The effect of location and configuration on forearm and upper arm hemodialysis arteriovenous grafts.

Objective: The arteriovenous graft (AVG) is most often used in hemodialysis patients when an autogenous fistula is not feasible. The optimal location (forearm or upper arm) and configuration (loop or straight) of AVGs are not known. To evaluate relationships of AVG location and configuration with patency, we conducted a secondary analysis using data from a randomized, placebo-controlled trial of dipyridamole plus aspirin for newly placed AVG.

Perioperative Outcomes in Patients Requiring Iliac Conduits or Direct Access for Endovascular Abdominal Aortic Aneurysm Repair.

Background: Iliac conduit or direct iliac access (ICDA) can be used when anatomy is unfavorable for femoral access during abdominal endovascular aortic aneurysm repair (EVAR). The impact of this approach has not been adequately addressed. The objective of this study was to analyze perioperative outcomes of patients requiring use of ICDAs for EVAR.

Comparison of a Vascular Study Group of New England risk prediction model with established risk prediction models of in-hospital mortality after elective abdominal aortic aneurysm repair.

Background: A certain number of deaths may result from elective abdominal aortic aneurysm (AAA) repair due to inherent risks of operation; however, no agreement exists about which predictive model for in-hospital mortality is most accurate in predicting these events. This study developed a risk prediction model using Vascular Study Group of New England (VSGNE) data and compared it with established models.

Methods: VSGNE data (2003-2013) were queried for patients undergoing elective AAA repair by open or endovascular techniques.

Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation.

Objective: We evaluated the outcomes of patients undergoing major lower-extremity amputation who received packed red blood cell transfusion.

Methods: Using the dataset of the National Surgical Quality Improvement Program (2005-2011), we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified by perioperative (preoperative, intraoperative, or postoperative) blood transfusion.

Perspectives on endovascular training in traditional 5+2 vascular surgery fellowship training programs.

This study aimed to compare expectations and experiences of fellows to those of faculty in vascular surgery fellowship programs with regard to endovascular training. Anonymous surveys were sent to fellows (n = 235) and program directors (n = 147), with 79 fellows and 65 faculty members responding. Fellows noted higher expectations of their endovascular skills prior to starting fellowship than the faculty group reported expecting.

The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for patients with critical limb ischemia.

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease and is associated with a risk of limb loss. This vascular condition is currently treated with limb revascularization by surgery or endovascular intervention performed by a variety of specialists. Because both open vascular bypass and the less invasive endovascular therapy can be performed in selected patients with CLI, there exists significant disagreement as to which therapy should be performed first and which is more successful.

Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques.

Introduction: In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia.

Methods: The National Inpatient Sample (2003-2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1).

Laparoscopic peritoneal dialysis catheter placement is associated with decreased deep organ infection and reoperation.

Introduction: The optimal method for placement of peritoneal dialysis catheters (PDC) is unclear. The objective of this study was to compare the outcomes of laparoscopic and open surgical placement of PDC.

Materials And Methods: Patients who underwent laparoscopic (LPD) and open (OPD) surgical placement of PDC between 2007 and 2011 were identified from the American College of Surgeons National Surgical Quality Initiative Project (NSQIP) dataset using current procedural terminology (CPT) and international classification of diseases 9th revision (ICD-9) codes.

Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates.

Background: Use of fluoroscopy and bone landmarks to guide percutaneous common femoral artery (CFA) access has decreased access site complications compared with palpation alone. However, only limited case series have examined the benefits of ultrasound to guide CFA access during peripheral vascular intervention (PVI). We evaluated the effect of routine vs selective use of ultrasound guidance (UG) on groin hematoma rates after PVI.

Interventions on the superficial venous system for chronic venous insufficiency by surgeons in the modern era: an analysis of ACS-NSQIP.

Objective: To evaluate patient characteristics, practice patterns, and outcomes for patients treated for chronic venous insufficiency (CVI).

Background: Chronic venous insufficiency is a common problem treated using open or endovascular methods by physicians from a number of surgical and nonsurgical specialties.

Methods: Patients treated for CVI in the American College of Surgeons National Surgical Quality Improvement Program data set (2005-2011) were identified.

Open repair of asymptomatic popliteal artery aneurysm is associated with better outcomes than endovascular repair.

