Journal of Vascular Surgery

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Use of Indocyanine Green Fluorescence Imaging in Predicting Distal Ischemia After Arteriovenous Fistula Placement

December 31, 2018 - 23:00
Vascular steal syndrome of the distal extremity following AV fistula placement can occur in up to 3% to 8% of patients. This occurrence often leads to additional surgery such as the distal revascularization, interval ligation (DRIL) procedure or fistula ligation. Although multiple risk factors have been shown to be associated with steal, there currently exists no reliable means by which to predict its development at the time of fistula creation. The purpose of this study was to apply a well-established perfusion measurement examination to the ipsilateral hand at the time of access to identify those patients at high risk for steal syndrome.

Fenestrated/Branched Endovascular Aortic Repair in Patients With Chronic Kidney Disease

December 31, 2018 - 23:00
Renal function impairment is a common complication after open repair of complex abdominal aortic aneurysms (AAAs) and thoracoabdominal aneurysms (TAAA). Fenestrated/branched endovascular aneurysm repair (F-BEVAR) has emerged as an alternative to open repair with improved perioperative outcomes. The effects of chronic kidney disease (CKD) on renal function after F-BEVAR has not been established. The purpose of this study was to assess renal perioperative outcomes and renal function deterioration after F-BEVAR in patients with CKD.

Clinical Outcome of Drug-Eluting Balloon Angioplasty in Patients With Femoropopliteal Disease: Real-World Single Center Experience

December 31, 2018 - 23:00
Several multicenter industry sponsored clinical trials reported satisfactory results in the use of drug-eluting balloons for the treatment of femoropopliteal occlusive disease. However, few single-center studies were published to verify the outcome from real world experience.

Missed Readmissions to a Different Hospital in Patients With Peripheral Vascular Disease Associated With Significantly Higher Mortality

December 31, 2018 - 23:00
Currently, there is a need for accurate nationally representative studies on 30-day readmissions. The 30-day readmission rate, which is now a quality outcome measured by the Centers for Medicare and Medicaid Services, has been previously studied on databases that exclude some payer types, states, or certain important data points. Furthermore, current studies do not take into account readmissions that occur at a hospital different from the index admission. This gap allows for potentially flawed data.

Process Improvement in Prophylaxis for Venous Thromboembolism

December 31, 2018 - 23:00
Venous thromboembolism (VTE) is associated with potentially preventable in-hospital morbidity and mortality. Although evidence-based guidelines for the prevention of VTE are widely available, their application in clinical practice varies markedly. VTE prevention relies on the correct risk stratification of the individual patient, ordering of the indicated chemical or mechanical prophylaxis and, finally, the delivery of this treatment throughout the continuum of the hospital stay. The aim of our study was to identify failure modes in VTE prophylaxis and use these as targets for intervention to decrease VTE incidence rates.

Outcomes of Staged Versus Primary Amputations for Diabetic Foot Disease

December 31, 2018 - 23:00
Lower extremity amputations (LEAs) are among the most common procedures performed by vascular surgeons in patients with diabetes and peripheral vascular disease. This population commonly suffers from readmission, wound complication, and conversion to more proximal amputation. These events impact quality in terms of cost, resources, and subjective quality of life. The aim of this study is to compare outcomes between primary LEA (pLEA) and staged guillotine amputation followed by interval formalization (sLEA) for diabetic foot disease.

Scope and Prevalence of Conflicts of Interest Among Highly Cited Peripheral Artery Disease Research Studies

December 31, 2018 - 23:00
Conflicts of interest (COI) potentially influence interpretation of study results for both authors and journal readers. Scientific journals often require author disclosure of relevant conflicts, but this is usually by self-report and seldom includes detailed quantification of reimbursement. The purpose of this analysis was to characterize COI among highly cited research studies related to peripheral artery disease (PAD) in terms of prevalence, quantity of reimbursement, and associations with manuscript characteristics.

Development of a Multifunctionalized Vascular Scaffolding System to Induce In Situ Endothelialization

December 31, 2018 - 23:00
Vascular tissue engineered grafts are one of the most promising alternatives to small-diameter prosthetic grafts, which often require reintervention within a decade of use. Previous methods of seeding vascular grafts with autologous patient cells have been successful; however, grafts constructed through these methods require copious amounts of preparation time before implantation. The growth or deposition of endothelial cells (ECs) onto the luminal surface of the prosthetic vessel may be critical for optimal physiological integration of a vascular scaffold to the host environment.

Influence of Hospital Volume on Patient Selection, Risk of Complications, and Mortality From Failure to Rescue After Open Abdominal Aortic Aneurysm Repair

December 31, 2018 - 23:00
The effect of hospital volume (HV) on mortality after open abdominal aortic aneurysm repair (OAAA) is well-known; however, the underlying mechanism for improved outcomes is poorly understood. Better patient selection, lower risk of complications, and improved ability to rescue patients after adverse events are assumed mechanisms, but few data exist to validate this hypothesis. The purpose of this analysis was to determine the influence of HV on patient selection, incidence of complications and failure to rescue (FTR) after adverse events resulting from OAAA repair.

