Journal of Vascular Surgery

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Invited commentary

July 1, 2019 - 00:00
The systemic review and meta-analysis by Hu et al suggests that the direct thrombin inhibitor bivalirudin is superior to unfractionated heparin (UFH) in peripheral endovascular procedures. Specifically, bivalirudin had lower odds ratios of periprocedural mortality, major adverse cardiovascular events, net adverse clinical events, perioperative myocardial infarction, major vascular complications, and minor vascular complications. These are intriguing data, given the fact that probably most vascular surgeons still primarily use UFH periprocedurally for intraluminal interventions, usually to maintain an activated clotting time >250 to 300 seconds, and often using protamine reversal.

A systematic review of the use of near-infrared fluorescence imaging in patients with peripheral artery disease

July 1, 2019 - 00:00
In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index plays an important role. However, results of the ankle-brachial index are unreliable in patients with severe media sclerosis. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) can provide information about tissue perfusion and has already been studied in oncologic, reconstructive, and cardiac surgery. For patients with PAD, this technique might give insight into skin perfusion and thereby guide treatment.

The potential benefits and challenges of advanced modeling in abdominal aortic aneurysm

July 1, 2019 - 00:00
This is an excellent presentation of a research project to develop a novel robust model of abdominal aortic aneurysm by a strong investigative team with great experience in this area. They have done a fine job of surveying biologic processes known to be related to aneurysm disease. Many advances in our understanding of the pathology of aneurysms have been made with animal models, including the recognition of the complexities of the disease. Unique models in this area are most welcome, and this model may yield additional insights to aid in the development of biologic and physical modifiers of the human disease.

Occupational injuries versus radiation exposure

July 1, 2019 - 00:00
Radiation safety has become a hot topic in the vascular field as more and more of our procedures are either purely endovascular or hybrid. There is a great deal of research already in the interventional radiology and interventional cardiology literature regarding occupational risks.1 In a study at Mayo Clinic in 2015, they found that individuals working in interventional procedures were more likely to experience work-related musculoskeletal pain (54.7% vs 44.7%; P < .001).2 In a 2004 survey from the Society for Cardiac Angiography and Interventions, almost 50% of respondents reported back problems, which is significantly higher than in the standard population.

Impact of a care delivery redesign initiative for vascular surgery

June 27, 2019 - 00:00
A hospital-wide quality improvement process through a care delivery redesign (CDR) was initiated to improve patient care efficiency, clinical documentation, and length of stay (LOS). The impact of CDR was assessed through LOS, unplanned readmission rates, and hospital financial metrics.

A systematic review of high-intensity interval training as an exercise intervention for intermittent claudication

June 27, 2019 - 00:00
Intermittent claudication (IC) is the most common symptom of peripheral arterial disease, which significantly affects walking ability, functional capacity and quality of life. Supervised exercise programs (SEP) are recommended as first-line treatment, but recruitment and adherence rates are poor. The time required to complete a SEP is the most common barrier to participation cited by patients who decline. High-intensity interval training (HIIT) is more time efficient than current SEPs and therefore has the potential to overcome this barrier.

Results from a prospective multicenter feasibility study of Zenith p-Branch stent graft

June 27, 2019 - 00:00
To evaluate the Cook Zenith p-Branch stent graft (William A. Cook Australia, Brisbane, Queensland, Australia) for the treatment of patients with asymptomatic juxtarenal or pararenal abdominal aortic aneurysms in a prospective, nonrandomized, multicenter, feasibility study conducted in the United States.

Anatomic suitability for “off-the-shelf” thoracic single side-branched endograft in patients with type B aortic dissection

June 24, 2019 - 00:00
Treatment of type B aortic dissections with thoracic endovascular aortic repair (TEVAR) has been adopted in many centers with the goal of covering the proximal entry tear. Coverage of the left subclavian artery (LSCA) is commonly required to achieve a dissection-free proximal seal zone. A novel thoracic single side-branched (TSSB) endograft device offers a potential off-the-shelf option to achieve total endovascular incorporation of LSCA during zone 2 TEVAR. The aim of this study was to determine what percentage of patients with type B aortic dissection who require zone 2 TEVAR meet the anatomical requirements for this device.

Acute experimental venous thrombosis impairs venous relaxation but not contraction

June 24, 2019 - 00:00
Venous thrombosis (VT) damages the vein wall, both physically by prolonged distension and from inflammation. These factors contribute to post-thrombotic syndrome (PTS). Interleukin (IL)-6 might play a role in experimental PTS and vein wall responses. Previous assessments of post-thrombotic vein wall injury used static measures such as histologic examination and immunologic assays. The purpose of the present study was to use myography to quantify the changes in contraction and relaxation of murine vessels exposed to an acute VT.

