Role for Lumbar Cerebrospinal Fluid Drainage in High-risk Thoracic Endovascular Aortic Repair: A Narrative Review.

Lumbar cerebrospinal fluid (CSF) drainage is one of the few preventative and therapeutic practices that may reduce spinal cord ischemia in high-risk thoracic endovascular aortic aneurysm repair (TEVAR). Although this is part of clinical guidelines in open thoracoabdominal aortic repair, there are no randomized controlled trials that provide convincing evidence on the protection conferred by CSF drainage in high-risk TEVAR patients. This gap in knowledge obfuscates clinical decision making given the risk of significant complications of CSF drain insertion and management.

Staged complex reconstruction of infected thoracic aortic endograft and adjacent spinal hardware using latissimus wrapped lateral aortic graft.

Thoracic endovascular aortic repair (TEVAR) enables rapid and effective treatment of life-threatening aortic injuries. The occurrence of long-term complications from TEVAR and their management is ill-defined in young patients. This report describes a complex case of a 38-year-old male patient who underwent staged interventions for different acute pathologies instigated by blunt thoracic spinal trauma.

Gluteal and thigh compartment syndrome after open abdominal aortic aneurysm repair.

Although compartment syndrome (CS) can occur in any myofascial compartment, the thigh and buttock are among the least common. CS is characterized by an increase in pressure of a myofascial compartment that results in a reduction of capillary blood flow and myonecrosis. Although >75% of cases of CS occur after long bone fractures, acute CS can also occur from nontraumatic and vascular etiologies.

A prebifurcated axillobifemoral polytetrafluoroethylene graft simplifies carotid to carotid to subclavian bypass.

The use of thoracic endovascular aortic repair for thoracic aortic disease will necessitate cervical debranching in cases involving the proximal arch. We have presented the case of a 57-year-old athletic woman who had developed a type A dissection that extended to the bilateral iliac arteries. After hemiarch repair, she underwent staged cervical debranching with carotid-carotid-subclavian bypass using a prebifurcated axillobifemoral graft and subsequent thoracic endovascular aortic repair.

Extra-Anatomic Bypass and Excision is Superior to Graft Salvage Attempts with Antibiotic Beads to Treat Vascular Graft Infections in the Groin.

Background: This study aimed to determine if conventional extra-anatomic bypass and graft removal versus aggressive attempts at graft preservation have better survival and limb salvage in patients with localized groin wound infections of vascular grafts.

Methods: We conducted a retrospective review of 53 consecutive patients with vascular graft infections presenting in the groin. Treatment groups consisted of group 1 (extra-anatomic bypass and graft excision, n = 22) and group 2 (initial graft preservation attempts with utilization of antibiotic beads, n = 31).

Factors associated with preference of choice of aortic aneurysm repair in the PReference for Open Versus Endovascular repair of AAA (PROVE-AAA) study.

Objective: Patients can choose between open repair and endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). However, the factors associated with patient preference for one repair type over another are not well-characterized. Here we assess the factors associated with preference of choice for open or endovascular AAA repair among veterans exposed to a decision aid to help with choosing surgical treatment.

Mathematical model of atherosclerotic aneurysm.

Atherosclerosis is a major cause of abdominal aortic aneurysm (AAA) and up to 80% of AAA patients have atherosclerosis. Therefore it is critical to understand the relationship and interactions between atherosclerosis and AAA to treat atherosclerotic aneurysm patients more effectively. In this paper, we develop a mathematical model to mimic the progression of atherosclerotic aneurysms by including both the multi-layer structured arterial wall and the pathophysiology of atherosclerotic aneurysms.

Predictors of Underutilization of Medical Therapy in Patients Undergoing Endovascular Revascularization for Peripheral Artery Disease.

Objectives: The aim of this study was to explore discharge prescription rates of guideline-directed medical therapy (GDMT), defined as aggregate antiplatelet agent, statin, and ACE inhibitor or angiotensin receptor blocker use after endovascular lower extremity (LE) peripheral vascular intervention.

Background: Little is known about contemporary GDMT prescription following LE PVI.

Methods: Sex, age, and comorbid conditions were related to discharge GDMT prescription among patients undergoing LE PVI for symptomatic peripheral artery disease in the 2014-2018 Vascular Study Group of New England Vascular Quality Initiative.

Long-term outcomes of transposed femoral vein arteriovenous fistula for abandoned upper extremity dialysis access.

Background: The number and longevity of patients with end-stage renal disease requiring dialysis access have continued to increase, leading to challenging situations, including exhausted upper extremity access and severe central venous stenosis. This has led to an increase in the use of alternative access sites, including the lower extremities. The transposed femoral vein arteriovenous fistula for dialysis access is a previously described alternative, although limited data are available on its long-term patency.

Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization.

The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database.

Endovascular Balloon Occlusion: An Adjunct to Hemostasis for Above-Knee Amputation After Recalcitrant Chronic Prosthetic Joint Infection of Knee in a Morbidly Obese Patient: A Case Report.

Case: A 72-year-old morbidly obese nonambulatory woman with bilateral chronically infected revision knee prostheses and incompetent extensor mechanisms who uses a wheelchair had limited functionality and presented with recalcitrant chronic infection with multiple hospitalizations. The patient underwent staged bilateral above-knee amputations. The first procedure caused extensive morbidity secondary to poor vascular control.

Patient Characteristics, Patterns, and Repair of Aneurysms in Human Immunodeficiency Virus-Positive Patients.

Background: Human immunodeficiency virus (HIV) is a multisystem disease and is associated with vascular complications including aneurysm formation. HIV-associated aneurysms are well documented and may present in unusual locations with concerning features. However, the literature regarding aneurysms in HIV-positive patients is limited to case series with limited data regarding aneurysm patterns.

