Bypass versus Endovascular Therapy in Chronic Limb Threatening Ischemia Requiring Infra-Popliteal Interventions.

Objectives: Chronic Limb Threatening Ischemia (CLTI) involving the crural arteries is clinically and anatomically challenging. The BASIL-2 trial and a subanalysis of the BEST-CLI trial examined the efficacy of endovascular therapy (EVT) versus surgical bypass (BP) among this cohort, but arrived at differing conclusions. This study aimed to compare the outcomes of EVT and surgical bypass among patients with CLTI requiring infra-popliteal interventions in a real-world registry.

Predictors of postoperative stroke after transfemoral carotid artery stenting.

Objective: In 2023, the Centers for Medicare and Medicaid Services expanded coverage for transfemoral carotid artery stenting (tfCAS) to include standard-risk patients. Given this shift, we sought to identify predictors of postoperative stroke in patients undergoing tfCAS.

Methods: We analyzed Vascular Quality Initiative data from 2011 to 2024, identifying tfCAS patients treated for atherosclerosis or restenosis.

Increased market competition is associated with lower mortality after complex aortic surgery.

Objective: Centralized aortic hubs frequently exist in competitive markets, which have at times demonstrated inferior surgical outcomes. Here we evaluate the impact of local market competition specifically on complex aortic surgical outcomes.

Methods: A retrospective review included all Vascular Quality Initiative (VQI) patients between 2013 and 2022 undergoing index complex endovascular aortic repair, thoracic endovascular aortic repair, or open aortic repair.

Comparison of isolated popliteal interventions in chronic limb-threatening ischemia.

Objective: Although the Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia trial demonstrated superiority of bypass with single-segment great saphenous vein for chronic limb-threatening ischemia (CLTI), an endovascular-first approach remains appropriate for patients lacking single-segment great saphenous vein, those who are high risk for open surgery, and most patients with Global Limb Anatomic Staging System stage I disease. Isolated popliteal artery disease is an anatomically challenging disease pattern for which evidence to drive operative decisions is lacking.

The Impact of Follow-Up on Mortality in Chronic Limb-Threatening Ischemia.

Background: Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. As such, close follow-up is recommended to ensure patency of revascularization, limb viability, and optimization of cardiovascular risk factors. This study aimed to test the association between follow-up adherence and mortality, and to identify risk factors for nonadherence with recommended vascular follow-up.

Endovascular abdominal aortic aneurysm repair (EVAR) outcomes of unibody and single/double docking limb endografts in Medicare beneficiaries between 2012 and 2018.

Objective: The evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts.

Design: This study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation.

Methods: All patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database.

Groin Complications Among Obese Patients Undergoing Vascular Procedures.

Background: Groin incision wound complications (WC) are common among vascular surgery patients. Obesity is a known risk factor, but there is no consensus on the best way to prevent WC in obese patients after vascular procedures. The objective of this study was to identify risk factors for WC and strategies to prevent these complications specifically in obese patients.

Impact of Chronic Kidney Disease on Outcomes following Vascular Procedure in the Vascular Quality Initiative.

Background: Chronic kidney disease (CKD) increases morbidity and mortality in most vascular procedures. However, a binary classification of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, which is often used in both modeling and clinical trials, may not be optimal for predicting clinical outcomes.

Real-world use of medical therapy in moderate asymptomatic carotid stenosis.

Objective: Despite level 1 evidence demonstrating the benefit of carotid endarterectomy for the prevention of stroke in patients with severe asymptomatic carotid stenosis (ACS), there has been a trend toward recommending optimal medical therapy (OMT) alone. This recommendation has been promulgated based on the observation that modern advances in OMT reduce the overall stroke risk in the general population, but the success of this treatment strategy is dependent on patient and provider adherence. In current practice, patients with moderate ACS are nearly all treated with OMT alone.

Outcomes of endovascular intervention for atherosclerotic lesions confined to the popliteal artery.

Objective: Most surgeons employ an endovascular-first approach to the treatment of peripheral arterial disease (PAD), but controversy remains regarding the ideal interventions for the management of isolated popliteal artery disease (IPAD). Indeed, there are a paucity of data that compare outcomes of popliteal stents vs other peripheral vascular interventions (PVIs). The goal of this study was to evaluate outcomes of PVIs in IPAD.

Carotid Endarterectomy With Simultaneous Proximal Common Carotid Endovascular Intervention is Beneficial for Symptomatic Stenosis and Likely Confers No Advantage for Asymptomatic Lesions.