Complete versus partial excision of infected arteriovenous grafts: Does remnant graft material impact outcomes?

June 24, 2019 - 00:00
Infected arteriovenous grafts necessitate intervention to obtain source control. However, excising the graft material can be challenging and can lead to complications. Leaving a cuff of graft at the sites of anastomosis allows for the avoidance of potential risks. However, it is unclear whether doing so places patients at risk of recurrent graft infection. The purpose of the present study was to investigate the effect of complete vs partial excision of infected arteriovenous prosthetic dialysis access grafts.

Suprarenal fixation is associated with worse midterm renal function after endovascular abdominal aortic aneurysm repair compared with infrarenal fixation

June 24, 2019 - 00:00
Several reports have indicated that suprarenal (SR) fixation may impair renal function after endovascular abdominal aortic aneurysm repair (EVAR). However, most were short-term or at most, 1-year observational studies; therefore, the midterm effects on renal function remain unclear. This study aimed to identify predictors of midterm renal dysfunction after EVAR and compare renal outcomes in patients after EVAR with SR and infrarenal (IR) fixation.

Factors associated with in-hospital complications and long-term implications of these complications in elderly patients undergoing endovascular aneurysm repair

June 24, 2019 - 00:00
Perioperative complications in elderly patients undergoing endovascular aneurysm repair (EVAR) occur frequently. Although perioperative mortality has been well-described in the elderly patient population, factors associated with in-hospital complications and their impact on long-term survival remain poorly characterized.

Predictors of poor outcome in infrainguinal bypass for trauma

June 24, 2019 - 00:00
Trauma remains a leading cause of morbidity and mortality worldwide. Vascular injuries are present in approximately 1% to 2% of trauma patients, with the majority of injuries occurring to the extremities. Trauma patients with vascular injuries have been shown to have increased morbidity and mortality as well as the need for increased resources compared with those without vascular injuries. This study aimed to determine predictors of poor outcomes in infrainguinal bypasses performed for traumatic arterial injury.

Endovascular treatment of spontaneous renal artery dissection

June 24, 2019 - 00:00
This study aimed to assess the outcomes of patients with spontaneous renal artery dissection (SRAD) after endovascular repair.

Transabdominal open abdominal aortic aneurysm repair is associated with higher rates of late reintervention and readmission compared with the retroperitoneal approach

June 24, 2019 - 00:00
Limited data exist comparing the transabdominal and retroperitoneal approaches to open abdominal aortic aneurysm (AAA) repair, especially late mortality and laparotomy-related reinterventions and readmissions. Therefore, we compared long-term rates of mortality, reintervention, and readmission after open AAA repair through a transabdominal compared with a retroperitoneal approach.

Female sex hormones and risk of incident abdominal aortic aneurysm in Norwegian women in the HUNT study

June 24, 2019 - 00:00
The delayed development of abdominal aortic aneurysm (AAA) in women compared with men might be secondary to a protective effect from endogenous estrogens. The role of postmenopausal hormone therapy remains unclear. The aim of the present study was to evaluate the effect of female sex hormones compared with other risk factors associated with AAA through a long-term study of a large female cohort.

Arteriovenous fistula maturation rate is not affected by ipsilateral tunneled dialysis catheter

June 20, 2019 - 00:00
The effect that ipsilateral tunneled dialysis catheters (TDC) have on arteriovenous fistula (AVF) maturation is unclear. We sought to define this association by comparing AVF maturation rates in patients with contralateral TDC with those with ipsilateral TDC.

Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with nine years of data from the National Surgical Quality Improvement Program

June 18, 2019 - 00:00
The American College of Surgeons' National Quality Improvement Program (NSQIP) database can be used to assess trends and outcomes of ruptured abdominal aortic aneurysm (rAAA) repair. The purpose of this study is to examine the morbidity and mortality for ruptured endovascular (rEVAR) and ruptured open (rOPEN) aneurysm repair compared with elective endovascular (EVAR) and elective open (OPEN) aneurysm repair.

Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout

June 18, 2019 - 00:00
Trainee burnout is on the rise and negative training environments may contribute. In addition, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and to determine how gender-based discrimination and bias (GBDB) affect the clinical experience.

In-hospital outcomes of transcarotid artery revascularization and carotid endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative

June 18, 2019 - 00:00
Transcarotid artery revascularization (TCAR) with flow reversal offers a less invasive option for carotid revascularization in high-risk patients and has the lowest reported overall stroke rate for any prospective trial of carotid artery stenting. However, outcome comparisons between TCAR and carotid endarterectomy (CEA) are needed to confirm the safety of TCAR outside of highly selected patients and providers.