A blunt look at stroke risk in BCVI: Do multiple injuries increase the risk of stroke?

Introduction: Minimal literature correlates stroke rates in blunt cerebrovascular injury (BCVI) to bilaterality, multi-vessel injury, or multifocal injury. We hypothesized that a synchronous cerebrovascular injury and a higher-grade injury would increase stroke rates.

Methods: A single-center retrospective (1/2016-12/2023) review was conducted identifying patients with BCVI.

Exploring penetrating carotid Injuries: Low grade, low yield?

Introduction: The role of mandatory exploration and repair of low-grade penetrating carotid injuries is unclear. We aim to compare outcomes of those managed non-operatively and operatively.

Methods: A single-center retrospective (1/2012-12/2023) review of penetrating common carotid (CCA) and internal carotid arteries (ICA) was performed.

Challenges surrounding hemodialysis initiation faced by undocumented immigrants.

Objective: Hemodialysis (HD) care in the United States for undocumented immigrants remains a challenging issue. The objective of this study is to evaluate the timeliness of nephrology and vascular surgery care provided to undocumented immigrants with end-stage renal disease compared with their documented counterparts. Additionally, we evaluate catheter-related complications in undocumented patients on HD.

Identifying Risk Factors for Poor Outcomes Following Popliteal Vascular Injuries.

Background: Popliteal artery injuries (PAIs) may have amputation rates as high as 20%. This study focuses on identifying risk factors associated with major amputations following PAIs in a large single-center cohort. Additionally, we assess the impact of repairing or ligating concomitant popliteal vein injuries.

Vein diameter, obesity, and rates of recanalization after mechanochemical ablation.

Objective: A large vein diameter is associated with higher recanalization rates after endovenous thermal ablation procedures of the great saphenous vein (GSV) and small saphenous vein (SSV). However, relatively few studies have explored the relationship between vein diameter and recanalization rates after mechanochemical ablation (MOCA).

Methods: We conducted a retrospective review of patients with chronic venous insufficiency who underwent MOCA of the GSV or SSV from 2017 to 2021 at a single hospital.

Aggressive Treatment Strategy at Index Thoracic Endovascular Aortic Surgery is Associated with Reduced Need for Short-Term Reintervention in Patients with Aortic Dissection.

Introduction: Thoracic endovascular aortic surgery (TEVAR) is the modern standard of treatment for patients with Type B aortic dissection, however it is unclear how the initial length of treated aorta affects long-term outcomes. This study aims to elucidate risk factors for secondary intervention after TEVAR for aortic dissection, focusing on length of aortic treatment at index operation.

Methods: A retrospective multihospital chart review was completed for patients treated between 2011 and 2022 who underwent TEVAR for aortic dissection with at least 1 year of post-TEVAR imaging and follow-up.

A comprehensive analysis of leadership attributes, discrepancies, and implications for gender equity in vascular surgery.

Objective: Well-developed leadership skills have been associated with a better understanding of health care context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. Although studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in vascular surgery.

Association between heart failure and arteriovenous access patency in patients with end-stage renal disease on hemodialysis.

Background: Heart disease and chronic kidney disease are often comorbid conditions owing to shared risk factors, including diabetes and hypertension. However, the effect of congestive heart failure (CHF) on arteriovenous fistula (AVF) and AV graft (AVG) patency rates is poorly understood. We hypothesize preexisting HF may diminish blood flow to the developing AVF and worsen patency.

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.

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.

Analysis of Medicare Payments and Patient Outcomes With Pre-Operative Imaging for Carotid Endarterectomy.

Objective: The use of radiographic evaluation of carotid disease may vary, and current guidelines do not strongly recommend the use of cross-sectional imaging (CSI) prior to surgical intervention. We sought to describe the trends in preoperative carotid imaging and evaluate the associated clinical outcomes and Medicare payments for patients undergoing carotid endarterectomy (CEA) for asymptomatic carotid disease.

Methods: We used a 20% Medicare sample from 2006 to 2014 identifying patients undergoing CEA for asymptomatic disease.

