Journal of Vascular Surgery

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Benefit of Arterial Duplex Ultrasound Stent Imaging After Superficial Femoral Artery Stent Implantation: Impact of Surveillance Method on Postprocedural Outcome

September 1, 2018 - 00:00
In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex ultrasound stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation (SI), whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up.

Popliteal Artery Aneurysm Repair With Minimally Invasive Endoscopic Vein Harvest Yields Outstanding Wound Healing Outcomes With Fast-Tracked Hospitalization

September 1, 2018 - 00:00
There is growing literature showing that minimally invasive vein harvest (MIVH) is safe, with good patency rates and decreased wound complications, in treating infrainguinal occlusive disease. Our institution has performed MIVH since 2003 with a dedicated team of providers specializing in endoscopic vein harvest. The purpose of this study was to specifically evaluate major outcomes of MIVH as an adjunct to the standard, open operative repair of popliteal artery aneurysms.

In Search of the Right Tool: Using a Standardized Risk Calculator to Predict Groin Wound Infection

September 1, 2018 - 00:00
Surgical site infection (SSI), particularly involving groin exposure during lower extremity revascularization, remains a challenge for vascular surgeons. Groin SSI is associated with limb loss, increased mortality, and cost of care. A useful tool to the vascular surgeon would be a standardized risk calculator that can help identify patients at risk and potentially prevent future complications. In this study, we test the Penn Groin Assessment Scale and a prediction model developed at Duke University in our population of patients.

Outcomes of Drug-Coated Balloons in Patients With Critical Limb Ischemia

September 1, 2018 - 00:00
The drug-coated balloon (DCB) is widely employed in treatment of peripheral arterial disease. Treatment outcomes of DCB in patients with critical limb ischemia (CLI) are still lacking. The objective of this study was to compare and to assess clinical outcomes of DCB treatment vs standard angioplasty and stenting (SAS) in patients with CLI.

Old Tradition of Prophylactic Fasciotomy Could Be Avoided

September 1, 2018 - 00:00
Compartment syndrome is one of the true emergencies in vascular and orthopedic surgery. Surgical treatment of this condition is mandated to prevent nerve and eventually further function loss. Traditional teaching and practice of prophylactic fasciotomy after revascularization in acute ischemia are still performed after certain criteria are met. Patients with longer ischemia time and concomitant artery and vein injury will get fasciotomy. Fasciotomy is a relatively morbid and debilitating procedure that may cause disability and permanent damage to nerves and limb function.

Early Findings With Vacuum-Assisted Thrombectomy for Acute Limb Ischemia

September 1, 2018 - 00:00
Interventional strategies for acute limb ischemia continue to evolve. Most studies have focused on the comparison between thrombolytic therapy and surgical revascularization. However, limited data exist on the use of novel vacuum-assisted thrombectomy (VAT) devices. The purpose of this study was to evaluate the outcomes of patients who have undergone VAT at our institution.

Variables Predicting Surgical Site Infection in Femoropopliteal Bypass in the Time of Endovascular Therapy: A Retrospective Analysis of the National Surgical Quality Improvement Program Database

September 1, 2018 - 00:00
Peripheral arterial disease (PAD) affects nearly 8.5 million patients in the United States according to the Centers for Disease Control and Prevention. Although lifestyle modification and medical management can delay the rate of disease progression, approximately 5% of patients with PAD will eventually require revascularization. The most common complication of lower extremity bypass is surgical site infection (SSI), which can lead to prolonged hospital stays, additional procedures, and additive patient and hospital costs.

Premature Peripheral Arterial Disease Is Associated With Worse Outcomes in Patients Undergoing Infrainguinal Bypass and Endovascular Intervention

September 1, 2018 - 00:00
Few data exist to accurately describe the difference in characteristics, management, and outcomes of patients with premature peripheral arterial disease (PPAD), defined as patients <50 years old at the time of intervention. Our goal was to use Vascular Quality Initiative (VQI) data to investigate differences between PPAD patients and non-PPAD patients who had lower extremity vascular interventions.

Cryoamputation of a Severely Infected Above-Knee Amputation Stump

September 1, 2018 - 00:00
A 67-year-old man with a recent above-knee amputation surgery presented to the emergency department with fever, tachycardia, hypotension, altered mental status, and a necrotic, foul-smelling amputation stump. He was taking warfarin for atrial fibrillation with an initial international normalized ratio of 6.1. Examination revealed skin crepitus suggestive of an anaerobic infection. Because of his progressive hemodynamic instability and coagulopathy, we performed cryoamputation using dry ice in the intensive care unit for resuscitation and correction of his coagulopathy.

Deleterious Effects of General Anesthesia on Minor Foot Amputations

September 1, 2018 - 00:00
Despite revascularization, antibiotics, and wound care, patients with peripheral arterial disease (PAD) often require partial foot amputation for limb salvage. General anesthesia (GA) is widely known to have deleterious cardiopulmonary effects. We previously demonstrated that GA increases the risk for prolonged ventilation after major amputation. It remains unclear whether GA poses similar increased risk in PAD patients requiring minor amputation. The aim of this study was to investigate outcomes associated with GA, regional anesthesia (RA), and local anesthesia (LA) in minor foot amputation procedures.

