Journal of Vascular Surgery

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Updated: 7 hours 34 min ago

MIPS: Clinical practice improvement activities

July 1, 2017 - 00:00
The Quality Payment Program (QPP), established by the Medicare Access and Children's Health Improvement Program (CHIP) Reauthorization Act (MACRA), represents a drastic shift in Medicare reimbursement from volume-based incentives to pay for performance. Under the QPP, providers who bill Medicare must participate in an Advanced Alternative Payment Model (APM) or the Merit-based Incentive Payment System (MIPS) in 2017 to avoid a 4% Medicare reimbursement penalty in 2019. As there are no vascular APMs in 2017, the majority of vascular providers will be participating in MIPS.

Endovascular treatment for claudication still awaits long-term results

July 1, 2017 - 00:00
Ever since the advent of the endovascular revolution, there has been a drive to prove endovascular revascularization to be as good as or better than its surgical counterpart. Countless manuscripts have been published on this topic, and yet we are still far from an evidence-based consensus of what type of revascularization works best for whom. Ohki and colleagues1 “threw down another gauntlet” by evaluating short-term outcomes in a cohort of mostly claudicants with long superficial femoral artery (SFA) lesions treated with self-expanding stent grafts.

Muscle strength and control characteristics are altered by peripheral artery disease

July 1, 2017 - 00:00
Peripheral artery disease (PAD), a common manifestation of atherosclerosis, is characterized by lower leg ischemia and myopathy in association with leg dysfunction. Patients with PAD have impaired gait from the first step they take with consistent defects in the movement around the ankle joint, especially in plantar flexion. Our goal was to develop muscle strength profiles to better understand the problems in motor control responsible for the walking impairment in patients with PAD.

Invited commentary

July 1, 2017 - 00:00
The successful use of fenestrated endografts for the treatment of complex aortic aneurysms was first published nearly 2 decades ago, in 1999.1,2 Now, we are in the midst of a rapid evolution of technical advances in endovascular catheter-based treatments for aortic aneurysms. Endografts designed with scallops, fenestrations, and branches allow for stent grafts to be placed across visceral arteries and great arteries of the arch, while preserving flow to the critical end organs supplied by these arteries.

Invited commentary

July 1, 2017 - 00:00
I want to congratulate Dr Behzad Farivar and colleagues on a well-written manuscript that analyzes the National Surgical Quality Improvement Program (NSQIP) database and focuses attention on the implications of concomitant hypogastric artery embolization and endovascular repair of infrarenal aortoiliac aneurysms.

Percutaneous treatment of adult aortic coarctation with multiple intrathoracic aneurysms

July 1, 2017 - 00:00
The following “vascular images” depict an adult type aortic coarctation (AoC) (A) associated with eight intrathoracic aneurysms originating from thoracic collaterals. Of these aneurysms, three appear particularly large and indicate initial thrombosis (B/Cover).

Midterm outcomes and evolution of gutter area after endovascular aneurysm repair with the chimney graft procedure

June 29, 2017 - 00:00
The objective of this study was to describe our experience with endovascular aneurysm repair (EVAR) with the use of chimney grafts for branch vessel preservation.

Overstenting the hypogastric artery during endovascular aneurysm repair with and without prior coil embolization: A comparative analysis from the ENGAGE Registry

June 27, 2017 - 00:00
Endovascular aneurysm repair of aortoiliac or iliac aneurysms is often performed with stent graft coverage of the origin of the hypogastric artery (HA) to ensure adequate distal seal. It is considered common practice to perform adjunctive coiling of the HA to prevent a type II endoleak. Our objective was to question the necessity of pre-emptive coiling by comparing the outcomes of HA coverage with and without prior coil embolization.

Reduced high-density lipoprotein cholesterol: A valuable, independent prognostic marker in peripheral arterial disease

June 27, 2017 - 00:00
The prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility.

Carotid artery revascularization in patients with contralateral carotid artery occlusion: Stent or endarterectomy?

June 27, 2017 - 00:00
The Centers for Medicare and Medicaid Services (CMS) considers that contralateral carotid artery occlusion puts the patients at high risk for carotid endarterectomy (CEA) and agrees to reimburse for carotid artery stenting (CAS) in these patients. However, there is a paucity of evidence that support the superiority of CAS compared with CEA in patients with contralateral carotid occlusion.