent-based therapies have been introduced with similar success rates and less discomfort, leading to high appeal to patients.

Ultrasound-Guided Cyanoacrylate Injection for the Treatment of Incompetent Perforator Veins

September 1, 2018 - 00:00
Lower limb perforator incompetence can exacerbate chronic venous disease and is a leading cause of varicose vein recurrence after treatment. With advancements in endovenous technology, minimally invasive treatments including sclerotherapy and thermal ablation have largely replaced open surgical techniques. Cyanoacrylate glue embolization is a relatively new treatment with good long-term results. However, its use in obliterating perforating veins has not yet been examined. Here we report our series of ultrasound-guided direct cyanoacrylate injection into perforator veins for the management of chronic varicose veins.

Ultrasound-Guided Cyanoacrylate Injection for the Treatment of Incompetent Perforator Veins

September 1, 2018 - 00:00
Lower limb perforator incompetence can exacerbate chronic venous disease and is a leading cause of varicose vein recurrence after treatment. With advancements in endovenous technology, minimally invasive treatments including sclerotherapy and thermal ablation have largely replaced open surgical techniques. Cyanoacrylate glue embolization is a relatively new treatment with good long-term results. However, its use in obliterating perforating veins has not yet been examined. Here we report our series of ultrasound-guided direct cyanoacrylate injection into perforator veins for the management of chronic varicose veins.

Surgically Positioned Paravertebral Catheters and Postoperative Analgesia After Open Abdominal Aortic Aneurysm Repair

September 1, 2018 - 00:00
The objective of this study was to compare postoperative morphine equivalent (MEQ) intake after open abdominal aortic aneurysm repair among analgesic modalities: standard analgesia (SA) with systemic opioid administration, epidural analgesia (EA), and surgically positioned paravertebral catheter analgesia (PA).

Surgically Positioned Paravertebral Catheters and Postoperative Analgesia After Open Abdominal Aortic Aneurysm Repair

September 1, 2018 - 00:00
The objective of this study was to compare postoperative morphine equivalent (MEQ) intake after open abdominal aortic aneurysm repair among analgesic modalities: standard analgesia (SA) with systemic opioid administration, epidural analgesia (EA), and surgically positioned paravertebral catheter analgesia (PA).

Impact of Declining Institutional Memory on Adverse Events After Open Aneurysm Repair

September 1, 2018 - 00:00
Since its introduction, endovascular aortic aneurysm repair has become a mainstay in the treatment of abdominal aortic aneurysms, resulting in the decline of open aneurysm repair (OAR). The objective of this study was to determine whether reduced OAR performance has led to a decline in institutional perioperative efficiency and an increase in postsurgical complications.

Impact of Declining Institutional Memory on Adverse Events After Open Aneurysm Repair

September 1, 2018 - 00:00
Since its introduction, endovascular aortic aneurysm repair has become a mainstay in the treatment of abdominal aortic aneurysms, resulting in the decline of open aneurysm repair (OAR). The objective of this study was to determine whether reduced OAR performance has led to a decline in institutional perioperative efficiency and an increase in postsurgical complications.

Long-term Outcomes Comparing Endovascular and Open Abdominal Aortic Aneurysm Repair in Octogenarians

September 1, 2018 - 00:00
Patients older than 80 years have significantly lower early mortality with endovascular aneurysm repair (EVAR) compared with open repair for abdominal aortic aneurysms (AAAs), but long-term results remain poorly studied. We analyzed the results of both emergent and elective AAA repair in patients 80 years old or older who had at least 5 years of follow-up.

Long-term Outcomes Comparing Endovascular and Open Abdominal Aortic Aneurysm Repair in Octogenarians

September 1, 2018 - 00:00
Patients older than 80 years have significantly lower early mortality with endovascular aneurysm repair (EVAR) compared with open repair for abdominal aortic aneurysms (AAAs), but long-term results remain poorly studied. We analyzed the results of both emergent and elective AAA repair in patients 80 years old or older who had at least 5 years of follow-up.

Current Risk Estimation Models Underestimate Significance of Perioperative Factors in Predicting Mortality After Elective Abdominal Aortic Surgery

September 1, 2018 - 00:00
The objective of this study was to determine the ability of current risk estimation models to predict operative mortality in patients undergoing elective aortic surgery. We hypothesize that perioperative events are more likely to predict 30-day mortality compared with these risk estimation models that incorporate only preoperative comorbidity variables.

Current Risk Estimation Models Underestimate Significance of Perioperative Factors in Predicting Mortality After Elective Abdominal Aortic Surgery

September 1, 2018 - 00:00
The objective of this study was to determine the ability of current risk estimation models to predict operative mortality in patients undergoing elective aortic surgery. We hypothesize that perioperative events are more likely to predict 30-day mortality compared with these risk estimation models that incorporate only preoperative comorbidity variables.