Expansion of WallStents® after Initial Deployment in Nonthrombotic Iliac Vein Lesions.

Background: To determine the structural changes of Wallstents (Boston Scientific, Natick, MA) in vivo following deployment in iliac veins.

Methods: This retrospective single-center study was performed from September 2012 to April 2013 and included 100 office-based patients who underwent initial stent placement for nonthrombotic iliac vein lesions with Wallstent as well as a second procedure for stenting of the contralateral iliac vein. Measurements were obtained with marker balloons and the diameters of the stents were compared at the time of the index procedure to the secondary procedure.

Incidence and Significance of Deep Venous Reflux in Patients Treated with Saphenous Vein Ablation.

Background: Venous ablation (VA) of the saphenous vein is the most common procedure performed for venous insufficiency. The incidence of concomitant deep venous reflux (DVR) in patients undergoing VA is unknown. Our hypothesis is that patients undergoing saphenous VA with concomitant DVR exhibit a higher clinical, etiology, anatomy, and pathophysiology (CEAP) stage and less relief after VA compared to patients without DVR.

Vein ablation is an effective treatment for patients with bleeding varicose veins.

Background: Bleeding is a rare but potentially life-threatening complication of varicose veins. There is paucity of literature about patients with varicose veins that present with bleeding and the effectiveness of vein ablation as therapy to prevent recurrent bleeding. This study compares patients treated with vein ablation for bleeding varicose veins with patients treated for venous symptoms other than bleeding.

Association of abdominal aortic aneurysm diameter indexed to patient height with symptomatic presentation and mortality.

Background: The current guidelines have recommended repair of abdominal aortic aneurysms (AAAs) according to the maximal AAA diameter and/or its growth rate. However, many studies have suggested that the AAA diameter alone is not sufficient to predict the risk of rupture or symptomatic presentation. Several investigators have attempted to relate the AAA diameter to the body surface area in predicting for rupture.

Frailty as a predictor of outcomes for patients undergoing carotid artery stenting.

Objective: The concept of frailty has been proposed to capture the vulnerability resulting from aging and has been implemented for the prediction of perioperative outcomes. Carotid artery stenting (CAS) is considered an appropriate minimally invasive procedure for patients considered to high risk to undergo carotid endarterectomy. Recently, the predictive accuracy for perioperative outcomes using the five-item modified frailty index (5mFI) has been reported to be relatively poor for cardiovascular surgery compared with other surgeries.

Physician impact on use of fluoroscopy during endovascular procedures to improve radiation safety.

Objective: To determine whether differences exist in fluoroscopy time and radiation exposure during lower extremity endovascular procedures performed by fellowship trained vascular surgeons vs general surgeons, to minimize radiation exposure to operating room staff.

Methods: A retrospective review of all lower extremity endovascular procedures was performed from August 1, 2014, to January 29, 2016. The procedures were performed by the surgical department's four surgeons with endovascular privileges: two vascular surgeons and two general surgeons.

Correlation of venous symptoms with iliac vein stenosis on magnetic resonance imaging.

Objective: Magnetic resonance imaging (MRI) is used in patients with lower extremity venous disease to screen for iliac vein stenosis. The objective of the present study was to determine the prevalence of iliac vein stenosis and associated lower extremity venous symptoms in consecutive patients undergoing MRI of the pelvis.

Methods: A retrospective study of all consecutive adult patients who had undergone MRI of the pelvis for various indications from March 2012 to June 2016 was performed.

Location of reflux in the saphenous vein does not affect outcomes of vein ablation.

Background: Varicose veins are commonly caused by valvular reflux in the saphenous vein. Most insurance companies will approve venous ablation (VA) for the treatment of junctional reflux only and will deny coverage for symptomatic patients with significant nonjunctional reflux of the saphenous vein at the deep system. The present study compared the outcomes of VA for patients with junctional reflux and patients with nonjunctional reflux.

Safety of vascular interventions performed in an office-based laboratory in patients with low/moderate procedural risk.

Objective: An exponential increase in number of office-based laboratories (OBLs) has occurred in the United States, since the Center for Medicare and Medicaid Services increased reimbursement for outpatient vascular interventions in 2008. This dramatic shift to office-based procedures directed to the objective to assess safety of vascular procedures in OBLs.

Methods: A retrospective analysis was performed to include all procedures performed over a 4-year period at an accredited OBL.

Etiology of iliocaval stent thrombosis.

Objective: Although correction of iliac vein stenosis is safe and efficacious, one of its major complications is iliac vein stent thrombosis. In an attempt to examine the cause of iliac vein stent thrombosis, we reviewed the location of underlying lesions encountered after thrombectomy or thrombolysis of iliac vein stents.

Methods: A retrospective analysis was performed of all iliac vein venograms with intravascular ultrasound examinations at our office-based surgical center from February 2012 to July 2016.

