Journal of Vascular Surgery

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Variation in Center-Level Frailty Burden and Its Impact on Long-Term Survival in Patients Undergoing Repair for Abdominal Aortic Aneurysms

September 1, 2018 - 00:00
Frailty is increasingly recognized as a key determinate in predicting postoperative outcomes. Centers may see patients who are more frail, potentially accounting for poorer outcomes in hospital comparisons that may not be captured in risk adjustment. We aimed to evaluate the variability in frailty burden among centers in the Vascular Quality Initiative database and to determine the effect of frailty on long-term mortality in patients undergoing abdominal aortic aneurysm (AAA) repair.

Variation in Center-Level Frailty Burden and Its Impact on Long-Term Survival in Patients Undergoing Repair for Abdominal Aortic Aneurysms

September 1, 2018 - 00:00
Frailty is increasingly recognized as a key determinate in predicting postoperative outcomes. Centers may see patients who are more frail, potentially accounting for poorer outcomes in hospital comparisons that may not be captured in risk adjustment. We aimed to evaluate the variability in frailty burden among centers in the Vascular Quality Initiative database and to determine the effect of frailty on long-term mortality in patients undergoing abdominal aortic aneurysm (AAA) repair.

Factors Associated With Microembolization After Carotid Intervention

September 1, 2018 - 00:00
Microembolization after carotid artery stenting (CAS) and carotid endarterectomy (CEA) has been documented and may confer risk for neurocognitive impairment. Patients undergoing stenting are known to be at higher risk for microemoblization. In this prospective cohort study, we compare the microembolization rates for patients undergoing CAS and CEA and patient and perioperative characteristics that may be associated with microembolization.

Factors Associated With Microembolization After Carotid Intervention

September 1, 2018 - 00:00
Microembolization after carotid artery stenting (CAS) and carotid endarterectomy (CEA) has been documented and may confer risk for neurocognitive impairment. Patients undergoing stenting are known to be at higher risk for microemoblization. In this prospective cohort study, we compare the microembolization rates for patients undergoing CAS and CEA and patient and perioperative characteristics that may be associated with microembolization.

Initial Open Versus Endovascular Treatment and Subsequent Limb Loss After Primary Minor Amputation

September 1, 2018 - 00:00
Studies of major amputation after initial minor amputation are limited; rates of subsequent major amputation range from 14% to 34%, with a limited understanding for associated comorbidities and time to subsequent amputation. We sought to determine major amputation rates for patients who undergo initial minor amputation and to determine which factors are associated with limb preservation with open vs endovascular treatment.

Initial Open Versus Endovascular Treatment and Subsequent Limb Loss After Primary Minor Amputation

September 1, 2018 - 00:00
Studies of major amputation after initial minor amputation are limited; rates of subsequent major amputation range from 14% to 34%, with a limited understanding for associated comorbidities and time to subsequent amputation. We sought to determine major amputation rates for patients who undergo initial minor amputation and to determine which factors are associated with limb preservation with open vs endovascular treatment.

Financial Analysis of Fenestrated Endovascular Aortic Aneurysm Repair at a High-Volume Medical Center

September 1, 2018 - 00:00
The objective of this study was to examine hospital finances and physician reimbursement associated with fenestrated endovascular aneurysm repair (FEVAR) for complex aortic disease at a high-volume aortic center. Costs and reimbursement for FEVAR were compared with those for open repair, and their trends were analyzed over time.

Financial Analysis of Fenestrated Endovascular Aortic Aneurysm Repair at a High-Volume Medical Center

September 1, 2018 - 00:00
The objective of this study was to examine hospital finances and physician reimbursement associated with fenestrated endovascular aneurysm repair (FEVAR) for complex aortic disease at a high-volume aortic center. Costs and reimbursement for FEVAR were compared with those for open repair, and their trends were analyzed over time.

Lower Extremity Revascularization in the Medicare Population: The Ongoing Rise of Office-Based Atherectomy

September 1, 2018 - 00:00
Peripheral artery disease is a growing health care burden, with rising costs related to use of lower extremity revascularization (LER). We sought to examine recent trends in procedure volumes by level of disease, provider specialty, and encounter setting.

Lower Extremity Revascularization in the Medicare Population: The Ongoing Rise of Office-Based Atherectomy

September 1, 2018 - 00:00
Peripheral artery disease is a growing health care burden, with rising costs related to use of lower extremity revascularization (LER). We sought to examine recent trends in procedure volumes by level of disease, provider specialty, and encounter setting.

