Ablation Length, Not Modality Type, Determines Healing Outcomes in Venous Leg Ulcers.

Objectives: Early endovenous intervention of the saphenous system improves healing and recurrence of venous leg ulcers (CEAP-6). As ablative methods continue to evolve, it is essential to identify outcome differences between the various techniques. This study aims to compare wound healing rates between primary non-thermal [cyanoacrylate glue (CAG) or commercial polidocanol microfoam ablation (MFA)] and thermal with adjunct MFA.

Appropriateness of care: Deep venous procedures.

In the past decade, technologies to treat venous pathologies have increased dramatically, to the benefit of an often underserved and overlooked population of patients with venous disease. However, given the rapid release of various technologies, including venous-dedicated stents and thrombectomy devices across varied venous pathologies, evidence-based guidelines have been slow to develop. When discussing appropriateness of care, one needs to consider optimal patient selection, technical approach, medical management, and surveillance protocols, to name a few.

Consensus Statement on the Management of Nonthrombotic Iliac Vein Lesions From the VIVA Foundation, the American Venous Forum, and the American Vein and Lymphatic Society.

A nonthrombotic iliac vein lesion is defined as the extrinsic compression of the iliac vein. Symptoms of lower extremity chronic venous insufficiency or pelvic venous disease can develop secondary to nonthrombotic iliac vein lesion. Anatomic compression has been observed in both symptomatic and asymptomatic patients.

Lower extremity woven and nonwoven venous stent morphology and luminal changes.

Objective: Venous stents are a common treatment modality for obstructive venous disease. Venous stents differentiate themselves by either a woven or braided structure, open or closed cell arrangement or based on material composition (elgiloy vs nitinol). Changes in the morphology of venous stents over time may contribute to restenosis or thrombosis.

Exploring the perception of venous disease within vascular surgery.

Background: Biases and gender disparities influence career pathways within medicine, and vascular surgery is no exception. Venous disease comprises an estimated 1% to 3% of total health care expenditures. However, its value among vascular surgeons is poorly understood.

Race, sex, and socioeconomic disparities affect the clinical stage of patients presenting for treatment of superficial venous disease.

Objective: Superficial venous disease has a U.S. prevalence of nearly 30%, with advanced disease contributing to a significant healthcare burden.

Type IV Hypersensitivity Reaction after Cyanoacrylate Venous Closure.

Background: Nonthermal endovenous closure techniques are routinely utilized to treat superficial axial venous reflux. Cyanoacrylate closure is a safe and effective modality implemented for truncal closure. However, an adverse reaction of type IV hypersensitivity (T4H), unique to cyanoacrylate, is a known risk.

A review of the current literature of ethnic, gender, and socioeconomic disparities in venous disease.

Venous disease is prevalent, undertreated, and frequently unrecognized. During the past two decades, new treatment modalities have changed how venous disease is approached. Some of these treatment modalities are only available in certain centers or locations and access to care could be inequitable.

Presence of a patent pedal arch is the primary predictor of transmetatarsal amputation healing and limb salvage.

Objective: Transmetatarsal amputation (TMA) is a durable and important functional limb salvage option. We have presented our results in identifying the angiographic predictors of TMA healing using single-institution retrospective data.

Methods: Consecutive patients within our institution who had undergone TMA and lower extremity arteriography from 2012 to 2020 were included.

Thrombotic complications after radiofrequency and cyanoacrylate endovenous ablation: Outcomes of a multicenter real-world experience.

Objective: Chronic venous insufficiency (CVI) affects >40% of the U.S. population; thus, intervention for symptomatic venous disease comprises a large portion of many vascular practices.

Transcarotid Arterial Revascularization Adoption Should not Be Hindered by a Concern for a Long Learning Curve.

Background: Transcarotid arterial revascularization (TCAR) offers a novel technique for carotid artery stenting (CAS) that provides flow reversal in the carotid artery and avoids aortic arch manipulation, thus, potentially lowering ipsilateral and contralateral periprocedural stroke rates. As a new technology, adoption may be limited by concern for learning a new technique. This study seeks to examine the number of cases needed for a surgeon to reach technical proficiency.

The risks and benefits of early venous thromboembolism prophylaxis after elective spinal surgery: A single-centre experience.

