Journal of Vascular Surgery

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Impact of external carotid artery occlusion at declamping of the external and common carotid arteries during carotid endarterectomy on development of new postoperative ischemic cerebral lesions

June 27, 2018 - 00:00
The external carotid artery (ECA) is inadvertently occluded during carotid endarterectomy (CEA). The importance of ECA occlusion has been emphasized as a loss of extracranial to intracranial collaterals, a source of chronic embolization, or a site for extended thrombosis during wound closure. This study aimed to determine whether ECA occlusion that inadvertently developed during endarterectomy and that was eventually detected using blood flow measurement of the ECA after declamping of all carotid arteries is a risk factor for development of new postoperative ischemic lesions at declamping of the ECA and common carotid artery (CCA) while clamping the internal carotid artery (ICA).

Fascial suture technique versus open femoral access for thoracic endovascular aortic repair

June 27, 2018 - 00:00
Fascial suture technique (FST) has proved to be a safe and effective access closure technique after endovascular repair of the abdominal aorta. FST has not yet been investigated for closure of large-bore access after thoracic endovascular aortic repair (TEVAR). The aim of this study was to compare FST with open femoral access in terms of access safety, hemostasis efficacy, and reintervention rate after TEVAR.

Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016)

June 27, 2018 - 00:00
Ruptured aortic aneurysms (rAAs) are associated with high mortality. The purpose of this study was to describe the trends of deaths due to rAA in the United States.

A comparison of different surfactants on foam stability in foam sclerotherapy in vitro

June 25, 2018 - 00:00
This article compares the effect of different surfactants on foam stability and determines the foam decay relationship, so that the suitability of surfactants in a clinical setting can be evaluated.

Safety and durability of infrarenal aorta as distal landing zone in fenestrated or branched endograft repair for thoracoabdominal aneurysm

June 23, 2018 - 00:00
Manufacturers often recommend the iliac arteries as the distal landing zone in fenestrated or branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aneurysm. It is not uncommon to choose distal landing at the infrarenal aorta for preservation of lumbar arteries or the inferior mesenteric artery (IMA); however, the safety and durability of this procedure have not been verified in the literature.

A contemporary, 7-year analysis of vascular injury from the war in Afghanistan

June 23, 2018 - 00:00
Vascular injury is a leading cause of death and disability in military and civilian trauma. Although a previous interim study defined the distribution of vascular injury during the wars in Iraq and Afghanistan, a contemporary epidemiologic assessment has not been performed. The objective of this study was to provide a current analysis of vascular injury during the final 7 years of the war in Afghanistan, including characterization of anatomic injury patterns, mechanisms of injury, and methods of acute management.

Risk factors for perioperative mortality after revascularization for acute aortic occlusion

June 23, 2018 - 00:00
Acute aortic occlusion (AAO) is a life-threatening event necessitating prompt revascularization to the pelvis and lower extremities. Because of its uncommon nature, outcomes after revascularization for AAO are not well characterized. Our aim was to describe the perioperative morbidity and mortality associated with revascularization and to identify the patients at highest risk.

Patients with end-stage renal disease have poor outcomes after endovascular abdominal aortic aneurysm repair

June 23, 2018 - 00:00
Although endovascular repair of abdominal aortic aneurysms (AAAs) has been demonstrated to have favorable outcomes, not all cohorts of patients with AAA fare equally well. Our goal was to investigate perioperative and 1-year outcomes in patients with end-stage renal disease (ESRD) on dialysis, who have traditionally fared worse after vascular interventions, to assess how ESRD affects outcomes in a large modern cohort of endovascular aneurysm repair (EVAR) patients.

Cerebrovascular injuries found in acute type B aortic dissections are associated with blood pressure derangements and poor outcome

June 23, 2018 - 00:00
Cerebrovascular injury (CVI) is a recognized but underappreciated complication of acute type B aortic dissection (ATBAD). This study was performed to determine risk factors for CVI associated with ATBAD and, in particular, the possible contributory role of aggressive anti-impulse therapy.

