Journal of Vascular Surgery

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Vascular surgeon accountability in accountable care organizations

31 December 2018 - 11:00pm
The Quality Payment Program aims to enhance individual patient care, improve population health, and decrease costs. To create a shift away from the traditional fee-for-service payment model, the Quality Payment Program requires physicians who bill Medicare to participate in one of two pathways: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). MIPS streamlined multiple legacy quality programs into a modified fee-for-service approach that includes a bonus/penalty structure and requires a relatively complex reporting mechanism.

Regarding “Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair”

31 December 2018 - 11:00pm
We read with great interest the study published by Tarbunou et al1 on the outcomes associated with hyperglycemia after abdominal aortic aneurysm (AAA) repair.

The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training

31 December 2018 - 11:00pm
The use of simulators has shown a profound impact on the development of both training and assessment of endovascular skills. Furthermore, there is evidence that simulator training is of great benefit for novice trainees. However, there are only a few simulators available geared specifically toward novice learners. Whereas research suggests that low-fidelity simulators could fill this gap, there are insufficient data available to determine the role of low-fidelity simulators in the training of endovascular skills.

Outpatient Grip Strength Measurement Predicts Survival, Perioperative Adverse Events, and Nonhome Discharge Among Patients With Vascular Disease

31 December 2018 - 11:00pm
Studies of frailty in patients with vascular disease have focused primarily on preoperative risk assessment, but population-specific associations with survival are unknown. The majority of studies evaluating frailty assessment in patients with vascular disease have relied upon accumulated deficits models that are calculated based upon data within the electronic medical record (which may be incomplete) and are often applied retrospectively. Grip strength measurement is a comparatively simple, quick, and inexpensive frailty screening tool.

Endograft Exclusion of the False Lumen Restores Local Hemodynamics in a Model of Type B Aortic Dissection

31 December 2018 - 11:00pm
The role of endovascular intervention in type B dissection on aortic hemodynamics is poorly understood. Although a stent graft may be indicated for patients facing immediate malperfusion or aneurysmal degeneration, its benefit in patients with uncomplicated disease is unclear. To date, only two randomized, controlled trials have been undertaken to study the effect of optimal medical management of uncomplicated dissection with and without adjunctive TEVAR. Despite showing improvements in true lumen caliber and overall aortic modeling, these studies do not definitively demonstrate improved mortality or event-free survival.

Effects of Statin and Antiplatelet Therapy Noncompliance and Intolerance on Patient Outcomes Following Vascular Surgery

31 December 2018 - 11:00pm
Prior studies have evaluated the effects of statin and antiplatelet (AP) medications on the vascular surgery patient population. Although the benefits of statin and AP use are well-described, there is a paucity of research into the specific outcomes of patients who are unable to take the medication owing to intolerance or noncompliance. Our goal is to examine the outcomes of intolerant patients and to compare to those who are noncompliant.

Influence of Gender and Frailty on Mortality After Elective Aortic Aneurysm Repair

31 December 2018 - 11:00pm
Controversy exists surrounding gender outcome disparity and abdominal aortic aneurysm (AAA) repair. Previous reports have demonstrated worse outcomes for female patients undergoing open aortic repair (OAR); however, these differences are less evident with endovascular aneurysm repair (EVAR). Epidemiologic studies have documented that nonsurgical, female patients score higher on most frailty assessment scales but paradoxically have a longer life expectancy compared with male patients. Notably, the interaction of gender/frailty and their influence on outcomes and practice patterns surrounding EVAR/OAR is poorly described.

National Incidence, Mortality Outcomes, and Predictors of Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

31 December 2018 - 11:00pm
Spinal cord ischemia (SCI) is a dreaded complication of thoracic endovascular aortic repair (TEVAR). There are limited national data describing the incidence and influence of in-hospital SCI recovery on long-term survival. Moreover, no robust preoperative SCI risk assessment tools currently exist. The purpose of this analysis was to analyze the Vascular Quality Initiative to determine the survival impact of SCI with or without in-hospital recovery, and develop a preoperative SCI prediction tool for patients undergoing TEVAR.

Liposomal Nanocarriers Designed for Subendothelial Matrix Targeting Under Vascular Sheer Stress

31 December 2018 - 11:00pm
Vascular interventions inherently result in disruption of the tunica intima and exposure of subendothelial matrix proteins. Spatially controlled nanoparticles designed to colocalize to these exposed matrices could provide a targeted drug delivery system aimed at inhibiting dysfunctional vascular remodeling and improving intervention outcomes. We have previously reported the development of a surface-modified liposomal platform designed to preferentially bind collagen type IV, an abundant subendothelial matrix protein, in a static in vitro environment.

A Prospective Randomized Study Comparing Ultrasound- Versus Fluoroscopic-Guided Femoral Arterial Access in Noncardiac Vascular Patients

31 December 2018 - 11:00pm
The aim of our prospective, randomized study was to compare the procedural outcomes and complication rates of ultrasound (US)-guided common femoral artery (CFA) access to fluoroscopic guidance in noncardiac procedures. Randomized studies comparing CFA access techniques and resultant complications have been almost exclusively performed in patients undergoing cardiac procedures. Differences between peripheral vascular disease and coronary artery disease patient populations and percutaneous techniques warrant US-guided femoral cannulation to be examined independently in procedures for peripheral vascular disease.

