Impact of preoperative risk factors on 5-year survival after fenestrated/branched endovascular aortic repair.

Objective: To investigate which preoperative factors most impact the 5-year survival of patients undergoing fenestrated/branched endovascular aortic repair (F/BEVAR) and to identify modifiable elements that, if time allows, should be actively managed and adequately controlled preoperatively.

Methods: Patients treated for aortic aneurysms with complex anatomy using either patient-specific company-manufactured or off-the-shelf F/BEVAR devices were included. The exposure of interest was aneurysm type (group I: type I-III thoracoabdominal aneurysms vs group II: type IV thoracoabdominal aneurysms vs group III: juxtarenal or suprarenal aneurysms), and the primary outcome was 5-year risk of all-cause mortality.

General Surgery Versus Integrated Surgical Sub-specialties: Predictors for Residency Match and Interview Invites Among Surgical Candidates.

Objective: The goal of this study was to assess predictive factors for receiving interviews and matching in general surgery (GS), cardiothoracic surgery (TS), vascular surgery (VS), and plastic surgery (PS).

Design: The Texas Seeking Transparency in Applications to Residency (STAR) survey was analyzed for match years 2018-2023. Chi-Square Tests of Independence were used to assess differences among participants who received ≥16 vs <16 interviews and, separately, participants who matched vs went unmatched.

Median Arcuate Ligament Syndrome: Where Are We Today?

Median arcuate ligament syndrome, or celiac artery compression syndrome (eponym: Dunbar syndrome), has historically been attributed to pathophysiologic vascular compression causing downstream ischemic symptoms of the organs supplied by the celiac trunk. However, the more we learn about the histology, clinical presentation, and treatment outcomes, health care providers are increasingly correlating the symptoms of MALS with the long-term, repetitive compression of the celiac ganglion rather than the celiac trunk. This article provides a comprehensive review of current MALS literature, emphasizing the multidisciplinary approach these patients require in all phases of their care.

Upper-limb neurovascular compression, pectoralis minor and quadrilateral space syndromes: A narrative review of current literature.

Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies.

Academic performance of students in an accelerated medical pathway.

Accelerated medical school curricula, such as three-year programs, have gained attention in recent years but studies evaluating their impact are still scarce. This study examines the Fully Integrated Readiness for Service Training (FIRST) program, a three-year accelerated pathway, to assess its impact on students' academic performance preparedness for residency. In this observational study, we compared the academic outcomes of FIRST program students to traditional four-year curriculum students from 2018 to 2023.

Five-year outcomes of fenestrated and branched endovascular repair of complex aortic aneurysms based on aneurysm extent.

Objective: The aim of this study was to evaluate the 5-year outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) for the treatment of complex aortic aneurysms stratified by the aneurysm extent.

Methods: Patients with the diagnosis of complex aortic aneurysm, who underwent F/BEVAR at a single center were included in this study and retrospectively analyzed. The cohort was divided according to the aneurysm extent, comparing group 1 (types I-III thoracoabdominal aneurysms [TAAAs]), group 2 (type IV TAAAs), and group 3 (juxtarenal [JRAAs], pararenal [PRAAs], or paravisceral [PVAAs] aortic aneurysms).

Perceived Pager Burden Among Trainees Across Medical Specialties.

Background: The experiences of pager use among trainees across medical specialties is underexplored. The aim of this study was to assess experiences of pager burden and communication preferences among trainees in different specialties.

Methods: An online survey was developed to assess perceived pager burden (eg, pager volume, mistake pages, sleep, and off-time interruptions) and communication preferences at a tertiary center in the United States.

Gender disparities in patients with aortoiliac disease requiring open operative intervention.

Objective: Peripheral artery disease is known to affect males and females in different proportions. Disparate surgical outcomes have been quantified after endovascular aortic aneurysm repair, arteriovenous fistula creation, and treatment of critical limb ischemia. The aim of this study is to objectively quantify the sex differences in outcomes in patients undergoing open surgical intervention for aortoiliac occlusive disease.

Preferred Feedback Styles Among Different Groups in an Academic Medical Center.

Introduction: Feedback is an essential component in complex work environments. Different generations have been shown to have different sets of values, derived from societal and cultural changes. We hypothesize that generational differences may be associated with preferred feedback patterns among medical trainees and faculty in a large academic institution.

Outcome Analysis Comparing Asymptomatic Juxtarenal Aortic Aneurysms Treated with Custom-Manufactured Fenestrated-Branched Devices and the "Off-The-Shelf" Zenith p-Branch Device.

Background: Numerous endovascular options have been used for the repair of juxtarenal aortic aneurysms (JRAAs) over the last 15 years. This study aims to compare the performance between the Zenith p-branch device and custom-manufactured fenestrated-branched devices (CMD) for the treatment of asymptomatic JRAA.

Methods: A single-center retrospective analysis of prospectively collected data was performed.

Richard Nixon's Left Knee and Its Impact on American History.

Richard Nixon injured his left knee in a limousine door while campaigning in North Carolina in 1960, resulting in septic arthritis that required a multi-day admission to Walter Reed Hospital. Still ill for the first presidential debate that fall, Nixon lost the contest based more on his appearance than his performance. Partly as a result of this debate, he was defeated by John F.

