Same-Day Discharge Following EVAR in Select Veteran Patients is Safe and Effective.

Background: Decreasing hospital length of stay (LOS) after surgery improves costs and resource utilization. We evaluated the safety and efficacy of the same-day discharge (SDD) after endovascular aortic aneurysm repair (EVAR) in a Veterans Affairs (VA) population.

Methods: We reviewed all EVARs between 2018 and 2024 at a single VA hospital.

Assessing Risk of Anterior Exposure for Anterior Lumbar Interbody Fusion in Obese Patients.

Introduction: Though obesity is common in patients undergoing anterior lumbar interbody fusion (ALIF), complications in those with BMI ≥30 kg/m are incompletely characterized. This retrospective study of ALIF patients aims to establish predictors of perioperative complications relating to anterior exposure. Our hypothesis was that obesity would be associated with increased rates of intraoperative and postoperative complications.

Secondary Limb-Salvage Fifty Years After Vascular Injury: A Case Report.

A 73-year-old veteran presented to vascular surgery with a nonhealing left lower leg wound. Fifty years before the presentation, he sustained a gunshot wound to the left leg during combat. Emergent superficial femoral artery to popliteal artery bypass using vein graft and complex bone and soft-tissue repair resulted in successful primary limb salvage.

More than a bag of tricks - Curriculum schema for chronic lower extremity wound healing.

Chronic wound treatment is a huge burden on our healthcare system, yet wound healing is not broadly taught in U.S. medical schools.

Heparin-Induced Thrombocytopenia (HIT) in the Direct Oral Anticoagulants (DOAC) Era.

Background: Heparin-induced thrombocytopenia (HIT) is an uncommon complication of heparin therapy with significant risk for severe morbidity and mortality. We investigated the role and outcome of direct oral anticoagulants (DOACs) for the management of HIT.

Methods: After institutional review board (IRB) approval, a retrospective review was performed identifying all patients with positive HIT serotonin-release assays between 2020 and 2022 at two hospitals.

Atypical Pyoderma Gangrenosum in the Setting of Venous and Arterial Insufficiency.

Ulcers of mixed etiology are diagnostically elusive and challenging to treat, especially when rare conditions are superimposed. Pyoderma gangrenosum (PG) is an autoinflammatory, ulcerative skin disease that is difficult to diagnose. Diagnostic criteria exist but there are no specific clinical tests to identify it.

Peak systolic velocity and color aliasing are important in the development of duplex ultrasound criteria for external carotid artery stenosis.

Objective: The external carotid artery (ECA) serves as a major collateral pathway for ophthalmic and cerebral artery blood supply. It is routinely examined as part of carotid duplex ultrasound, but criteria for determining ECA stenosis are poorly characterized and typically extrapolated from internal carotid artery data. This is despite the fact that the ECA is smaller in diameter, with a higher resistance and lower volume flow pattern.

Pyoderma gangrenosum underrepresentation in non-dermatological literature.

Background: Pyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI).

Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses.

Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH) vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience.

Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49) or through a single open incision (n = 64) from 2012 to 2017.

Treatment of L5-S1 spondyloptosis with stand-alone anterior lumbar interbody fusion in a patient with neurofibromatosis.

Background: Neurofibromatosis type 1 (NF1) is a multisystem disorder that causes multiple tumor formations throughout the nervous system. Common spinal dysplasias seen with NF1, such as dural ectasia (DE), often undergo modulation and predispose these patients to spondylolisthesis, making surgical treatment challenging.

Case Description: A patient with NF1 presented with a 12-year-history of back and left lower extremity radicular pain.

Predictors of perioperative morbidity and mortality in open abdominal aortic aneurysm repair.

Introduction: The major advantage of endovascular abdominal aortic aneurysm repair (EVAR) over open repair (OAR) is improved perioperative morbidity and mortality. Long term results of the two modalities are comparable. We sought to quantify factors predicting perioperative morbidity and mortality in patients undergoing OAR.

Two-level reverse Bohlman transsoseous approach for treatment of symptomatic pseudarthrosis.

Surgical treatment for high-grade spondylolisthesis with high sacral slope remains controversial and no definitive gold standard procedure has been identified. The Bohlman technique, in which a fibular strut is reamed posteriorly across the L5-S1 disc space in an oblique, inferior to superior trajectory, has been increasingly utilized. Recently, a Reverse Bohlman technique has been described, in which a graft is reamed anteriorly across a single disc space in a superior to inferior trajectory.

Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit.

