The association of reduced ejection fraction with the outcomes of endovascular abdominal aortic aneurysm repair.

Objective: It is estimated that 20% of patients undergoing elective abdominal aortic aneurysm repair suffer from cardiomyopathy. This study examines the impact of reduced ejection fraction (EF) on the outcomes of endovascular aneurysm repair (EVAR) and compares the different types of cardiomyopathies causing reduction of EF. Our hypothesis is that reduction in EF is associated with higher mortality after EVAR.

The Incidence and Significance of Iliac Vein Stenosis in Patients with Deep Vein Thrombosis.

Background: The role of iliac vein stenosis (IVS) in the development of deep vein thrombosis (DVT) is poorly understood. This study determines the incidence of IVS in patients diagnosed with DVT and assesses its impact on presentation and outcomes. Our hypothesis is that the presence of IVS increases the risk of long-term ipsilateral DVT recurrence.

Long-term outcomes of elective endovascular vs open repair of popliteal artery aneurysms in the VISION database.

Background: The best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single-center studies suggest that open popliteal aneurysm repair (OPAR) is more durable than endovascular PAR (EPAR), but large, randomized, multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database.

Open and endovascular treatment of the common femoral artery in a tertiary care center.

Objectives: Endovascular treatment of peripheral arterial disease involving the common femoral artery (CFA) remains controversial. This study compares the perioperative and long-term outcomes of open and endovascular lower extremity revascularization (LER) involving the CFA.

Methods: A retrospective analysis of all patients undergoing LER for peripheral arterial disease in a tertiary care center was performed.

Ruptured Complex Aortoiliac Aneurysm in an Elderly Patient With a Kidney Transplant Presenting With Sciatica.

Common iliac artery aneurysms are uncommon, with an estimated incidence of less than 0.01% in adults and accounting for only 1% of all intra-abdominal aneurysms. While the risk of rupture is approximately 5%, it increases significantly to 29% once the aneurysm reaches 4 cm.

Early experience with diclofenac topical gel for moderate to severe postablation phlebitis.

Objective: Oral (PO) nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat phlebitis and thrombus extension postendovenous ablation. Few studies have evaluated diclofenac topical gel for treating postablation phlebitis. This study assesses diclofenac 1% topical gel as a first-line treatment for patients with moderate to severe phlebitis after ablation.

The impact of diabetes mellitus on the outcomes of revascularization for chronic limb-threatening ischemia in the BEST-CLI trial.

Objective: Several observational studies have demonstrated an association between diabetes mellitus (DM) and above-ankle amputation after lower extremity revascularization (LER). However, data from prospective randomized trials is lacking. This analysis compares the outcomes of patients with and without DM enrolled in the Best Endovascular vs Best Surgical Therapy in patients with Chronic Limb-Threatening Ischemia (BEST-CLI) trial.

The Degree of Inferior Vena Cava Filter Tilt Associated with Challenging Retrieval.

Background: Inferior vena cava (IVC) filter tilt is associated with technical difficulties at the time of retrieval. However, the degree of tilt that predisposes patients to undergo complex or failed retrieval has not been defined.

Methods: The electronic charts of patients undergoing IVC filter removal between 2010 and 2019 at a single tertiary center were reviewed.

Presentation and patterns of reinterventions after revascularization in patients with premature peripheral arterial disease.

Objective: Premature peripheral arterial disease (PAD) (age ≤50 years) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared with older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (ie, 60-80 years).

The evolution and impact of the Society for Vascular Surgery Resident and Student Program.

Objective: There is an ongoing national shortage in the vascular surgery (VS) workforce. To increase interest in the specialty, the Society for Vascular Surgery (SVS) Resident and Student Outreach Committee (RSOC) developed a dedicated general surgery (GS) resident and medical student (MS) program at the Vascular Annual Meeting (VAM) and invested in a scholarship program to help reduce attendee expenses. This study assesses the program's effectiveness, correlating recipient feedback with the likelihood of matching into a VS training program.

Intravascular Ultrasound Use is Associated with Improved Patency in Lower Extremity Peripheral Arterial Interventions.