Transcarotid artery revascularization versus transfemoral carotid artery stenting in the Society for Vascular Surgery Vascular Quality Initiative

June 22, 2018 - 00:00
Recent evidence from the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial in high-risk patients undergoing transcarotid artery stenting with dynamic flow reversal reported the lowest stroke rate compared with any prospective trial of carotid artery stenting. However, clinical trials have selection criteria that exclude many patients from enrollment and are highly selective of operators performing the procedures, which limit generalizability.

The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications

June 22, 2018 - 00:00
Postoperative delirium (POD) has a high prevalence among vascular surgery patients, increasing morbidity, mortality, and length of stay. We prospectively studied preoperative risk factors for delirium that can be assessed by the surgical team to identify high-risk patients and assessed its impact on hospital costs.

Shear rate is a better marker of symptomatic ischemic cerebrovascular events than velocity or diameter in severe carotid artery stenosis

June 22, 2018 - 00:00
This study was designed to test the hypothesis that the high shear rate of flow in the area of carotid stenosis is associated with the incidence of ischemic symptoms in patients with a high degree of carotid stenosis.

Outcomes from the Gore Global Registry for Endovascular Aortic Treatment in patients undergoing thoracic endovascular aortic repair for type B dissection

June 22, 2018 - 00:00
The Global Registry for Endovascular Aortic Treatment (GREAT) is a prospective multicenter registry collecting real-world data on the performance of W. L. Gore (Flagstaff, Ariz) aortic endografts. The purpose of the present study was to analyze the implementation and outcomes of thoracic endovascular aortic repair (TEVAR) in GREAT patients with type B aortic dissection (TBAD).

Another means to meet MIPs requirements: The virtual group

June 21, 2018 - 00:00
The Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) requires eligible providers to participate in an Advanced Payment Model or in the Merit-based Incentive Payment System (MIPS). Providers can participate in MIPS as individuals or as a group. Beginning in 2018, providers also have the option to participate in MIPS as a virtual group.

Discussion

June 21, 2018 - 00:00
Dr Francesco Aiello (Worcester, Mass). Very much enjoyed your talk and we have also had a lot of experience with coding and documentation issues. I have two questions.

Discussion

June 21, 2018 - 00:00
Dr Ronald Fairman (Philadelphia, Pa). When you were in the elective setting, how does the implanted device, for example, whether it's a short-trunk or a long-trunk device, influence your decision about moving directly to an explant vs trying to revise it with a ZFEN or a branched device?

Financial implications of coding inaccuracies in patients undergoing elective endovascular abdominal aortic aneurysm repair

June 21, 2018 - 00:00
Previous cost analyses have found small to negative margins between hospitalization cost and reimbursement for endovascular aneurysm repair (EVAR). Hospitals obtain reimbursement on the basis of Medicare Severity Diagnosis Related Group (MS-DRG) coding to distinguish patient encounters with or without major comorbidity or complication (MCC). This study's objective was to evaluate coding accuracy and its effect on hospital cost for patients undergoing EVAR.

Choice of a second vascular access in hemodialysis patients whose initial arteriovenous fistula failed to mature

June 21, 2018 - 00:00
We have previously shown that arteriovenous fistulas (AVFs) are more expensive to create and to maintain than arteriovenous grafts (AVGs) in patients undergoing their first access. Because those for whom this first access fails may be a more disadvantaged group, we hypothesized that the cost of a second access may be different from that in the primary access group. With this in mind, we compared access costs in patients receiving a secondary AVF or AVG after their initial AVF failed to mature.

Management of failed endovascular aortic aneurysm repair with explantation or fenestrated-branched endovascular aortic aneurysm repair

June 21, 2018 - 00:00
The incidence of failed endovascular aneurysm repair (EVAR) is increasing, and understanding the different methods of management and repair is paramount. The objective of this study was to evaluate the clinical management and rescue of failed EVAR by either explantation or fenestrated-branched EVAR (F/B-EVAR).

Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative

June 21, 2018 - 00:00
Peripheral atherectomy has been shown to have technical success in single-arm studies, but clinical advantages over angioplasty and stenting have not been demonstrated, leaving its role unclear. We sought to describe patterns of atherectomy use in a real-world U.S. cohort to understand how it is currently being applied.