Journal of Vascular Surgery

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Updated: 11 hours 7 min ago

Experience After Implementation of an Acute Cardiovascular Emergency Protocol (ACEP)

August 1, 2017 - 00:00
Prompt treatment of cardiovascular emergencies is associated with improved outcomes. We describe findings after implementation of an acute cardiovascular emergency protocol (ACEP) for diagnoses of aortic dissection (AD), ruptured aneurysm (RA), and acute limb ischemia (ALI).

Hybrid Approach to the Treatment of Thoracoabdominal Aortic Degeneration in a Marfan Patient

August 1, 2017 - 00:00
Aortic interventions in patient with underlying connective tissues disorders present a unique challenge to vascular surgeons. The inevitable degeneration of the native aorta can lead to the need for multiple staged interventions with significant risk of complications associated with reoperative aortic procedures. We present a challenging case of thoracoabdominal aortic degeneration in a patient with Marfan syndrome. The patient initially presented with a prior history of a valve-sparing aortic root replacement.

Why Vascular Medicine Belongs With Vascular Surgery: Advantages to the Integration of Vascular Medicine and Vascular Surgery Services

August 1, 2017 - 00:00
Medical management of vascular disease was treated piecemeal by many physicians in the past. Advances and explosive growth in vascular biology over the decades has led to a specialization in vascular medicine, which has often functioned as a section within cardiology. We describe a unique service model that integrates vascular medicine and vascular surgery services and present the advantages of the model on both disciplines.

Persistent Hypoglossal Artery and Proatlantal Intersegmental Artery, Case Report and Review

August 1, 2017 - 00:00
We present case of persistent hypoglossal artery and persistent proatlantal intersegmental artery and highlight the difference between these rare findings and clinical implications. Patient 1: The patient is 50-year-old man with a history of recurrent right hemispheric transient ischemic attacks. Workup revealed total occlusion of left internal carotid artery (ICA) and tight stenosis of the right ICA. He also was noted to have a persistent hypoglossal artery originating from the right internal carotid artery.

Splenic Artery-to-Superior Mesenteric Artery Transposition in Chronic Mesenteric Ischemia

August 1, 2017 - 00:00
A 56-year-old woman with history of polycythemia and massive splenomegaly presented with progressive weight loss and midepigastric abdominal pain precipitated by eating leading to fear of eating. A computed tomography abdominal scan revealed massive splenomegaly with multiple splenic infarcts and an occluded superior mesenteric artery (SMA). An angiogram showed patent celiac and inferior mesenteric vessels with collaterals supplying the SMA. The patient was treated with chemotherapy to control thrombophilia and decrease the splenic size, but she continued to have disabling postprandial abdominal pain and left upper quadrant discomfort.

Paneled Saphenous Vein Graft Repair of an Iliac Artery Injury in a Contaminated Abdomen: Late Complication of Aneurysmal Degeneration Illustrating the Need for Continued Surveillance

August 1, 2017 - 00:00
The management of acute intra-abdominal arterial injury (AIAAI) in the setting of enteric contamination is challenging. When the AIAAI is extensive enough to preclude primary repair, the choice of conduit in the arterial reconstruction becomes critical. Use of in-line prosthetic grafts exposes the patient to the devastating possibility of subsequent graft infection, while extra-anatomic bypasses have limited durability as well as residual infection risk. Autogenous options in the emergency setting are limited and complicated by size mismatch.

A Novel Endovascular Approach for Management of Traumatic Arteriovenous Fistulas

August 1, 2017 - 00:00
A 43-year-old man was evaluated in the emergency department for a complaint of right lower extremity projectile bleeding after scraping his right calf. The patient had a history of multiple bleeding episodes from large varicose veins in his right leg. He also complained of swelling and heaviness of his right leg, which limited his ability to work. On examination, he had a palpable thrill along a medial cord in his thigh. He admitted a stab wound to his right thigh 20 years ago. The wound was treated locally without further imaging.

“Chimney Patch” Balloon Occlusion Technique for Transplantation to Heavily Calcified Vessels

August 1, 2017 - 00:00
Renal transplantation is a lifesaving procedure for individuals on dialysis; however, patient comorbidities, such as diabetes and hypertensive nephrosclerosis, can be technically limited by severe arterial calcification. External clamp application to these vessels frequently results in plaque damage and subsequent occlusion or stenosis. We report a technique of internal balloon occlusion via chimney arterial conduit to safely avoid plaque disruption.

Hybrid Retrograde Endovascular Repair of a Rapidly Expanding Chronic SMA Dissection

August 1, 2017 - 00:00
A 59-year-old man with a 7-cm superior mesenteric artery (SMA) aneurysm had expanded 2 cm in the past 4 months. He presented 7 years after being lost to follow-up in the early postoperative period after thoracic endovascular aortic repair for type B dissection with dilated chronic aortic and aortic branch dissections: a 12-cm type 3 thoracoabdominal aortic aneurysm, a 59-cm SMA aneurysm, and 4-cm common and internal iliac artery aneurysms. As the patient underwent and recovered from a staged, multimodal, thoracoabdominal aortic and iliac artery repair, the SMA aneurysmal dilation rapidly progressed.

