Upper Extremity Arteriovenous Grafts are Less likely to be Abandoned Compared to Autogenous Fistulas Despite a Higher Reintervention Rate.

Objective: Upper-extremity arteriovenous (AV) access often requires re-intervention. However, the frequency of re-interventions and subsequent access failure is not well-characterized. Our goal was to evaluate the frequency and type of re-interventions, risk-factors, and outcomes after AV access creation.

Optimizing Hospital Billing by Using Data from the Vascular Quality Initiative.

Introduction: Hospitals are reimbursed for inpatient admissions by Medicare based on the principal Medicare severity diagnostic related group (MS-DRG) assigned to that admission. MS-DRGs with complication or comorbidity (CC) or major complication or comorbidity (MCC) increase reimbursement to reflect the added cost of caring for complex patients. Under-coding DRG complexity has been shown to result in unrecovered reimbursement and financial losses for hospitals.

Three-year risk of stroke after transcarotid artery revascularization versus carotid endarterectomy among Medicare beneficiaries.

Background: Transcarotid artery revascularization (TCAR) has seen widespread adoption in contemporary practice. However, the risk of stroke after TCAR vs carotid endarterectomy (CEA) beyond the perioperative period remains poorly defined. Our objective was to compare the 3-year risk of stroke after TCAR vs CEA.

Validation of Codes to Distinguish Between Claudication and Chronic Limb-Threatening Ischemia in Patients Undergoing Peripheral Vascular Intervention Using Medicare-Matched Registry Data.

Background: The accuracy of contemporary administrative claims codes to discriminate between different phenotypes of peripheral artery disease is not well defined. We aimed to validate a predefined set of , codes used to distinguish between claudication and chronic limb-threatening ischemia (CLTI) and to optimize their diagnostic accuracy using a supervised machine-learning approach.

Methods: We included all patients who underwent a peripheral vascular intervention for claudication or CLTI in the US Medicare-matched VQI-VISION (Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network) registry database between January 2016 and December 2019.

Research priorities for peripheral artery disease: A statement from the Society for Vascular Medicine.

Lower-extremity peripheral artery disease (PAD) affects approximately 236 million people worldwide and at least eight million people in the United States (US). Despite availability of new therapies that prevent major adverse cardiovascular events (MACE), these and major adverse limb events (MALE) remain common and occur more frequently in people with PAD, either with or without coronary artery disease (CAD), compared to people with CAD who do not have PAD. The most effective therapies to prevent cardiovascular events are not identical in people with PAD and those with CAD.

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.

Effectiveness of Transcarotid vs Transfemoral Carotid Stenting for Stroke Prevention.

Importance: The effectiveness of surgical transcarotid artery revascularization (TCAR) compared with percutaneous transfemoral carotid artery stenting (TF-CAS) for stroke prevention beyond the periprocedural period is poorly quantified.

Objective: To compare the risk of stroke after TCAR vs TF-CAS.

Design, Setting, And Participants: This retrospective cohort study used data from the Vascular Implant Surveillance and Outcomes Network (VISION), a procedural registry linked to Medicare claims data that captures clinical, procedural, and outcome data on patients who underwent carotid stenting.

Accuracy of posthospitalization stroke detection following carotid revascularization in Medicare claims.

Background: Stroke after carotid revascularization is a key effectiveness and quality metric relevant to patients, clinicians, and policymakers. To date, the accuracy of stroke rates reported from Medicare claims-based datasets for patients who underwent carotid revascularization remain unknown. The objective of this study was to validate the accuracy of using International Classification of Diseases, Tenth Revision (ICD-10) codes to detect stroke after carotid artery revascularization.

Selecting Treatments for Peripheral Artery Disease: Differences Between Registry and a Randomized Controlled Trial Population.

Introduction: Patients enrolled in randomized trials are carefully selected and may have different comorbidities than patients treated in everyday practice.

Methods: We compared characteristics of 1815 patients enrolled in the Best Endovascular or Surgical Treatment for Critical Limb Ischemia (BEST-CLI, NCT02060630) with 104,877 patients receiving endovascular treatment and 32,120 patients undergoing bypass in the Vascular Quality Initiative's (VQI) registry from 2014 to 2020 using descriptive statistics. We studied mortality by treatment type among patients in both the trial and registry using Cox regression.

The Implications of Oxygen-Dependent Chronic Obstructive Pulmonary Disease on Sac Growth and Mortality Following Endovascular Aneurysm Repair.