Bleeding and Thrombotic Outcomes Associated With Postoperative use of Direct Oral Anticoagulants After Open Peripheral Artery Bypass Procedures

31 December 2018 - 11:00pm
The widespread use of the direct oral anticoagulants (DOACs) for the treatment of atrial fibrillation and venous thromboembolism has inevitably resulted in peripheral bypass patients receiving therapeutic anticoagulation (AC) with DOACs postoperatively. No recommendations exist to guide whether DOACs can be safely used as an alternative to vitamin K antagonists (VKAs) for prophylaxis of high-risk bypass grafts. This study was undertaken to evaluate the bleeding and thrombotic outcomes of patients undergoing open peripheral bypass treated with DOACs compared with VKAs.

Prevalence of Chronic Opioid use in Patients With Peripheral Arterial Disease Undergoing Lower Extremity Interventions

31 December 2018 - 11:00pm
Opiate use, dependence, and the associated morbidity and mortality are major current public health problems in the United States. Little is known about patterns of opioid use in patients with peripheral arterial disease (PAD). The purpose of this study was to identify the prevalence of chronic preoperative and postoperative prescription opioid use in patients with PAD. A secondary aim was to determine the demographic, comorbid conditions, and operative characteristics associated with chronic opioid use.

Balloon-Assisted Remote External Iliac Artery Endarterectomy: A Safe and Durable Technique for the Treatment of Iliac Artery Occlusive Disease

31 December 2018 - 11:00pm
Historically, the treatment of iliac artery occlusive disease required a surgical bypass usually consisting of an aortobifemoral bypass or an iliofemoral bypass. With the advent of balloon angioplasty and stenting, these procedures are frequently replaced with endovascular options. However, the treatment of diffuse occlusive disease of the external iliac artery (EIA) does not carry a favorable long-term patency rate using balloon angioplasty and/or stenting. Remote endarterectomy of the EIA using ring dissectors with balloon assistance provides a novel, controlled, safe, and durable treatment of the diseased and/or occluded EIA.

Socioeconomically Distressed Communities Index independently Predicts Major Adverse Limb Events After Infrainguinal Bypass in a National Cohort

31 December 2018 - 11:00pm
Socioeconomic status is a major determinant of quality of life, as well as life expectancy and health care-related outcomes. Comprising factors such as financial security, housing, employment and education, socioeconomic status can be difficult to measure comprehensively, limiting its inclusion in large databases. There is a growing interest in the relationship between social determinants of health and outcomes as healthcare shifts from volume to quality-driven metrics. Both community- and individual-level socioeconomic factors broadly impact surgical morbidity and mortality, although the effect on peripheral vascular disease is not well-understood.

Use of Indocyanine Green Fluorescence Imaging in Predicting Distal Ischemia After Arteriovenous Fistula Placement

31 December 2018 - 11:00pm
Vascular steal syndrome of the distal extremity following AV fistula placement can occur in up to 3% to 8% of patients. This occurrence often leads to additional surgery such as the distal revascularization, interval ligation (DRIL) procedure or fistula ligation. Although multiple risk factors have been shown to be associated with steal, there currently exists no reliable means by which to predict its development at the time of fistula creation. The purpose of this study was to apply a well-established perfusion measurement examination to the ipsilateral hand at the time of access to identify those patients at high risk for steal syndrome.

Fenestrated/Branched Endovascular Aortic Repair in Patients With Chronic Kidney Disease

31 December 2018 - 11:00pm
Renal function impairment is a common complication after open repair of complex abdominal aortic aneurysms (AAAs) and thoracoabdominal aneurysms (TAAA). Fenestrated/branched endovascular aneurysm repair (F-BEVAR) has emerged as an alternative to open repair with improved perioperative outcomes. The effects of chronic kidney disease (CKD) on renal function after F-BEVAR has not been established. The purpose of this study was to assess renal perioperative outcomes and renal function deterioration after F-BEVAR in patients with CKD.

Clinical Outcome of Drug-Eluting Balloon Angioplasty in Patients With Femoropopliteal Disease: Real-World Single Center Experience

31 December 2018 - 11:00pm
Several multicenter industry sponsored clinical trials reported satisfactory results in the use of drug-eluting balloons for the treatment of femoropopliteal occlusive disease. However, few single-center studies were published to verify the outcome from real world experience.

Missed Readmissions to a Different Hospital in Patients With Peripheral Vascular Disease Associated With Significantly Higher Mortality

31 December 2018 - 11:00pm
Currently, there is a need for accurate nationally representative studies on 30-day readmissions. The 30-day readmission rate, which is now a quality outcome measured by the Centers for Medicare and Medicaid Services, has been previously studied on databases that exclude some payer types, states, or certain important data points. Furthermore, current studies do not take into account readmissions that occur at a hospital different from the index admission. This gap allows for potentially flawed data.

Process Improvement in Prophylaxis for Venous Thromboembolism

31 December 2018 - 11:00pm
Venous thromboembolism (VTE) is associated with potentially preventable in-hospital morbidity and mortality. Although evidence-based guidelines for the prevention of VTE are widely available, their application in clinical practice varies markedly. VTE prevention relies on the correct risk stratification of the individual patient, ordering of the indicated chemical or mechanical prophylaxis and, finally, the delivery of this treatment throughout the continuum of the hospital stay. The aim of our study was to identify failure modes in VTE prophylaxis and use these as targets for intervention to decrease VTE incidence rates.

Outcomes of Staged Versus Primary Amputations for Diabetic Foot Disease

31 December 2018 - 11:00pm
Lower extremity amputations (LEAs) are among the most common procedures performed by vascular surgeons in patients with diabetes and peripheral vascular disease. This population commonly suffers from readmission, wound complication, and conversion to more proximal amputation. These events impact quality in terms of cost, resources, and subjective quality of life. The aim of this study is to compare outcomes between primary LEA (pLEA) and staged guillotine amputation followed by interval formalization (sLEA) for diabetic foot disease.