Journal of Vascular Surgery

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Strength is in numbers when participating in an Accountable Care Organization

28 February 2019 - 11:00pm
The Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) established the Quality Payment Program, which requires physicians who bill Medicare to participate in either the Merit-based Incentive Payment System or an Advanced Alternative Payment Model (AAPM). For reporting year 2019, providers who do not participate adequately will experience a 7% penalty in their 2021 Medicare reimbursements.1

Computational Fluid Dynamics in Descending Thoracic Aortic Aneurysm: Tortuosity Associated With High Displacement Forces

28 February 2019 - 11:00pm
Tortuosity comes with higher displacement forces in the aorta. As the descending thoracic aorta (DTA) is becoming longer and more tortuous with age, it is important to understand the influence of tortuosity on displacement forces in the DTA.

Limb Salvage for “Hopeless” Lymphedema: Reviving the Charles Procedure

28 February 2019 - 11:00pm
The Charles procedure offers radical excision of lymphedematous tissue followed by skin grafting. This procedure is rarely offered because of the potential for complications, but it may provide excellent outcomes in improving quality of life. We describe our experience with a modified technique and a multidisciplinary team approach in treating patients with advanced lymphedema.

Factors Predicting Failure of Retrieval of Inferior Vena Cava Filters

28 February 2019 - 11:00pm
Inferior vena cava (IVC) filters are commonly used to prevent pulmonary embolism in patients with deep venous thrombosis. However, IVC filters are associated with risks, including IVC perforation, filter migration, fracture, and thrombosis. Filter retrieval is not always successful. Our objective was to identify factors associated with failure of retrieval of IVC filters.

Primary Venous Leiomyosarcoma: Reconstructive and Oncologic Outcomes

28 February 2019 - 11:00pm
Primary venous leiomyosarcomas (PVLs) are rare and pose challenges in oncologic management. Surgical resection is the primary therapy, with less clear roles for chemotherapy and radiation. This study evaluates the clinical outcomes and identifies predictors of survival in our surgical series of PVLs.

An Analysis of the Current Educational Courses Offered to Vascular Trainees

28 February 2019 - 11:00pm
Whereas there is increasing evidence that short educational courses provide a valuable supplement to vascular surgical training, there are few data regarding the prevalence, content, and educational goals of these programs. Our objective was to catalogue the available extraresidency experiences available to vascular trainees in North America.

Gender-Based Discrimination Is Prevalent in the Integrated Vascular Trainee Experience and Serves as a Predictor of Burnout

28 February 2019 - 11:00pm
Trainee burnout is on the rise, and negative training environments may contribute. In addition, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and to determine how gender-based discrimination and bias (GBDB) affect the clinical experience.

Training in Modern Lower Extremity Revascularization: Analysis of the Operative Experience of Surgical Trainees During 20 Years

28 February 2019 - 11:00pm
Lower extremity (LE) revascularization training has changed during the last 20 years, with increased emphasis on endovascular procedures and development of integrated programs. The impact of these changes on the surgical resident’s LE revascularization experience is unclear. The objective of this study was to evaluate national trends in training in LE revascularization of general surgery residents (GSRs), vascular fellows (VFs), and integrated vascular residents (IVRs) during the past 20 years. We hypothesized that LE revascularizations of GSRs are downtrending, and patterns among VFs and IVRs may further define these changes.

Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons

28 February 2019 - 11:00pm
Past surveys demonstrated that a significant number of patients thought that social media content would affect their choice of physician, hospital, or medical facility. Our goal was to evaluate the extent of unprofessional social media content among recent vascular surgery fellows and residents.

Site of Service Influence on Stent Utilization for Hemodialysis Access Interventions

28 February 2019 - 11:00pm
With unsustainably rising health care spending in the United States, the Centers for Medicare and Medicaid Services (CMS) has in recent years attempted to use reimbursement rates to influence utilization of less expensive care sites for covered patients, such as ambulatory surgery facilities and office-based interventions in lieu of hospital service sites. It has been suggested that cost savings have not been realized because of an increase in procedure numbers performed by physicians with ownership interests in nonhospital facilities.

