Journal of Vascular Surgery

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Integrated Residency Is Associated With an Increase in Women Among Vascular Surgery Trainees

September 1, 2018 - 00:00
During the past decade, the proportion of women within graduate medical education (GME) 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 (VS) training programs.

Early Experience With the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms

September 1, 2018 - 00:00
The octopus endovascular strategy for thoracoabdominal aortic aneurysm (TAAA) involves placement of bifurcated grafts in the thoracic aorta to create separate limbs that facilitate deployment of multiple parallel covered stents for branch perfusion. We reviewed our early outcomes of the octopus TAAA repair strategy.

Association of Vascular Surgery Board of the American Board of Surgery Examination Performance With Clinical Outcomes: Experience Matters

September 1, 2018 - 00:00
The Vascular Surgery Board of the American Board of Surgery (VSB-ABS) Vascular Surgery Qualifying and Certifying examinations are meant to assess qualifications, but it is unclear whether examination performance correlates with clinical outcomes. We assessed this relationship using data from the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI).

Impact of Physician-Owned Office-Based Laboratories on Physician Practice Patterns and Outcomes After Percutaneous Vascular Interventions for Peripheral Artery Disease

September 1, 2018 - 00:00
Percutaneous vascular interventions (PVIs) for peripheral artery disease have shifted from a hospital-based setting (HBS) to physician-owned office-based laboratories (OBLs). We sought to evaluate the changes of physicians’ treatment decisions and patients’ outcomes after the transition to OBLs.

Proximalization of Arterial Inflow for Treatment of Hemodialysis-Induced Arterial Steal Syndrome

September 1, 2018 - 00:00
This was a retrospective analysis of proximalization of arterial inflow for treatment of hemodialysis access-related arterial steal syndrome.

Innominate Artery Through Ministernotomy With Anatomic Tunneling for Critical Ischemia of the Left Upper Extremity

September 1, 2018 - 00:00
The patient is a 58-year-old woman with a history of left-sided mastectomy and axillary node dissection for cancer. She developed occlusive disease requiring extensive stenting of the left subclavian-axillary artery and subsequent carotid to proximal brachial artery prosthetic bypass, complicated by stroke. She was referred for critical ischemia of the left upper extremity and computed tomography angiography showing occlusion of the bypass with reconstitution of the proximal brachial artery.

Noninvasive and Patient-Specific Assessment of True Severity of Renal Artery Stenosis for New Guidelines for Planning Stent Therapy

September 1, 2018 - 00:00
Renal artery stenosis (RAS) causes renovascular hypertension, but its severity is difficult to determine. Thus, effective stenting therapy cannot be well planned. This research is to develop and to validate a new, noninvasive, and patient-specific means to assess the true severity of RAS based on clinical computed tomography angiography and Doppler ultrasound.

Area Deprivation Index Score Is Associated With Lower Rates of Long-Term Follow-up After Upper Extremity Vascular Injuries

September 1, 2018 - 00:00
The Area Deprivation Index (ADI) has recently been shown to be a key determinant of several health care outcomes in both medical and surgical fields. We sought to analyze rates of long-term follow-up and outcomes in patients with upper extremity vascular injuries who were admitted during a 5-year period to a level I trauma center based in a university hospital setting.

Outcomes Associated With Postoperative Glycemic Control After Carotid Procedures

September 1, 2018 - 00:00
There are limited data evaluating the impact of postoperative hyperglycemia (POH) in patients undergoing vascular procedures. This study evaluated the relationship between POH and outcomes after carotid artery stenting (CAS) and carotid endarterectomy (CEA).

Retrograde Stenting of Brachiocephalic Artery With Juxtaposed Left Common Carotid Artery

September 1, 2018 - 00:00
The patient is a 68-year-old woman who presented with amaurosis fugax of the right eye. She had prior right carotid endarterectomy. Computed tomography angiography showed >85% stenosis of the right brachiocephalic trunk. The left common carotid artery was juxtaposed, and there was a concern that primary stenting of the brachiocephalic trunk could lead to ostial stenosis or occlusion of the left common carotid artery. We performed cervical cutdown to access the right common carotid artery. Bilateral common femoral artery access was obtained for access to the left common carotid artery and placement of a pigtail catheter for angiography.