Impact of Temporal Artery Biopsy on Clinical Management of Suspected Giant Cell Arteritis.

Background: Temporal arteritis (TA) is a systemic inflammatory vasculitis of unclear etiology that affects medium-sized vessels. The gold standard for diagnosis has traditionally been histological, by temporal artery biopsy. Improved imaging modalities have been increasingly used to aid diagnosis and are recommended in the newest 2018 European (EULAR) guidelines.

Practice patterns of dual antiplatelet therapy after lower extremity endovascular interventions.

Antiplatelet therapy is commonly prescribed following endovascular interventions. However, there is limited data regarding the regimen and duration of antiplatelet therapy following lower extremity endovascular interventions. The aim of this study was to investigate the practice patterns of dual antiplatelet therapy (DAPT) after lower extremity endovascular interventions.

Safety and efficacy of venous ablation in octogenarians.

Objective: Venous ablation (VA) is the recommended treatment of superficial venous insufficiency affecting the lower extremities. The safety and efficacy of the procedure in octogenarians have not been well studied. We postulate that VA in octogenarians is as safe and effective as in younger age groups.

Patient information sources when facing repair of abdominal aortic aneurysm.

Objective: Shared medical decision making is most important when there are competing options for repair such as in treatment of abdominal aortic aneurysm (AAA). We sought to understand the sources of patients' pre-existing knowledge about AAA to better inform treating physicians about patients' needs for preoperative counseling.

Methods: We performed a multicenter survey of patients facing AAA repair at 20 Veterans Affairs hospitals across the United States as part of the Preferences for Open Versus Endovascular Repair of AAA study.

Design of the PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Trial.

For patients with abdominal aortic aneurysm (AAA), randomized trials have found endovascular AAA repair (EVAR) is associated with lower perioperative morbidity and mortality than open surgical repair (OSR). However, OSR has fewer long-term aneurysm-related complications, such as endoleak or late rupture. Patients treated with EVAR and OSR have similar survival rates within two years after surgery, and OSR does not require intensive surveillance.

Intravascular Ultrasound in Venous Thoracic Outlet Syndrome.

Background: Venous thoracic outlet syndrome (vTOS) is a rare disease with no defined guidelines regarding treatment. Patients with first rib resection with anterior scalenectomy (FRRS) often have residual subclavian vein stenosis. The aim of this study was to evaluate the use of intravascular ultrasound (IVUS) in the treatment of vTOS patients who have been surgically decompressed with FRRS.

The effect of increasing catheter distance from the deep junction on the outcomes of radiofrequency vein ablation.

Objective: Thermal vein ablation (VA) is the recommended treatment modality for superficial venous reflux, with a recommended positioning of the catheter at 2 to 3 cm from the junction of the deep venous system. In contrast, novel sealing technology for saphenous VA involves treatment starting at 3 to 5 cm distal to the deep junction. This study examines the effect of increasing catheter distance from the junction on the outcomes of VA using radiofrequency.

The effect of commercial insurance policies on outcomes of venous ablation.

Objective: The use of venous ablation (VA) for treatment of chronic venous insufficiency has exponentially increased. To limit cost and overuse, insurance companies have adopted aleatory policies. The goal of this study was to compare the policies of five major local insurance carriers and to determine whether treatment within the criteria of a certain policy is associated with improved patient outcomes.

The Impact of Functional Status on the Outcomes of Endovascular Lower Extremity Revascularization for Critical Limb Ischemia in the Elderly.

Background: Functional status is an important predictor of outcomes after infrainguinal bypass surgery. There are little data on the effect of functional status on the outcomes of endovascular lower extremity interventions, especially in the elderly frail population.

Methods: This is a retrospective analysis of the American College of Surgeons - National Surgical Quality Improvement Program files for the years 2011-2013 to assess the impact of functional status on outcome after endovascular intervention for critical limb ischemia (CLI).

Trends and outcomes in endovascular and open surgical treatment of visceral aneurysms.

Objective: Visceral artery aneurysms (VAAs) are rare but often repaired because of dire consequences of rupture. This is a population-based evaluation of chronologic trends in management, risk factors, and outcomes of endovascular and open therapy.

Methods: The 2003 to 2013 Agency for Healthcare Research and Quality (AHRQ) National Inpatient Sample (NIS) database was reviewed.

Gender Predicts Rupture of Pancreaticoduodenal Artery Aneurysms.

Background: There remains no consensus on indication or technique for repair of pancreaticoduodenal artery aneurysms (PDAA) due to the fact that they are exceedingly rare. We sought to evaluate risk factors for rupture, as well as compare the outcomes of open and endovascular surgery.

Methods: We performed a retrospective review of all PDAAs over a 15-year period.

Validation of a modified Frailty Index to predict mortality in vascular surgery patients.

Background: Patient frailty has been implicated as a predictor of poor patient outcomes; however, there is no consensus on how to define or quantify frailty to assess perioperative risk. A previously described modified Frailty Index (mFI) has been shown to predict adverse outcomes after selected vascular surgical procedures, but no studies to date have compared its utility against other recognized risk indices in specific populations of vascular surgery patients.

Methods: National Surgical Quality Improvement Program data were reviewed for all patients undergoing carotid revascularization, abdominal aortic aneurysm (AAA) repair, and lower extremity revascularization for peripheral arterial disease (PAD) from 2006 to 2012.

Risk of venous thromboembolic events following inferior vena cava resection and reconstruction.

Objective: The perioperative risk of an acute venous thromboembolism (VTE) event after inferior vena cava (IVC) reconstruction is unknown. We sought to describe VTE outcomes of our 15-year IVC reconstruction experience.

Methods: We performed a retrospective institutional review of all patients who underwent IVC reconstruction (September 1999-October 2014) and describe perioperative VTE outcomes.