Journal of Vascular Surgery

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Updated: 9 hours 11 min ago

PC080 Ultrasound-Guided Scalene Blocks Decrease Radiation Exposure in Patients and Staff While Preserving Quality of Clinical Assessment in Diagnosis and Treatment of Neurogenic Thoracic Outlet Syndrome

June 1, 2017 - 00:00
We describe a strategy to decrease patient and staff radiation exposure and enhance patient safety and therapeutic efficacy using an ultrasound-guided technique, and illustrate a technique for maintaining procedural safety.

PC078 Context-Based 2D-3D Vascular Image Fusion Technique to Integrate Preoperative CTA Images With Fluoroscopy During Endovascular Interventions

June 1, 2017 - 00:00
Fusion of computed tomography (CT) angiography (CTA) images with fluoroscopy have been demonstrated to provide additional guidance and save iodinated contrast agent during complex endovascular procedures. Image fusion can be achieved with a three-dimensional (3D) technique after a noncontrast cone-beam CT acquisition or with 2D-3D technique after acquiring two fluoroscopic images acquired at least 30° apart. The primary objective of this work was to illustrate context-based 2D-3D image fusion techniques individualized to specific endovascular interventional scenarios.

PC076 A New “Angle” on Aortic Neck Angulation Measurement

June 1, 2017 - 00:00
There is growing evidence that severe infrarenal aortic neck angle is an important predictor for EVAR failure. While the gold standard to measure this important angle is a three-dimensional (3D) centerline measurement, many surgeons rely on estimations of angulation based on coronal and sagittal computed tomography (CT) views. Unfortunately, neither of these 2D views accurately represents the true angle (Fig 1). In response to this need, our group has developed a novel trigonometry-based formula (the “paired angle formula”), which uses coronal and sagittal measured angles to calculate the true angle (Fig 2).

PC074 Computed Tomography Fusion Imaging-Guided EVAR Reduces Radiation: The Results of a Prospective Radiation Evaluation During EVAR (REVAR)

June 1, 2017 - 00:00
We performed a multicenter, prospective observational study evaluating radiation exposure during abdominal aorta aneurysm (AAA) endovascular repair (EVAR), performed under intraoperative guidance with preoperative computed tomography angiography (CTA) fusion in a modern hybrid room.

PC072 Safety and Efficacy of Vascular Interventions Performed in a Busy Office-Based Surgery Center (OBSC) in Selected Patients With Low and Moderate Periprocedural Risk

June 1, 2017 - 00:00
An explosion in the number of office-based surgery centers (OBSCs) has occurred in the United States since the Centers for Medicare and Medicaid Services increased reimbursement for outpatient vascular interventions in 2008. Yet, there continues to be a paucity of published data to support OBSC patient safety and treatment effectiveness.

PC070 Complications of Percutaneous Endovascular Repair for Ruptured Aortic Abdominal Aneurysms Are Uncommon

June 1, 2017 - 00:00
Percutaneous access and repair of femoral arteries (Perclose technique) for endovascular aneurysm repair (EVAR) has been described; however, its role in the management of ruptured aortic abdominal aneurysm (rAAA) is yet to be defined. The aim of this study was to evaluate whether percutaneous access and repair of femoral arteries for ruptured EVAR (rEVAR) can be safely performed.

PC068 Implications of Clostridium difficile Infection in Vascular Surgery Patients

June 1, 2017 - 00:00
Clostridium difficile infection (C.Diff inf) is considered a national health problem. In 2017, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention -National Health Safety Network (CDC-NHSN) includes C.Diff inf as a measure for in-hospital-acquired condition (HAC) reduction program. Implications of C.Diff inf in health care setting will include loss of revenue for health systems as well as poor outcomes for affected patients. We sought to examine its impact on patients undergoing vascular surgery procedures.

PC066 How to Predict Wound Complications After Endovascular Aortic Aneurysm Repair

June 1, 2017 - 00:00
Endovascular aortic aneurysm repair (EVAR) is becoming the preferred method for treating infrarenal aortic aneurysms. A traditional open approach to the common femoral artery can create a potential wound complication. We examined our EVAR population to discover factors that contribute to wound complications postoperatively.

PC064 Location of Diabetic Foot Ulcer Affects Wound Outcomes

June 1, 2017 - 00:00
The aim of this study was to determine whether the location a diabetic foot ulcer has an independent effect on wound outcome in diabetic foot ulcers.

PC062 Anterior Lumbar Exposure in Obese Patients and Outcomes

June 1, 2017 - 00:00
Anterior lumbar instrumentation and fusion (ALIF) procedures often involve vascular surgeons to provide the exposure because of the expertise in retroperitoneal dissection and need for iliac vessel mobilization. Exposing the spine from an anterior approach can be very challenging in the obese patient. This study sought to evaluate outcomes of ALIF in obese vs nonobese patients to determine whether vascular surgeons should be more selective regarding which patients they choose to assist with.

