Journal of Vascular Surgery

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Invited commentary

31 January 2019 - 11:00pm
In their article, “Variability in hospital costs for carotid artery revascularization,” Drs Mell and colleagues examined variations in hospital costs for patients undergoing carotid revascularization at a regional referral center in California. The found that costs were lower in asymptomatic patients by more than a third; that surgeon specialties who commonly perform carotid revascularization tended to have lower costs; and that operating room expenses, such as devices, supplies, and materials, made up more than three-quarters of the expenses surrounding the episode of care.

Invited commentary

31 January 2019 - 11:00pm
Postoperative groin complications continue to be the bane of vascular surgeons, often resulting in patients' increased morbidity (or mortality if associated with prosthetic material) and resource utilization with longer lengths of stay, higher rates of readmissions or returns to the operating room, and increased overall costs. Current literature supports a rate of up to nearly 40% of vascular surgery patients' developing groin wound infections after their procedures, and multiple studies have outlined ways to curb these events ranging from negative pressure dressings to perioperative care paths.

Variation in timing and type of groin wound complications highlights the need for uniform reporting standards

31 January 2019 - 11:00pm
Groin wound infections represent a substantial source of patients' morbidity and resource utilization. Definitions and reporting times of groin infections are poorly standardized, which limits our understanding of the true scope of the problem and potentially leads to event under-reporting. Our objective was to investigate the timing and variation of groin wound complications after vascular surgery.

Vascular access for hemodialysis in the elderly

31 January 2019 - 11:00pm
The objective of this study was to compare the outcomes of arteriovenous fistulas (AVFs) with arteriovenous grafts (AVGs) in a large population-based cohort of elderly patients in the United States.

Long-term durability of multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysms

31 January 2019 - 11:00pm
The objective of this study was to assess the durability of multibranched endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms by examining the rates of late-occurring (beyond 30 days) complications.

Invited commentary

31 January 2019 - 11:00pm
On first reviewing this manuscript, I did have some concerns. The authors fail to achieve their primary goal; vonapanitase does not result in a significant increase in primary patency in patients receiving a radiocephalic arteriovenous fistula. Statistics in this study, however, may be misleading. The authors employ a hierarchical statistical model, which means that if the primary end point is not achieved, then the secondary and tertiary end points may only be considered descriptive.

A randomized trial of vonapanitase (PATENCY-1) to promote radiocephalic fistula patency and use for hemodialysis

31 January 2019 - 11:00pm
Arteriovenous fistulas created in patients with chronic kidney disease often lose patency and fail to become usable. This prospective trial evaluated the efficacy of vonapanitase, a recombinant human elastase, in promoting radiocephalic fistula patency and use for hemodialysis.

Invited commentary

31 January 2019 - 11:00pm
In laminar flow situations, shear occurs in the zone between the blood vessel wall (velocity = zero) and the central column of flow. In vitro measurement of shear, sometimes difficult, has been achieved with laser Doppler sensors and with magnetic resonance techniques.1,2 Casa et al diagrammed the cross section of flow velocity as parabolic for laminar flow and showed how platelets and blood clotting factors can be activated in the shear zone, the region where the velocity curve becomes asymptotic with the wall (Casa Fig 1).

Invited commentary

31 January 2019 - 11:00pm
The use of foam decay experiments is novel in the vascular surgery literature and emphasizes the science from chemical engineering that can be applied in this area. This technique represents a new initiative in the area of science of sclerotherapy in the quest to improve outcomes and minimize side effects. The authors present a series of experiments looking at the effects of different surfactants on foam stability. The use of sodium morrhuate and polidocanol will be more familiar to physicians using sclerotherapy in the treatment of venous disease.