Clopidogrel Use Is Not Associated With Increased Complications After Carotid Endarterectomy

September 1, 2018 - 00:00
The objective of this study was to evaluate the use of clopidogrel at the time of carotid endarterectomy (CEA) and its association with postoperative complications.

Results of Carotid Endarterectomy in Patients With Contralateral Internal Carotid Artery Occlusion From the Society for Vascular Surgery Vascular Quality Initiative

September 1, 2018 - 00:00
Carotid endarterectomy (CEA) is among the most commonly performed vascular procedures. Some have suggested worse outcomes with contralateral internal carotid artery (ICA) occlusion (cICAoccl). We compared patients with vs without cICAoccl using the Society for Vascular Surgery Vascular Quality Initiative database.

Intravascular Ultrasound-Guided Catheter-Directed Mechanical Thrombectomy in a Pregnant Woman With Iliofemoral Acute Deep Venous Thrombosis

September 1, 2018 - 00:00
Pregnancy induces a transient hypercoagulable state, increasing the risk for venous thromboembolism. Early thrombus removal over anticoagulation alone reduces post-thrombotic syndrome, especially in those with acute iliofemoral deep venous thrombosis (DVT). However, pregnancy is a relative contraindication because of radiation exposure of the fetus and increased risk of bleeding with tissue plasminogen activator (tPA). This case report demonstrates successful treatment of acute iliofemoral DVT in a pregnant woman using intravascular ultrasound (IVUS)-guided catheter thrombectomy without fluoroscopy or tPA.

Trends in Management and Outcomes of Vascular Emergencies in the United States

September 1, 2018 - 00:00
The objective of this study was to evaluate trends in frequency, mortality, and treatment paradigms for nontraumatic vascular emergencies (VEs) in the United States.

Survey of Vascular Surgery Trainees Suggests Standardized Vascular Laboratory Curriculum During Training May Be Valuable

September 1, 2018 - 00:00
Although the Registered Physician in Vascular Interpretation (RPVI) examination is required for vascular surgery board certification, no standardized noninvasive vascular laboratory (NIVL) curriculum for vascular surgery trainees exists. The purpose of this study was to investigate the NIVL experience of trainees to understand what helps them feel well prepared.

Creation of an Affordable Pulsatile Cadaver-Based Abdominal Aortic Surgery Training Model

September 1, 2018 - 00:00
Developing competence in open aortic surgery is increasingly challenging in vascular surgery training programs. Whereas static cadaver models provide an opportunity for dissection and exposure, the lack of pulsatility limits aortic surgery skill set acquisition. We developed an affordable pulsatile cadaver simulation model to improve training in open abdominal aortic surgery with the primary objective of determining whether it incorporated the fidelity required to teach critical techniques.

Complete Endovascular Arch Reconstruction With a Multibranch Device for the Management of Aortic Arch Aneurysm

September 1, 2018 - 00:00
Open surgical repair through median sternotomy remains the standard of care for aortic arch aneurysms; however, such operative approach is associated with significant morbidity and mortality. New endovascular technology now allows us to treat those patients who are poor candidates for open surgical repair.

Endovascular Elephant Trunk Completion for Distal Arch-Proximal Thoracic Aortic Aneurysms

September 1, 2018 - 00:00
Aneurysms involving the distal arch-proximal thoracic aorta can be difficult to treat because of their location. A hybrid approach with endovascular elephant trunk (ET) completion is a hybrid technique that combines surgical creation of a proximal ET in conjunction with distal thoracic endograft placement. We report our single-center experience with endovascular ET completion during a 10-year period.

Parallel Stent Graft Approaches in Zone 0 and Zone 1 Aortic Arch Aneurysmal Diseases

September 1, 2018 - 00:00
Parallel snorkel endografting is well acknowledged in complex aortic endovascular procedures but has not seen widespread use in proximal aortic arch procedures (zones 0 and 1) because of presumed superiority of total intrathoracic debranching approaches and exaggerated concerns about stroke risk. Our recent experience compelled us to reconsider this approach as a valid option in these conditions.

Benefit of Arterial Duplex Ultrasound Stent Imaging After Superficial Femoral Artery Stent Implantation: Impact of Surveillance Method on Postprocedural Outcome

September 1, 2018 - 00:00
In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex ultrasound stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation (SI), whether surveillance with ADSI yielded a better outcome than in those with only ankle-brachial index (ABI) follow-up.