PC060 Reoperation Following Lower Extremity Amputation

June 1, 2017 - 00:00
Unplanned reoperation has been identified as an independent risk factor for increased morbidity and mortality as well as for hospital readmission following surgical intervention. With such pressure to improve patient quality outcomes and reduce hospital readmission rates, we sought to describe the risk factors and indications for reoperation in a tertiary care lower extremity amputation population.

PC058 What Is the Real Mode of Failure? Trends in Angio-Seal Adverse Events Reported to the MAUDE Database

June 1, 2017 - 00:00
The Manufacturer and User Facility Device Experience (MAUDE) Database was established by the United States Food and Drug Administration to allow for voluntary reporting of adverse outcomes of medical devices. The Angio-Seal device (St. Jude Medical, Minnetonka, Minn) closure device is one of many devices reported to the database. We set out to determine whether defined failure mode (DFM; collagen plug, device handle, footplate, and/or sheath) at index deployment vs an undefined failure mode (UFM) had differing outcomes in terms adverse patient consequences and/or returned devices (Table).

PC056 Loss of Independence, Complications, and Death After Discharge After Endovascular Abdominal Aortic Aneurysm Repair

June 1, 2017 - 00:00
Loss of independence after surgery has been shown to increase mortality and readmission in geriatric patients. We studied loss of independence in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (EVAR).

PC054 The Impact of Cannula-Related Limb Ischemia on ECMO Patient Survival

June 1, 2017 - 00:00
Multiple mechanical devices are available to support patients with cardiovascular collapse due to acute heart failure. When partial support methods, such as balloon pumps or Impella devices are inadequate, the last lifesaving effort is the use of venous-arterial (VA) extracorporeal membrane oxygen (ECMO) circuits to support these patients while organ systems recover or as a bridge to further surgical therapies. ECMO, however, uses large arterial and venous cannulae and is associated with a risk of device-related lower extremity ischemia.

PC052 Causes and Outcomes of Finger Ischemia in Hospitalized Patients in the Intensive Care Unit

June 1, 2017 - 00:00
Vascular surgeons are frequently consulted to evaluate hospitalized patients in the intensive care unit (ICU) with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in ICU patients.

PC050 Risk Factors for Major Cardiac Complications After Endovascular Repair of Aortic Aneurysms: A Nationwide Survey

June 1, 2017 - 00:00
Although endovascular aortic repair (EVAR) is the preferred treatment for abdominal aortic aneurysms (AAA), postoperative acute myocardial infarction (MI) and arrest remains a significant cause of morbidity and mortality. The Vascular Quality Initiative Cardiac Risk Index was developed to predict MI following elective vascular surgery including EVAR. We identify patient and hospital-level predictors of major adverse cardiac events (MACE) after EVAR in the largest national inpatient database.

PC048 Improved Value of Open AAA Repair in the Hands of High-Volume Surgeons

June 1, 2017 - 00:00
Over the past 15 years, as endovascular aortic aneurysm repair has become the principal mode of intact abdominal aortic aneurysm (AAA) repair, the frequency of open surgical repair (OSR) has decreased. There is little evidence in the literature about the effect of surgeon volume on procedure value. In the setting of decreased rates of OSR in patients with more complex anatomy, the hypothesis of this study is that high-volume surgeons will provide improved value by having lower rates of morbidity and mortality.

PC046 Long-Term Outcomes After Repair of Symptomatic Abdominal Aortic Aneurysms

June 1, 2017 - 00:00
Previous studies have reported increased perioperative mortality of symptomatic nonruptured abdominal aortic aneurysms (sxAAA) compared with asymptomatic AAA (asxAAA), but no long-term outcomes for sxAAA have been reported. We sought to compare long-term outcomes of sxAAA and asxAAA after repair at a single academic institution.

PC044 Ethnic Disparities in Outcomes in Patients With Complicated Type B Aortic Dissection

June 1, 2017 - 00:00
This study evaluated the difference in outcomes following endovascular intervention in patients with complicated type B aortic dissection (TBAD) based on ethnicity and blood pressure control.

PC042 Concordance of Contrast-Enhanced Ultrasound and Carbon Dioxide Automated Angiography in the Detection of Type II Endoleaks

June 1, 2017 - 00:00
The presence of type II endoleak (ELII) after endovascular aortic repair (EVAR) can be investigated with different methods. Since intraoperative completion angiography (ICA) may underestimate their presence, particularly if they are at low flow, contrast-enhanced ultrasound (CEUS) imaging has been proposed as the gold standard during EVAR follow-up. Intraprocedural carbon dioxide (CO2) angiography has been shown to be useful in this setting; however, no comparative studies including these three techniques are currently available.