Journal of Vascular Surgery

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Updated: 3 hours 30 min ago

Inpatient coding and the diagnosis-related group

October 31, 2017 - 23:00
Physicians are compensated based on Current Procedural Terminology (CPT) codes that describe specific evaluations, procedures, and operations performed in the office or in a hospital setting. This is generally referred to as professional reimbursement. When a patient is admitted to the hospital, the facility is remunerated using a separate and distinct system. Virtually all inpatient hospitalizations are reimbursed based on a diagnosis-related group (DRG). DRGs were created as a grouping organization for similar conditions to assess resource utilization and quality of care for inpatient hospitalizations.

Proposed Quality Payment Program changes for 2018

October 31, 2017 - 23:00
Each year, the Centers for Medicare and Medicaid Services (CMS) releases a Notice of Proposed Rule Making, referred to as the “proposed rule,” which details how the Quality Payment Program (QPP) will be implemented in the following calendar year(s). Stakeholders, including the Society for Vascular Surgery, have 60 days to submit comments to CMS.1 The final rule is released late in the year, around November 1st.

Reply

October 31, 2017 - 23:00
We thank Dr Lederle for his Letter to the Editor. We want to express our sincerest apologies for misrepresenting the methodology of the Open Versus Endovascular Repair (OVER) trial. We hope that our analysis in conjunction with the OVER trial helps to elucidate the potential long-term burden of reoperations in open vs endovascular repair of abdominal aortic aneurysms.

Regarding “Reoperation rates after open and endovascular abdominal aortic aneurysm repairs”

October 31, 2017 - 23:00
In their recent paper on reoperation rates after abdominal aortic aneurysm (AAA) repair,1 Hynes et al misinterpreted the methodology of the Open Versus Endovascular Repair (OVER) trial.2 They state in the introduction and discussion that secondary abdominal procedures were included only to 30 days after AAA repair. Our Methods section described secondary therapeutic procedures as “resulting directly or indirectly from the initial procedure and requiring a separate trip to the procedure suite, including any unplanned surgical procedures within 30 days of the initial procedure and any additional aorto-iliac procedures at any time.” The 30-day limit applied only to unplanned procedures not otherwise considered to be related to AAA repair.

Look, listen, and feel

October 31, 2017 - 23:00
Being president of the Society for Clinical Vascular Surgery has been the highlight of my career. I know of no words that can accurately express my deep gratitude to all of you for the privilege to serve as your president.

Regarding “Current practice of thoracic outlet decompression surgery in the United States”

October 31, 2017 - 23:00
We have read with attention and pleasure Rinehardt and colleagues' “Current practice of thoracic outlet decompression surgery in the United States.”1 The authors describe the current management and surgical treatment of a still debated neurovascular condition, thoracic outlet syndrome (TOS). Data from an American national database of 1431 patients who underwent surgical intervention for TOS during 2005 to 2014 were analyzed, including surgical approach and adverse outcomes.1 TOS is defined as a variety of conditions attributed to involvement of the vascular, muscular, and peripheral nervous system at the cervicobrachial anatomic region.

Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms

October 31, 2017 - 23:00
Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair.

The DREAM remains the same

October 31, 2017 - 23:00
In extending follow-up to 12 years after cessation of enrollment, the update published in this issue of the Journal of Vascular Surgery examines the long-term consequences of random assignment to either open or endovascular repair of abdominal aortic aneurysm for participants in the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. This study complements the recently published update of its contemporary trial in the United Kingdom, Endovascular Aneurysm Repair (EVAR) trial 1.1 The main contribution of the DREAM update, at least the sixteenth in the series (PubMed search, June 7, 2017; keywords Blankensteijn and DREAM), is the observation that unlike in the EVAR 1 experience, participants randomized to EVAR in DREAM did not experience increased late all-cause mortality or cancer incidence compared with those treated with open surgical repair.

Invited commentary

October 31, 2017 - 23:00
Infections after placement of a prosthetic graft, for either aortic or peripheral arterial reconstruction, are feared and potentially devastating complications. These infections can have significant morbidity and can also lead to subsequent infections. In this issue of the Journal of Vascular Surgery, Fariñas et al report their experience with postoperative infectious complications after placement of prosthetic grafts for both lower extremity and aortic reconstruction. Their all-cause infection rate was 27.2%.

Invited commentary

October 31, 2017 - 23:00
Dr Harris and colleagues argue that services for vascular acute care surgery (VACS) should be established in tertiary referral centers for nonelective care. Further, they speculate that additional training and advanced certification of vascular surgeons and VACS program accreditation may be required in the future.

