Association between imaging surveillance compliance and long-term outcomes after endovascular abdominal aortic aneurysm repair at Veterans Affairs hospitals.

Objective: To assess the association between compliance with guideline-recommended annual imaging surveillance after endovascular aortic aneurysm repair (EVAR) and long-term outcomes.

Methods: Veterans who underwent EVAR between January 1, 2000, and December 31, 2023, in US Department of Veterans Affairs facilities were examined retrospectively. The exposure was imaging surveillance compliance, defined as at least one imaging study (computed tomography, ultrasound examination, or magnetic resonance imaging) per year after EVAR.

Endovascular surgery does not mitigate the adverse effects of frailty on the risk of losing life or limb.

Objectives: Evidence behind frail patients preferentially undergoing minimally invasive endovascular interventions for peripheral arterial disease remains sparse; thus, we evaluated the association of frailty and revascularization-approach with long-term mortality and major adverse limb events (MALEs).

Methods: The Vascular Quality Initiative-Medicare-linked Vascular Implant Surveillance and Interventional Outcomes Network databases were queried for patients who had their first infrainguinal open or endovascular (endo) procedure between 2011 and 2015 (n = 27,200). Frailty was measured using the Vascular Quality Initiative Risk Analysis Index (RAI) and dichotomized into frail (RAI ≥ 37) and nonfrail (RAI < 37).

Prehabilitation and rehabilitation in peripheral arterial disease: Protocol and study design of the PREPARE-IT trial.

Background: Both prehabilitation and rehabilitation programs have been shown to improve functional capabilities, surgical outcomes, and quality of life in patients with peripheral arterial disease (PAD). However, referral rates remain low, and the benefits of combined prehabilitation and rehabilitation for PAD have not been explored.

Methods: Three hundred patients with symptomatic claudication referred for femoral-popliteal endovascular stenting will be studied.

Understanding the risks of abdominal aortic endograft explantation with early outcomes from two decades of experience.

Objective: Endovascular aneurysm repair (EVAR) currently comprises more than two-thirds of all abdominal aortic aneurysm repairs in the United States. However, data show that patients are at higher risk for late mortality after EVAR compared with open repair. As the number of aging EVARs grow, so, too, does the number requiring explant.

Quantification of arterial calcification in peripheral artery disease and its association with amputation and/or mortality: A systematic review.

Arterial calcification is prevalent in peripheral artery disease (PAD), especially among patients with advanced age, diabetes, or renal disease. Peripheral arterial calcium score (PACS) is an emerging tool to quantify calcification in peripheral arteries and predict outcomes such as amputation and mortality. This systematic review evaluates PACS methodologies and its association with these adverse outcomes.

Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively.

Objective: Compare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies.

Summary Background Data: A surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown.

Methods: In an observational cohort study across a multi-hospital healthcare system including adults presenting to outpatient surgical clinics (2016-2023) for evaluation of eight conditions feasibly managed operatively or nonoperatively as defined by modified Delphi consensus.

Imaging Surveillance Adherence After Endovascular Abdominal Aortic Aneurysm Repair at VA Hospitals.

Importance: Guidelines recommend annual imaging surveillance after endovascular abdominal aortic aneurysm repair (EVAR). How these guidelines translate into practice among veterans remains poorly described.

Objective: To characterize post-EVAR surveillance among veterans.

Establishing Clinically Operational Domains of Multidimensional Frailty: A Consensus Approach to Improve Multidimensional Frailty Diagnosis at Point of Care.

Background And Objectives: Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty.

Research Design And Methods: We reviewed instruments that assess frailty and extracted the domains measured by each tool.

Long-Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long-Term Survival Study (PEARLS).

Background: Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify patients with PAD.

Methods: Leveraging a novel natural language processing system that identifies PAD with high accuracy using ankle-brachial index and toe-brachial index values, we created a registry of 103 748 patients with new-onset PAD in the Veterans Health Administration. Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and non-Veterans Affairs encounters.

Sex Differences in Peripheral Vascular Disease: A Scientific Statement From the American Heart Association.

Sex differences in the risk factors, diagnosis, treatment, and outcomes of patients with cardiovascular disease have been well described; however, the bulk of the literature has focused on heart disease in women. Data on sex differences in peripheral vascular disease are ill defined, and there is a need to report and understand those sex-related differences to mitigate adverse outcomes related to those disparities. Although peripheral vascular disease is a highly diverse group of disorders affecting the arteries, veins, and lymphatics, this scientific statement focuses on disorders affecting the peripheral arteries to include the aorta and its branch vessels.

Leveraging the Vascular Quality Initiative to reduce length of stay following elective carotid endarterectomy and endovascular aortic aneurysm repair.

Objective: Length of stay (LOS) is a key quality metric for the Society for Vascular Surgery's Vascular Quality Initiative (VQI). In 2021, our hospital was an outlier for 'prolonged LOS' after carotid endarterectomy (CEA >1 day; 67% vs target 21%) and endovascular aortic aneurysm repair (EVAR >2 days; 36% vs target 22%). In response, we launched a quality improvement initiative to reduce LOS following elective CEA and EVAR.

Frailty Screening Using the Risk Analysis Index: A User Guide.

The Risk Analysis Index (RAI) has emerged as the most thoroughly validated and flexible assessment of surgical frailty, proven feasible for at-scale bedside screening and available in a suite of tools, that effectively risk stratifies patients across a wide variety of clinical contexts and data sources. This user guide provides a definitive summary of the RAI's theoretical model, historical development, validation, statistical performance, and clinical interpretation, placing the RAI in context with other frailty assessments and emphasizing some of its advantages. Detailed instructions are provided for each RAI variant, along with a systematic review of existing RAI-related literature.

The Surgical Pause: The Importance of Measuring Frailty and Taking Action to Address Identified Frailty.

Conceptual Framework: The Surgical Pause is a rapid, scalable strategy for health care systems to optimize perioperative outcomes for high-risk, frail patients considering elective surgery. The first and most important step is to screen for frailty, thereby identifying the 5% to 10% of patients at most risk for postoperative complications, loss of independence, institutionalization, and mortality. The second step is to take action to improve outcomes.

Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery.

Importance: Surgical quality improvement efforts have largely focused on 30-day outcomes, such as readmissions and complications. Surgery may have a sustained impact on the health and quality of life of patients considered frail, yet data are lacking on the long-term health care utilization of patients with frailty following surgery.

Objective: To examine the independent association of preoperative frailty on long-term health care utilization (up to 24 months) following surgery.

Comparison of EndoSuture vs fenestrated aortic aneurysm repair in treatment of abdominal aortic aneurysms with unfavorable neck anatomy.

Background: Hostile aortic neck anatomy is associated with loss of proximal seal and increased late reinterventions. Although both EndoSuture aneurysm repair (ESAR) and fenestrated endovascular aortic repair (FEVAR) are commercially available options for treatment of short neck aneurysms, branch vessel patency is a potential tradeoff for improved seal with FEVAR owing to the incorporation of renovisceral vessels. This study compares the performance of ESAR vs FEVAR in hostile aortic necks.

Implementation of a preoperative frailty screening and optimization pathway for vascular surgery patients is associated with decreased 30-day readmission.

Objective: Frailty is characterized by decreased physiological reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for patients undergoing vascular surgery and assessed its impact on postoperative outcomes.

Methods: As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI).