The Two-Decade Experience of Onco-vascular Reconstruction in Patients with Retroperitoneal Sarcoma.

Introduction: Surgical resection remains the cornerstone of sarcoma treatment; however, tumor involvement of major vasculature presents challenges. Multidisciplinary approaches incorporating vascular surgery have expanded feasibility of resection, yet long-term outcome data remain limited.

Methods: We performed a retrospective review of patients with retroperitoneal sarcomas who underwent resection with vascular reconstruction at a tertiary referral center from 2001-2024.

Endovascular surgery does not mitigate the adverse effects of frailty on the risk of losing life or limb.

Objectives: Evidence behind frail patients preferentially undergoing minimally invasive endovascular interventions for peripheral arterial disease remains sparse; thus, we evaluated the association of frailty and revascularization-approach with long-term mortality and major adverse limb events (MALEs).

Methods: The Vascular Quality Initiative-Medicare-linked Vascular Implant Surveillance and Interventional Outcomes Network databases were queried for patients who had their first infrainguinal open or endovascular (endo) procedure between 2011 and 2015 (n = 27,200). Frailty was measured using the Vascular Quality Initiative Risk Analysis Index (RAI) and dichotomized into frail (RAI ≥ 37) and nonfrail (RAI < 37).

Discovery and Optimization of Selective Inhibitors of Large Tumor Suppressor Kinases LATS1 and 2 for In Vivo Investigation of the Hippo-YAP Pathway in Tissue Regeneration.

Large Tumor Suppressor kinases LATS1 and 2 (LATS1/2) are serine/threonine kinases and core regulators of the Hippo-YAP pathway. Inhibition of LATS1/2 promotes nuclear translocation of nonphosphorylated YAP, thereby initiating a downstream cascade promoting cell proliferation. We set out to investigate the potential of LATS inhibition as a therapeutic approach to enhance tissue regeneration and hereby report a structure-guided optimization of screening hit for potency, binding efficiency, and physicochemical properties, leading to a highly selective, cellularly active, and orally available tool compound (NIBR-LTSi) that demonstrated target engagement and in vivo YAP target gene activation in rodents.

Angiosarcoma Beneath a Bleeding Aneurysmal Veil.

Background: Angiosarcoma is a rare and aggressive vascular tumor that often presents diagnostic and therapeutic challenges. Its potential for misdiagnosis emphasizes the importance of a multidisciplinary approach.

Case Summary: A 54-year-old man with Loeys-Dietz syndrome and a history of popliteal artery aneurysm treated with surgical exclusion and autologous vein bypass presented with a recurrent hemorrhage from the popliteal fossa.

Comparison of In-Person and Virtual Integrated Vascular Surgery Residency Interviews from the Applicant's Perspective.

Background: The COVID-19 pandemic provoked an abrupt transition from in-person to virtual format interviews for integrated vascular surgery residency. Recently, 12 programs (15.8%) resumed in-person interviews in 2023-2024.

Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively.

Objective: Compare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies.

Summary Background Data: A surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown.

Methods: In an observational cohort study across a multi-hospital healthcare system including adults presenting to outpatient surgical clinics (2016-2023) for evaluation of eight conditions feasibly managed operatively or nonoperatively as defined by modified Delphi consensus.

Phlegmasia cerulea dolens as a complication of radiation therapy in endometrial cancer: a case report.

This study reports the case of a 61-year-old female patient with recurrent endometrial cancer who developed phlegmasia cerulea dolens and compartment syndrome of the right lower extremity 1 day after receiving high-dose radiation therapy. In addition, the patient had a right main pulmonary artery embolus. The patient underwent inferior vena cava filter placement, open common femoral vein thrombectomy, 4-compartment fasciotomy, and vacuum-assisted superficial groin wound closure.

Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery.

Importance: Surgical quality improvement efforts have largely focused on 30-day outcomes, such as readmissions and complications. Surgery may have a sustained impact on the health and quality of life of patients considered frail, yet data are lacking on the long-term health care utilization of patients with frailty following surgery.

Objective: To examine the independent association of preoperative frailty on long-term health care utilization (up to 24 months) following surgery.

Implementation of a preoperative frailty screening and optimization pathway for vascular surgery patients is associated with decreased 30-day readmission.

Objective: Frailty is characterized by decreased physiological reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for patients undergoing vascular surgery and assessed its impact on postoperative outcomes.

Methods: As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI).

Endovascular retrieval of an entrapped balloon in a tibial artery.

Balloon entrapment is a rare complication of angioplasty in calcified or recalcitrant lesions. A 65-year-old man with chronic limb-threatening ischemia underwent balloon angioplasty of his heavily calcified tibial arteries with a low-profile, tapered, compliant balloon. The balloon became entrapped within the posterior tibial artery and required multiple endovascular maneuvers to deflate and separate the balloon from the calcified arterial wall.

Outcomes of Women Undergoing Noncardiac Surgery in Veterans Affairs Compared With Non-Veterans Affairs Care Settings.

