Variation in the elective management of small abdominal aortic aneurysms and physician practice patterns.

Objective: Recent vascular societal guidelines have recommended an abdominal aortic aneurysm (AAA) size threshold for elective intervention; however, limited data have documented how well these AAA diameter benchmarks are being met. The objective of this study was to analyze variation in management of AAAs based on diameter and to determine the physician's rationale for intervention on small AAAs in relation to recommended treatment guidelines.

Methods: A retrospective review of a statewide vascular surgery registry of all elective endovascular or open surgical AAA repairs from January 2012 to January 2016 was performed.

The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC.

Objective: To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease.

Methods/results: Between 2010-2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion.

The association of perioperative transfusion with 30-day morbidity and mortality in patients undergoing major vascular surgery.

Objective: Blood transfusions are common among patients undergoing major vascular surgery. Prior studies suggest an association between blood transfusion and increased morbidity and mortality among patients undergoing cardiac surgery. The predictors of perioperative transfusion and its impact on patients undergoing vascular surgery have been poorly defined.

Vascular function and carotid intimal-medial thickness in children with insulin-dependent diabetes mellitus.

Objectives: The objective of this study was to evaluate endothelium-dependent vasodilation and carotid intimal-medial thickness (IMT) in children with insulin-dependent diabetes mellitus.

Background: Diabetes mellitus is an established risk factor for atherosclerosis. Vascular complications of diabetes are not clinically evident in diabetic children.

Intraoperative insertion of Greenfield filters: lessons learned in a personal series of 152 cases.

The objective of this study was to define outcomes of 151 patients who underwent insertion of 152 Greenfield filters in the operating room by general and vascular surgery residents with supervision by one attending vascular surgeon. Each patient was taken to the operating room for inferior vena cava (IVC) interruption immediately after a vena cavagram was performed. One patient required a subsequent return to the operating room after developing paradoxical arterial embolism from a large venous thromboembolism which was trapped by and spanned both sides of the first IVC filter.

Very late survival after vascular surgery.

Purpose: The aim of this study was to define very late survival in veterans who routinely underwent preoperative assessment of left ventricular function using radionuclide ventriculography (RNVG) before elective major vascular surgery from 7/84 to 7/88 at one Veterans Affairs Medical Center.

Methods: RNVG defined left ventricular ejection fraction (EF) and determined the presence of ventricular wall motion abnormalities. Patients undergoing elective vascular surgery (n = 310) who had preoperative RNVG were then followed over the years using direct contact, VA administrative databases, and, most recently, the Social Security Death Index.

Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age.

Objective: To determine whether high-volume hospitals (HVHs) have lower in-hospital death rates after abdominal aortic aneurysm (AAA) repair compared with low-volume hospitals (LVHs).

Summary Background Data: Select statewide studies have shown that HVHs have superior outcomes compared with LVHs for AAA repair, but they may not be representative of the true volume-outcome relationship for the entire United States.

Methods: Patients undergoing repair of intact or ruptured AAAs in the Nationwide Inpatient Sample (NIS) for 1996 and 1997 were included (n = 13,887) for study.

Duplex examination of the inferior vena cava.

Duplex examination of the inferior vena cava (IVC) was performed in 270 patients from 1/1/96 to 1/1/00 to define suitability of the IVC for caval interruption using noninvasive means. The IVC was interrogated using a 3-mHz curved linear array probe and an ATL Ultramark 9 ultrasound machine (Bothell, WA). Duplex measured IVC dimensions and defined presence of thrombus or anomalies.

Aneurysm rupture is independently associated with increased late mortality in those surviving abdominal aortic aneurysm repair.

Purpose: The aim of this study was to define whether veterans who survived repair of ruptured abdominal aortic aneurysms (AAA) experienced late survival rates similar to those surviving repair of intact AAA.

Methods: All veterans undergoing AAA repair in DRGs 110 and 111 during fiscal years 1991-1995 were identified using the Veterans Affairs (VA) Patient Treatment File (PTF). Late mortality was defined using VA administrative databases including the Beneficiary Identification and Record Locator System and PTF.

Is there differential access to carotid endarterectomy based on gender?

The purpose of this study was to determine whether there was differential access to carotid endarterectomy (CEA) based on gender at our institution. In 1995, the year after ACAS results were published, 1774 carotid duplex studies were performed in our vascular laboratory in 765 men and 1009 women. The incidence of 50-99% carotid stenosis was 13% (n = 235) overall and did not differ between men (13.

Massive hematuria in adults with Klippel-Trenaunay syndrome associated with vascular malformation of the bladder.

Although hematuria has been reported in children with Klippel-Trenaunay syndrome, it is a rare presentation in the adult population. Two cases of massive hematuria in adults with Klippel-Trenaunay syndrome are reported here. A unique feature was venous malformations of the bladder which were responsible for massive recurrent bleeding in 1 patient.

Do patients with acute deep vein thrombosis have fever?

The purpose of this study was to determine whether those with lower extremity acute venous thrombosis have fever. During a recent 14.5-month period, 1847 patients undergoing lower extremity venous duplex scanning also had their oral temperature measured using a digital thermometer at the time of duplex examination.

