Journal of Vascular Surgery

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Information for Readers

January 31, 2019 - 23:00
Communications regarding original articles and editorial management should be addressed to Peter Gloviczki, MD, and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery, 633 N. St. Clair, 22nd Floor, Chicago, IL 60611; telephone: 603-523-2222; fax: 312-334-2320; e-mail: JVASCSURG@vascularsociety.org. Information for authors appears in the January and July issues, at www.jvascsurg.org, and at jvs.editorialmanager.com. Authors should consult this document before submitting manuscripts to this Journal.

Contents

January 31, 2019 - 23:00

Editorial Board

January 31, 2019 - 23:00

Increased requirements to avoid payment penalites in Quality Payment Program Year 3

January 31, 2019 - 23:00
The Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) established the Quality Payment Program (QPP). The QPP requires that most physicians who submit claims to the Centers for Medicare and Medicaid Services (CMS) participate in one of two programs: Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (APM). There is currently no approved vascular APM, so most vascular surgeons will participate in MIPS.

Correction

January 31, 2019 - 23:00
In the August 2018 issue of the Journal of Vascular Surgery, the article by Wiske et al (Wiske C, Arhuidese I, Malas M, Patterson R. Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. J Vasc Surg 2018;68:416-25) had the incorrect Article Highlights published by mistake. The correct Article Highlights for this article are as follows:

Temporal Trends in the Management and Clinical Outcomes of Lower Extremity Arterial Thromboembolism Within a National Veteran Population

January 31, 2019 - 23:00
Review of patients admitted to the Veterans Affairs Healthcare System between October 1, 2002, and September 30, 2014.

Comparison of Outcomes and Cost of Endovascular Management vs Surgical Bypass for the Management of Lower Extremity Peripheral Arterial Disease

January 31, 2019 - 23:00
Propensity score-matched analysis of the National Inpatient Sample from 2012 to 2014.

Durability of Stroke Prevention With Carotid Endarterectomy and Carotid Stenting

January 31, 2019 - 23:00
A single-center, retrospective review at a tertiary academic medical center between January 2001 and December 2011.

Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair in Zone 2

January 31, 2019 - 23:00
Retrospective, multicenter, observational study from January 2010 to February 2017.

Aortic Surgery Outcomes of Marfan Syndrome and Ehlers-Danlos Syndrome Patients at Teaching and Non-teaching Hospitals

January 31, 2019 - 23:00
Retrospective review of a National Inpatient Sample from 2000 to 2014.

Regarding “Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database”

January 31, 2019 - 23:00
We reviewed the published report1 with great interest and commend the authors on seeking to complete an analysis of such a large cohort. Protection against hypoperfusion injury offered by shunting in carotid endarterectomy remains a topic around which there is much debate. There is wide variation not only nationally and internationally but between surgeons within individual units. There is conflicting evidence to support and to disparage intraoperative shunt use. Larger scale reviews have been unable to make definitive conclusions to support either standpoint as there is insufficient strong evidence.

Reply

January 31, 2019 - 23:00
Thank you, Drs Fisher, Benson, and Imray, for your interest in our article and for highlighting some of the evidence to support the use of general anesthesia for its neuroprotective effects, which are derived from the uncoupling of cerebral metabolism and blood flow. Although general anesthesia likely provides some neuroprotective effect (so-called luxury perfusion), we found that it does not significantly lower the rate of clinically significant strokes in our study, as evidenced by the equivalent rate of stroke between patients who had local anesthesia and those who were routinely shunted under general anesthesia.

Regarding “Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery”

January 31, 2019 - 23:00
In a recent article, Duceppe and colleagues1 assessed the association between preoperative antihypertensive medication administration and postoperative acute kidney injury (AKI) in patients undergoing major vascular surgery who had received chronic antihypertensive therapy. The multivariable logistic regression analysis showed that antihypertensive medication intake on the morning of surgery was associated with an increased risk of postoperative AKI. The research conducted is valuable, but there are two issues in their methods and results that need to be discussed and clarified.

Reply

January 31, 2019 - 23:00
Zi Shao et al commented on the variables included in the multivariable analysis of predictors of postoperative acute kidney injury (AKI) after major vascular surgery, noting that an estimated glomerular filtration rate (eGFR) of less than 60 mL/minute and clinically significant intraoperative hypotension were not included in the final model. The authors put forward that this was because they had low incidence and it was not shown to be associated in univariable analysis. We would like to emphasize that the decision to include or not variables in the multivariable model was not based on their prevalence or result of the univariable analyses, but it was rather predefined when designing the statistical analysis plan.

Current status of noninvasive perfusion assessment in individuals with diabetic foot ulceration

January 31, 2019 - 23:00
The global prevalence of diabetic foot ulceration (DFU) has recently been reported as 6.3%.1 The problem is particularly significant in North America, with a prevalence of 13%; in Europe, the rate is 5.5%. In a prospective study of 725 diabetic patients with a mean follow-up of 691.8 days, the mortality of individuals with DFU was more than two-fold higher than diabetic patients without ulceration, irrespective of age, diabetes type, and treatment of diabetes.2 Management of both the foot and the patient as a whole in the context of DFU depends on a coordinated, multidisciplinary team approach: good glycemic control, prompt referral to diabetic foot services with effective pathways in place, adequate pressure offloading, and establishing whether peripheral arterial disease (PAD) exists—and addressing it—are essential.

Stent graft as a bridge to allograft to treat a septic thoracic aortic pseudoaneurysm after spinal fusion

January 31, 2019 - 23:00
A 29-year-old woman was admitted to our institution for severe septic syndrome. Her medical history included a T6-T8 posterior spinal fusion 7 years earlier for tuberculous spondylodiscitis. Contrast-enhanced computed tomography (CT) revealed a 70- × 58-mm pseudoaneurysm of the descending thoracic aorta extending from T6 to T8 level, surrounding the left T6 screw (A/Cover). A T6-T8 spondylodiscitis and bilateral paraspinal collections were also observed. Blood and T7 bone biopsy specimens grew Escherichia coli.

Reply

January 31, 2019 - 23:00
Grazioli et al commented on the utility of mean arterial pressure (MAP) to assess potential hemodynamic compromise. The authors mention that even brief and nonsustained periods of intraoperative decline in MAP are associated with acute kidney injury (AKI), as seen in the study of Walsh et al,1 in which a MAP <55 mm Hg had the strongest association with AKI. In our study, data on lowest intraoperative MAP were collected, and we did not find a significant association between lowest MAP (P = .118) and MAP <55 mm Hg (P = .085) and postoperative AKI.

Regarding “Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery”

January 31, 2019 - 23:00
We read with great interest the article entitled “Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery” in the June 2018 issue of Journal of Vascular Surgery. This retrospective study of 406 patients undergoing major vascular surgery finds that in chronically hypertensive patients, the number of antihypertensive drugs administered on the morning of surgery is independently associated with an increased risk of postoperative acute kidney injury (AKI).

The BEST-CLI trial is nearing the finish line and promises to be worth the wait

January 31, 2019 - 23:00
There is significant variability and equipoise in the management of critical limb ischemia (CLI). The Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial, funded by the National Heart, Lung, and Blood Institute, is a prospective, open label, multicenter, multispecialty randomized controlled trial designed to compare treatment efficacy, functional outcomes, cost-effectiveness, and quality of life for 2100 patients suffering from CLI. BEST-CLI is enrolling those patients who are determined to be candidates for open surgical or endovascular revascularization and is designed to be comprehensive, pragmatic, and balanced.