Transcarotid Artery Revascularization Learning Curves Differ between Surgeon Experience Level.

Background: There has been ensuing interest in adopting transcarotid artery revascularization (TCAR), because of its low perioperative stroke and complication rates. In our study, we aimed to identify the case number at which there is improvement in TCAR technical proficiency. We also assessed how surgeon experience influenced outcomes.

Outcomes of balloon-assisted maturation with large-diameter balloons.

Objectives: Balloon-assisted maturation (BAM) is a well-established technique for maturation of inadequate arteriovenous fistulas (AVF). The objective of this study was to evaluate outcomes of initial BAM using large-diameter angioplasty balloons.

Methods: Charts of patients who underwent BAM between 2018 and 2021 at a single academic institution were reviewed.

Sex Disparities in Arteriovenous Fistula Maturation Outcomes.

Background: The end-stage kidney disease life-plan aims to individualize hemodialysis (HD) access selection in patients requiring renal replacement therapy. Paucity of data on risk factors for poor arteriovenous fistula (AVF) outcomes limits the ability of physicians to guide their patients on this decision. This is especially true for female patients, who are known to have worse AVF outcomes when compared to male patients.

Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes.

Background: Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes.

Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations.

Background: In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss.

Transradial access for balloon-assisted maturation of arteriovenous fistulas.

Balloon-assisted maturation (BAM) of arteriovenous fistulas has conventionally been performed via direct fistula access. The transradial approach has not been well described for BAM, although its use has been reported throughout the cardiology literature. The purpose of the present study was to assess the outcomes of transradial access for its use with BAM.

Predictors of poor outcomes after lower extremity revascularization for acute limb ischemia.

Objectives: Acute lower extremity ischemia is one of the most common emergencies in vascular surgery and is a cause of considerable morbidity and mortality. The goal of this study was to evaluate outcomes of revascularization for acute lower extremity ischemia and to determine factors associated with perioperative morbidity and mortality.

Methods: A total of 354 patients underwent urgent revascularization for acute lower extremity ischemia at an academic medical center between 2014 and 2019.

Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation.

Background: We assessed the utility of intraoperative vein mapping performed by the operating surgeon for evaluating vessel suitability for arteriovenous fistula (AVF) creation.

Methods: In a retrospective review of 222 AVFs, vein diameter measurements were compared between intraoperative and preoperative mapping in the same anatomical location. AVF creation was based on intraoperative vein diameter ≥2 mm, using a distal to proximal and superficial veins first approach.

The effect of nutrition on stroke risk: A systematic review.

An estimated 33% reduction in cardiovascular events can be achieved when incorporating whole grains, fruits, vegetables, poultry, nuts, and vegetable oils in the diet along with reduced consumption of refined carbohydrates, processed meats, and sugar sweetened beverages. We performed a systematic review to analyze the impact of nutritional intervention on stroke risk, as there is no current consensus concerning dietary recommendation for primary and secondary stroke prevention. A literature search of the PubMed database from January 2010 to June 2020 was performed using combinations of the following search terms: carotid disease, carotid artery disease, carotid stenosis, carotid intima-media thickness (CIMT), diet, nutrition, micronutrition, embolic stroke, and stroke.

Hemodynamic instability in the immediate postoperative setting after transcarotid artery revascularization.

Objective: Transcarotid artery revascularization (TCAR) is a relatively recent development in the management of carotid artery occlusive disease, the utilization of which is becoming more prevalent. This study aims to evaluate the timing, prevalence, and types of hemodynamic instability after TCAR.

Methods: We performed a retrospective review of all TCAR procedures performed at two tertiary care academic medical centers within a single hospital system from 2017 through 2019.

Intraparotid facial varix.

A 72-year-old man had presented with a 4-day history of progressive left-sided facial swelling associated with pain. The physical examination revealed left facial fullness over the parotid gland without tenderness to palpation. His vital signs and laboratory test findings were within normal limits.

Modified Banding of Arteriovenous Fistulas for the Treatment of Vascular Access Induced Digital Ischaemia.

Objective: Vascular access induced digital ischaemia is an uncommon complication of haemodialysis access procedures and is difficult to manage. Several techniques have been described to treat this phenomenon, with variable long term success. Although all of these procedures have been shown to work, they have a significant failure rate, such as persistent high vascular access flow or loss of access.

An Interdisciplinary Team Approach to Decrease Sacral Hospital-acquired Pressure Injuries: A Retrospective Cohort Study.

Background: Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in health care. Multi-intervention programs have been shown to decrease the prevalence of pressure injuries.

Purpose: To assess changes in the yearly incidence of sacral HAPIs before and after implementation of a 3-pronged interdisciplinary intervention to reduce HAPI incidence.