Cost-Effectiveness of Repeated Interventions on Failing Arteriovenous Fistulas: When Is It Time to Start Over?

September 1, 2018 - 00:00
Arteriovenous fistulas (AVFs) used for hemodialysis commonly undergo multiple percutaneous and open interventions to maintain function patency, but it is unclear whether this strategy is cost-effective. The aim of this study was to evaluate the cost-effectiveness of performing repeated interventions vs starting a new AVF.

Cost-Effectiveness of Repeated Interventions on Failing Arteriovenous Fistulas: When Is It Time to Start Over?

September 1, 2018 - 00:00
Arteriovenous fistulas (AVFs) used for hemodialysis commonly undergo multiple percutaneous and open interventions to maintain function patency, but it is unclear whether this strategy is cost-effective. The aim of this study was to evaluate the cost-effectiveness of performing repeated interventions vs starting a new AVF.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR). It is associated with shorter recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and the economic impact of P-EVAR has important implications for resource allocation. The objective of our study was to determine the differences in cost between P-EVAR and S-EVAR.

Percutaneous Approach to Endovascular Aortic Aneurysm Repair: A Cost-Minimization Study

September 1, 2018 - 00:00
Percutaneous access for endovascular aneurysm repair (P-EVAR) is less invasive compared with surgical access (S-EVAR). It is associated with shorter recovery and fewer wound complications. However, vascular closure devices (VCDs) are costly, and the economic impact of P-EVAR has important implications for resource allocation. The objective of our study was to determine the differences in cost between P-EVAR and S-EVAR.

Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas: Analysis Based on Duplex Ultrasound Simulation

September 1, 2018 - 00:00
Volume flow measurements obtained by duplex ultrasound (DU) are recommended for monitoring arteriovenous dialysis access fistulas (DAFs) and assessing maturation. We developed a DU simulator and used it to assess the accuracy of volume flow measurements.

Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas: Analysis Based on Duplex Ultrasound Simulation

September 1, 2018 - 00:00
Volume flow measurements obtained by duplex ultrasound (DU) are recommended for monitoring arteriovenous dialysis access fistulas (DAFs) and assessing maturation. We developed a DU simulator and used it to assess the accuracy of volume flow measurements.

Lower Extremity Revascularization With Transmetatarsal Amputation Improves Healing and Reduces Major Amputation

September 1, 2018 - 00:00
A transmetatarsal amputation (TMA) allows patients with forefoot wounds to maintain ambulatory function and preserves a sensate heel and ankle. However, healing after TMA is often compromised in older patients by peripheral artery disease (PAD). The aim of this study was to investigate the effect of lower extremity revascularization (LER) on TMA healing and prevention of major amputation.

Lower Extremity Revascularization With Transmetatarsal Amputation Improves Healing and Reduces Major Amputation

September 1, 2018 - 00:00
A transmetatarsal amputation (TMA) allows patients with forefoot wounds to maintain ambulatory function and preserves a sensate heel and ankle. However, healing after TMA is often compromised in older patients by peripheral artery disease (PAD). The aim of this study was to investigate the effect of lower extremity revascularization (LER) on TMA healing and prevention of major amputation.

Lessons Learned From the Largest Cohort of Type III Endoleaks With the Endologix AFX Stent Graft

September 1, 2018 - 00:00
Our institution has noted a continual rise in the incidence of late graft failure by type III endoleak (T3EL) with early-generation AFX (Endologix, Irvine, Calif) endografts. We also noted repeated T3ELs in these patients treated with bridging AFX grafts. Previous authors noted a much lower incidence of T3EL (0%-5%) but high aneurysm-related mortality (18%) when repairing T3ELs with bridging grafts. Failure rates may be due to significant aortic remodeling in this population.

Lessons Learned From the Largest Cohort of Type III Endoleaks With the Endologix AFX Stent Graft

September 1, 2018 - 00:00
Our institution has noted a continual rise in the incidence of late graft failure by type III endoleak (T3EL) with early-generation AFX (Endologix, Irvine, Calif) endografts. We also noted repeated T3ELs in these patients treated with bridging AFX grafts. Previous authors noted a much lower incidence of T3EL (0%-5%) but high aneurysm-related mortality (18%) when repairing T3ELs with bridging grafts. Failure rates may be due to significant aortic remodeling in this population.