Journal of Vascular Surgery

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Updated: 11 hours 7 min ago

Long-term Outcomes of the Vascular Study Group of New England Carotid Patch Quality Initiative

August 1, 2017 - 00:00
Patch angioplasty has been shown to decrease rates of restenosis after carotid endarterectomy (CEA). In 2003, the Vascular Study Group of New England (VSGNE) began reporting rates of patch closure after CEA as a quality measure. This study reports the long-term outcomes of that initiative including the overall rates of restenosis, neurologic events, and bleeding.

Risk Factor Profile of Previously Asymptomatic Patients Presenting With Carotid-Related Stroke

August 1, 2017 - 00:00
Whereas carotid atherosclerosis-mediated stroke remains a major cause of morbidity and mortality, some have suggested that intervention in carotid stenosis should be limited to symptomatic patients, given advances in medical therapy. This study was conducted to assess atherosclerotic risk factor profiles of those previously asymptomatic patients admitted with stroke of carotid etiology.

How Far Is too Far? The Effect of Increasing Catheter Distance From the Deep Junction on the Outcomes of Vein Ablation

August 1, 2017 - 00:00
The novel sealing technology for saphenous vein ablation (VA) involves treatment starting at 3 to 5 cm distal to the deep junction. In contrast, traditional surgery advocates high ligation of all tributaries at the junction. This study examines the effect of catheter distance from the deep junction on outcomes of VA using radiofrequency.

Disparity in Amputation Risk for Black Patients: Is It Constant Across All Surgeons?

August 1, 2017 - 00:00
Disparities in amputation rates for limb ischemia between white and black patients have been extensively studied. Whereas these disparities have often been attributed to differences in the patient’s disease burden, the goal of this study was to determine whether possible bias in provider decision-making also plays a role in contributing to this disparity. We hypothesized that the magnitude of this disparity would not be consistent across surgeons of different disease-specific operative volumes.

Long-Term Survival After Carotid Endarterectomy and Carotid Stenting: A Propensity-Matched Analysis

August 1, 2017 - 00:00
Survival after carotid endarterectomy (CEA) and carotid artery stenting (CAS) is required for patients to derive a stroke prevention benefit. Randomized trials report no difference, whereas observational studies of “real-world” results document CEA to be associated with a survival advantage. Our objective was to examine long-term survival after CEA vs CAS using a propensity-matched cohort.

The Durability of Open Surgical Repair of Type IV Thoracoabdominal Aneurysm

August 1, 2017 - 00:00
Perioperative outcomes and late mortality after open type IV thoracoabdominal aneurysm (TAAA) repair are described, yet risk of late graft and unrelated aortic events are infrequently reported. Such data are increasingly important as endovascular repair becomes an option and are the subject of this study.

Transperitoneal Open Abdominal Aortic Aneurysm Repair Is Associated with Higher Rates of Late Reintervention and Readmission Compared With the Retroperitoneal Approach

August 1, 2017 - 00:00
There are limited data comparing the transabdominal and retroperitoneal approaches to abdominal aortic aneurysm (AAA) repair. We compared long-term rates of mortality, reintervention, and readmission, including laparotomy-related complications, after open AAA repair through a transabdominal compared with a retroperitoneal approach.

External Validation of the Vascular Study Group of New England Risk Predictive Model of Adverse Outcomes After Carotid Endarterectomy in Procedure-Targeted American College of Surgeons National Surgical Quality Improvement Program Database

August 1, 2017 - 00:00
Previously, we described a Vascular Study Group of New England (VSGNE) risk predictive model to predict composite adverse outcomes (postoperative death, stroke, myocardial infarction, or discharge to extended care facilities) after carotid endarterectomy (CEA). The goal of this study was to externally validate this model in an independent database.

Comparison of Major Adverse Event Rates After Elective Endovascular Aneurysm Repair in the Vascular Study Group of New England Using a Novel Measure of Complication Severity

August 1, 2017 - 00:00
Major adverse event (MAE) rates are used as a measure of outcomes assessment after surgical procedures. Although MAE rates summarize the occurrences of adverse events, they do not reflect differences in severity of these events. We propose that a measure of complication severity could provide a more sensitive assessment about the quality of care. We compare outcomes of elective endovascular aneurysm repair (EVAR) across centers in the Vascular Study Group of New England (VSGNE) using actual MAE rates, predicted MAE rates, complication severity-adjusted MAE rates, and mortality.