Impact of Suprarenal Neck Angulation on Endovascular Repair Outcomes

December 31, 2018 - 23:00
Hostile infrarenal proximal neck (β) anatomy of abdominal aortic aneurysm (AAA) has been associated with increased risk of aneurysm-related complications after endovascular repair (EVAR). However, there is a paucity of literature addressing the suprarenal angle (α). The aim of this study is to evaluate short and long-term outcomes after EVAR in patients with severe suprarenal neck angulation (>60°).

Association of Preoperative Spinal Drainage Placement With Spinal Cord Ischemia Among Patients Undergoing Thoracic Endovascular Aortic Repair

December 31, 2018 - 23:00
Spinal cord ischemia (SCI) is among the most devastating complications of thoracic endovascular aortic repair (TEVAR). Spinal fluid drainage has been proposed as a viable means to reduce SCI, but few data exist to support its routine use. This study investigated the association of preoperative spinal fluid drainage with risk of SCI after TEVAR.

Type B Aortic Intramural Hematoma: To TEVAR or not to TEVAR?

December 31, 2018 - 23:00
Intramural hematoma (IMH) is on the spectrum of acute aortic syndrome but optimal management is poorly understood. The aim of this study was to evaluate outcomes of patients with type B IMH after best medical therapy (BMT), and assess what variables are associated with failure of BMT

Comparative Outcomes of Open, Hybrid, and Fenestrated Branched Endovascular Repair of Extent II and III Thoracoabdominal Aortic Aneurysms

December 31, 2018 - 23:00
Open repair of Crawford extent II and III thoracoabdominal aortic aneurysms (TAAA) is associated with substantial perioperative risk. In an effort to decrease this risk, endovascular technologies are increasingly used and include either a hybrid operation combining proximal thoracic endovascular aortic repair followed by staged open distal TAAA repair (hybrid) or a total endovascular approach using fenestrated/branched endografts (FEVAR). However, the benefits of these alternative approaches compared with open surgery remains unclear.

Technical video of endovascular repair of chronic postdissection thoracoabdominal aortic aneurysm using a five-vessel preloaded fenestrated-branched stent graft

December 31, 2018 - 23:00
Fenestrated-branched endovascular repair has been applied to treat chronic postdissection thoracoabdominal aortic aneurysms (TAAAs). We report a patient with diffuse postdissection aortic aneurysm involving the arch and thoracoabdominal aorta treated in a staged fashion with redo aortic arch repair using the frozen elephant trunk technique, followed by completion endovascular TAAA using preloaded guidewire system and a five-vessel fenestrated and branched stent graft. A technical video illustrates the use of onlay fusion and sequential catheterization with the preloaded guidewire system to facilitate TAAA repair.

Regarding “Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients”

December 31, 2018 - 23:00
We read, with interest, “Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients” by Yang et al.1 Central venous catheter insertion is associated with morbidity and mortality,2 with catheter-related right atrial thrombosis (CRAT) described as one common complication in end-stage renal disease patients requiring hemodialysis.3 Yang et al described 20 end-stage renal disease patients with tunneled-cuffed catheters treated for CRAT. Tunneled-cuffed catheter placement was performed secondary to recurrent arteriovenous fistula failure in 18 (90%) patients and refusal of arteriovenous fistula for personal reasons in two (10%) patients.

Reply

December 31, 2018 - 23:00
We greatly appreciate the comment of Drs Ghannam, Chick, and Srinivasa. Chick and colleagues have conducted a study examining the benign management of catheter tip-associated thrombi1 and have raised the question of the necessity of anticoagulation and catheter removal in hemodialysis patients. For the management of catheter-related right atrial thrombosis (CRAT) in hemodialysis patients in our study, we treated our patients effectively by replacing catheters and providing oral anticoagulation and antiplatelet therapies.

The proposed UK abdominal aortic aneurysm guidelines: A much needed wakeup call

December 31, 2018 - 23:00
Broadly categorized, surgical revolutions come in three major forms: technical, philosophical, and transformative.

Invited commentary

December 31, 2018 - 23:00
Kapetanios and colleagues have comprehensively reviewed the published literature on the use of contrast-enhanced ultrasound (CEUS) for detection of endoleaks after endovascular aneurysm repair (EVAR). Unfortunately, the methodology used may only amplify biases present in the reviewed publications. Thus, analyses in the current review do not provide substantial new insights.

Discussion

December 31, 2018 - 23:00
Michael M. McNally (Knoxville, Tenn). I want to congratulate Dr Sabra and authors from the University of Florida Jacksonville on their research and presentation on Blunt Traumatic Aortic Injury Occurring at Unusual Locations. This study is a single-institution retrospective study investigating 74 consecutive patients with blunt traumatic aortic injury. The identified patients were then divided between usual and unusual locations based off an anatomic division 5 cm below the left subclavian artery.

Identification of unique characteristics and the management of blunt traumatic aortic injuries occurring at unusual locations in the descending thoracic aorta

December 31, 2018 - 23:00
The usual location of thoracic blunt traumatic aortic injury (BTAI) is just distal to the left subclavian artery; however, injuries can also be found in other locations in the descending thoracic aorta (DTA).