Journal of Vascular Surgery

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Overuse of early peripheral vascular interventions for claudication

June 14, 2019 - 00:00
Guidelines from the Society for Vascular Surgery and the Choosing Wisely campaign recommend that peripheral vascular interventions (PVIs) be limited to claudication patients with lifestyle-limiting symptoms only after a failed trial of medical and exercise therapy. We sought to explore practice patterns and physician characteristics associated with early PVI after a new claudication diagnosis to evaluate adherence to these guidelines.

A systematic review and meta-analysis of isolated abdominal aortic dissection

June 13, 2019 - 00:00
Isolated abdominal aortic dissection (IAAD) has remained poorly understood because of its rarity. We explored the prevalence, clinical characteristics, risk factors, imaging characteristics, and treatment strategy of IAAD to facilitate its diagnosis and treatment.

Association between surgical repair of aortic aneurysms and the diagnosis of intracranial aneurysms

June 13, 2019 - 00:00
Aortic aneurysms (AAs) and intracranial aneurysms (IAs) share several clinical risk factors, a genetic predisposition, and molecular signaling pathways. Nonetheless, associations between IAs and AAs remain to be thoroughly validated in large-scale studies. In addition, no effective medical therapies exist for unruptured IAs or AAs.

Clinical validation of three-dimensional ultrasound for abdominal aortic aneurysm

June 13, 2019 - 00:00
Three-dimensional ultrasound (3D-US) examination is a relatively new modality that can be used for abdominal aortic aneurysm (AAA) surveillance, and may offer improved reproducibility over conventional two-dimensional ultrasound (2D-US) examination. The aim of this study was to evaluate the interoperator reproducibility of maximum anterior-to-posterior diameter by nonphysician ultrasound technicians in a typical vascular laboratory setting, on patients with infrarenal AAAs using 3D-US and 2D-US examination.

Health literacy and abdominal aortic aneurysms

June 13, 2019 - 00:00
Little is known about the public's knowledge of abdominal aortic aneurysms (AAA). Although preventive screening is available, millions of Americans remain unaware of their risk. Improved health literacy has been associated with increased screening and improvement in health outcomes. This study assessed the level of AAA literacy among respondents who participated in a free AAA screening event.

Development of gene therapy with a cyclic adenosine monophosphate response element decoy oligodeoxynucleotide to prevent vascular intimal hyperplasia

June 13, 2019 - 00:00
Intimal hyperplasia (IH) is the main cause of therapeutic failure after vascular and endovascular surgery. However, there is currently no targeted therapy for the treatment of IH. We recently reported that the inhibition of cyclic adenosine monophosphate response element (CRE) binding protein (CREB) activation is important in vein graft IH. We focused on a decoy oligodeoxynucleotide (ODN) therapeutic strategy for suppressing IH as a clinical application. The objective of this study was to confirm the therapeutic effect of a CRE decoy ODN in an animal model as a novel therapy for preventing intimal hyperplasia as the first step of the preclinical study of our strategy.

Impact of office-based laboratories on physician practice patterns and outcomes after percutaneous vascular interventions for peripheral artery disease

June 13, 2019 - 00:00
Percutaneous vascular interventions (PVIs) for peripheral artery disease have shifted from hospital-based facilities to office-based laboratories (OBLs). The transition to OBLs is due to a variety of factors such as technology advancement, increased efficiency, and financial incentives. We evaluated the impact of physicians switching to OBLs use from hospital-based facilities on procedure volume, procedure type, and patient outcomes.

Socioeconomic Distressed Communities Index associated with worse limb-related outcomes after infrainguinal bypass

June 13, 2019 - 00:00
Several studies have demonstrated that socioeconomic factors may affect surgical outcomes. Analyses in vascular surgery have been limited by the availability of individual or community-level socioeconomic data. We sought to determine whether the Distressed Communities Index (DCI), a composite socioeconomic ranking by ZIP code, could predict short- and long-term outcomes for patients with peripheral artery disease.

Imaging characteristics of acute type A aortic dissection and candidacy for repair with ascending aortic endografts

June 12, 2019 - 00:00
Acute type A aortic dissection (ATAD) remains associated with substantial short-term mortality, and despite increasing rates of surgical repair, as many as 10% to 20% of patients do not undergo surgery because of comorbidities and dissection-related complications. For patients unable to undergo open repair, previous attempts at endovascular treatment of ATAD used devices originally designed for deployment in the descending thoracic aorta. Industry has begun to support early investigational devices meant specifically for placement within the ascending aorta.