Importance: Recent legislation facilitates veterans' ability to receive non-Veterans Affairs (VA) surgical care. Although veterans are predominantly male, the number of women receiving care within the VA has nearly doubled to 10% over the past decade and recent data comparing the surgical care of women in VA and non-VA care settings are lacking.

Objective: To compare postoperative outcomes among women treated in VA hospitals vs private-sector hospitals.

Cost-effectiveness analysis of endovascular vs surgical arteriovenous fistula creation in the United States.

Objective: In the United States, an estimated $2.8 billion annually is spent on vascular access and its complications. Endovascular arteriovenous fistula (endoAVF) creation is a novel, minimally invasive alternative to traditional surgical AV fistula (sAVF) creation in ≤60% of patients.

Precocious Rupture of Abdominal Aortic Aneurysms Below Size Criteria for Repair: Risk Factors and Outcomes.

Background: Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAAs) ≥ 5.5 cm in men and ≥ 5 cm in women to prevent rupture; however, some rupture at smaller diameters. We identify risk factors for rupture AAA (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria.

Simplifying Hospital Quality Comparisons for Vascular Surgery Using Center-Level Frailty Burden Rather Than Comorbidities.

Background: Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores.

Racial, ethnic, and socioeconomic inequities in amputation risk for patients with peripheral artery disease and diabetes.

Peripheral artery disease and diabetes are highly prevalent diseases and the leading cause of limb loss. Despite advances in medical and surgical techniques, there are stark differences in delivery and outcomes of lower extremity amputation among populations when stratified by race, ethnicity, and socioeconomic status. We reviewed studies from the last 2 decades (1999-2022) to provide a comprehensive assessment of the current impact of disparities on the risk for, and management of, lower extremity amputation and offer action items that can optimize health outcomes.

Most privately insured patients do not receive federally recommended abdominal aortic aneurysm screening.

Objective: Since 2005, the United States Preventative Services Task Force has recommended abdominal aortic aneurysm (AAA) ultrasound screening for 65- to 75-year-old male ever-smokers. Integrated health systems such as Kaiser Permanente and the Veterans Affairs (VA) health care system report 74% to 79% adherence, but compliance rates in the private sector are unknown.

Methods: The IBM Marketscan Commercial and Medicare Supplemental databases (2006-2017) were queried for male ever-smokers continuously enrolled from age 65 to 75 years.

Female sex is independently associated with reduced inpatient mortality after endovascular repair of blunt thoracic aortic injury.

Background: Female sex has been associated with decreased mortality after blunt trauma, but whether sex influences the outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown.

Methods: In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative registry was queried from 2013 to 2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and χ tests were performed, followed by multivariate logistic regression for variables associated with inpatient mortality.

Trends in annual open abdominal aortic surgical volumes for vascular trainees compared with annual national volumes in the endovascular era.

Objective: A prior analysis predicted a shortfall in open abdominal aortic repair (OAR) experience for vascular trainees resulting from the rapid adoption, and increased anatomic suitability, of endovascular aortic aneurysm repair (EVAR) technology. We explored how EVAR has transformed contemporary open aortic surgical education for vascular trainees.

Methods: We examined the Accreditation Council for Graduate Medical Education case volumes of open abdominal aortic aneurysm (AAA) repair and reconstruction for aortoiliac occlusive disease via aortoiliac or femoral bypass (AFB) from integrated vascular surgery residents (VSRs) and fellows (VSFs) graduating from 2006 to 2017 and compared them to the national estimates of total OAR (open AAA repair plus AFB) in the Agency for Healthcare Research and Quality National Inpatient Sample using the International Classification of Diseases, 9th and 10th revision, procedural codes.

Perspectives on Home Time and Its Association With Quality of Life After Inpatient Surgery Among US Veterans.

Importance: Home time, defined as time spent at home after hospital discharge, is emerging as a novel, patient-oriented outcome in stroke recovery and end-of-life care. Longer home time is associated with lower mortality and higher patient satisfaction. However, a knowledge gap exists in the measurement and understanding of home time in the population undergoing surgery.

Comparing Veterans Affairs and Private Sector Perioperative Outcomes After Noncardiac Surgery.

Importance: Recent legislation facilitates veterans' ability to receive non-Veterans Affairs (VA) surgical care. However, contemporary data comparing the quality and safety of VA and non-VA surgical care are lacking.

Objective: To compare perioperative outcomes among veterans treated in VA hospitals with patients treated in private-sector hospitals.

Female sex is independently associated with in-hospital mortality after endovascular aortic repair for ruptured aortic aneurysm.

Background: Endovascular aortic repair (EVAR) can treat anatomically compatible ruptured abdominal aortic aneurysms (rAAA), but registry data suggests that women undergo more open abdominal aneurysm repairs than men. We evaluate in-hospital outcomes of EVAR for rAAA by sex.

Methods: The Vascular Quality Initiative (VQI) registry was queried from 2013 to 2019 for rAAA patients treated with EVAR.