Background: There is a wide ranging incidence of venous thromboembolism after surgery and it continues to be a major cause of morbidity after spinal procedures.This study's aim was to investigate the relationship between timing and administration of venous thromboembolism (VTE) pharmacologic chemoprophylaxis after spinal surgery and the resulting VTE and bleeding complications by reviewing current practices and outcomes at a high-volume single institution to better define opportunities for perioperative intervention to prevent VTE without increasing bleeding complications.

Methods: All patients who underwent elective one or two-stage lumbar spinal fusion procedures were identified.

The need for perforator treatment after VenaSeal and ClosureFast endovenous saphenous vein closure in CEAP 6 patients.

Objective: The authors have previously demonstrated that VenaSeal (Medtronic, Inc, Minneapolis, Minn) adhesive, compared with radiofrequency ablation (RFA, ClosureFast; Medtronic, Inc), in treatment of refluxing saphenous veins in CEAP 6 limbs, results in shorter healing times of venous ulcers. The authors hypothesize that the longer treated length possible with VenaSeal's nonthermal modality may affect the number of critical refluxing perforators contributing to the nonhealing wound. This follow-up study compares the need for follow-up treatment of perforator veins after saphenous vein treatment with either radiofrequency ablation (ClosureFast RFA) or adhesive closure (VenaSeal).

Delayed referral of venous ulcers increases resource usage.

Objective: Venous insufficiency is often not readily recognized as a contributing etiology to nonhealing wounds by nonvascular surgery specialists, potentially delaying appropriate treatment to achieve wound healing and increasing healthcare costs. The objective of the present study was to understand the time and resources used before the definitive treatment of venous ulcers.

Methods: A single-institution retrospective medical record review of C6 patients undergoing radiofrequency saphenous and perforator vein ablation from May 2016 to January 2018 identified 56 patients with 67 diseased limbs.

Thrombotic complications of superficial endovenous ablation: a contemporary review of thermal and non-thermal techniques.

Endovenous ablation has become the preferred means to treat superficial venous insufficiency. Ablative technologies have evolved to include a variety of both thermal and non-thermal techniques. The reported thrombotic complications of endovenous heat induced thrombosis (EHIT) and deep venous thrombosis (DVT) associated with thermal techniques are low (<2% overall).

Optimization of factors for the prevention of spinal cord ischemia in thoracic endovascular aortic repair.

Objectives: Spinal cord ischemia following thoracic endovascular aortic repair (TEVAR) is a devastating complication. This study seeks to demonstrate how a standardized protocol to prevent spinal cord ischemia affects incidence in patients undergoing TEVAR.

Methods: Using CPT codes 33880 and 33881, all TEVAR procedures performed at a single tertiary care center from January 2017 to December 2018 were examined.

Results of Obturator Foramen Bypass in Patients with Groin Infection and Arterial Involvement.

Background: Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts.

Methods: A multihospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020.

Parallel Grafting Should Be Considered as a Viable Alternative to Open Repair in High-Risk Patients With Paravisceral Aortic Aneurysms.

Background: Parallel grafting presents a viable method for treating patients with complex aortic aneurysms. The current literature is limited to mostly pararenal configurations. We examined our results in patients with SMA and/or Celiac artery involvement.

A comparison of cyanoacrylate glue and radiofrequency ablation techniques in the treatment of superficial venous reflux in CEAP 6 patients.

Objective: Venous leg ulcers (CEAP [clinical, etiologic, anatomic, pathophysiologic] class 6) represent the most severe form of chronic venous insufficiency. As closure techniques for superficial venous reflux evolve, direct outcome comparisons of treatments are integral, because many studies have already demonstrated that early endovenous intervention improves wound healing. The present study compared the rates of venous wound healing between two techniques of superficial vein closure: ClosureFast radiofrequency ablation (RFA) and adhesive closure (VenaSeal; both Medtronic, Inc, Minneapolis, Minn).

Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers.

Objective: To evaluate the impact of three treatment modalities, superficial truncal vein ablation, perforator vein ablation, and deep venous stenting on venous leg ulcer (VLU) healing, as well as their cumulative effect on ulcer healing, in an attempt to establish the best algorithm for the treatment of chronic and recalcitrant VLUs.

Methods: Multicenter retrospective cohort study using a standardized database to evaluate patients with chronic venous ulcers treated between January 2013 and December 2017.

Results: Eight-hundred thirty-two consecutive patients with VLU were identified at 11 centers in the United States.