Social and Structural Determinants of Lower Extremity Amputations in Diabetes.

Purpose Of Review: Lower extremity amputations (LEAs) are among the most severe complications of diabetes, with approximately 1.5 million procedures performed globally each year. This review explores the impact of social and structural determinants of health on amputation rates in diabetic patients, highlighting disparities driven by systemic factors.

Utilizing natural language processing to improve abdominal aortic aneurysm surveillance.

Background: Screening and surveillance are essential to prevent aneurysm rupture. We used natural language processing (NLP) software to evaluate efficacy of aneurysm surveillance.

Methods: NLP software was used to review 7 years of imaging reports at a single institution to identify patients with an abdominal aortic aneurysm.

Advancing opportunity and representation in the American Venous Forum.

Objective: Diversity, equity, and inclusion (DEI) within the physician workforce is critical to establishing a diverse provider network that accurately represents the patient population served by vascular surgeons. Vascular surgery remains a largely male-dominated surgical specialty, and the number of women in leadership positions in academic surgical specialties continues to be disproportionate. The representation of women in leadership roles differs across vascular surgery societies.

Intravascular lithotripsy in carotid disease.

Transcarotid artery revascularization (TCAR) is a hybrid approach with neuroprotective flow reversal for treating carotid stenosis. Providers are increasingly choosing it for patients, especially those at high risk for carotid endarterectomy (CEA). However, TCAR's efficacy is limited by calcific atherosclerosis, which can hinder stent expansion and increase the risk of perioperative embolization.

Using Vascular Deserts as a Guide for Limb Preservation Outreach Programs Successfully Targets Underserved Populations.

Background: Vascular deserts, regions without vascular providers, previously described targets for limb salvage efforts. The Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks (CHAMPIONS) programs targeted regions for outreach and evaluated the population using desert maps.

Methods: At 2 events targeting underserved regions between 2022 and 2023, providers screened and educated participants on peripheral arterial and cardiovascular disease (PACD).

Multi-center experience with intravascular lithotripsy for treatment of severe calcification during transcarotid artery revascularization for high-risk patients.

Objective: Transcarotid artery revascularization (TCAR) offers a safe alternative to carotid endarterectomy (CEA), but severe calcification is currently considered a contraindication in carotid artery stenting. This study aims to describe the safety and effectiveness of TCAR with intravascular lithotripsy (IVL) in patients with traditionally prohibitive calcific disease.

Methods: All consecutive patients who underwent TCAR+IVL from 2018-2022 at nine institutions were identified.

Vascular In-person for Students In the match Trial: An investigation of postinterview site visits to address the limitations of virtual interviews.

Purpose: The graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in-person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program's rank list is "locked," avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit.

Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease.

ObjectiveThe COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice.

Evaluating growth patterns of abdominal aortic aneurysms among women.

Objective: Though initially protected from vessel dilation by estrogen, women may experience rapid abdominal aortic aneurysm (AAA) growth post-menopause. The rate of growth has been poorly defined in prior literature. Here, we describe aneurysm growth in a cohort of women found through an AAA screening program.

Early experience with the Gore TAG thoracic branch endoprosthesis for treatment of acute aortic pathology.

The Gore TAG thoracic branch endoprosthesis (TBE) is the first Food and Drug Administration-approved device for zone 2 thoracic endovascular aortic repair, allowing for graft placement proximal to the left subclavian artery origin and maintaining vessel patency through a side branch. We describe our experience with the Gore TBE device in 20 patients for acute indications, including blunt thoracic aortic injuries, complicated dissections, and ruptured aneurysms. Technical success, with exclusion of pathology and left subclavian patency, was 100% without major complications within 30 days.

Thoracic outlet syndrome in females: A systematic review.

Thoracic outlet syndrome (TOS) is a rare anatomic condition caused by compression of neurovascular structures as they traverse the thoracic outlet. Depending on the primary structure affected by this spatial narrowing, patients present with one of three types of TOS-venous TOS, arterial TOS, or neurogenic TOS. Compression of the subclavian vein, subclavian artery, or brachial plexus leads to a constellation of symptoms, including venous thrombosis, with associated discomfort and swelling; upper extremity ischemia; and chronic pain due to brachial plexopathy.

The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer.

Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999.

The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer.

Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999.

Editor's Choice - The Intersocietal IWGDF, ESVS, SVS Guidelines on Peripheral Artery Disease in People With Diabetes Mellitus and a Foot Ulcer.

Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999.

Use of a prosthetic conduit for stent delivery in transcarotid artery revascularization for patients with unfavorable anatomy.

Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cm minimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement.

Assessing the Utility of Toe Arm Index and Toe Pressure in Predicting Wound Healing in Patients Undergoing Vascular Intervention.

Background: Objective measures of perfusion such as an ankle-brachial index (ABI) and toe pressure remain important in prognosticating wound healing. However, the use of ABI is limited in patients with incompressible vessels and toe pressure may not be comparable across patients. While a toe arm index (TAI) may be of value in this setting, its role as clinical indicator of perfusion for healing in patients with lower-extremity wounds has not been well established.

Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review.

Introduction: Peripheral artery disease (PAD) is associated with an increased likelihood of delayed or non-healing of a diabetes-related foot ulcer, gangrene, and amputation. The selection of the most effective surgical technique for revascularisation of the lower limb in this population is challenging and there is a lack of conclusive evidence to support the choice of intervention. This systematic review aimed to determine, in people with diabetes and tissue loss, if direct revascularisation is superior to indirect revascularisation and if endovascular revascularisation is superior to open revascularisation for the outcomes of wound healing, minor or major amputation, and adverse events including mortality.

Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review.

Introduction: The presence of peripheral artery disease (PAD) confers a significantly increased risk of failure to heal and major lower limb amputation for people with diabetes-related foot ulcer (DFU). Determining performance of non-invasive bedside tests for predicting likely DFU outcomes is therefore key to effective risk stratification of patients with DFU and PAD to guide management decisions. The aim of this systematic review was to determine the performance of non-invasive bedside tests for PAD to predict DFU healing, healing post-minor amputation, or need for minor or major amputation in people with diabetes and DFU or gangrene.

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review.

As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes-related foot ulcer (DFU) development, non-healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non-invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non-invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra- and inter-rater reliability of non-invasive bedside tests in adults with diabetes.

A bio-instructive parylene-based conformal coating suppresses thrombosis and intimal hyperplasia of implantable vascular devices.

Implantable vascular devices are widely used in clinical treatments for various vascular diseases. However, current approved clinical implantable vascular devices generally have high failure rates primarily due to their surface lacking inherent functional endothelium. Here, inspired by the pathological mechanisms of vascular device failure and physiological functions of native endothelium, we developed a new generation of bioactive parylene (poly(p-xylylene))-based conformal coating to address these challenges of the vascular devices.

Defining Vascular Deserts to Describe Access to Care and Identify Sites for Targeted Limb Preservation Outreach.

Background: Access to care plays a critical role in limb salvage in chronic limb-threatening ischemia (CLTI). A "medical desert" describes a community lacking access to medical necessities, resulting in increased morbidity and mortality. We sought to describe vascular deserts, which we defined as regions with decreased access to specialty care.

How I do it. Thoracic outlet syndrome and the transaxillary approach.

Thoracic outlet syndrome (TOS) is a disease pattern that involves compression of neurologic venous or arterial structures as they pass through the thoracic outlet. TOS was first described as a vascular complication arising from the presence of a cervical rib. Over time, a better understanding of TOS has led to its wide range of presenting symptoms being divided into three distinct groups: arterial, venous, and neurogenic.

The use of telemedicine in peripheral artery disease and limb salvage.

Chronic limb-threatening ischemia represents the morbid end stage of severe peripheral artery disease, with significant impact on patient quality of life. Early diagnosis of arterial insufficiency and referral for vascular intervention are essential for successful limb salvage. Disparate outcomes have been reported among patients residing in rural areas due to decreased access to care.

Patient and provider perspectives to utilization of telemedicine in surgery.

Objectives: Determine patient and provider perspectives on widespread rapid telemedicine implementation, understand the key components of a surgical telemedicine visit and identify factors that affect future telemedicine use.

Summary Of Background Data: Compared to other specialties, the field of surgery heretofore has had limited adoption of telemedicine. During the COVID-19 pandemic Healthcare, including the surgical specialties, saw new widespread use of telemedicine.

Provider ankle brachial index and wound classification teaching as part of a comprehensive limb preservation outreach program.

Objective: Utilization of evidence-based specialty guidelines is low in primary care settings. Early use of ankle-brachial index (ABI) testing and a validated wound classification system allows prompt referral of patients for specialty care. We implemented a program to teach providers ABI testing and the use of the Wound, Ischemia, and foot Infection (WIfI) classification tool.