Scoping review of non-thermal technologies for endovenous ablation for treatment of venous insufficiency.

Introduction: The aim of this review article was to compare the outcomes of newer non-thermal endovenous ablation techniques to thermal ablation techniques for the treatment of symptomatic venous insufficiency.

Evidence Acquisition: Three independent reviewers screened PubMed and EMBASE databases to identify relevant studies. A total of 1173 articles were identified from database search that met our inclusion criteria.

Anatomically Coiled Internal Carotid Artery Resulting in Severe Dysphagia and Burning Mouth Syndrome.

This is a report of a 65-year-old female presenting with symptoms of dysphagia due to a coiled left internal carotid artery, treated with resection and primary repair. Dysphagia lusoria is more commonly caused by aortic arch anomalies, aberrant subclavian or common carotid arteries. Internal carotid tortuosity as a cause of severe dysphagia and burning mouth syndrome is highly unusual.

The Role of Duplex Ultrasound in Assessing AVF Maturation.

Background: Arteriovenous fistulas (AVFs) are favored for hemodialysis (HD) access. However, in many instances, AVFs fail to mature. We examined the utility of postoperative color duplex ultrasound (CDU) in assessing AVF maturation and determining the need for balloon-assisted maturation (BAM).

Epiglottic hematoma after carotid endarterectomy with cervical block.

There are few trials assessing the risks and benefits of performing a cervical plexus block (CPB) in urgent carotid endarterectomies (CEA). We describe a case of a patient who underwent urgent CEA under CPB and suffered a complication of postoperative epiglottic hematoma. There were clinical findings that helped to distinguish the hematoma from other, more common postoperative complications.

Maturation Rates of Arteriovenous Fistulas Using Small Veins in the Era of Endovascular Interventions.

Background: Traditional practice suggests the abandonment of veins smaller than 3 mm in diameter for arteriovenous fistula (AVF) creation because of a low rate of maturation. This study aims to show that with balloon-assisted maturation (BAM), undersized veins can be used to create functional AVFs with a high rate of success.

Methods: All patients who underwent AVF creation between 2014 and 2018 at a tertiary academic medical center were retrospectively reviewed.

Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area.

Background: Coronavirus disease 2019 (COVID-19) predisposes to arterial and venous thromboembolic complications. We describe the clinical presentation, management, and outcomes of acute arterial ischemia and concomitant infection at the epicenter of cases in the United States.

Methods: Patients with confirmed COVID-19 infection between March 1, 2020 and May 15, 2020 with an acute arterial thromboembolic event were reviewed.

Maximizing proximal seal zone in fenestrated endografting: Evolution in the approach to graft configuration.

Objective: Fenestrated endografting for juxtarenal and pararenal abdominal aortic aneurysms affords the ability to seal stent grafts in normal aorta at and above the renal arteries. The Zenith fenestrated graft (ZFEN; Cook Medical, Bloomington, Ind) is custom-made to surgeon specifications, subject to certain manufacturing limitations. The most common configuration in the pivotal trial and in commercial use after approval has been as a scallop for the superior mesenteric artery (SMA) and two small fenestrations for the renal arteries (configuration A).

A rare complication of testicular infarction after femorofemoral bypass highlighting the importance of surgical technique.

We present an interesting case of a 66-year-old male who had acute testicular infarction following a right common femoral artery to left profunda femoris artery bypass with advanced symptoms of claudication. Angiography in the preoperative period demonstrated the extent of peripheral arterial disease present, revealing a calcified aorta, partially occluded left hypogastric artery, occluded left external iliac, common femoral and superficial femoral arteries and an occluded right hypogastric artery. A bypass was performed without any initial complications and subsequent relief of symptoms of claudication and rest pain.

Infections of Prosthetic Grafts and Patches Used for Infrainguinal Arterial Reconstructions.

Background: Prosthetic grafts are often used as alternative conduits in patients with peripheral vascular disease who do not have an adequate autologous vein for bypass. Prosthetic grafts, unfortunately, carry an increased risk of infection and are associated with increased morbidity and mortality. The goal of this study was to identify potential risk factors and subsequent outcomes associated with lower extremity prosthetic graft infections.

Improving the Power of the American Society of Anesthesiology Classification System to Risk Stratify Vascular Surgery Patients Based on National Surgical Quality Improvement Project-Defined Functional Status.

Background: Recently published reports have shown that the American Society of Anesthesiology (ASA) classification system has limited applicability in vascular surgery patients. Most patients undergoing vascular procedures are designated as ASA class III, limiting discrimination in preoperative risk assessment. The 2006 National Surgical Quality Improvement Project (NSQIP), containing over 170,000 surgical cases, demonstrated that functional status is an important predictor of mortality.