Objective: Open (OPAR) and endovascular (EPAR) repair are both used to treat popliteal artery aneurysm (PAA). We assessed outcomes of both modalities in the treatment of asymptomatic PAAs.

Methods: Vascular Quality Initiative (VQI) databases (2010 to 2013) were queried for patients undergoing asymptomatic PAA repair using OPAR and EPAR.

Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals.

Objective: This study compared in-hospital mortality and resource utilization among vascular surgical patients at safety net public hospitals (SNPHs) with those at nonsafety net public hospitals (nSNPHs).

Methods: The National Inpatient Sample (2003-2011) was queried to identify surgical patients with peripheral arterial disease (PAD), carotid stenosis, or nonruptured abdominal aorta aneurysm based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. The cohort was then divided into SNPH and nSNPH groups according to the definition of SNPH used by the National Association of Public Hospitals.

Using vascular quality initiative as a platform for organizing multicenter, prospective, randomized clinical trials: OVERPAR trial.

Background: We describe the organization of a prospective, randomized, multicenter trial comparing the effectiveness of open popliteal artery aneurysm repair (OPAR) and endovascular popliteal artery aneurysm repair (EPAR) of asymptomatic popliteal artery aneurysms (PAAs) as an example for how to use the Vascular Quality Initiative (VQI) framework. Given that many centers participate in the VQI, this model can be used to perform multicenters' prospective trials on very modest budget.

Methods: VQI prospectively collects data on many vascular procedures.

The BEST-CLI trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia.

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease and is associated with a significant risk of limb loss. It is currently treated with limb revascularization by a variety of specialists. Although both open vascular bypass and endovascular therapy are offered to patients with infrainguinal peripheral arterial disease and CLI, significant disagreement exists as to which therapy works best in candidates for both types of intervention.

Factors associated with surgical site infection after lower extremity bypass in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI).

Background: Surgical site infection (SSI) is a major source of morbidity after infrainguinal lower extremity bypass (LEB). This study examines processes of care associated with in-hospital SSI after LEB and identifies factors that could potentially be modified to improve outcomes.

Methods: The Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) registry (2003 to 2012) was queried to identify in-hospital SSI after 7908 consecutive LEB procedures performed by 365 surgeons at 91 academic and community hospitals in 45 states.

Observation and surgery are associated with low risk of amputation for blunt brachial artery injury in pediatric patients.

Background: The ideal treatment for blunt brachial artery (BBA) injury in pediatric patients is controversial. We compared outcomes of surgical and nonsurgical management of BBA injury using the National Trauma Data Bank.

Methods: All patients younger than 18 years who had suffered BBA injury were identified in the pediatric National Trauma Data Bank (2002-2010) by Current Procedural Terminology code.

Routine use of completion imaging after infrainguinal bypass is not associated with higher bypass graft patency.

Background: Significant variability exists in completion imaging (CIM) after infrainguinal lower extremity bypass (LEB). We evaluated the use of CIM and compared graft patency in patients treated by surgeons who performed routine CIM vs those who performed selective CIM.

Methods: We reviewed the Vascular Study Group of New England database (2003-2010) and assessed the use of CIM (angiography or duplex ultrasound) among patients undergoing LEB.

Contemporary comparison of supra-aortic trunk surgical reconstructions for occlusive disease.

Objective: Open surgical reconstruction for supra-aortic trunk occlusive disease persists despite advances in endovascular therapy. Although extrathoracic reconstructions developed as a safer alternative to transthoracic reconstructions, contemporary national data evaluating relative rates of operative outcomes are lacking.

Methods: With use of the National Surgical Quality Improvement Program (2005-2011), patients who underwent transthoracic or extrathoracic reconstruction were evaluated.

Rapid identification of Enterobacter hormaechei and Enterobacter cloacae genetic cluster III.

Aim: Enterobacter cloacae complex bacteria are of both clinical and environmental importance. Phenotypic methods are unable to distinguish between some of the species in this complex, which often renders their identification incomplete. The goal of this study was to develop molecular assays to identify Enterobacter hormaechei and Ent.

Associated venous injury significantly complicates presentation, management, and outcomes of axillosubclavian arterial trauma.

Axillosubclavian vessel injury (ASVI) is associated with high morbidity and mortality. Most studies are single-center experiences of small numbers of patients with penetrating injury. We assessed 21st-century presentation and management of ASVI and focused on outcomes of combined arterial/venous injury.