Appropriateness of care: Deep venous procedures.

In the past decade, technologies to treat venous pathologies have increased dramatically, to the benefit of an often underserved and overlooked population of patients with venous disease. However, given the rapid release of various technologies, including venous-dedicated stents and thrombectomy devices across varied venous pathologies, evidence-based guidelines have been slow to develop. When discussing appropriateness of care, one needs to consider optimal patient selection, technical approach, medical management, and surveillance protocols, to name a few.

Elevated Neutrophil to Lymphocyte Ratio is Associated with Worse Outcomes after Carotid Endarterectomy in Asymptomatic Patients.

Objective: Management of carotid artery stenosis (CAS) remains controversial and proper patient selection critical. Elevated neutrophil to lymphocyte ratio (NLR) has been associated with poor outcomes after vascular procedures. The effect of NLR on outcomes after carotid endarterectomy (CEA) in asymptomatic and symptomatic patients is assessed.

Elevated neutrophil to lymphocyte ratio is associated with decreased amputation-free survival after femoropopliteal percutaneous revascularization.

Background: An elevated neutrophil-lymphocyte ratio (NLR) is a biomarker associated with adverse outcomes after cardiovascular surgery. This study evaluates the association of preoperative NLR with clinical outcomes after peripheral vascular intervention (PVI) of the femoropopliteal segments.

Methods: A retrospective review identified 488 patients who underwent percutaneous interventions of femoropopliteal arteries between 2011 and 2018 and had a pre-procedural complete blood count with differential with normal white blood cell count within 30 days prior to intervention.

Paclitaxel-coated peripheral arterial devices are associated with improved overall survival and limb salvage in patients with chronic limb-threatening ischemia.

Objective: Paclitaxel (PTX)-coated peripheral arterial devices have been shown to decrease femoropopliteal artery restenosis and the need for reintervention compared with non-PTX-coated devices. The data regarding PTX efficacy and safety come from randomized controlled trials that almost exclusively enrolled patients with claudication. The outcomes of PTX treatment in patients who present with chronic limb-threatening ischemia (CLTI) are unknown.

Systematic review of hemostatic agents used in vascular surgery.

Background: Hemostatic agents are routinely used in vascular surgery to complement proper suture techniques and decrease the risk of perioperative bleeding. A relative lack of comparative research studies have left surgeons with the option of choosing hemostatic agents based on their personal experience. The present review has highlighted the efficacy and safety of hemostatic agents and categorized them according to their primary mechanism of action and cost.

Paclitaxel-Coated Peripheral Arterial Devices are Associated with Reduced Mortality in Younger Patients.

Background: Paclitaxel-coated devices have been shown to decrease restenosis when used in the femoropopliteal artery. Recent reports have suggested a possible risk of increased late mortality in patients treated with paclitaxel. It has been suggested that younger patients and those with limited comorbidities may be at higher risk.

Midterm outcomes in patients with upper extremity deep vein thrombosis.

Background: Outcomes and the necessity for anticoagulation in patients with upper extremity deep vein thrombosis (UE DVT) are unclear. The purpose of this study was to determine the incidence of UE DVT, the outcomes of patients stratified by anticoagulation treatment, and which factors were significantly associated with mortality.

Methods: This study was a single-center, retrospective review of all patients undergoing UE venous duplex imaging in 2016.

Anatomic criteria in the selection of treatment modality for atherosclerotic carotid artery disease.

Objective: Three procedures are currently available to treat atherosclerotic carotid artery stenosis: carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Although there is considerable debate evaluating each of these in a head-to-head comparison to determine superiority, little has been mentioned concerning the specific anatomic criteria that make one more appropriate. We conducted a study to define anatomic criteria in relation to inclusion and exclusion criteria and relative contraindications.

Elevated neutrophil-lymphocyte ratio predicts mortality following elective endovascular aneurysm repair.

Objective: The neutrophil-lymphocyte ratio (NLR) is an inexpensive and useful inflammatory marker that incorporates the balance of the innate (neutrophil) and adaptive (lymphocyte) immune responses. Data exist on the association between NLR and mortality in various coronary diseases and in cancer surgery, but there is a paucity of data on the impact of preoperative NLR on vascular surgical outcomes. The aim of this study was to evaluate the relationship between preoperative NLR and elective endovascular aortic aneurysm repair (EVAR) outcome.

Frequency of perigraft hygroma after open aortic reconstruction.

Objective: The incidence of perigraft hygroma (PGH) development after aortic reconstruction remains poorly defined and its clinical relevance is questionable. This study was designed to establish the incidence of and determine the risk factors associated with PGH formation and its outcomes.

