Increased Frailty Associated with Higher Long-Term Mortality after Major Lower Extremity Amputation.

Background: Frailty assessments have been incorporated into preoperative planning for surgery in the elderly population. Frailty in patients undergoing lower extremity amputation has been associated with increased short-term mortality. We compared 2 frailty scores, modified Frailty Index (mFI) and Risk Analysis Index (RAI), to evaluate the short- and long-term mortality stratified by frailty status after lower extremity amputation.

Surgical risk calculators in veterans following lower extremity amputation.

Objective: To evaluate the accuracy of multiple risk calculators for 30-day mortality on patients undergoing major lower extremity amputation.

Methods: The actual 30-day mortality at a single Veterans Affairs institution was compared to the predicted outcome from the following risk calculators: ACS-NSQIP, VASQIP, amputation scoring tool (AST), and POTTER elective.

Results: The overall calculated 30-day mortality was similar to the actual mortality with the VASQIP and POTTER elective risk calculators, while the NSQIP and AST over-estimated the 30-day mortality.

Predictive Accuracy of the American College of Surgeons Risk Calculator in Patients Undergoing Major Lower Extremity Amputation.

Background: The American College of Surgeons Risk Calculator (ACS-RC) provides an assessment of a patient's risk of 30-day postoperative complications. The Surgeon Adjusted Risk (SAR) parameter of the calculator allows for ad hoc adjustment of risk based on risk factors not considered by the model. This study aims to evaluate the predictive accuracy of the ACS-RC in vascular surgery patients undergoing major lower-extremity amputation (LEA) and identify additional risk factors that warrant use of the SAR parameter.

Vascular and Endovascular Surgical Procedural Skills Training: Survey of Vascular Surgery Program Directors About Extracurricular Vascular Surgical Educational Courses for Vascular Trainees.

Background: Over the past decade, there has been an increase in the number of Vascular Surgery Educational Courses (VSEC) provided by academic institutions, regional and national vascular surgical societies, as well as industry partners. Each course has its own curriculum and how these curricula align with the modern needs of vascular surgery trainees are unclear. As such, there is a lack of unified content, syllabus, and trainee evaluations/feedback of these courses.

Outcomes of isolated inframalleolar interventions for chronic limb-threatening ischemia in diabetic patients.

Background: Inframalleolar disease is present in many diabetic patients presenting with tissue loss. The aim of this study was to examine the patient-centered outcomes after isolated inframalleolar interventions.

Methods: A database of patients undergoing lower extremity endovascular interventions for tissue loss (critical limb-threatening ischemia, Wound, Ischemia, and foot Infection [WIfI] stage 1-3) and a de novo intervention on the index limb between 2007 and 2017 was retrospectively queried.

Upper extremity arterial endovascular interventions for symptomatic vascular access-induced steal syndrome.

Background: Critical hand ischemia owing to vascular access-induced steal syndrome (VASS) continues to be a significant problem. The aim of this study was to examine the outcomes of arterial endovascular interventions in the upper extremity of patients presenting with VASS.

Methods: A database of patients presenting with documented VASS between 2006 and 2016 was retrospectively queried.

Outcomes of upper extremity interventions for chronic critical ischemia.

Background: Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management.

Methods: A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried.

Outcomes of reintervention for recurrent symptomatic disease after tibial endovascular intervention.

Objective: Tibial interventions for critical limb ischemia are now commonplace. Restenosis and occlusion remain barriers to durability after intervention. The aim of this study was to examine the patient-centered outcomes of open and endovascular reintervention for symptomatic recurrent disease after a primary isolated tibial endovascular intervention.

A comparison of preoperative and intraoperative vein mapping sizes for arteriovenous fistula creation.

Background: Duplex ultrasound (DUS) mapping of the veins and arteries of the upper extremity is a well-established practice in arteriovenous fistula creation for long-term hemodialysis access. Previous publications have shown that vein diameters varying from 2 to 3 mm are predictive of success. Regional anesthesia is known to result in vasodilation and thus to increase the diameter of upper extremity veins.

