Anticoagulation does not improve limb outcomes after lower extremity cryopreserved vein bypass.

Objective: Cryopreserved vein grafts serve as alternative conduits for infrainguinal bypass when autogenous vein is unavailable or inadequate. Anticoagulation has been advocated to improve outcomes, but published studies demonstrate conflicting results. We assessed the association of anticoagulation on outcomes after infrainguinal bypass with cryopreserved vein in patients with chronic limb-threatening ischemia.

Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.

Chronic limb-threatening ischemia is defined as ischemic rest pain or tissue loss (eg, ulceration/gangrene) that has been present for greater than 2 weeks. Workup includes a careful history, physical examination focused on evaluation of pulses and wounds, lower extremity noninvasive vascular studies (eg, ankle-brachial indices, toe pressures), saphenous vein mapping, and imaging of the lower extremity arterial anatomy (eg, computed tomography, magnetic resonance, or subtraction angiography) if a revascularization intervention is planned.

Patients Experience Significant Long-Term Social and Health Challenges After Major Lower Extremity Amputation.

Background: Major lower extremity amputation is a significant life-changing event that can have long-term implications. The goal of this study was to assess long-term medical outcomes and social determinants of health (SDH) challenges in this population.

Methods: A retrospective review of major lower extremity (previously mentioned ankle) amputations (2018-2022) was performed at a safety-net tertiary care center.

Medicare billing and utilization trends in vascular surgery.

Objective: Within the past decade, Medicare Part B reimbursements for various surgical procedures have been declining, whereas health care expenses continue to increase. As a result, hospitals may increase service charges to offset losses in revenue, which may disproportionately affect underinsured patients. Our analysis aimed to characterize Medicare billing and utilization trends across common vascular surgical procedures.

Evaluation of Computerized Tomography Utilization in Comparison to Digital Subtraction Angiography in Patients with Peripheral Arterial Disease.

Background: Perform literature review to analyze current practices in imaging patient with peripheral arterial disease (PAD) and examine patterns in our practice in order to assess whether a lower extremity computed tomography angiography (CTA) in addition to digital subtraction angiography enhanced the assessment of vessel calcification, percentage of stenosis, and affected outcomes in patients with PAD.

Methods: The study included patients who underwent lower extremity imaging and were followed up to 12 months. This population was divided into cases who had both an angiogram and CTA performed within 30 days (n = 20), and controls who underwent angiography only (n = 19).

Characterization of long-term survival in Medicare patients undergoing arteriovenous hemodialysis access.

Background: Patients undergoing arteriovenous (AV) access creation for hemodialysis often have significant comorbidities. Our goal was to quantify the long-term survival and associated risks factors for long-term mortality in these patients to aid in optimization of goals and expectations.

Methods: The Vascular Implant Surveillance and Interventional Outcomes Network Vascular Quality Initiative Medicare linked data was used to assess long-term survival in the HD registry.

Long-term functional outcomes of upper extremity civilian vascular trauma.

Objective: Civilian analyses of long-term outcomes of upper extremity vascular trauma (UEVT) are limited. Our goal was to evaluate the management of UEVT in the civilian trauma population and explore the long-term functional consequences.

Methods: A retrospective review and analysis was performed of patients with UEVT at an urban Level 1 trauma center (2001-2022).

Outcomes of lower extremity revascularization in octogenarians and nonagenarians for intermittent claudication.

Objective: Revascularization for intermittent claudication (IC) due to infrainguinal peripheral arterial disease (PAD) is dependent on durability and expected benefit. We aimed to assess outcomes for IC interventions in octogenarians and nonagenarians (age ≥80 years) and those younger than 80 years (age <80 years).

Methods: The Vascular Quality Initiative was queried (2010-2020) for peripheral vascular interventions (PVIs) and infrainguinal bypasses (IIBs) performed to treat IC.

Functional Impairment is Associated with Poor Long-Term Outcomes after Arteriovenous Access Creation.

Background: Functional impairment affects outcomes after a variety of procedures. However, the impact of functional impairment on outcomes of arteriovenous (AV) access creation is unclear. We aimed to evaluate the association of patients' ability to ambulate and perform activities of daily living (ADL) with AV access outcomes.

Analysis of Early Death after Elective Open Abdominal Aortic Aneurysm Repair.

Background: Mortality after open abdominal aortic aneurysm repair is a quality measure and early death may represent a technical complication or poor patient selection. Our objective was to analyze patients who died in the hospital within postoperative day (POD) 0-2 after elective abdominal aortic aneurysm repair.

Methods: The Vascular Quality Initiative was queried from 2003-2019 for elective open abdominal aortic aneurysm repairs.

Brachiocephalic and Radiocephalic Arteriovenous Fistulas in Patients with Tunneled Dialysis Catheters Have Similar Outcomes.

