The impact of current smoking on outcomes after infrainguinal bypass for claudication.

Objective: Although smoking cessation is a benchmark of medical management of intermittent claudication, many patients require further revascularization. Currently, revascularization among smokers is a controversial topic, and practice patterns differ institutionally, regionally, and nationally. Patients who smoke at the time of revascularization are thought to have a poor prognosis, but data on this topic are limited.

Regional variation in outcomes for lower extremity vascular disease in the Vascular Quality Initiative.

Background: Increased focus has been placed on perioperative and long-term outcomes in the treatment of peripheral artery disease (PAD), both for purposes of quality improvement and for assessment of performance at a surgeon and institutional level. This study evaluates regional variation in outcomes after treatment for PAD within the Vascular Quality Initiative (VQI). By describing the variation in practice patterns and outcomes across regions, we hope that each regionally based quality group can select which areas are most important for them to focus on as they will have access to their regional data to compare.

Better survival for African and Hispanic/Latino Americans after infrainguinal revascularization in the Society for Vascular Surgery Vascular Quality Initiative.

Objective: Inferior survival outcomes have historically been reported for African Americans with cardiovascular disease, and poorer outcomes have been presumed for peripheral arterial disease (PAD) as well. The current study evaluates the effect of race and ethnicity on survival of patients undergoing open or endovascular interventions for lower extremity PAD.

Methods: Data of patients from the Society for Vascular Surgery Vascular Quality Initiative database were obtained for patients undergoing open infrainguinal (INFRA) or suprainguinal (SUPRA) bypass, peripheral vascular intervention (PVI), and amputation (AMP).

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative.

Objective: Prior studies on the cause and effect of surgical variation have been limited by utilization of administrative data. The Vascular Quality Initiative (VQI), a robust national clinical registry, provides anatomic and perioperative details allowing a more robust analysis of variation in surgical practice.

Methods: The VQI was used to identify all patients undergoing infrainguinal open bypass or endovascular intervention from 2009 to 2014.

A comparative evaluation of risk-adjustment models for benchmarking amputation-free survival after lower extremity bypass.

Background: Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB).

Predicting outcomes for infrapopliteal limb-threatening ischemia using the Society for Vascular Surgery Vascular Quality Initiative.

Objective: The outcomes of open surgical or endovascular intervention for limb-threatening ischemia (LTI) involving the infrapopliteal vessels are dependent on complex anatomic, demographic, and disease factors. To assist in decision-making, we used the Vascular Quality Initiative (VQI) to derive a model using only preoperatively available factors to predict important outcomes for open or endovascular revascularization.

Methods: National VQI data for the infrainguinal bypass and peripheral vascular intervention (PVI) modules were reviewed in a blinded fashion for patients who underwent intervention for LTI of the infrapopliteal vessels.

Preoperative antiplatelet and statin treatment was not associated with reduced myocardial infarction after high-risk vascular operations in the Vascular Quality Initiative.

Objective: Medical management with antiplatelet (AP) and statin therapy is recommended for nearly all patients undergoing vascular surgery to reduce cardiovascular events. We assessed the association between preoperative use of AP and statin medications and postoperative in-hospital myocardial infarction (MI) in patients undergoing high-risk open surgery.

Methods: We studied patients who underwent elective suprainguinal (n = 3039) and infrainguinal (n = 8323) bypass and open infrarenal abdominal aortic aneurysm repair (n = 3007) in the Vascular Quality Initiative (VQI, 2005-2014).

Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival.

Objective: Medical management (MM) with antiplatelet (AP) and statin therapy is recommended for most patients undergoing vascular surgery and has been advocated by the Vascular Quality Initiative (VQI). We analyzed the effect of VQI participation on perioperative (preoperative and postoperative) MM use over time and the effect of discharge MM on patient survival.

Methods: We studied VQI patients treated with MM preoperatively and at discharge from 2005 to 2014, including all elective carotid endarterectomy/carotid stenting (n = 28,092), suprainguinal/infrainguinal bypass (n = 11,362), peripheral vascular interventions (n = 24,476), open/endovascular abdominal aortic aneurysm repair (n = 13,503), and thoracic endovascular aneurysm repair (n = 702).

Regional quality groups in the Society for Vascular Surgery® Vascular Quality Initiative.

The Society for Vascular Surgery Vascular Quality Initiative (SVS VQI) is designed to improve the quality, safety, effectiveness, and cost of vascular health care. The SVS VQI is uniquely organized as a distributed network of regional quality improvement groups across the United States. The regional approach allows for the involvement of a variety of health care professionals, the pooling of available resources and expertise, and serves as a motivating factor for each participating institution.