Invited commentary

October 31, 2017 - 23:00
The ideal aneurysm repair should be safe, effective, associated with the lowest possible complication rates, and durable to balance the risk of rupture. In performing infrarenal abdominal aortic aneurysm (AAA) repair, it is imperative that any concurrent iliac artery ectasia or aneurysm be adequately addressed in both open repair and endovascular aneurysm repair (EVAR). This paper addresses the important issue of how to manage ectasia and aneurysms of the iliac arteries at the time of EVAR for an aortic aneurysm.

Comparison of percutaneous versus open femoral cutdown access for endovascular repair of ruptured abdominal aortic aneurysms

October 31, 2017 - 23:00
Ruptured endovascular aortic aneurysm repair (REVAR) is being increasingly used to treat ruptured abdominal aortic aneurysms (rAAAs). However, the comparison between totally percutaneous (pREVAR) vs femoral cutdown (cREVAR) access for REVAR has not been studied. We used a national surgical database to evaluate the 30-day outcomes in patients undergoing pREVAR vs cREVAR.

Inflammatory aneurysm of ileocolic artery discovered on fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography

October 31, 2017 - 23:00
A 68-year-old man with periodontal disease presented with a 2-month history of recurrent fevers. Although much effort had been expended to identify the cause of fever, the origin remained unclear. The patient was referred to our hospital for further diagnostic workup. Blood tests showed an elevated white blood cell count (16.7 × 109 cells/L) and C-reactive protein level of 4.48 mg/dL, but were otherwise normal. A blood culture resulted in growth of Streptococcus sanguinis. Echocardiography showed no pathognomonic findings of infectious endocarditis.

Predictors of delayed wound healing after successful isolated below-the-knee endovascular intervention in patients with ischemic foot ulcers

October 30, 2017 - 23:00
The purpose of this study was to explore the predictors of delayed wound healing and their use in risk stratification for endovascular treatment (EVT) of patients with critical limb ischemia (CLI) due to isolated below-the-knee lesions.

Comparison of sacrificed healthy aorta during thoracoabdominal aortic aneurysm repair using off-the-shelf endovascular branched devices and open surgery

October 30, 2017 - 23:00
Off-the-shelf devices for branched endovascular aortic repair of thoracoabdominal aortic aneurysm (TAAA) have been developed to overcome the manufacturing- and logistics-related delays characteristic of device customization. Nonetheless, the structural requirements of branched endovascular aortic repair, together with the need for additional thoracic components to suit different anatomies, might lead to a large sacrifice of healthy aorta.

Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair

October 29, 2017 - 23:00
Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this.

Standard “off-the-shelf” multibranched thoracoabdominal endograft in urgent and elective patients with single and staged procedures in a multicenter experience

October 29, 2017 - 23:00
The objective of this study was to assess immediate and midterm outcomes for urgent/emergent and elective patients with thoracoabdominal aortic aneurysms (TAAAs) treated with the first commercially available “off-the-shelf” multibranched endograft for endovascular aneurysm repair, with a single-step or a staged surgical approach.

Comparable perioperative mortality outcomes in younger patients undergoing elective open and endovascular abdominal aortic aneurysm repair

October 29, 2017 - 23:00
Evidence for benefit of endovascular aneurysm repair (EVAR) over open surgical repair for de novo infrarenal abdominal aortic aneurysms (AAAs) in younger patients remains conflicting because of heterogeneous study populations and small sample sizes. The objective of this study was to compare perioperative and short-term outcomes for EVAR and open surgery in younger patients using a large national disease and procedure-specific data set.

Clinical characteristics and outcome of isolated infrarenal aortic stenosis in young patients

October 29, 2017 - 23:00
The objective of this study was to identify young patients with isolated infrarenal aortic atherosclerotic stenosis and to determine the clinical characteristics and midterm results of angioplasty and stenting.

Discussion

October 23, 2017 - 23:00
Dr Daniel F. Fisher (Chattanooga, Tenn). This paper is a thought-provoking report about 811 amputations done at Montefiore Medical Center in New York during the 5-year period from 2009 to 2014. I understand that all of these cases were done within the general surgery residency program at that hospital under the direct supervision of an attending surgeon. Sixty percent of these amputations were below-the-knee amputations (BKAs); 40% percent were above-the-knee amputations (AKAs). The 30-day readmission rate was 29%—one-third of this number were due to stump complications.