Background: Patients with tunneled dialysis catheters (TDCs) have a time-sensitive need for a functional permanent access due to high risk of catheter-associated morbidity. Brachiocephalic arteriovenous fistulas (BCF) have been reported to have higher maturation and patency compared to radiocephalic arteriovenous fistulas (RCF), although more distal creation is encouraged when possible. However, this may lead to a delay in establishing permanent vascular access and, ultimately, TDC removal.

The Effect of Chronic and End-Stage Renal Disease on Long-Term Outcomes after Infrainguinal Bypass.

Background: Patients undergoing infrainguinal bypass for chronic limb threatening ischemia (CLTI) with renal dysfunction are at an increased risk for perioperative and long-term morbidity and mortality. Our goal was to examine perioperative and 3-year outcomes after lower extremity bypass for CLTI stratified by kidney function.

Methods: A retrospective, single-center analysis of lower extremity bypass for CLTI was performed between 2008 and 2019.

Qualitative Analysis of Length of Stay and Readmission after Carotid Endarterectomy.

Background: Length of stay (LOS) and readmissions are common measures to evaluate quality of health care. The objective of this study was to evaluate factors related to hospital LOS and readmission within 90 days following carotid endarterectomy (CEA) in patients who have not had a stroke.

Methods: Using a single institution database, patients who underwent CEA for carotid stenosis between 2014 and 2019 were identified.

Research methods for retrospective analyses in vascular surgery.

There are many resources available for retrospective analyses in vascular surgery research. Methods used commonly when conducting clinical research include data gathering, literature review, database integration, and statistical analysis. In this review, the databases used commonly in vascular surgery are discussed, including the following institutional data sets: Vascular Quality Initiative, American College of Surgeons National Surgical Quality Improvement Program, National Inpatient Sample, and Nationwide Readmissions Database.

Hemodialysis Access Outcomes for Patients with Unstable Housing.

Background: End-stage renal disease has traditionally been noted to disproportionately affect patients with fewer resources. Our goal was to assess practice patterns and outcomes in patients with unstable housing undergoing permanent hemodialysis access creation.

Study Design: A retrospective, single-center review of patients with unstable housing was conducted.

Unplanned Shunting Is Associated with Higher Stroke Risk after Eversion Carotid Endarterectomy.

Background: Shunting during eversion carotid endarterectomy (eCEA) may be technically challenging. Whether shunting practice patterns modify perioperative stroke risk after eCEA is unclear. We aimed to compare eCEA outcomes based on shunting practice.

Access site complications are uncommon with vascular closure devices or manual compression after lower extremity revascularization.

Objective: Vascular closure devices (VCDs) and manual compression (MC) are used to achieve hemostasis after peripheral vascular interventions (PVIs). We sought to compare perioperative outcomes between MC and four VCDs after PVI in a multicenter setting.

Methods: The Vascular Quality Initiative was queried for all lower extremity PVIs with common femoral artery access performed from 2010 to 2020.

Outcomes of axillofemoral bypass for intermittent claudication.

Objective: Although endovascular therapy is often the first-line option for medically refractory intermittent claudication (IC) caused by aortofemoral disease, suprainguinal bypass is often performed. Although this will often be aortofemoral bypass (AoFB), axillofemoral bypass (AxFB) is still sometimes performed despite limited data evaluating its utility in the management of IC. Our goal was to assess the safety and durability of AxFB performed for IC.

The Association of Body Mass Index with Outcomes after Carotid Endarterectomy.

Background: Patients who are obese or underweight are traditionally at higher risk for perioperative morbidity and mortality. The effect of body mass index (BMI) on outcomes after carotid endarterectomy (CEA) is unclear. Our goal was to analyze the association of BMI with perioperative and long-term outcomes after elective CEA.

Perioperative Outcomes for Centers Routinely Admitting Postoperative Endovascular Aortic Aneurysm Repair to the ICU.

Background: Intensive care unit (ICU) admission after endovascular aortic aneurysm repair (EVAR) varies across medical centers. We evaluated the association of postoperative ICU use with perioperative and long-term outcomes after EVAR.

Study Design: The Vascular Quality Initiative (2003-2019) was queried for index elective EVARs.

The Association of the Day of the Week with Outcomes of Infrainguinal Lower Extremity Bypass.

Background: The day of the week (DOW) for performing procedures and operations has been shown to affect clinical and resource utilization outcomes. Limited published data are available on vascular surgery operations. Our primary objective was to assess outcomes by DOW for infrainguinal lower extremity bypass (LEB) performed for claudication or rest pain.

Selective Nonoperative and Delayed Management of Severe Asymptomatic Carotid Artery Stenosis.

Objectives: Although intervention is generally the standard of care for severe (80-99%) asymptomatic carotid stenosis, conservative management may be appropriate for a subset of patients. Our goal was to assess reasons for and outcomes of nonoperative/delayed operative management of asymptomatic severe carotid stenosis.

Methods: Institutional vascular laboratory data from 2010 to 2018 was queried for all patients who underwent a carotid duplex ultrasonography.