Journal of Vascular Surgery

Syndicate content
Journal of Vascular Surgery RSS feed.
Updated: 5 days 8 hours ago

Comparison of open and endovascular procedures in patients with critical limb ischemia on dialysis

24 March 2019 - 11:00pm
Peripheral artery disease is a common comorbidity in patients with end-stage renal disease (ESRD), but there is a paucity of data comparing outcomes of different interventions in this group of patients. In this study, we examined perioperative outcomes of lower extremity endovascular revascularization (ER) and open revascularization (OR) in dialysis patients with critical limb ischemia (CLI).

Collapsed bifurcated modular infrarenal endograft

24 March 2019 - 11:00pm
Bilateral acute limb ischemia after endovascular aneurysm repair is extremely rare. We present the case of a 70-year-old man treated by endovascular aneurysm repair for a 7.9-cm asymptomatic infrarenal abdominal aortic aneurysm using a bifurcated modular GORE EXCLUDER endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz). The initial recovery was uneventful, but 14 days later, the patient presented with bilateral acute limb ischemia caused by collapse and thrombosis of the endograft, requiring emergency axillobifemoral bypass, fasciotomies, and subsequent endograft removal with open aneurysm repair.

The 10-year outcomes of a regional abdominal aortic aneurysm screening program

24 March 2019 - 11:00pm
In 2007, Medicare established ultrasound screening guidelines to identify patients at risk for abdominal aortic aneurysm (AAA). The purpose of this study was to evaluate AAA diagnosis rates and compliance with screening during 10 years (2007-2016) of the Screen for Abdominal Aortic Aneurysms Very Efficiently Act implementation within a regional health care system.

A systematic review and meta-analysis of 18F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography for detection of infected prosthetic vascular grafts

24 March 2019 - 11:00pm
The purpose of this investigation was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of vascular prosthetic graft infection (VPGI) using a diagnostic accuracy test.

A systematic review of enhanced recovery after surgery for vascular operations

24 March 2019 - 11:00pm
Patients undergoing vascular operations face high rates of intraoperative and postoperative complications and delayed return to baseline. Enhanced recovery after surgery (ERAS), with its aim of delivering high-quality perioperative care and accelerating recovery, appears well suited to address the needs of this population.

Implementation and results of a practical grading system for thoracic blunt aortic injury

24 March 2019 - 11:00pm
We previously proposed a grading system for blunt thoracic aortic injury (BTAI) designed to guide therapy. This study analyzed our outcomes since implementing this system.

Systematic review of civilian intravascular ballistic embolism reports during the last 30 years

24 March 2019 - 11:00pm
Intravascular ballistic embolization is a rare complication of missile injury. Because of its rarity, much remains to be known about its presentation, pathophysiology, complications, and management. In this study, we analyze case reports of ballistic embolization in the last 30 years and available cases from our institution to determine the likely patient, the nature of the embolization, the possible complications, and a general management strategy.

Regional variation in use and outcomes of combined carotid endarterectomy and coronary artery bypass

24 March 2019 - 11:00pm
In treating concomitant carotid and coronary disease, some recommend staged carotid endarterectomy (CEA) and coronary artery bypass grafting, whereas others favor the combined approach (CCAB). Pressure to reduce surgical variation and to improve quality is real, yet little is known about how geographic practice differences affect outcomes. Using the Vascular Quality Initiative (VQI), this study evaluated regional variation in use and outcomes of CCAB.

Rupture of a previously thrombosed hepatic artery aneurysm

24 March 2019 - 11:00pm
Hepatic artery aneurysm (HAA) is a rare form of visceral artery aneurysm. Historically, most HAAs were ruptured at presentation, but advances in imaging have led to an increase in the diagnosis of asymptomatic HAAs. Description of the natural history of patent HAAs has been difficult because of their rarity, even more so for less common thrombosed HAAs. We report the case of a 74-year-old man who experienced the rupture of a previously thrombosed HAA. He was successfully surgically treated with ligation of the aneurysm.

Double homemade fenestrated stent graft for total endovascular aortic arch repair

24 March 2019 - 11:00pm
The aim of this retrospective analysis was to evaluate the outcomes of physician-modified double fenestrated stent grafts for total endovascular aortic arch repair: one proximal large fenestration for the brachiocephalic trunk and the left common carotid artery and one distal fenestration for the left subclavian artery (LSA).