Background: Intravascular ultrasound (IVUS) facilitates detailed visualization of endoluminal anatomy not adequately appreciated on conventional angiography. However, it is unclear if IVUS use improves clinical outcomes of peripheral vascular interventions (PVIs) for peripheral arterial disease. This study aimed to evaluate the impact of IVUS on 1-year outcomes of PVI in the vascular quality initiative (VQI).

The radiographic relationship of the femoral head, inguinal ligament, and common femoral artery bifurcation for optimal vascular access.

Objective: Common femoral artery (CFA) access is commonly used for endovascular interventions. Access site complications contribute to significant morbidity and mortality. This study characterizes the radiographic variability in the relationship of the femoral head, the inguinal ligament, and the CFA bifurcation, to identify the zone of optimal CFA access.

Anticoagulation in Patients with Premature Peripheral Artery Disease Undergoing Lower Extremity Revascularization.

Background: Premature peripheral artery disease (PAD), defined by lower extremity revascularization (LER) at age ≤ 50 years, is associated with poor major adverse limb events. The early onset of disease is thought to be influenced by genetic factors that regulate homeostasis of the vascular wall and coagulation. The aim of this study is to investigate the effect of anticoagulation as an adjunct to antiplatelet therapy on the outcomes of LER in patients with premature PAD.

Atherectomy - The Options, the Evidence, and When Should It Be Used.

The use of atherectomy for peripheral vascular interventions (PVIs) has increased exponentially and reached 18% of all PVI in the United States. The theoretical benefit on extensive arterial calcification relies on the concept of plaque modification and removal instead of displacement, as with other endovascular techniques. To date, there are no prospective studies comparing the different atherectomy technologies (directional, rotational, orbital, and laser).

Comparative Outcomes of Peripheral Vascular Interventions in Patients on Chronic Anticoagulation with Factor Xa Inhibitors and Vitamin K Antagonists.

Background: In patients undergoing revascularization for peripheral arterial disease (PAD), low-dose Factor Xa inhibitors (FXaI) taken with aspirin improved limb and cardiovascular outcomes compared to aspirin alone. Furthermore, in atrial fibrillation and venous thromboembolism, FXaI are recommended over vitamin K antagonists (VKA) for chronic anticoagulation. While studies have evaluated different perioperative anticoagulation regimens in patients treated for PAD, the optimal regimen for chronic anticoagulation in patients with PAD undergoing peripheral vascular intervention (PVI) has not been determined.

The Use and Impact of Cilostazol on Patients Undergoing Endovascular Peripheral Interventions.

Background: Cilostazol is used for the treatment of intermittent claudication. The impact of cilostazol on the outcomes of peripheral vascular interventions (PVIs) remains controversial. This study assesses the use and impact of cilostazol on patients undergoing PVI for peripheral arterial disease (PAD).

Insulin Requirement and Infrainguinal Bypass Outcomes in Patients with Peripheral Arterial Disease.

Background: Diabetes mellitus (DM) is a major risk factor for peripheral artery disease. The association of DM with major adverse limb events (MALE) after lower extremity revascularization remains controversial, as patients with diabetes are typically analyzed as a single, homogenous group. Using a large national database, this study examines the impact of insulin use and glycemic control on the outcomes following infrainguinal bypass.

The Utilization of Protamine during Peripheral Vascular Interventions in the VQI.

Background: Protamine administration was shown to reduce bleeding after carotid surgery but the role of protamine during peripheral vascular interventions (PVIs) remains unknown. This study evaluates the trend and outcomes of protamine use in the Vascular Quality Initiative (VQI). Our hypothesis is that the use of protamine is associated with decreased bleeding after PVI.

The development of a novel endovascular grasper for challenging inferior vena cava filter retrieval.

Objective: Although inferior vena cava (IVC) filters are commonly retrieved using a snare, lateral tilt and fibrosis around struts can complicate the procedure and sometimes require the use of off-label devices. We describe the development of a novel articulating endovascular grasper designed to remove permanent and retrievable IVC filters in any configuration.

Methods: For in vitro testing, the IVC filters were anchored to the inner wall of a flexible tube in a centered or tilted configuration.