Journal of Vascular Surgery

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Vascular surgery residents spend one fifth of their time on electronic health records after duty hours

1 May 2019 - 12:00am
Electronic health records (EHR) have largely replaced paper-based medical records. Academic institutions have adapted EHR successfully and technological innovations now allow remote access. Thus, self-reported resident duty hours may not accurately reflect the actual time that is spent on patient care-related activities.

Comparison of dynamic changes in aortic diameter during the cardiac cycle measured by computed tomography angiography and transthoracic echocardiography

1 May 2019 - 12:00am
This study aimed to examine the relationship between dynamic changes in aortic diameter and corresponding measurement methods.

Vascular repair after firearm injury is associated with increased morbidity and mortality

1 May 2019 - 12:00am
Firearm injuries have high morbidity and mortality. Presentation of injuries requiring concurrent vascular repair and its outcomes are unclear. Our study's objective was to characterize the injury details and to assess the associated mortality and morbidity after vascular repair.

Duty hours are frequently inaccurate

1 May 2019 - 12:00am
For all its well-publicized deficiencies, the electronic medical record (EMR) is exquisitely capable of precisely tracking the activities of users. With dispassionate objectivity, the EMR knows where you are when you sign in, which patient records you access, and what orders you give and notes you write. Dr Aziz and colleagues have tested the feasibility of using the EMR to quantify off-duty access to the EMR by vascular surgery residents in an integrated training program. The results are important for two interconnected findings: (1) approximately 20% of vascular surgery residents' access to the EMR occurs during off-duty hours, or so-called pajama time; and (2) self-reporting of duty hours appears to be a flawed process.

Invited commentary

1 May 2019 - 12:00am
All of the published prospective randomized controlled trials (RCTs) comparing carotid artery stenting (CAS, presumably from the transfemoral approach) with carotid endarterectomy (CEA) have made the uniform observation that “older patients” had fewer end points (death and stroke) with CEA compared with CAS. These findings have been criticized by some as not necessarily reflecting everyday clinical practice (often erroneously referred to as “real world”) because the strict inclusion and exclusion parameters necessary for a well-defined clinical trial may exclude patients otherwise undergoing treatment in daily clinical practice.

Invited commentary

1 May 2019 - 12:00am
The science of vascular simulation remains in its infancy. Even as our simulators become more advanced, the technology they replicate evolves faster, confounding our efforts. We have no large-scale multicenter, randomized clinical trials on which to hang our hats. Therefore, as each new relevant investigation is published, we must look closely to see what pearls can be harvested. The “gold standard” remains to provide a link between simulation use and patient outcomes—a very lofty goal, and one much easier to demonstrate with endovascular simulation rather than open.

Association between the choice of anesthesia and in-hospital outcomes after carotid artery stenting

1 May 2019 - 12:00am
Several prior studies have shown lower risk of myocardial infarction (MI) in carotid artery stenting (CAS) compared with carotid endarterectomy. This is likely because the majority of endarterectomies are performed under general anesthesia (GA), whereas CAS is mainly performed under local anesthesia (LA). Performing CAS under GA may reverse its minimally invasive benefits. The aim of this study was to compare the safety profile of CAS-GA with that of CAS-LA.

Age modifies the efficacy and safety of carotid artery revascularization procedures

1 May 2019 - 12:00am
Several randomized clinical trials have shown that carotid artery endarterectomy (CEA) is safer than carotid artery stenting (CAS) in the elderly. However, those studies were limited by their strict inclusion criteria that might make their findings inapplicable to real-world practice. Therefore, the aim of this study was to evaluate the association of age with the efficacy of CEA and CAS in a population-based registry.

Invited commentary

1 May 2019 - 12:00am
Endovascular aneurysm repair has become standard of care. The short-term outcomes are well established and long-term outcomes are now being adjudicated to determine the indications for treatment in different populations. Part of the refinement of indications requires the delicate decision of whether to proceed in cases in which patients have a compromised quality of life or when the quality of life is good but the high comorbid risk makes the likelihood of a complication great. The question of whether to live with an unrepaired aneurysm often involves more art than science to answer as it requires determining the patient's motivation for living and the elements of life that provide the most joy and choosing the path that puts those elements at lowest risk.

RhoA inhibitor-eluting stent attenuates restenosis by inhibiting YAP signaling

1 May 2019 - 12:00am
Current drug-eluting stent (DES) treatment is promising, but it still has the drawback of in-stent restenosis, which remains a clinically relevant problem. Efforts should be made to discover new signaling molecules and novel potential targets for the prevention of arterial restenosis. In this study, we fabricated a novel DES targeting the RhoA pathway and further examined this promising strategy in vitro and in a rabbit carotid model.

Discussion

10 April 2019 - 12:00am
Kristofer M. Charlton-Ouw (Houston, Tex). Thank you for an on-time, concise, and well-written paper. The authors adjusted for many of the known risks of spinal cord ischemia (SCI) but can only adjust for associations that we know about. I did not see hypogastric artery status or length of aortic coverage listed.

Systematic review and meta-analysis of elective and urgent late open conversion after failed endovascular aneurysm repair

3 April 2019 - 11:00pm
In this study, we systematically reviewed late open conversions after failed endovascular aneurysm repair (EVAR), assessed the methodologic quality of the included studies, and performed a meta-analysis on the 30-day mortality rates for urgent and elective late conversions.

Journal of Vascular Surgery – April 2019 Audiovisual Summary

31 March 2019 - 11:00pm
Welcome the April issue of the Journal of Vascular Surgery. We have four outstanding papers for you to read for free, as well as many other outstanding papers.

Events of interest

31 March 2019 - 11:00pm
News items of interest to the vascular surgeon must be received at least 8 weeks before the desired month of publication. Announcements published at no charge include those received from a sponsoring society of this Journal, those courses and conferences sponsored by state, regional, national, or international vascular surgical organizations, and university-sponsored continuing medical education courses. Send applicable events to Andrew O’Brien, Journal Manager, at a.obrien@elsevier.com. All other news items selected for publication carry a charge of $60.00 US for each insertion, and the fee must accompany the request to publish.

Information for readers

31 March 2019 - 11:00pm
Communications regarding original articles and editorial management should be addressed to Peter Gloviczki, MD, and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery, 9400 W. Higgins Road, Suite 315, Rosemont IL 60018; 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

31 March 2019 - 11:00pm

Editorial Board

31 March 2019 - 11:00pm

Correction

31 March 2019 - 11:00pm
In the February 2019 issue of the Journal of Vascular Surgery, the article by Bleyer et al (Bleyer AJ, Scavo VA, Wilson SE, Browne BJ, Ferris BL, Ozaki CK, et al. A randomized trial of vonapanitase (PATENCY-1) to promote radiocephalic fistula patency and use for hemodialysis. J Vasc Surg 2019;69:507-15) contained a typo in the manufacturer name of VasCore. The correct name is VasCore and not VasCare as published.

Hemodialysis access creation episode-based cost measure

31 March 2019 - 11:00pm
The Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) established the Quality Payment Program. The Quality Payment Program requires providers who bill Medicare to participate in the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model. Most vascular surgeons will participate in MIPS as no Advanced Alternative Payment Model is approved for vascular surgery. Failure to participate adequately in MIPS in 2019 will result in a 7% penalty in 2021 reimbursements.

Correction

31 March 2019 - 11:00pm
1/6/2018