Surgical intervention among asymptomatic patients aged ≥80 with a contralateral carotid occlusion appears selectively warranted.

Objective: The role of prophylactic carotid revascularization in asymptomatic patients aged ≥80 remains controversial. Current guidelines stipulate that asymptomatic older patients at "higher risk of stroke" on best medical therapy may still benefit from carotid intervention. Specifically, there is a widespread perception that a contralateral internal carotid artery (ICA) occlusion may confer an increased anatomical stroke risk, thus creating a surgical dilemma, particularly among older patients.

Differences in aortic remodeling in patients with type 1a and type 5 endoleak who undergo salvage with fenestrated/branched endovascular aortic repair.

Objective: Aneurysm sac growth following endovascular aortic aneurysm repair (EVAR) is multifactorial. A specific cause of growth (eg, type 1a endoleak [EL1a]) may be present or a specific cause may be absent (no observed endoleak resulting in "endotension" or type 5 endoleak [EL5]). Salvage of EL1a with fenestrated/branched EVAR (F/BEVAR) to obtain supraceliac seal is a viable strategy to achieve sac stability or regression.

The Impact of Reintervention on Arteriovenous Fistula Maturation and Functional Patency in the Hemodialysis Fistula Maturation Study.

Rationale & Objective: Arteriovenous dialysis fistula (AVF) reinterventions are sought to assist with maturation and/or maintain functional patency; however, their ultimate impact on fistula lifespan remains poorly documented. Furthermore, current clinical practice guidelines lack clarity regarding reintervention paradigms to achieve optimal AVF performance. Therefore, the purpose of this study was to document reintervention rates and their association with AVF maturation and functional patency among patients enrolled in the Hemodialysis Fistula Maturation (HFM) study.

Large endograft diameter is associated with poor outcomes following thoracic endovascular aortic aneurysm repair in Medicare beneficiaries.

Objective: Multiple factors contribute to early and/or late failure after endovascular aortic repair. Notably, the impact of device-related parameters, specifically diameter, on postoperative outcomes following thoracic endovascular aortic aneurysm repair (TEVAR) has not been thoroughly explored. This study aimed to determine whether use of large diameter (≥40 mm) endografts increase the risk of adverse outcomes after TEVAR.

Racial and ethnic minority groups, female sex, and tissue loss are associated with increased risk for hospital readmission following revascularization for chronic limb-threatening ischemia.

Background: Unplanned hospital readmission following surgery for peripheral arterial disease is among the highest in all diagnosis-related groups. Although previous studies have examined readmissions in certain subgroups, such as for patients undergoing lower extremity bypass, few have examined longer term readmissions for those with the most severe form of peripheral arterial disease, chronic limb-threatening ischemia (CLTI). Among patients with CLTI undergoing revascularization, we sought to outline rates of readmission beyond 30 days up to 1 year and identify patient and procedural characteristics associated with readmission.

Outcomes associated with type II endoleaks after infrarenal endovascular aneurysm repair in the Vascular Quality Initiative linked to Medicare claims.

Objective: Type II endoleaks (T2ELs) are commonly identified after endovascular aneurysm repair (EVAR) and may occur either at the completion of the procedure or during follow-up. However, the impact of T2EL on reintervention and survival remains poorly described. This study aims to evaluate the outcomes associated with T2EL in a real-world cohort using the Vascular Quality Initiative linked Medicare claims (Vascular Quality Initiative-Medicare) database.

Age-Related Outcomes After Revascularization for Chronic Limb-Threatening Ischemia: An Analysis of BEST-CLI.

Background: The impact of age on outcomes after revascularization for chronic limb-threatening ischemia has not been studied in a prospective trial.

Methods: A total of 1780 patients were grouped into age quartiles (≤55 years, 55< age ≤65 years, 65< age ≤75 years, and >75 years) and by type of revascularization (open bypass or endovascular). The primary outcome was major adverse limb events (MALE) or death, and the secondary outcomes were above-ankle amputation, reintervention, and major adverse cardiovascular events.

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.

Testing ChatGPT's Ability to Provide Patient and Physician Information on Aortic Aneurysm.

Introduction: Our objective was to test the ability of ChatGPT 4.0 to provide accurate information for patients and physicians about abdominal aortic aneurysms (AAA) and to assess its alignment with Society for Vascular Surgery (SVS) clinical practice guidelines (CPG) for AAA care.

Material And Methods: Fifteen patient-level questions, 37 questions selected to reflect 28 SVS CPGs and 4 questions regarding AAA rupture risk were posed to ChatGPT 4.

Multiomic Analysis of Calf Muscle in Peripheral Artery Disease and Chronic Kidney Disease.