Discussion

June 10, 2019 - 00:00
Dr Kristina A. Giles (Gainesville, Fla). The authors present their work from the Nationwide Readmissions Database looking at readmissions in patients after intervention for peripheral vascular disease. The unique facet of this paper is that they were able to identify readmissions to nonindex hospitals and this totaled nearly a quarter of all of the readmissions. Overall, 30-day readmission rates were 22% for critical limb ischemia but surprisingly 9% for claudication. Additionally, they identified a number of factors that predicted early readmission to unindexed hospitals.

Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms

June 5, 2019 - 00:00
Several studies of biomechanical rupture risk assessment (BRRA) showed its advantage over the diameter criterion in rupture risk assessment of abdominal aortic aneurysm (AAA). However, BRRA studies have not investigated the predictability of biomechanical risk indices at different time points ahead of rupture, nor have they been performed blinded for biomechanical analysts. The objective of this study was to test the predictability of the BRRA method against diameter-based risk indices in a quasi-prospective patient cohort study.

Cigarette smoking intensity informs outcomes after open revascularization for peripheral artery disease

June 5, 2019 - 00:00
Cigarette smoking is the leading risk factor for peripheral artery disease (PAD). Existing literature often defines smoking history in broad categories of current, former, and never smokers, which may not sufficiently identify patients at the highest risk for poor outcomes. The purpose of this study was to examine the use of more informative categorization of smoking and to determine the association with important revascularization outcomes.

Perioperative blood transfusion in anemic patients undergoing elective endovascular abdominal aneurysm repair

June 5, 2019 - 00:00
Although blood transfusion can be lifesaving in active hemorrhage or severe anemia, it is also associated with increased morbidity and mortality. Several trials have established this risk and therefore defined a restrictive standard for transfusion, but this threshold and the risk of transfusions have not been specifically examined in vascular surgery patients. We therefore sought to assess transfusion practices and outcomes of anemic patients undergoing elective endovascular aneurysm repair (EVAR).

Comparison of type B dissection by open, endovascular, and medical treatments

June 5, 2019 - 00:00
This study aimed to address the shortcomings of previous clinical trials that were inadequate to prove the superiority of thoracic endovascular aortic repair (TEVAR) in managing type B aortic dissection (TBAD) over open surgery (OS) or best medical treatment (BMT). The comparative effectiveness of these three treatments was analyzed using data of the National Inpatient Sample, a large U.S. database including patients from 4378 hospitals.

Integrated residency is associated with an increase in women among vascular surgery trainees

June 5, 2019 - 00:00
During the past decade, the proportion of women within graduate medical education has increased. Correspondingly, the proportion of women in almost every specialty has increased, including surgical specialties. We sought to evaluate the effect of establishing vascular surgery integrated residencies (VSIRs) on the proportion of women in vascular surgery training programs.

Cost-minimization study of the percutaneous approach to endovascular aortic aneurysm repair

June 5, 2019 - 00:00
Percutaneous access for endovascular aortic aneurysm repair (P-EVAR) is less invasive compared with surgical access for endovascular aortic aneurysm repair (S-EVAR). P-EVAR has been associated with shorter recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and the economic effects of P-EVAR have important implications for resource allocation. The objective of our study was to estimate the differences in the costs between P-EVAR and S-EVAR.

Meta-analysis of the outcomes of revascularization after intentional coverage of the left subclavian artery for thoracic endovascular aortic repair

June 5, 2019 - 00:00
Coverage of the left subclavian artery (LSA) is often required to achieve complete proximal sealing during thoracic endovascular aortic repair. However, whether LSA revascularization should be performed remains controversial.

Real-world cost analysis of endovascular repair versus open repair in patients with nonruptured abdominal aortic aneurysms

June 3, 2019 - 00:00
The aim of this study was to provide a nationwide, all-payer, real-world cost analysis of endovascular aortic aneurysm repair (EVAR) versus open aortic aneurysm repair (OAR) in patients with nonruptured abdominal aortic aneurysms (non-rAAA).

Information for Readers

June 1, 2019 - 00:00
Communications regarding original articles and editorial management should be addressed to Peter Gloviczki, MD, and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery, 9400 W. Higgins Road, Suite 315, Rosemont IL 60018; telephone: 312-334-2355; fax: 312-334-2320; e-mail: JVASCSURG@vascularsociety.org. Information for authors appears in the January and July issues, at www.jvascsurg.org, and at jvs.editorialmanager.com. Authors should consult this document before submitting manuscripts to this Journal.

Contents

June 1, 2019 - 00:00