National Surgical Quality Improvement Program Data Indicate Blood Transfusion After Lower Extremity Bypass Increases Complication Rates

September 1, 2018 - 00:00
Blood transfusions have been found to increase the risk of postoperative complications in surgical patients. The aim of this study was to investigate the effect of blood transfusions on postoperative morbidity and mortality in patients undergoing lower extremity bypass procedures using the National Surgical Quality Improvement Program database.

Analysis of Outpatient Telemedicine Reimbursement in an Integrated Health Care System

September 1, 2018 - 00:00
Current reimbursement policy surrounding telemedicine has been cited as a barrier to the adaptation of this care model. The objective of this study was to analyze reimbursement figures for outpatient telemedicine consultation in vascular surgery in an integrated health care system.

Intramural Hematomas of the Thoracic Aorta: Current Management and Outcomes: A Single Institution’s Experience During a Decade

September 1, 2018 - 00:00
Intramural hematomas (IMHs) of the aorta are a rare variant of aortic dissection without the presence of an intimal flap or defect. Controversy exists as to the optimal management for patients with type A IMH. Our objective was to evaluate the outcomes of surgically and medically managed patients.

Resuscitative Endovascular Balloon Occlusion of the Aorta and Thoracic Endograft Placement for Paravisceral Aortic Injury

September 1, 2018 - 00:00
Achievement of hemodynamic stability is a basic tenet of trauma surgery. Hemorrhage represents the most common cause of traumatic death worldwide, and the goal of hemorrhage control is to improve the circulating volume to the benefit of end-organ perfusion. Traditionally, resuscitative thoracotomy with aortic cross-clamping is used in noncompressible torso bleeds; however, resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct in the control of hemorrhage has been advocated in select cases.

Outcomes After Thoracic Endovascular Aortic Repair for Management of Complicated Acute Aortic Syndromes

September 1, 2018 - 00:00
Whereas medical treatment remains the “gold standard” for acute aortic syndrome (AAS), mortality remains high. Thoracic endovascular aortic repair (TEVAR) is increasingly used for AAS, a spectrum of disease that includes complicated type B aortic dissection, penetrating aortic ulcer, and intramural hematoma (IMH). We report our institutional outcomes after TEVAR for AAS.

A Frailty-Based Risk Score Predicts Morbidity and Mortality After Elective Endovascular Thoracic Aortic Aneurysm Repair

September 1, 2018 - 00:00
Thoracic endovascular aortic repair (TEVAR) has expanded access to thoracic aortic aneurysm (TAA) repair, particularly for elderly and frail patients. However, there are limited data on this higher risk population to inform appropriate selection of patients. Our objective was to develop and to validate a frailty-based, procedure-specific risk score for patients undergoing TEVAR for elective TAA.

Not All Rib Resections Are Considered Equal: A Case of Successful Paraclavicular Surgical Decompression for Recurrent Venous Thoracic Outlet Syndrome

September 1, 2018 - 00:00
The appropriate surgical treatment of effort thrombosis in young patients with venous thoracic outlet syndrome (TOS) is controversial. The major approaches include supraclavicular, infraclavicular, paraclavicular, and transaxillary first rib resection. We present the successful paraclavicular surgical management for the relatively rare observation of recurrent venous TOS with effort thrombosis 5 years after transaxillary rib resection.

Treatment Results and Patient-Reported Outcomes Measures in Patients With Neurogenic Thoracic Outlet Syndrome

September 1, 2018 - 00:00
The objective of this study was to assess results of physical therapy management (PTM) and surgical treatment (SRx) in a prospective observational cohort of patients with neurogenic thoracic outlet syndrome (NTOS) using standardized patient-reported outcomes measures (PROMs).

Computational Analysis of Renal Artery Flow Characteristics by Modeling Aortoplasty and Aortic Bypass Interventions for Abdominal Aortic Coarctation

September 1, 2018 - 00:00
Severe angiotensin-mediated hypertension, refractory to drug therapy, often accompanies suprarenal abdominal aortic coarctations. It is hypothesized that coarctation-induced disturbances in renal artery flow and pressure waveforms initiate excessive renin release from the juxtaglomerular apparatus of the kidney. Successful treatment necessitates restoration of normal aortorenal blood flow. This study undertook computational modeling to define the effectiveness of thoracoabdominal bypass (TAB) and patch aortoplasty (PA) in achieving normal postoperative renal artery flow using retrospective data from an abdominal aortic coarctation patient treated with TAB.

Management of Advanced Aortoiliac Occlusive Disease with the Gore Iliac Branch Endoprosthesis

September 1, 2018 - 00:00
Aortoiliac occlusive disease (AIOD) is a common late manifestation of peripheral vascular disease. The TransAtlantic Inter-Society Consensus guidelines have established aortobifemoral bypass as the “gold standard” for advanced lesions, with 10-year patency rates upward of 90%, but open surgery carries significant morbidity and mortality. Endovascular techniques have begun to challenge the open paradigm, especially in high-risk surgical candidates. We present our experience using the Gore Iliac Branch Endoprosthesis (IBE; W.