Journal of Vascular Surgery

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The Futility of Surveillance for Old and Small Aneurysms

September 1, 2018 - 00:00
Inspired by the Canadian Choosing Wisely campaign, we investigated the yield and cost of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, compared with a younger population, for detecting AAA growth that reaches a sex-specific threshold size for repair.

The Futility of Surveillance for Old and Small Aneurysms

September 1, 2018 - 00:00
Inspired by the Canadian Choosing Wisely campaign, we investigated the yield and cost of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, compared with a younger population, for detecting AAA growth that reaches a sex-specific threshold size for repair.

Long-Term Survival After Endovascular Aneurysm Repair and Open Repair in Patients With Anatomy Outside Endovascular Aneurysm Repair Instructions for Use Criteria

September 1, 2018 - 00:00
Patients who do not meet instructions for use (IFU) criteria are often still treated by endovascular aneurysm repair (EVAR), even though some studies have shown higher graft-related adverse events. The goal of this study was to compare the long-term survival of EVAR and open repair (OR) in patients with anatomy outside standard IFU criteria.

Long-Term Survival After Endovascular Aneurysm Repair and Open Repair in Patients With Anatomy Outside Endovascular Aneurysm Repair Instructions for Use Criteria

September 1, 2018 - 00:00
Patients who do not meet instructions for use (IFU) criteria are often still treated by endovascular aneurysm repair (EVAR), even though some studies have shown higher graft-related adverse events. The goal of this study was to compare the long-term survival of EVAR and open repair (OR) in patients with anatomy outside standard IFU criteria.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR) and is associated with faster recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and better understanding of the precise economic impact of P-EVAR has important implications for resource allocation. The objective was to determine the differences in cost between P-EVAR and S-EVAR.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR) and is associated with faster recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and better understanding of the precise economic impact of P-EVAR has important implications for resource allocation. The objective was to determine the differences in cost between P-EVAR and S-EVAR.

A Prospective Cohort Study of a Same-Day Discharge Percutaneous Endovascular Aneurysm Repair Pathway

September 1, 2018 - 00:00
A retrospective study conducted at our institution suggested that a same-day discharge pathway after percutaneous endovascular aneurysm repair (PEVAR) is safe. This prospective cohort study therefore evaluated the postoperative course and short-term follow-up of patients who qualified for a same-day discharge pathway designed to discharge select patients undergoing PEVAR within 24 hours of surgery.

A Prospective Cohort Study of a Same-Day Discharge Percutaneous Endovascular Aneurysm Repair Pathway

September 1, 2018 - 00:00
A retrospective study conducted at our institution suggested that a same-day discharge pathway after percutaneous endovascular aneurysm repair (PEVAR) is safe. This prospective cohort study therefore evaluated the postoperative course and short-term follow-up of patients who qualified for a same-day discharge pathway designed to discharge select patients undergoing PEVAR within 24 hours of surgery.

Early Experience With the INCRAFT Device

September 1, 2018 - 00:00
Several low-profile grafts have been created for use in endovascular aneurysm repair in patients with small or difficult access vessels. Our objective was to evaluate outcomes of patients undergoing endovascular aneurysm repair with the INCRAFT device (Cordis, Miami Lakes, Fla) in a real-world North American setting.

Early Experience With the INCRAFT Device

September 1, 2018 - 00:00
Several low-profile grafts have been created for use in endovascular aneurysm repair in patients with small or difficult access vessels. Our objective was to evaluate outcomes of patients undergoing endovascular aneurysm repair with the INCRAFT device (Cordis, Miami Lakes, Fla) in a real-world North American setting.

Carotid Endarterectomy After Systemic Thrombolysis in Stroke Patients: A Retrospective Comparative Analysis

September 1, 2018 - 00:00
Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, focusing on comparison with symptomatic patients. The goal was to evaluate the hemorrhagic and overall outcomes of patients undergoing CEA after IVT and to compare them with a similar population.

Carotid Endarterectomy After Systemic Thrombolysis in Stroke Patients: A Retrospective Comparative Analysis

September 1, 2018 - 00:00
Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, focusing on comparison with symptomatic patients. The goal was to evaluate the hemorrhagic and overall outcomes of patients undergoing CEA after IVT and to compare them with a similar population.

Impact of Statins on Clinical Outcomes After Carotid Endarterectomy and Stenting: A Population-Based Cohort Study

September 1, 2018 - 00:00
We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and clinical outcomes among an older population after carotid revascularization.

Impact of Statins on Clinical Outcomes After Carotid Endarterectomy and Stenting: A Population-Based Cohort Study

September 1, 2018 - 00:00
We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and clinical outcomes among an older population after carotid revascularization.

Ultrasound Surveillance Following Carotid Endarterectomy: Prudent or Pointless?

September 1, 2018 - 00:00
The objective of this study was to assess the utility of duplex ultrasound (DUS) surveillance with respect to rates, outcomes, and management of restenosis after carotid endarterectomy (CEA).

Ultrasound Surveillance Following Carotid Endarterectomy: Prudent or Pointless?

September 1, 2018 - 00:00
The objective of this study was to assess the utility of duplex ultrasound (DUS) surveillance with respect to rates, outcomes, and management of restenosis after carotid endarterectomy (CEA).

Transforming Practice: Using a Systems-Based, Multidisciplinary Approach to Achieve a 600% Reduction in Early Symptomatic Carotid Revascularization Referral and Treatment

September 1, 2018 - 00:00
Achieving early carotid revascularization is a key goal for secondary stroke prevention in patients with symptomatic carotid artery stenosis. Whereas evidence shows that early revascularization provides an absolute risk reduction of 30% for severe and 15% for moderate carotid artery stenosis treated within 14 days (Lancet 2004;363:915), this is rarely achieved in practice. We sought to identify barriers to carotid revascularization and to implement an early referral process in our institution to achieve this seldom-realized evidence-based standard.

Transforming Practice: Using a Systems-Based, Multidisciplinary Approach to Achieve a 600% Reduction in Early Symptomatic Carotid Revascularization Referral and Treatment

September 1, 2018 - 00:00
Achieving early carotid revascularization is a key goal for secondary stroke prevention in patients with symptomatic carotid artery stenosis. Whereas evidence shows that early revascularization provides an absolute risk reduction of 30% for severe and 15% for moderate carotid artery stenosis treated within 14 days (Lancet 2004;363:915), this is rarely achieved in practice. We sought to identify barriers to carotid revascularization and to implement an early referral process in our institution to achieve this seldom-realized evidence-based standard.

Quality Improvement in Timing and Delivery of Carotid Endarterectomies at The Ottawa Hospital: Is the Pendulum Swinging Too Far?

September 1, 2018 - 00:00
Quality improvement initiatives at The Ottawa Hospital (TOH) have aimed to reduce time between symptom onset and carotid endarterectomy (CEA) delivery. However, recent evidence suggests that perioperative stroke risk may be higher in the hyperacute setting. The study objective was to identify factors—such as timing—that lead to adverse outcomes after CEA.

Quality Improvement in Timing and Delivery of Carotid Endarterectomies at The Ottawa Hospital: Is the Pendulum Swinging Too Far?

September 1, 2018 - 00:00
Quality improvement initiatives at The Ottawa Hospital (TOH) have aimed to reduce time between symptom onset and carotid endarterectomy (CEA) delivery. However, recent evidence suggests that perioperative stroke risk may be higher in the hyperacute setting. The study objective was to identify factors—such as timing—that lead to adverse outcomes after CEA.