Background: Chronic obstructive pulmonary disease (COPD) is a known risk factor for abdominal aortic aneurysm (AAA) growth and rupture. The impact of COPD on AAA sac behavior following endovascular aneurysm repair (EVAR) is poorly understood. This study aimed to determine the association between COPD and sac remodeling after EVAR.

The contemporary natural history of minor amputation among diabetic patients with peripheral arterial disease.

Objectives: The growing prevalence of diabetes and concomitant peripheral arterial disease (DM/PAD) has led to an increase in patients at risk for adverse limb events in current practice. Despite a widespread perception that minor amputation may result in both limb salvage and preserved functionality, the natural history of minor amputations remains unknown. Thus, we sought to quantify the rates of subsequent major amputation and survival among DM/PAD patients with any prior minor amputation.

Trends in patient characteristics and mortality among Medicare patients diagnosed with peripheral artery disease.

Introduction: Peripheral artery disease (PAD) is a well-described risk factor for mortality, but few studies have examined secular trends in mortality over time for patients with PAD. We characterized trends in mortality in patients with PAD in recent years among Medicare patients.

Methods: We used Medicare claims to identify patients with a new diagnosis code for PAD between January 1, 2006 and December 31, 2018 using International Classification of Diseases (ICD) diagnosis codes.

Editor's Choice - Reduction of Major Amputations after Surgery versus Endovascular Intervention: The BEST-CLI Randomised Trial.

Objective: BEST-CLI, an international randomised trial, compared an initial strategy of bypass surgery with endovascular treatment in chronic limb threatening ischaemia (CLTI). In this substudy, overall amputation rates and risk of major amputation as an initial or subsequent outcome were evaluated.

Methods: A total of 1 830 patients were randomised to receive surgical or endovascular treatment in two parallel cohorts: patients with adequate single segment great saphenous vein (SSGSV) (n = 1 434) were assigned to cohort 1; and patients without adequate SSGSV (n = 396) were assigned to cohort 2.

Long-term outcomes of great saphenous vein harvest techniques for infrainguinal arterial bypass in a Medicare-matched registry database.

Objective: Long-term outcomes for harvesting techniques for great saphenous vein (GSV) and its impact on the outcomes of infrainguinal arterial bypass remains largely unknown. Endoscopic GSV harvesting (EVH) has emerged as a less invasive alternative to conventional open techniques. Using the Vascular Quality initiative Vascular Implant Surveillance & Interventional Outcomes Network (VQI-VISION) database, we compared the long-term outcomes of infrainguinal arterial bypass using open and endoscopic GSV harvest techniques.

Association between tissue loss type and amputation risk among Medicare patients with concomitant diabetes and peripheral arterial disease.

Objective: Prior studies have described risk factors associated with amputation in patients with concomitant diabetes and peripheral arterial disease (DM/PAD). However, the association between the severity and extent of tissue loss type and amputation risk remains less well-described. We aimed to quantify the role of different tissue loss types in amputation risk among patients with DM/PAD, in the context of demographic, preventive, and socioeconomic factors.

Infrapopliteal Endovascular Interventions for Claudication Are Associated with Poor Long-Term Outcomes in Medicare-Matched Registry Patients.

Background: There are limited data supporting or opposing the use of infrapopliteal peripheral vascular interventions (PVI) for the treatment of claudication.

Objectives: We aimed to evaluate the association of infrapopliteal PVI with long-term outcomes compared with isolated femoropopliteal PVI for the treatment of claudication.

Methods: We conducted a retrospective analysis of all patients in the Medicare-matched Vascular Quality Initiative database who underwent an index infrainguinal PVI for claudication from January 2004-December 2019 using Cox proportional hazards models.

The Sustained Impact of the COVID-19 Pandemic on Vascular Surgical Care Delivery.

Background: The COVID-19 pandemic necessitated postponement of vascular surgery procedures nationally. Whether procedure volumes have since recovered remains undefined. Therefore, our objective was to quantify changes in procedure volumes and determine whether surgical volume has returned to its prepandemic baseline.

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Aim: The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia).

Methods: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate.

Most preoperative stress tests fail to comply with practice guideline indications and do not reduce cardiac events.

Background: There is wide variation in stress test utilization before major vascular surgery and adherence to practice guidelines is unclear. We defined rates of stress test compliance at our institution and led a quality improvement initiative to improve compliance with American Heart Association (ACC/AHA) guidelines.

Methods: We implemented a stress testing order set in the electronic medical record at one tertiary hospital.