The State of the LGBTQ+ Community in Surgery.

The LGBTQ+ community is a diverse community that faces unique needs and multidimensional form of discrimination. Cultural awareness and awareness of intersectionality of experiences are essential in creating an equitable environment for health care professionals and patients.

Analysis of wound healing time and wound-free period in patients with chronic limb-threatening ischemia treated with and without revascularization.

Background: The traditionally reported outcomes for patients with ischemic wounds have centered on amputation-free survival. However, that discounts the importance of other patient-centered outcomes such as the wound healing time (WHT) and wound-free period (WFP). We evaluated the long-term wound outcomes of patients treated for chronic limb-threatening ischemia at our institution.

Gender Disparities in Aortoiliac Revascularization in Patients with Aortoiliac Occlusive Disease.

Background: Gender disparities have been previously reported in aortic aneurysm and critical limb ischemia outcomes; however, limited info is known about disparities in aortoiliac occlusive disease. We sought to characterize potential disparities in this specific population.

Material And Methods: Patients who underwent aortobifemoral bypass and aortic thromboendarterectomy (Current Procedural Terminology codes 35646 and 35331) between 2012 and 2019 were identified in the National Surgical Quality Improvement Program database.

Surgical Implications of LGBTQ+ Health Disparities: A Review.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) patients face challenging health care disparities. However, due to restrictions in reporting and collection of sexual orientation and gender identity (SOGI) demographic data, comprehensive studies of surgical disparities in the LGBTQ+ population are limited. This review aims to summarize the existing literature describing surgical disparities in LGBTQ+ patients and to identify areas of surgical care in which further studies are warranted.

Small Group Tutorial Curriculum During Third Year Surgical Clerkship and Identification of Surgical Role Models.

Identification of surgical mentors is associated with medical student interest in surgical careers. Small group learning has been a fundamental component of the surgical clerkship at the University of North Carolina (UNC) School of Medicine for 14 years. The curriculum was standardized on 2018 and has long been hypothesized to facilitate mentoring relationships.

Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues.

Many of the systemic practices in medicine that have alienated lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals persist today, undermining the optimal care for these patients and isolating LGBTQ medical providers from their colleagues. The 2020 Task Force on Diversity, Equity, and Inclusion Report recently published by the Society for Vascular Surgery marked the first publication advocating for the inclusion of sexual orientation and sexual identity in the development of initiatives promoting and protecting diversity across vascular surgery. Vascular providers should be aware that it is crucial to cultivate an environment that is inclusive for LGBTQ patients because a large proportion of these patients have reported not self-disclosing their status to medical providers, either out of concern over potential personal repercussions or failing to recognize the potential relevance of LGBTQ status to their medical care.

A Novel Educational Tool to Improve Medical Student Knowledge Acquisition During Surgical Rotations.

Background: The addition of a novel education tool helps students improve understanding of general surgery topics. However, the effect of the new tool on objective exam performance is unknown.

Materials: A 10-item card of high-yield general surgery topics was implemented in the third-year surgery clerkship.

Multidisciplinary Management of an Aorto-esophageal Injury Caused by Foreign Body Ingestion.

A 37-year-old incarcerated male ingested a complex "X-shaped" foreign body that resulted in a penetrating aorto-esophageal injury. A primary esophagotomy with retrieval of the foreign body and muscle flap closure was performed simultaneously with thoracic endovascular aortic repair. This multidisciplinary surgical approach controls for both immediate exsanguination and postoperative complications to improve patient outcome.

Ensuring equity, diversity, and inclusion in the Society for Vascular Surgery: A report of the Society for Vascular Surgery Task Force on Equity, Diversity, and Inclusion.

Diversity, equity, and inclusion represent interconnected goals meant to ensure that all individuals, regardless of their innate identity characteristics, feel welcomed and valued among their peers. Equity is achieved when all individuals have equal access to leadership and career advancement opportunities as well as fair compensation for their work. It is well-known that the unique backgrounds and perspectives contributed by a diverse workforce strengthen and improve medical organizations overall.

Enhancing Medical Student Education and Combating Mistreatment During a Surgery Clerkship With a Novel Educational Tool: A Pilot Study.

Background: Medical education changes dramatically from preclinical to clinical years, and the learning environment becomes key as students strive to develop clinical competence and informed career decisions. This change becomes heightened on a surgical clerkship where student mistreatment is often perceived, and the fast-paced nature of surgery can result in limited resident-student interactions and time for examination preparation.

Objective: To evaluate medical student and resident perception of educational strategies during a surgical clerkship and to determine whether the addition of a novel educational tool would increase satisfaction with the surgical clerkship on examination preparation and team dynamics.

Performance of Viabahn balloon-expandable stent compared with self-expandable covered stents for branched endovascular aortic repair.

Objective: The objective of this study was to compare the performance between the Viabahn balloon-expandable stent (VBX; Viabahn [W. L. Gore & Associates, Flagstaff, Ariz]) and a covered self-expandable stent (SES; Fluency [Bard Peripheral Vascular, Tempe, Ariz]) used as bridging stents for directional branches during fenestrated or branched endovascular aneurysm repair of complex aortic aneurysms.