Carotid stenting and endarterectomy and contralateral carotid occlusion

24 March 2019 - 11:00pm
The presence of contralateral carotid occlusion (CCO) has been controversial throughout the history of carotid intervention. Some studies cite a higher stroke risk in the setting of CCO, whereas other studies document no difference in stroke risk. We investigated the risk of stroke after intervention in the setting of CCO in a large, national, validated dataset.

Association of opioid use and peripheral artery disease

24 March 2019 - 11:00pm
Prescription opioids account for 40% of all U.S. opioid overdose deaths, and national efforts have intensified to reduce opioid prescriptions. Little is known about the relationship between peripheral artery disease (PAD) and high-risk opioid use. The objectives of this study were to evaluate this relationship and to assess the impact of PAD treatment on opiate use.

A comprehensive report of long-term outcomes after catheter-directed thrombolysis for occluded infrainguinal bypass grafts

24 March 2019 - 11:00pm
The objective of this study was to assess the technical and short- and long-term clinical outcomes of catheter-directed thrombolysis (CDT) with urokinase for occluded infrainguinal bypass grafts. In addition, factors associated with technical success and amputation-free survival were assessed.

Molecular changes associated with vascular malformations

24 March 2019 - 11:00pm
Vascular anomalies are typically classified into two major categories, vascular tumors and vascular malformations. Most vascular malformations are caused sporadically by somatic mosaic gene mutations, and genetic analyses have advanced our understanding of the biomolecular mechanisms involved in their pathogenesis. Culprit gene mutations typically involve two major signaling pathways; the RAS/MAPK/ERK pathway is typically involved in fast-flow arteriovenous malformations, whereas the PI3K/AKT/mTOR pathway is typically mutated in slow-flow venous and lymphatic malformations.

Cost-effectiveness of the treatments for critical limb ischemia in the elderly population

24 March 2019 - 11:00pm
The treatment of critical limb ischemia (CLI), with the intention to prevent limb loss, is often an intensive and expensive therapy. The aim of this study was to examine the cost-effectiveness of endovascular and conservative treatment of elderly CLI patients unsuitable for surgery.

Using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification to identify patients most likely to benefit from revascularization

24 March 2019 - 11:00pm
The Society of Vascular Surgery Wound Ischemia foot Infection (WIfI) classification system for chronic limb-threatening ischemia was intended to predict 1-year major lower extremity amputation (LEA) risk and to identify which patients benefit most from revascularization. We aimed to identify which WIfI presentations benefited most from revascularization to explore whether a cluster analysis could identify a more data-driven WIfI score, and to quantify which component of the WIfI score was most strongly associated with 1-year LEA after revascularization.

Perioperative major adverse cardiac events in urgent femoral artery repair after coronary stenting are less common than previously reported

24 March 2019 - 11:00pm
Noncardiac surgery early after coronary stenting has been associated with a high rate of stent thrombosis and catastrophic outcomes. However, those outcomes were mostly seen when dual antiplatelet therapy (DAPT) was discontinued before surgery. This observational study sought to estimate the risk of major adverse cardiac events (MACEs) after femoral artery repair following recent stent-percutaneous coronary intervention under continued DAPT and to explore potential risk factors. We suspect that in this setting, the risk of MACEs is lower than previously reported.

A prognostic score for clinical success after revascularization of critical limb ischemia in hemodialysis patients

24 March 2019 - 11:00pm
The revascularization of critical limb ischemia (CLI) in hemodialysis (HD) patients features poor results in terms of patient survival and limb salvage. Recent predictive models in CLI revascularization did not specifically address HD patients. The aim of this study was to define risk factors for clinical success (CS) after revascularization of CLI in HD patients and to transform findings in a prognostic score.

Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients

24 March 2019 - 11:00pm
Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance.

Validation of a preoperative prediction model for mortality within 1 year after endovascular aortic aneurysm repair of intact aneurysms

24 March 2019 - 11:00pm
Most would agree that at least 1-year survival is necessary after intact abdominal aortic aneurysm (AAA) repair to appropriately justify the cost and risk of the procedure. No validated clinical decision instruments exist to predict survival after endovascular aneurysm repair (EVAR) beyond the perioperative period. The purpose of this analysis was to create a preoperative prediction model for 1-year mortality after EVAR for intact AAA in the Society for Vascular Surgery Vascular Quality Initiative.