Major lower extremity amputation in Veterans Affairs medical centers.

Our objective was to assess outcomes for 8696 patients who underwent 9236 above- (AKA) and/or below-knee (BKA) amputations during a 4-year period for disorders of the circulatory system. Veterans Affairs (VA) Patient Treatment File (PTF) data were acquired for all patients in Diagnosis Related Groups (DRGs) 113 and 114 hospitalized in VA medical centers (VAMCs) during fiscal years 1991-1994. Data were further analyzed by Patient Management Category (PMC) software, which measured illness severity, patient complexity, and relative intensity score (RIS), a measure of resource utilization.

Outcomes after abdominal aortic aneurysm repair: comparison of mortality defined by centralized VA Patient Treatment File data versus hospital-based chart review.

Background: Outcomes after abdominal aortic aneurysm (AAA) repair have been reported by individual Veterans Affairs medical centers (VAMCs) and for the entire VA patient population.

Purpose: This study was done to determine whether outcomes defined using VA Patient Treatment File (PTF) data were comparable to those defined by direct chart review in those undergoing repair of intact AAA.

Methods: Focused chart review was performed in all veterans undergoing such AAA repair in a sample of VAMCs (n = 5) for separate 1-year periods during fiscal years (FY) 1991-1993.

Outcomes after lower-extremity reconstruction in DRGs 478 and 479.

Purpose: To assess outcomes for 21,261 patients in DRGs 478 and 479 hospitalized in Veterans Affairs Medical Centers (VAMCs) during fiscal years 1991-1994. DRGs 478 and 479 contain patients undergoing a variety of vascular procedures including lower-extremity arterial reconstruction.

Methods: VA Patient Treatment File (PTF) data were analyzed using Patient Management Category (PMC) software which defined illness severity, patient complexity as defined by PMC count, and calculated resource intensity scale (RIS), a measure of resource utilization, for each admission.

Pulmonary embolism in Veterans Affairs Medical Centers: is vena cava interruption underutilized?

Veterans with venous thrombosis or pulmonary embolism (PE) were evaluated using Veterans Affairs patient treatment file (PTF) data from fiscal years 1990-1995, inclusive, to define outcomes for those with PE. The specific aims of the study were to define how often those with PE underwent vena cava interruption (VCI) and whether VCI affected in-hospital mortality rates. Outcomes were defined using PTF data and Patient Management Category (PMC) software for 26,132 veterans discharged from all Veterans Affairs Medical Centers (VAMCs) with venous thromboembolism, which included a subset of 4,882 patients identified by both PTF data and PMC software to have PE.

Acute calf vein thrombosis: outcomes and implications.

The purpose of this study was to define the incidence of and outcomes associated with isolated acute calf vein thrombosis (CVT). From 11/95 through 6/97, 3096 patients underwent lower extremity venous duplex testing in a hospital-based vascular laboratory in which bilateral tibial and peroneal vein imaging were standard components of the venous duplex examination. CVT was present in 118 patients (3.

Acute mesenteric ischemia.

Acute mesenteric ischemia (AMI) remains a complex and difficult clinical problem. Such acute ischemia is usually either embolic or thrombotic in nature, but other etiologies exist. The diagnosis of AMI is difficult to establish and often delayed, resulting in irreversible bowel injury that requires intestinal resection.

Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus.

Background: C ardiac sympathetic signals play an important role in the regulation of myocardial perfusion. We hypothesized that sympathetically mediated myocardial blood flow would be impaired in diabetics with autonomic neuropathy.

Methods And Results: We studied 28 diabetics (43+/-7 years old) and 11 age-matched healthy volunteers.

Aortocaval fistula: diagnosis with carbon dioxide angiography.

Aortocaval fistulas are an uncommon complication of atherosclerotic aneurysms that can present with a variety of clinical symptoms. Many of these patients present with oliguric renal failure, a contraindication for the use of iodinated contrast in radiological studies. We present a case of an aortocaval fistula diagnosed by using carbon dioxide gas without the use of traditional contrast media.

Cervical reconstruction of the supra-aortic trunks: a 16-year experience.

Purpose: The purpose of this study was to review 182 consecutive cervical reconstructions of supra-aortic trunks, which were performed over a 16-year period.

Methods: A total of 182 innominate, common carotid, or subclavian arteries were reconstructed with a cervical approach in 173 patients aged 23 days to 83 years. Indications included hemispheric (n = 79), vertebrobasilar (n = 56), upper extremity (24), and internal mammary/cardiac ischemia (n = 5), asymptomatic severe common carotid disease (n = 33), or other (n = 3).

Carotid surgery in octogenarians in Veterans Affairs medical centers.

The purpose of this study was to define outcomes after carotid surgery in octogenarians in the Veterans Affairs health care system. During fiscal years 1991-1994, 9152 patients in DRG 5 underwent extracranial vascular surgery procedures in Veterans Affairs medical centers. Those >/=80 years of age constituted 2.