The Role of Duplex Ultrasound in Assessing Arteriovenous Fistula Maturation

28 February 2019 - 11:00pm
We examined the utility of postoperative color duplex ultrasound (CDU) in assessing arteriovenous fistula (AVF) maturation and determining the need for balloon-assisted maturation (BAM).

Single-Center Cost Analysis Comparing High-Risk Carotid Endarterectomy and Transcarotid Artery Revascularization

28 February 2019 - 11:00pm
Transcarotid artery revascularization (TCAR) using reversal of flow has been shown to be a safe and effective means of treating carotid artery stenosis. However, no real-world analysis of the cost of using TCAR instead of carotid endarterectomy (CEA) for high-risk carotid stenosis has been performed.

The Effect of Clinical Coronary Disease Severity on Outcomes of Carotid Endarterectomy With and Without Combined Coronary Bypass

28 February 2019 - 11:00pm
The management of patients with carotid stenosis and symptomatic coronary artery disease (CAD) is challenging. This study assessed the impact of clinical CAD severity on carotid endarterectomy (CEA) with and without combined coronary artery bypass (CCAB).

Differential Impact of Etiology on Long-term Functional Outcomes of Patients With Thoracic Outlet Syndrome

28 February 2019 - 11:00pm
Thoracic outlet syndrome (TOS) results from compression of the neurovascular structures in the thoracic outlet. Decompression provides relief of TOS symptoms, but little is known about long-term function and quality of life (QoL) from a patient’s perspective. The purpose of this study was to evaluate surgical and QoL outcomes after surgical decompression of the thoracic outlet using a paraclavicular approach.

Predictors of Blunt Abdominal Aortic Injury in Trauma Patients and Analysis for Mortality

28 February 2019 - 11:00pm
Blunt abdominal aortic injury (BAAI) occurs in <0.1% of blunt trauma. A previous multi-institutional study found an associated mortality rate of 39%. We sought to identify risk factors for BAAI and risk factors for mortality in patients with BAAI using a large national database.

BEST-CLI Site Performance Comparison Between Multidisciplinary Sites and Nonmultidisciplinary Sites

28 February 2019 - 11:00pm
There is limited evidence regarding the role of multidisciplinary teams in vascular clinical trials. Best Endovascular vs Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI), a randomized trial comparing surgical and endovascular revascularization strategies, is structured to foster multidisciplinary collaboration. To evaluate the impact of collaboration, we compared enrollment rates at multidisciplinary and nonmultidisciplinary sites.

Poor Medical Management, Atherectomy, and Multilevel Therapy Are Associated With Worse Outcomes After Endovascular Interventions for Claudication

28 February 2019 - 11:00pm
Treatment of claudication is elective; thus, good outcomes are imperative. The objective of this study was to examine patterns of claudication management and outcomes after peripheral vascular intervention (PVI) for claudication in the Vascular Quality Initiative.

Economic Burden and Clinical Impact of Opioid Dependence in Patients Undergoing Lower Extremity Bypass Surgery: Quantifying the Cost of a New Epidemic

28 February 2019 - 11:00pm
Surgeons’ contributions to the opioid epidemic have received significant attention in the media. Few data exist, however, of the impact of prior or coexistent opioid use on vascular surgery outcomes. This study aimed to quantify the economic impact of pre-existing opioid dependency in patients undergoing lower extremity bypass surgery.

Treatment Strategies and Outcomes of Infected Thoracoabdominal and Pararenal Aortic Aneurysms

28 February 2019 - 11:00pm
Mycotic thoracoabdominal and pararenal aortic aneurysms (mTAAAs/PRAAs) or infections of TAAA and PRAA grafts (iTAAAs/PRAAs) are a rare but devastating clinical problem. Treatment requires complex surgical reconstruction to maintain visceral and renal perfusion. There is a paucity of literature describing outcomes for this technically challenging and highly lethal problem. Herein, we report our experience in the management of these patients.

Outcomes of Directional Branches Using Self-Expandable Versus Balloon-Expandable Stent Grafts During Endovascular Repair of Thoracoabdominal Aortic Aneurysms

28 February 2019 - 11:00pm
The objective of this study was to evaluate outcomes of directional branches using self-expandable stent grafts (SESGs) or balloon-expandable stent grafts (BESGs) during fenestrated-branched endovascular aneurysm repair of thoracoabdominal aortic aneurysms.