Postoperative Opioid Prescribing Patterns After Vascular Surgery

August 1, 2017 - 00:00
The objective of this study was to assess postoperative opioid prescribing patterns and use and pain control after common vascular surgery procedures to develop patient-centered best practice guidelines.

Variation in Timing and Type of Groin Wound Complications Highlights the Need for Uniform Reporting Standards

August 1, 2017 - 00:00
Groin wound infections represent a substantial source of patient morbidity and resource utilization. Definitions and reporting times of groin infections are poorly standardized, which limits our understanding of the true scope of the problem and potentially leads to event under-reporting. Our objective was to investigate the timing and variation of groin wound complications after vascular surgery.

Declining Mortality Rates From Abdominal Aortic Aneurysms Across All Age, Sex, and Racial Groups

August 1, 2017 - 00:00
Abdominal aortic aneurysm (AAA)-related mortality is decreasing since the introduction of endovascular aneurysm repair, but mortality from AAAs by age, sex, and race has not been recently reported.

Postanesthetic Ultrasound Facilitates More Preferential Hemodialysis Access Creation Without Affecting Access Patency

August 1, 2017 - 00:00
Environmental and clinical factors (ambient temperature, acute illness, recent phlebotomy, hypovolemia) affect preoperative ultrasound (US) vein mapping (pre-US) measurements. These factors may drive inadvertent exclusion of viable access construction options. We hypothesized that duplex US re-evaluation in the operating room after anesthetic administration (conscious sedation, regional, general; post-US) would identify preferable (more distal, autogenous) access configurations not appreciated on pre-US.

Increasing the Number of Integrated Vascular Surgery Residency Positions Is Necessary to Address the Impending Shortage of Vascular Surgeons in the United States

August 1, 2017 - 00:00
During the next two decades, the demand for vascular surgeons is expected to far exceed the current supply. Whereas the number of vascular fellowship programs/positions is stable, the number of vascular residency programs/positions has expanded dramatically. We sought to evaluate the qualifications of this new workforce and its ability to meet future needs.

Postdischarge Events After Lower Extremity Revascularization

August 1, 2017 - 00:00
Outcome studies using hospital discharge data likely underestimate postoperative morbidity and mortality after lower extremity revascularization because they fail to capture postdischarge events. However, the degree of underestimation and the timing of postdischarge complications are not well characterized.

Avoid the 4% penalty: Pace yourself into MIPS by October 2, 2017

August 1, 2017 - 00:00
Starting in 2017, providers who receive payment from Medicare must participate in either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APMs). Those who do not participate appropriately will be subject to a 4% payment penalty in 2019 under the Quality Payment Program (QPP).1 The 4% payment penalty would apply to all of a practices' Medicare revenue in 2019.

Endarterectomy achieves lower stroke and death rates compared with stenting in patients with asymptomatic carotid stenosis

August 1, 2017 - 00:00
It is currently unclear if carotid artery stenting (CAS) is as safe as carotid endarterectomy (CEA) for patients with significant asymptomatic stenosis. The aim of our study was to perform a systematic review and meta-analysis of trials comparing CAS with CEA.

Reply

August 1, 2017 - 00:00
We are grateful for the attention our manuscript has received from Kouvelos et al and for the opportunity to clarify their inquiries.

Reply

August 1, 2017 - 00:00
We thank Dr Roy and colleagues for their comments to our article.1 The main finding of this study was that complex fenestrated endovascular aneurysm repair (FEVAR), mainly with three fenestrations (3× FEVAR) was not associated with a higher perioperative risk than standard FEVAR with two fenestrations (2× FEVAR). Therefore, a liberal approach toward adding one extra fenestration whenever needed to achieve a durable proximal sealing zone was suggested.

Current status of carbon dioxide angiography

August 1, 2017 - 00:00
Unfamiliarity of endovascular surgeons with carbon dioxide (CO2) angiography is one of the main reasons for its limited use. This review is intended to familiarize the reader with the principles and applications of that modality.