Iliac Vein Stent Placement and the Iliocaval Confluence.

Objective: Prior literature has recommended routine iliac vein stent extension into the inferior vena cava (IVC) to assure adequate outflow for iliac vein stenting procedures. Our bias was that only the lesion should be stented without routine stent extension up to the IVC. We report our experience with this limited stenting technique.

Safety and efficacy of venous ablation in octogenarians.

Objective: Venous ablation (VA) is the recommended treatment of superficial venous insufficiency affecting the lower extremities. The safety and efficacy of the procedure in octogenarians have not been well studied. We postulate that VA in octogenarians is as safe and effective as in younger age groups.

Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia.

Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI.

Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI.

Effect of venous access site on postintervention stent thrombosis for nonthrombotic iliac vein stenting.

Objective: Prior literature suggests that routine femoral vein (FV) puncture is necessary for interrogation of the iliac veins for stenosis to avoid missing common femoral vein (CFV) lesions. However, this can be technically challenging and poses small but increased risks. The purpose of this study was to compare the incidence of stent thrombosis after iliac vein stenting in the treatment of nonthrombotic iliac vein lesions with use of two discrete venous access sites-the CFV and FV.

Is it necessary to dilate stents in management of nonthrombotic iliac vein lesions?

Objective: Iliac vein stenting is an evolving treatment option for chronic venous insufficiency and management of nonthrombotic iliac vein lesions (NIVLs). Currently described protocols recommend deployed stents to be dilated with balloon venoplasty before completion of the procedure, based on previous literature established from management of arterial lesions. The objective of the study was to investigate the role of balloon venoplasty after stent deployment in the management of NIVLs.

Efficacy of balloon venoplasty alone in the correction of nonthrombotic iliac vein lesions.

Objective: Iliac vein stenting of nonthrombotic iliac vein lesions is an evolving treatment course for management of chronic venous insufficiency. To characterize these lesions, we examined our experience treating these lesions with balloon venoplasty before stenting.

Methods: A retrospective analysis was performed to study all patients who underwent venograms with venoplasty and stenting of iliac veins from February 2013 to July 2016.

The Society of Vascular Surgery International Scholars Program: The First Decade.

Objective: The Society for Vascular Surgery (SVS) is a not-for-profit medical society, whose goal is to further advance in vascular health on a global scale. With its 10th anniversary in sight, we were interested in analyzing the impact of a specific scholarship given under the SVS, the International Scholars Program. Our goal was to examine the awardees' characteristics and academic productivity.

Early Results of Duplex-Guided Transradial Artery Fistuloplasties.

Background: Although arteriovenous fistulae (AVFs) are the preferred mode of hemodialysis access because of their high patency rates, they are associated with an appreciable rate of nonmaturation. Balloon-assisted maturation (BAM) has been described to treat this issue. BAM is defined as repeated sequential graduated dilatation of the outflow vein.

Routine use of ultrasound to avert mechanical complications during placement of tunneled dialysis catheters for hemodialysis.

Objective: While placement of tunneled dialysis catheters for hemodialysis access is considered a routine procedure, it is associated with a small chance of mechanical complications. Because the literature examining these issues is not recent and our impression of the incidence of these postprocedural complications is at variance with the existing literature, we decided to review our experience.

Methods: Since 1998, our vascular service has placed 1766 tunneled hemodialysis catheters in 1065 patients for hemodialysis access.

Patient perspectives on inferior vena cava filter retrieval.

Objective: Inferior vena cava (IVC) filter retrieval rates remain low. Previous literature identified provider and system factors to enhance retrieval, but patients' perspectives have not been studied. This study compared the attitudes of men and women with retained filters to identify patient factors that would increase compliance and facilitate retrieval when indicated.

Endovascular treatment of duplicated inferior vena cava compression from retroperitoneal fibrosis.

A 68-year-old man with a history of retroperitoneal fibrosis was referred to our clinic because of disabling bilateral lower extremity swelling and venous claudication, worse on the right side than on the left. He was noted to have a duplicated inferior vena cava and an iliac vein obliteration from retroperitoneal fibrosis. The patient underwent bilateral iliac vein stenting and had complete relief of symptoms through follow-up of 46 months with no recurrence.

Endovascular iliac vein recanalization after Palma procedure for treatment of recalcitrant venous ulcer.

A 57-year-old man with post-thrombotic syndrome presented to the vascular clinic with multiple recurrent nonhealing ulcerations, swelling, and hyperpigmentation of the right lower extremity 30 years after a Palma procedure. On venography, a right to left femoral-femoral Palma bypass graft was noted to be patent, with occlusion of the iliac vein. Endovascular stenting of the right iliac veins led to complete resolution of symptoms and ulcer healing.