A registry-based study of paclitaxel drug-coated balloon angioplasty for the treatment of in-stent restenosis of the femoral-popliteal artery.

Objective: The aim of this study was to report the results of a prospective, single-arm, registry-based study assessing the safety and performance of a paclitaxel drug-coated balloon (DCB) for the treatment of superficial femoral artery (SFA) or popliteal artery in-stent restenosis (ISR) in a United States population.

Methods: We conducted a prospective, non-randomized, multi-center, single-arm, post-market registry of the IN.PACT Admiral DCB for the treatment of ISR lesions in the SFA or popliteal artery at 43 sites within the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) Registry from December 2016 to January 2020.

Outcomes of carotid artery stenting in patients with radiation arteritis compared with those with atherosclerotic disease.

Objective: Head and neck malignancies are often treated with radiotherapy (RT). Nearly 80% of patients who have undergone RT will develop carotid radiation arteritis to some degree and 29% will develop stenosis >50%. Surgery in a radiated neck has higher rates of complications, and carotid artery stenting (CAS) has become the primary therapy.

Correlating Toe-Brachial Indices and Angiographically Confirmed Peripheral Artery Disease: A Retrospective Review.

In advanced peripheral arterial disease (PAD), medial arterial calcification is known to inflate the ankle-brachial index. An alternative method of evaluating symptomatic patients is toe-brachial indexes (TBI), where a ratio less than .7 indicates PAD and less than .

Anesthetic choice for arteriovenous access creation: A National Anesthesia Clinical Outcomes Registry analysis.

Background: We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time.

Methods: National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018.

Opportunities for diabetes and peripheral artery disease-related lower limb amputation prevention in an Appalachian state: A longitudinal analysis.

Lower extremity amputation due to peripheral artery disease (PAD) and diabetes (DM) is a life-altering event that identifies disparities in access to healthcare and management of disease. West Virginia (WV), a highly rural state, is an ideal location to study these disparities. The WVU longitudinal health system database was used to identify 1) risk factors for amputation, 2) how disease management affects the risk of amputation, and 3) whether the event of amputation is associated with a change in HbA1c and LDL levels.

Vascular Complications Increase Hospital Charges and Mortality in Adult Patients on Extracorporeal Membrane Oxygenation in the United States.

Patients on extracorporeal membrane oxygenation (ECMO) who suffer vascular complications frequently accrue additional procedures and costs. We sought to evaluate the effect of ECMO-related vascular complications on hospital charges and in-hospital mortality. Adult discharges involving ECMO from 2004 to 2013 in the National Inpatient Sample were examined.

Machine Learning Confirms Nonlinear Relationship between Severity of Peripheral Arterial Disease, Functional Limitation and Symptom Severity.

Background: Peripheral arterial disease (PAD) involves arterial blockages in the body, except those serving the heart and brain. We explore the relationship of functional limitation and PAD symptoms obtained from a quality-of-life questionnaire about the severity of the disease. We used a supervised artificial intelligence-based method of data analyses known as machine learning (ML) to demonstrate a nonlinear relationship between symptoms and functional limitation amongst patients with and without PAD.

The effect of rurality on the risk of primary amputation is amplified by race.

Objective: Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship.

Geographic variation in amputation rates among patients with diabetes and/or peripheral arterial disease in the rural state of West Virginia identifies areas for improved care.

Objective: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease (PAD). Multiple studies have focused on disparities in amputation rates based on race and socioeconomic status, but few focus on amputation trends in rural populations. The objective of this study was to identify the prevalence of major and minor amputation among patients admitted with diabetes and/or PAD in a rural, Appalachian state, and to identify geographic areas with higher than expected major and minor amputations using advanced spatial analysis while controlling for comorbidities and rurality.

Impact of rural versus urban geographic location on length of stay after carotid endarterectomy.

Background: Reducing the incidence of extended length of stay (ELOS) after carotid endarterectomy (CEA), defined as LOS > I day, is an important quality improvement focus of the Vascular Quality Initiative (VQI). Rural patients with geographic barriers pose a particular challenge for discharge and may have higher incidences of ELOS as a result. The purpose of this study was to examine the impact of patients’ home geographic location on ELOS after CEA.

A Novel Quality of Life Instrument for Patients with an Abdominal Aortic Aneurysm.

Objective: The surveillance and treatment of abdominal aortic aneurysms (AAAs) may impact patient quality of life (QOL). A novel AAA specific QOL instrument was developed and validated to quantify the impact of AAA surveillance on QOL.

Methods: The study was performed in two phases: development (2011-2013) and validation (2013-2014) of a survey instrument.

Long-Term Results of Endovascular Femoropopliteal Interventions.

 Short-term results of endovascular intervention for femoropopliteal lesions have been extensively reported; however, there exists a paucity of long-term objective data related to outcomes of these interventions. We sought to characterize these long-term results including patency, limb salvage, and mortality.  From May 2003 to July 2009, all patients who underwent technically successful endovascular balloon angioplasty and/or stenting for Trans-Atlantic Inter-Societal Consensus (TASC) II B, C, and D lesions were identified in a retrospective fashion.

Cardiopulmonary Exercise Testing Limitation in Peripheral Arterial Disease.

Background: Peripheral artery disease (PAD) is associated with a markedly increased risk of cardiovascular mortality and remains underrecognized and undertreated. New screening approaches are needed to prevent disability in patients with PAD.