Natural History of the Proximal Aorta in Patients With Descending Thoracic Aortic Disease

August 1, 2017 - 00:00
This study investigated the growth and behavior of the ascending aorta in patients with descending thoracic aortic pathology.

A Single-Institution Experience With Ruptured Aortic Aneurysms

August 1, 2017 - 00:00
With the continued advancement in aortic endografts and increasing surgeon experience, endovascular aortic aneurysm repair (EVAR) is now commonly used for ruptured abdominal aortic aneurysms (rAAAs). Although randomized controlled trials have shown improved short-term morbidity and mortality with EVAR compared to open repair in the elective setting, the data for rAAA remain scarce. This study reviewed the data on rAAA at our institution and compared outcomes of open repair vs EVAR.

Transition From Current Accuracy Measures in the Vascular Laboratory Will Be Required for Future Accreditation and Payment Models

August 1, 2017 - 00:00
The Medicare Accessibility and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA) brings with it increased regulatory requirements not traditionally addressed by standard vascular laboratory (VL) accreditation, which is based on accuracy. The Intersocietal Accreditation Commission new Quality Improvement project may satisfy an Improvement Activity (IA) of MACRA. We hypothesize that other IAs in MACRA, such as timeliness of test results or patient care Quality Performance requirements, can be met by analyzing data already collected by the VL.

Laparoscopic Aortobifemoral Bypass in the United States

August 1, 2017 - 00:00
Although endovascular approaches are used for aortoiliac occlusive disease, selected patients are more suited to aortobifemoral bypass (ABF). European centers have compared laparoscopic ABF (LapABF) favorably to open surgery, but this has not been embraced in the United States (U.S.). We reviewed our10-year experience with LapABF, evolving from completely laparoscopic to a standardized laparoscopic-assisted approach.

Sarcopenia as a Predictor of Mortality After Endovascular Aneurysm Repair

August 1, 2017 - 00:00
Endovascular aneurysm repair (EVAR) is currently the most common treatment of abdominal aortic aneurysms (AAA). Potential predictors of long-term survival after EVAR include assessment of physiologic, functional, and cognitive status. Objective radiographic findings, such as skeletal muscle atrophy, or sarcopenia, may be an additional measure. This study investigated sarcopenia as a method of predicting a primary outcome of survival for patients undergoing EVAR.

Socioeconomic Disparities and Outcomes After Carotid Revascularization

August 1, 2017 - 00:00
Race has been associated with inferior outcomes after multiple procedures, but the impact of socioeconomic status is not well established. We assessed the association between socioeconomic status and outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Pre- and Post-Transcarotid Artery Revascularization Characteristics of Common Carotid Artery: A Post Hoc Analysis of ROADSTER-1 Trial

August 1, 2017 - 00:00
Transcarotid artery revascularization (TCAR) is an alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stents (CAS). The procedure combines direct common carotid artery (CCA) access with robust flow reversal during transcarotid stent placement. We report the pre- and 30-day postintervention CCA access characteristics and outcomes with TCAR.

Arterial Reconstructions for Pediatric Splanchnic Artery Occlusive Disease

August 1, 2017 - 00:00
Pediatric splanchnic arterial occlusive disease is a rare cause of intestinal ischemia. This study was undertaken to better define the clinical relevance of celiac and superior mesenteric arterial occlusive disease in children.

Supraclavicular Versus Transaxillary First Rib Resection for Thoracic Outlet Obstruction: A Single-Institution Experience

August 1, 2017 - 00:00
Thoracic outlet syndrome (TOS) results from compression of the neurovascular structures supplying the upper extremity as they exit through the thoracic outlet. Depending on the clinical presentation, surgical decompression may be required. The transaxillary (TA) approach has been the preferred approach, although the supraclavicular (SC) approach has become more widely used, especially when adjunct procedures are required. Our objective was to review the results with both approaches in our institution.

Contemporary Results for Open Repair of Pararenal Aortic Aneurysms Are Comparable to the Prefenestrated Endograft Era

August 1, 2017 - 00:00
Endovascular technologies continue to evolve for the treatment of complex aortic aneurysms. This results in less experience with open repair of juxtarenal and pararenal abdominal aortic aneurysms (PAAA) and repairs occurring in patients with prior endovascular interventions. We sought to determine contemporary patient characteristics and early outcomes for open repair of PAAA.

Timing of Hospital-Acquired Venous Thromboembolism (VTE) and its Relationship With VTE Prevention Measures in Immobile Patients

August 1, 2017 - 00:00
This study describes the timing of venous thromboembolism (VTE) diagnosis in patients with cerebral or spinal trauma and stroke and the relationships between VTE prevention and timing of VTE diagnosis at a community hospital.