Outcomes of tibial endovascular intervention in patients with poor pedal runoff.

Objective: Tibial interventions for critical limb ischemia are now commonplace. The aim of this study was to examine the impact of pedal runoff on patient-centered outcomes after tibial endovascular intervention.

Methods: A database of patients undergoing lower extremity endovascular interventions at a single urban academic medical center between 2006 and 2016 was retrospectively queried.

An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants.

Background: Vascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW).

Novel approach in using ultrasound in treating acute limb ischemia.

Background: It is imperative to gain safe access into the occluded targeted vessel and begin treating acute extremity limb ischemia. Often the origin of the targeted native artery or bypass graft will have a flush occlusion making it difficult to cannulate. This paper looks at the novel use of portable ultrasound to evaluate the origin of the artery or bypass graft to help facilitate the start of thrombolysis.

Outcomes of Isolated Tibial Endovascular Intervention for Rest Pain in Patients on Dialysis.

Background: Tibial interventions for critical limb ischemia are frequent in patients with end-stage renal disease (ESRD) presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient-centered outcomes following tibial endovascular Intervention for rest pain.

Methods: A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried.

Development and construct validity of a low-fidelity training platform for driving large and small suture needles.

Background: The objective of this study was to describe and validate a novel training platform for driving large and small suture needles, which can ultimately be used for elemental vascular surgical training.

Methods: We developed a novel trainer and proficiency-based training curriculum that provides a platform for practice with handling fine vascular tools and needles as well as precision in suture targeting. The trainer comprises 2 concentric circles printed on cotton fiber material with 8 evenly spaced targets on each circle.

Chronic kidney disease and dialysis access in women.

Chronic kidney disease currently affects one in nine Americans and over 500,000 have progressed to failure requiring kidney replacement therapy, with nearly 45% being women. Clinical Practice Guidelines have been developed in an effort to synthesize the latest literature, particularly randomized controlled trials, to assist clinical decision making. Women have different levels of kidney function than men at the same level of serum creatinine and may also lose kidney function over time more slowly than men.

Radiation physics.

Introduction: Radiation comes in different forms of energy in motion. Doses of radiation and the area of interest are important considerations when imaging patients, particularly during percutaneous procedures.

Methods: Reference texts in essential physics, principles of radiation imaging, and radiation dosimetry were reviewed.

Rupture of a nonaneurysmal aorta secondary to Staphylococcus aortitis.

Infectious aortitis has become increasingly uncommon and, when diagnosed, typically occurs in an immunocompromised elderly male with a history of Staphylococcus or Salmonella infection and underlying atheromatous cardiovascular disease. The authors report a case of a 74-year-old man with aortitis complicated by rupture secondary to Staphylococcus aureus infection. The patient presented with worsening abdominal pain and fever after being discharged from the emergency room 2 weeks before with back pain and leukocytosis diagnosed as urinary tract infection and bronchitis.

A changing pattern of infection after major vascular reconstructions.

Wound and graft infection can occur in more than 40% of patients undergoing vascular reconstructions for peripheral arterial disease (PAD). A recent increase in the frequency and severity of infections, as well as a change in the microorganisms recovered, led us to undertake a retrospective case-controlled study of wound/graft infections at this institution. The medical records of all patients undergoing vascular reconstruction for PAD during the previous 36 months were reviewed.

Morphologic characteristics of varicose veins: possible role of metalloproteinases.

Background: Although varicose veins are a common cause of morbidity, etiologic factors predisposing to dilatation, elongation, and tortuosity of the saphenous vein and its tributaries are poorly understood. We compared histologic features of normal and varicose saphenous veins and investigated the role of enzyme or inhibitor imbalance in development of varicosities.

Methods: Eight normal and 10 varicose (C(2,3)E(P,S)A(S)P(R,O)) vein segments were used for this analysis.