Early results and lessons learned from a multicenter, randomized, double-blind trial of bone marrow aspirate concentrate in critical limb ischemia.

Objectives: Despite advances in endovascular therapies, critical limb ischemia (CLI) continues to be associated with high morbidity and mortality. Patients without direct revascularization options have the worst outcomes. We sought to explore the feasibility of conducting a definitive trial of a bone marrow-derived cellular therapy for CLI in this "no option" population.

The role of amputation as an outcome measure in cellular therapy for critical limb ischemia: implications for clinical trial design.

Background: Autologous bone marrow-derived stem cells have been ascribed an important therapeutic role in No-Option Critical limb Ischemia (NO-CLI). One primary endpoint for evaluating NO-CLI therapy is major amputation (AMP), which is usually combined with mortality for AMP-free survival (AFS). Only a trial which is double blinded can eliminate physician and patient bias as to the timing and reason for AMP.

A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies.

Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms.

Methods And Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis.

Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture.

Objectives: To ascertain whether acute aortic dissection (AAD) remains the most common aortic catastrophe, as generally believed, and to detect any improvement in outcomes compared with previously reported population-based data.

Patients And Methods: We determined the incidence, operative intervention rate, and long-term survival rate of Olmsted County, Minnesota, residents with a clinical diagnosis of AAD initially made between 1980 and 1994. The incidence of degenerative thoracic aortic aneurysm (TAA) rupture was also delineated.

Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery.

Decision-making in regard to elective repair of abdominal aortic aneurysms (AAA) requires careful assessment of factors that influence rupture risk, operative mortality, and life expectancy. Individualized consideration of these factors in each patient is essential, and the role of patient preference is of increasing importance. It is not possible or appropriate to recommend a single threshold diameter for intervention which can be generalized to all patients.

Trends in rehabilitation after amputation for geriatric patients with vascular disease: implications for future health resource allocation.

Objective: To assess the effect of demographic changes on rehabilitation of geriatric patients after amputation and the implications for future health resource allocation.

Design: Population-based study.

Setting: Olmsted County, MN.

Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (Phase II) multicenter study.

Background: The primary purpose of this study was to evaluate compliance, side effects, and safety associated with prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms (AAAs). A secondary goal was to determine how treatment with doxycycline influences circulating levels of matrix metalloproteinase-9 (MMP-9) in this patient population.

Methods: Thirty-six patients with AAAs (30 men and 6 women; mean age, 69 +/- 1 years) were enrolled into a 6-month phase II study to evaluate treatment with doxycycline (100 mg orally twice a day).

Splenic artery aneurysms: two decades experience at Mayo clinic.

Although rare, splenic artery aneurysms (SAAs) have a definite risk of rupture. The optimal management of these aneurysms remains elusive. A retrospective chart review of all patients treated at our institutions with the diagnosis of SAA from January 1980 until December 1998 was undertaken.

Human leukocyte antigen class II immune response genes, female gender, and cigarette smoking as risk and modulating factors in abdominal aortic aneurysms.

Objective: Aortic inflammation and the genes that regulate the immune response play an important role in abdominal aortic aneurysm pathogenesis. However, the modulating effects of such genetic and other environmental factors on the severity on aneurysm inflammation is not known. The objective of this study was to determine the influence of the human leukocyte antigen (HLA) class II genes, gender, and environmental factors on degree of abdominal aortic aneurysm tissue inflammation.

Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison.

Objective: Questions remain concerning the optimal site of graft origin and the extent of revascularization necessary to achieve excellent results for chronic mesenteric ischemia (CMI). Endovascular therapy also is performed for CMI. These factors prompted us to review our results to provide a current standard.

Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography.

Objective: To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography.

Patients And Methods: This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured.

Contemporary management of acute mesenteric ischemia: Factors associated with survival.

Purpose: Acute mesenteric ischemia (AMI) is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the results of current management and the examination of factors associated with survival, we reviewed our experience.

Methods: The clinical data of all the patients who underwent operation for AMI between January 1, 1990, and December 31, 1999, were retrospectively reviewed, clinical outcome was recorded, and factors associated with survival rate were analyzed.

Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study.

Objective: The objectives of this study were the comparison of patients who needed mesh closure of the abdomen with patients who underwent standard abdominal closure after ruptured abdominal aortic aneurysm repair and the determination of the impact of timing of mesh closure on multiple organ failure (MOF) and mortality.

Methods: We performed a case-control study of patients who needed mesh-based abdominal closure (n = 45) as compared with patients who underwent primary closure (n = 90) after ruptured abdominal aortic aneurysm repair.

Results: Before surgery, the patients who needed mesh abdominal closure had more blood loss (8 g versus 12 g of hemoglobin; P <.