Intraoperative heparin use is associated with reduced mortality without increasing hemorrhagic complications after thoracic endovascular aortic repair for blunt aortic injury.

Objective: Thoracic endovascular aortic repair (TEVAR) is an effective treatment of blunt thoracic aortic injury (BTAI). However, the risks and benefits of administering intraoperative heparin in trauma patients are not well-defined, especially with regard to bleeding complications.

Methods: The Vascular Quality Initiative registry was queried from 2013 to 2019 to identify patients who had undergone TEVAR for BTAI with or without the administration of intraoperative heparin.

Secondary interventions in patients with implantable cardiac devices and ipsilateral arteriovenous access.

Objective: The number of patients with end-stage renal disease who require implantable cardiac devices is increasing. Rates of secondary interventions or fistula failure are not well studied in patients who have arteriovenous fistula (AVF) access placed on the ipsilateral side as a pacemaker. This study aimed to compare central vein-related interventions and failure rates of arteriovenous access in patients with pacemakers placed on the ipsilateral vs contralateral side.

Long-term durability of Oakes salvage procedure to preserve Brescia-Cimino arteriovenous fistula.

Background: In 2002, Oakes et al described a novel procedure designed to salvage the distal cephalic venous outflow of a Brescia-Cimino fistula by placing a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist. In this fashion, the more proximal veins were saved for future procedures. Their approach was reported and found to be successful in the short term, but the long-term durability of the Oakes procedure has not been described.

Arteriovenous Fistula and Graft Construction in Patients with Implantable Cardiac Devices: Does Side Matter?

Background: Limited reports have documented the effect cardiac implantable electronic devices (CIEDs) have on arteriovenous (AV) access patency. Current recommendations suggest placing the access on the contralateral side of the CIEDs, as there is concern for increased central venous stenosis and access failure. The goal of this study is to review our single-center AV access patency rates for dialysis patients with an ipsilateral or contralateral side CIED.

Mycotic Renal Artery Aneurysm Presenting as Critical Limb Ischemia in Culture-Negative Endocarditis.

Mycotic renal artery aneurysms are rare and can be difficult to diagnose. Classic symptoms such as hematuria, hypertension, or abdominal pain can be vague or nonexistent. We report a case of a 53-year-old woman with a history of intravenous drug abuse presenting with critical limb ischemia, in which CT angiography identified a mycotic renal aneurysm.

Postoperative Infections are Associated with Increased Risk of Cardiac Events in Vascular Patients.

Background: Despite advances in perioperative care, the rate of cardiac events in vascular patients remains high. We have previously shown that infections in trauma patients are associated with higher rates of subsequent cardiac complications, likely due to the additive effect of a second hit of an infection following the trauma. The aim of this study was to investigate whether there is an association between postoperative infections and subsequent cardiac events in vascular patients.

Open revascularization procedures are more likely to influence smoking reduction than percutaneous procedures.

Background: Among patients with peripheral arterial disease (PAD), smokers have a higher incidence of life- and limb-threatening complications, including lower extremity ischemic rest pain, myocardial infarction, and cardiac death, highlighting the need for smoking reduction. Several studies have previously investigated the perioperative period as a teachable moment for smoking cessation. The purpose of this study is to determine whether the type of revascularization for PAD (percutaneous versus open) is associated with smoking reduction.

A 14-year experience with blunt thoracic aortic injury.

Objective: This study reviewed the natural history of blunt thoracic aortic trauma (BTAT) over a 14-year period at our level 1 trauma center and compared open vs endovascular treatment.

Methods: All patients with BTAT presenting to a level 1 trauma center from 1998 to 2011 were included in a retrospective analysis. Multiple data points and short-term and midterm outcomes were ascertained through a retrospective record review.

Primary extracranial vertebral artery aneurysms.

Background: Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult.

Endovascular repair of mycotic aneurysm of the descending thoracic aorta.

Background: Mycotic thoracic aortic aneurysms (MTAAs) are a rare yet life-threatening disease. The current standard of care consists of surgical resection, in situ or extra-anatomic revascularization, and antibiotic therapy. Despite this treatment, mortality remains high (range, 5-40%).