Methods: We performed a retrospective analysis of clinically stable cardiovascular patients who were referred for cardiopulmonary exercise testing (CPET) due to a variety of cardiovascular complaints.

Transaortic gunshot wound through perivisceral segment successfully managed by placement of thoracic stent graft.

We describe a 36-year-old woman who presented to our facility after sustaining a gunshot wound to the epigastric region. The gunshot resulted in injury to the left lobe of the liver and the twelfth thoracic vertebral body as well as in a through-and-through injury to the abdominal aorta at the level of the celiac axis. The vascular injury was managed successfully by placement of a thoracic stent graft with coverage of the celiac axis.

Comparative Outcomes of Ultrasound-Assisted Thrombolysis and Standard Catheter-Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism.

Objectives: The objective of this study was to compare the outcomes of patients undergoing ultrasound-accelerated thrombolysis (USAT) and standard catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE).

Methods: The records of all patients in our institution having undergone CDT or USAT for massive or submassive PE from 2009 to 2014 were retrospectively reviewed. Standard statistical methods were used to compare characteristics and to assess for longitudinal change in outcomes.

Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism.

Objective The hemodynamic benefits of catheter-directed thrombolysis for acute pulmonary embolism have not been clearly defined beyond the periprocedural period. The objective of this study is to report midterm outcomes of catheter-directed thrombolysis for treatment of acute pulmonary embolism. Methods Records of all patients undergoing catheter-directed thrombolysis for high- or intermediate-risk pulmonary embolism were retrospectively reviewed.

Primary closure after carotid endarterectomy is not inferior to other closure techniques.

Objective: Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience.

Methods: A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed.

Endovascular management of symptomatic gastrointestinal complications associated with retrievable inferior vena cava filters.

Objective: With the increase in retrievable inferior vena cava (IVC) filter use, a higher than expected reported rate of pericaval tine penetration is observed. Symptomatic gastrointestinal (GI) complications associated with retrievable IVC filters have been documented; however, their management remains controversial. We describe a series of GI complications of retrievable IVC filters, detailing the spectrum of presenting symptoms and multiple treatment options, including the safety of endovascular retrieval.

A national survey of disease-specific knowledge in patients with an abdominal aortic aneurysm.

Objective: Patient education is a fundamental responsibility of medical providers caring for patients with abdominal aortic aneurysms (AAA). We sought to evaluate and quantify AAA-specific knowledge in patients under AAA surveillance and in patients who have undergone AAA repair.

Methods: In 2013, 1373 patients from 6 U.

Risk Factors for Long-Term Mortality and Amputation after Open and Endovascular Treatment of Acute Limb Ischemia.

Background: Acute limb ischemia (ALI) is a highly morbid and fatal vascular emergency with little known about contemporary, long-term patient outcomes. The goal was to determine predictors of long-term mortality and amputation after open and endovascular treatment of ALI.

Methods: A retrospective review of ALI patients at a single institution from 2005 to 2011 was performed to determine the impact of revascularization technique on 5-year mortality and amputation.

Contemporary outcomes of open and endovascular popliteal artery aneurysm repair.

Objective: The purpose of this study was to evaluate contemporary practice and outcomes of open repair (OR) or endovascular repair (ER) for popliteal artery aneurysms (PAAs).

Methods: Consecutive patients with PAA treated at one institution from January 2006 to March 2014 were reviewed under an Institutional Review Board-approved protocol. Demographics, indications, anatomic characteristics, and outcomes were collected.

Long-term clinical outcomes and cardiovascular events after carotid endarterectomy.

Background: Long-term atherosclerotic adverse events are anticipated in patients undergoing carotid endarterectomy (CEA); however, their incidence and risk predictors remain unknown.

Methods: A consecutive cohort of CEAs between 1/1/2000-12/31/2007 was analyzed. End points were any stroke, coronary event (myocardial infarction, coronary bypass, or stenting), vascular interventions for critical limb ischemia, aortic aneurysm or carotid disease, and death.

Contemporary outcomes of intact and ruptured visceral artery aneurysms.

Objective: The treatment outcomes of ruptured visceral artery aneurysms (rVAAs) have been sparsely characterized, with no clear comparison between different treatment modalities. The purpose of this paper was to review the perioperative and long-term outcomes of open and endovascular interventions for intact visceral artery aneurysms (iVAAs) and rVAAs.

Methods: This was a retrospective review of all treated VAAs at one institution from 2003 to 2013.

Revascularization of asymptomatic carotid stenosis is not appropriate in patients on dialysis.

Objective: Outcomes of carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) for asymptomatic disease in patients on dialysis are not well characterized, with questionable stroke prevention and survival. This study reports outcomes of carotid revascularization in asymptomatic dialysis patients in the United States.

Methods: Using United States Renal Data System (USRDS) databases, we identified all dialysis patients who underwent CEA or CAS for asymptomatic disease from 2005 to 2008.

Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia.

Objective: Thrombolysis and open surgical revascularization are current options for the treatment of acute limb ischemia (ALI). Despite the several randomized controlled trials comparing the two options, no single treatment can yet be recommended as a universal initial management of ALI. The purpose of this study was to evaluate contemporary endovascular and surgical revascularization for ALI.