Background: Chronic kidney disease (CKD) has emerged as a significant risk factor that accelerates atherosclerosis, decreases muscle function, and increases the risk of amputation or death in patients with peripheral artery disease (PAD). However, the modulators underlying this exacerbated pathobiology are ill-defined. Recent work has demonstrated that uremic toxins are associated with limb amputation in PAD and have pathological effects in both the limb muscle and vasculature.

Textbook outcomes as a novel patient-centric metric to inform carotid revascularization.

Objective: The recent National Coverage Determination surrounding carotid stenting and shared decision-making has ushered in an era of patient-centric carotid care. However, historical carotid intervention endpoints have lacked patient-centered nuances to inform clinical decisions. Accordingly, we aimed to create a comprehensive novel, patient-centric textbook outcome (TO) to inform treatment paradigms.

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.

Financial Toxicity and Unemployment in Patients with Major Lower Limb Amputation are High.

Background: Major limb amputation can place a significant financial burden on patients and their families because of costs of care and loss of income, encapsulated by the concept of financial toxicity. We sought to measure and understand factors associated with financial toxicity among patients undergoing major lower limb amputation for diabetic foot ulcers or peripheral arterial disease.

Methods: We identified patients in an institutional database who received lower limb amputations and excluded patients who underwent amputation due to known trauma or cancer.

Standards for Abdominal Aortic Aneurysm Repair Quality Improvement Registries: A Delphi Consensus Report From VASCUNET and the International Consortium of Vascular Registries.

Objective: Outcome registries in vascular surgery are used increasingly to drive quality improvement by vascular societies. The VASCUNET collaboration, within the European Society for Vascular Surgery (ESVS), and the International Consortium of Vascular Registries (ICVR) developed a set of variables for quality improvement registries on abdominal aortic aneurysm (AAA) repair as a registry standard.

Methods: Representatives from international vascular registries within VASCUNET, ICVR, and other nations with established registries were invited to provide the variables.

Cognitive Impairment is Common and Unrecognized in Vascular Surgery Patients.

Background: Patients' capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States.

A prevention protocol reduces spinal cord ischemia in patients undergoing branched/fenestrated endovascular aortic repair.

Objective: Spinal cord ischemia (SCI) is a devastating complication that is associated with thoracoabdominal aortic repair, with higher risk associated with increased aortic coverage length, making patients undergoing branched/fenestrated endovascular repair (B/FEVAR) particularly vulnerable. A bundled SCI prevention protocol was previously reported to reduce SCI rates when compared to a historic cohort in a single-center study. Therefore, this analysis aims to further validate and update outcomes associated with the protocol given the routine implementation of this strategy at two institutions (University of Florida and the University of Alabama at Birmingham) since inception.

Association of Surgeon Self-Reported Gender and Surgical Outcomes in Current US Practice.

Objective: This study aimed to evaluate the association of surgeon self-reported gender on clinical outcomes in contemporary US surgical practice.

Background: Previous research has suggested that there are potentially improved surgical outcomes for female surgeons, yet the underlying causal path for this association remains unclear.

Methods: Using the Vizient Clinical Database(2016-2021), 39 operations categorized by the CDC's National Healthcare Safety Network were analyzed.

Venoarterial Extracorporeal Membrane Oxygenation for "Protected" Percutaneous Coronary Intervention Secondary to Refractory Polymorphic Ventricular Tachycardia and Cardiac Arrest.

We present a case of cardiogenic shock secondary to refractory polymorphic ventricular tachycardia associated with coronary ischemia resulting in cardiac arrest. Following the return of spontaneous circulation, the patient was cannulated for peripheral venoarterial extracorporeal membrane oxygenation (V-A ECMO) in anticipation of high-risk "protected" percutaneous coronary intervention (PCI). Under full V-A ECMO support, inotropes and vasopressors were weaned off, and the patient underwent uneventful PCI of left circumflex and obtuse marginal lesions.

A patient-centered textbook outcome measure effectively discriminates contemporary elective open abdominal aortic aneurysm repair quality.

Background: There is persistent controversy surrounding the merit of surgical volume benchmarks being used solely as a sufficient proxy for assessing the quality of open abdominal aortic aneurysm (AAA) repair. Importantly, operative volume quotas may fail to reflect a more nuanced and comprehensive depiction of surgical outcomes most relevant to patients. Accordingly, we herein propose a patient-centered textbook outcome (TO) for AAA repair that is analogous to other large magnitude extirpative operations performed in other surgical specialties, and test its feasibility to discriminate hospital performance using Society for Vascular Surgery (SVS) volume guidelines.

Temporal Trends and Outcomes of Abdominal Aortic Aneurysm Care in the United States.

Background: Endovascular aortic aneurysm repair (EVAR) has had a dynamic impact on abdominal aortic aneurysm (AAA) care, often supplanting open AAA repair (OAR). Accordingly, US AAA management is often highlighted by disparities in patient selection and guideline compliance. The purpose of this analysis was to define secular trends in AAA care.