Introduction: Carotid bifurcation stenosis may co-exist simultaneously with more proximal common carotid artery (CCA) atherosclerotic plaquing, primarily at the vessel origin in the aortic arch. This scenario is relatively infrequent and its' management does not have quality randomized data to support medical vs surgical treatment. It is logical to treat any high grade common carotid lesions proximal to a carotid bifurcation endarterectomy (CEA) site both to prevent perioperative emboli or thrombosis as well as future embolization.

Preoperative Anemia Is Associated With Postoperative Renal Failure After Elective Open Aortic Repair.

Introduction: Preoperative anemia has been consistently shown to be a risk factor for acute kidney injury (AKI) after cardiac surgery. However, this association has not been examined in the open abdominal aortic aneurysm repair (OAR) population and is the subject of this analysis.

Methods: Targeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing OAR from 2013 to 2019.

Inferior mesenteric artery revascularization can supplement salvage of mesenteric ischemia.

The inferior mesenteric artery (IMA) has often been overlooked in favor of the celiac or superior mesenteric artery in arterial mesenteric ischemia, owing to the typically robust visceral collateral networks. In the present report, we have described a case series of patients in whom "salvage" revascularization of the IMA was performed after attempted celiac or superior mesenteric artery revascularization had been unsuccessful. The restored IMA inflow had resolved the symptoms for three patients.

Characteristics and Outcomes of Patients Undergoing Infrainguinal Bypass in the Endovascular Era.

Background: The Society for Vascular Surgery (SVS) developed objective performance goals (OPGs) for lower extremity bypass (LEB) in chronic limb-threatening ischemia (CLTI) based on studies that included patients who were at good risk for open revascularization. In the endovascular era, many LEB patients have had prior interventions, and most would be considered high-risk by the original SVS OPG standards. The goal of this study is to characterize a contemporary patient population undergoing LEB for CLTI and determine if outcomes remain commensurate with the parameters established by the SVS OPG.

Longer patient travel distance is associated with increased non-index readmission after complex aortic surgery.

Objective: Recently evolving practice patterns in complex aortic surgery have led to regionalization of care within fewer centers in the United States, and thus patients may have to travel farther for complex aortic care. Travel distance has been associated with inferior outcomes after non-vascular surgery, particularly non-index readmission. This study aims to assess the impact of patient travel distance on perioperative outcomes and readmissions after complex aortic surgery.

In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement.

Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI.

Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database.

Vascular smooth muscle cell phenotype switching in carotid atherosclerosis.

Carotid plaque instability contributes to large vessel ischemic stroke. Although vascular smooth muscle cells (VSMCs) affect atherosclerotic growth and instability, no treatments aimed at improving VSMC function are available. Large genetic studies investigating atherosclerosis and carotid disease in relation to the risk of stroke have implicated polymorphisms at the locus.

Reassuring Intraoperative Parameters Do Not Obviate the Need for Infrainguinal Bypass Completion Angiograms.

Objective: To determine if routine completion angiography for lower extremity bypasses using vein conduit results in lower rates of postoperative bypass occlusion.

Summary Of Background Data: With the increasing availability of on-table angiography and significant advancements in endovascular techniques, some operators routinely perform completion angiograms. The effect of this surgical paradigm has yet to be rigorously compared to the more widespread selective use of completion imaging in the modern era.

Imaging High-Risk Atherothrombosis Using a Novel Fibrin-Binding Positron Emission Tomography Probe.

Background And Purpose: High-risk atherosclerosis is an underlying cause of cardiovascular events, yet identifying the specific patient population at immediate risk is still challenging. Here, we used a rabbit model of atherosclerotic plaque rupture and human carotid endarterectomy specimens to describe the potential of molecular fibrin imaging as a tool to identify thrombotic plaques.

Methods: Atherosclerotic plaques in rabbits were induced using a high-cholesterol diet and aortic balloon injury (N=13).

The Effect of Retrograde External Iliac Artery Runoff on Aortofemoral Bypass Limb Patency.

Background: Superficial femoral artery and profunda patency has been shown to affect aortofemoral bypass (AFB) limb patency. However, the effect of retrograde flow through the external iliac artery (EIA) is unknown and is the subject of this analysis.

Methods: Institutional AFB data from 2000 to 2017 were gathered, excluding that where Superficial femoral artery /EIA patency could not be determined.

Late Type 1A Endoleaks: Associated Factors, Prognosis and Management Strategies.

Background: Unlike periprocedural Type 1A endoleaks, late appearing proximal endoleaks have been poorly described.

Methods: We studied all elective EVAR from 2010 -2018 in a single institution. Late endoleaks were defined as those appearing after 1 year.