Male kidney-specific BMAL1 knockout mice are protected from K-deficient, high-salt diet-induced blood pressure increases.

The circadian clock protein basic helix-loop-helix aryl hydrocarbon receptor nuclear translocator-like protein 1 (BMAL1) is a transcription factor that impacts kidney function, including blood pressure (BP) control. Previously, we have shown that male, but not female, kidney-specific cadherin Cre-positive BMAL1 knockout (KS-BMAL1 KO) mice exhibit lower BP compared with littermate controls. The goal of this study was to determine the BP phenotype and immune response in male KS-BMAL1 KO mice in response to a low-K high-salt (LKHS) diet.

A Tiered Mentorship Program to Integrate Medical Students Into Clinical Research Projects.

Objective: Herein we describe the development, implementation, and growth of our Vascular Research Training Program (VRTP), emphasizing the intentional involvement of medical students in clinical research.

Methods: We developed a VRTP focusing on medical student engagement to encompass 4 pillars: ownership, mentorship, experience, and independence within the research process. The program is organized by clinical projects with an attending surgeon, surgical trainee (fellow or resident), and medical student comprising each research project team.

Spontaneous Thrombosis of an Isolated Internal Iliac Artery Aneurysm.

Background: Isolated internal iliac artery aneurysms (IIAAs) are uncommon but potentially morbid lesions that are a challenge to monitor and treat. However, given the small numbers of reported cases and high rates of incidentally discovered lesions, the natural history of isolated IIAAs is not well characterized. This case describes an atypical and previously unreported spontaneous thrombosis of an isolated IIAA, a lesion typically thought to progressively enlarge and rupture.

Successful Treatment of Acute Limb Ischemia Secondary to Iatrogenic Distal Embolization Using Catheter Directed Aspiration Thrombectomy.

Acute limb ischemia (ALI) due to thromboembolism is a limb- and life-threatening condition regularly encountered by vascular surgeons. Iatrogenic distal embolization is occasionally seen as a complication of various endovascular procedures. We present a series of four patients who developed ALI due to arterial embolization during cardiovascular procedures that were successfully treated via catheter directed aspiration embolectomy.

Modeling variability in the inferior vena cava into fenestrated endografts for retrohepatic caval injuries.

Objective: Injury of the retrohepatic inferior vena cava (IVC) is rare, but extremely fatal. Open repair of these injuries is challenging. Various maneuvers, including atriocaval shunting and total vascular isolation, have been described, but are poorly tolerated in the severely injured patient.

Intraoperative Fragmentation and Retention of Endovascular Devices: Clinical Consequences and Preventative Strategies.

Background: Expanded applications and increasing volumes of complex endovascular procedures have increased the risk of unintended intraoperative fragmentation and retention of catheters and sheaths. We describe a series of retained or fragmented endovascular devices, a quality improvement program to address this unmet need for improved detection of catheter fragmentation, and the results of this program.

Methods: Cases utilizing endovascular devices that resulted in a retained catheter fragment were identified and analyzed during divisional quality improvement review.

Considerations beyond Stenosis for Carotid Endarterectomy in Treating Free-Floating Thrombus of the Carotid Artery.

Background: Free-floating thrombus (FFT) of the carotid artery is an uncommon condition that can present with neurologic symptoms, often in the setting of ischemic stroke. The literature pertaining to the incidence and optimal treatment of this condition is limited. Herein, we report our contemporary experience with FFT across a range of degrees of carotid stenosis.

A Novel Risk Score Predicts Operative Mortality After Acute Type A Aortic Dissection Repair.

Background: Current stratification systems for patients presenting with acute type A aortic dissection rely on signs of malperfusion to predict mortality. The authors sought to develop an algorithm to readily risk stratify these patients using admission characteristics.

Methods: Two hundred sixty-nine consecutive patients who underwent type A repair between 2002 and 2015 were reviewed for easily obtainable preoperative demographics and laboratory values deemed a priori as potential predictors of operative mortality.

Blunt multifocal aortic injury with abdominal aortic intimointimal intussusception.

Blunt abdominal aortic injury is an infrequent occurrence after blunt trauma. The majority of these injuries result from deceleration forces sustained in motor vehicle collisions. Effects of these forces on the thoracic aorta are well described, but associated spinal compression or distraction can also lead to injury of the affixed abdominal aorta.

Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury.

Objective: To review rates of permanent paraplegia and lumbar drain-related complications in patients undergoing thoracic endovascular aortic repair (TEVAR) surgery with prophylactic cerebrospinal fluid (CSF) drainage at the authors' institution.

Design: Retrospective cohort study.

Setting: Tertiary care, academic medical center.

Continuous Flow Perfused Cadaver Model for Endovascular Training, Research, and Development.

Background: Endovascular simulation employing computer, animal, and static models are common and useful adjuncts for teaching endovascular procedures and developing novel, complex endovascular techniques. Unfortunately, these models lack realistic haptic feedback and thus do not faithfully replicate many of the technical challenges associated with clinical endovascular procedures (e.g.

Defining the burden, scope, and future of vascular acute care surgery.

Objective: The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland.

Flow Reduction-Aided Thrombin Injection for Complex Femoral Pseudoaneurysms: Case Series and Review of the Literature.

Background: Peripheral pseudoaneurysms are a known complication of vascular access procedures. Complex lesions-those with short, wide necks or other complex arrangements-would conventionally require open repair, but we believe that even these lesions could be managed with an endovascular approach.

Methods: Four patients with complex pseudoaneurysms were offered an open repair or thrombin injection with the use of flow-reducing balloons.

Transcervical Carotid Artery Stenting Using a Prosthetic Arterial Conduit: Case Series of a Novel Surgical Technique.

We present a series of 4 patients with carotid restenosis following carotid endarterectomy (CEA) who underwent transcervical carotid artery stenting (CAS) using a novel prosthetic conduit technique. The patients were high risk for repeat CEA (short and obese necks) and had contraindications to transfemoral CAS (bovine arch, prior dissection). CAS was thus performed via a transcervical approach with a polytetrafluoroethylene conduit anastomosed to the proximal common carotid artery.

Management and outcomes of carotid artery extension of aortic dissections.

Background: Aortic dissection (AD) is the most common aortic catastrophe. Carotid artery dissection due to extension of AD (CAEAD) is one severe complication of this condition. Despite years of refinement in the techniques for repair of AD, the optimal management strategy for CAEAD remains yet to be described.

Functional status predicts major complications and death after endovascular repair of abdominal aortic aneurysms.

Objective: Endovascular aneurysm repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status to EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR.

Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms.

Objective: Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR).

Management and outcomes of blunt common and external iliac arterial injuries.

Objective: Blunt iliac arterial injuries (BIAI) require complex management but are rare and poorly studied. We investigated the presentation, management, and outcomes of patients with blunt common or external iliac arterial injuries.

Methods: We identified and reviewed 112 patients with BIAI admitted between 2000 and 2011 at a Level I trauma center.

Patterns and management of blunt abdominal aortic injury.

Background: Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management.

Methods: Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry.

Emergency department medication history taking: current inefficiency and potential for a self-administered form.

Background: Emergency Departments (EDs) struggle with obtaining accurate medication information from patients.

Objective: Our aim was to estimate the proportion of urban ED patients who are able to complete a self-administered medication form and record patient observations of the medication information process.

Methods: In this cross-sectional study, we consecutively sampled ED patients during various shifts between 8 AM and 10 PM.