Objective: Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients.

Methods: All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed.

Characterization of profunda femoris vein thrombosis.

Objective: The incidence of and risk factors for profunda femoris vein (PFV) thrombosis are poorly characterized. We prospectively identified patients with PFV deep venous thrombosis (DVT) to characterize the demographics and anatomic distribution of proximal DVT in patients with PFV DVT.

Methods: A prospective study was conducted of patients at a tertiary care university hospital with DVT diagnosed by venous duplex ultrasound scanning between June 2014 and June 2015.

Tibial artery duplex ultrasound-derived peak systolic velocities may be an objective performance measure after above-knee endovascular therapy for arterial stenosis.

Objective: The ankle-brachial index (ABI) is a well-established measure of distal perfusion in lower extremity ischemia; however, the ABI is of limited value in patients with noncompressible lower extremity arteries. We sought to demonstrate whether duplex ultrasound-determined tibial artery velocities can be used as an alternative to ABI as an objective performance measure after endovascular treatment of above-knee arterial stenosis.

Methods: Thirty-six patients undergoing above-knee endovascular intervention had preprocedure and postprocedure duplex ultrasound examination within 6 months of intervention.

Ambulation and functional outcome after major lower extremity amputation.

Objective: Major lower extremity amputations (MLEAs) remain a significant source of disability. It is unknown whether postamputation functional outcomes and outcome predictability have changed with a population of increasingly aging and obese patients. Accordingly, we sought to evaluate contemporary trends.

Nonatherosclerotic vascular causes of acute abdominal pain.

Background: To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease.

Methods: Subjects were reviewed over a six year period. Categories included embolism (EM), dissection (DI), and aneurysm (AN).

Interhospital vascular surgery transfers to a tertiary care hospital.

Objective: Interhospital transfers (IHTs) to tertiary care centers are linked to lower operative mortality in vascular surgery patients. However, IHT incurs great health care costs, and some transfers may be unnecessary or futile. In this study, we characterize the patterns of IHT at a tertiary care center to examine appropriateness of transfer for vascular surgery care.

Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease.

Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients remains insufficiently assessed. Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, Cox proportional hazards models were used to examine the association of cardiovascular risk factors and all-cause and cardiovascular mortality.

Patterns of Care in Hospitalized Vascular Surgery Patients at End of Life.

Importance: There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients.

Objective: To identify factors driving end-of-life decisions in vascular surgery patients.

Design, Setting, And Participants: In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014.

Arterial duplex for diagnosis of peripheral arterial emboli.

Background: Whether duplex ultrasound (DUS) imaging alone can be used to successfully plan revascularization for peripheral arterial embolism (PAE) is unknown. This study evaluated the utility of DUS imaging alone for the diagnosis and treatment of PAE.

Methods: Patients with cardiogenic PAE to the lower or upper extremities during a 20-year period were retrospectively evaluated.

Use of an extracorporeal bypass for renal preservation to treat a rare case of a true mycotic aneurysm in a renal transplant patient.

True mycotic aneurysms of the abdominal aorta are extremely rare after organ transplantation. We report a renal transplant recipient who presented with bacteremia and a new saccular infrarenal aortic aneurysm. A temporary extracorporeal axillofemoral bypass was placed to maintain perfusion to the transplant kidney.

Inhibition of intestinal epithelial apoptosis improves survival in a murine model of radiation combined injury.

World conditions place large populations at risk from ionizing radiation (IR) from detonation of dirty bombs or nuclear devices. In a subgroup of patients, ionizing radiation exposure would be followed by a secondary infection. The effects of radiation combined injury are potentially more lethal than either insult in isolation.

The endogenous bacteria alter gut epithelial apoptosis and decrease mortality following Pseudomonas aeruginosa pneumonia.

The endogenous bacteria have been hypothesized to play a significant role in the pathophysiology of critical illness, although their role in sepsis is poorly understood. The purpose of this study was to determine how commensal bacteria alter the host response to sepsis. Conventional and germ-free (GF) C57Bl/6 mice were subjected to Pseudomonas aeruginosa pneumonia.

Mechanisms of methicillin-resistant Staphylococcus aureus pneumonia-induced intestinal epithelial apoptosis.

Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia-induced sepsis is a common cause of morbidity in the intensive care unit. Although pneumonia is initiated in the lungs, extrapulmonary manifestations occur commonly. In light of the key role the intestine plays in the pathophysiology of sepsis, we sought to determine whether MRSA pneumonia induces intestinal injury.