Methods: Patients who underwent open aortic reconstruction for either aneurysmal or occlusive disease with an expanded polytetrafluoroethylene (ePTFE) or polyester graft from 2004 to 2018 were retrospectively reviewed (n = 262).

Paclitaxel-coated peripheral artery devices are not associated with increased mortality.

Objective: Long-term safety concerns have been raised that the use of paclitaxel-coated balloons and stents is linked to excess mortality. Our objective was to compare outcomes in patients treated with paclitaxel vs uncoated devices and to analyze long-term mortality.

Methods: We conducted a retrospective single-institution review of 1170 consecutive patients who underwent femoropopliteal percutaneous revascularization by angioplasty, atherectomy, stent placement, or combination between 2011 and 2018.

Effect of surgical wound classification on biologic graft performance in complex hernia repair: an experimental study.

Background: Despite relatively sparse data regarding their outcomes in the setting of infection, biologic grafts have gained rapid acceptance by the surgical community for complex hernia repair. These materials are heterogeneous in their procurement and processing techniques, which may ultimately have an impact in their ability to withstand infection. The objective of this study is to evaluate the impact of varying levels of contamination on biologic graft performance in a chronic ventral hernia animal model.

Stitch versus scar--evaluation of laparoscopic pediatric inguinal hernia repair: a pilot study in a rabbit model.

Background: Many have questioned whether the laparoscopic, percutaneous hernia repair technique is as durable as an open repair in which the sac is divided and ligated. We set out to assess if the suture alone causes enough injury and scar over time to obliterate the internal ring.

Materials And Methods: In total, 28 male rabbits with congenital patent processus vaginalis underwent laparoscopic repair with the subcutaneous endoscopically assisted ligation technique.

Predicting severe postoperative respiratory complications following abdominal wall reconstruction.

Background: Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction.

Methods: All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed.

Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model.

Background: The ideal method to secure biologic mesh during laparoscopic hiatal hernia repair remains uncertain. Suture or tack fixation can be technically difficult, and serious cardiovascular complications have been reported. Fibrin sealant (FS) offers a potential solution to this problem.

Open versus endoscopic component separation: a cost comparison.

Background: The components separation technique (CST) is performed through an open or endoscopic approach. It is unclear whether the costs associated with the endoscopic instruments outweigh any clinical benefit derived from their use and the avoidance of lipocutaneous flaps. This study aimed to compare the direct costs associated with each approach.

Optimum repair for massive ventral hernias in the morbidly obese patient--is panniculectomy helpful?

Background: The appropriate surgical management of morbidly obese patients with symptomatic hernias is not well defined. The authors evaluated the role of simultaneous panniculectomy in complex abdominal wall reconstruction.

Methods: A retrospective study (2007-2010) was conducted of morbidly obese (body mass index > 40 kg/m(2)) patients undergoing open complex abdominal wall reconstruction.

Analysis of the rising incidence of thyroid cancer using the Surveillance, Epidemiology and End Results national cancer data registry.

Background: The incidence of thyroid cancer has more than doubled in recent decades. Debate continues on whether the increasing incidence is a result of an increased detection of small neoplasms or other factors.

Methods: Using the Surveillance, Epidemiology and End Results database, we examined the overall incidence of thyroid cancer with variations based on tumor pathology, size, and stage, as well as the current surgical and adjuvant therapy of thyroid carcinoma.

Thirty-day readmission after ventral hernia repair: predictable or preventable?

Introduction: Thirty-day readmission has become an increasingly scrutinized event in the field of surgery, especially in light of projected cuts in reimbursement. Although studies have evaluated large populations, little work has been done on procedure-specific populations. Our objective is to determine if any factors are predictive of 30-day readmission in patients undergoing ventral hernia repair.

Antibiotic-releasing mesh coating to reduce prosthetic sepsis: an in vivo study.

Background: Mesh related infections are a major challenge with few adequate prevention and treatment options. We evaluate the ability of a slow affinity based drug-releasing polymer to prevent a Staphylococcus aureus mesh infection using an in vivo animal model.

Methods: A surgical wound infection model was used to evaluate a vancomycin (VM) drug loaded polymer.

Endoscopic versus open component separation in complex abdominal wall reconstruction.

Background: Open component separation has a high wound complication rate. Newer endoscopic approaches are described with no comparative trials.

Methods: A retrospective review (2005-2009) of patients undergoing open or endoscopic component separation was performed.

Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction.

Background: There is limited research for xenograft biologic mesh performance in the setting of infection despite widespread use and significant associated costs.

Design: The authors retrospectively reviewed an FDA database for reported xenograft adverse events (AEs). All meshes were used in the setting of abdominal wall reconstruction from 1997 to 2008.