Outcomes of chronic limb-threatening ischemia revascularization in patients with chronic kidney disease in the BEST-CLI trial.

Background: Chronic limb-threatening ischemia (CLTI) in patients with chronic kidney disease (CKD) has a high risk of poor outcomes. We aimed to compare the outcomes of lower extremity revascularization in patients with CLTI stratified by CKD severity in patients enrolled in the prospective, randomized Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

Methods: The BEST-CLI trial dataset was queried to categorize patients into three groups according to CKD stage.

Sex-Based Differences of Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissections.

Background: There is a paucity of data on sex-based differences in outcomes after thoracic endovascular aortic repair (TEVAR) performed for Stanford type B aortic dissections (TBADs). Examining the predictive role of sex could shape future clinical guidelines for TEVAR. Thus, this study aims to evaluate the association between sex and postoperative outcomes after TEVAR performed for TBAD.

Physicians' Preference for Carotid Revascularization Impacts Postoperative Stroke and Death Outcomes.

Background: TransCarotid artery revascularization (TCAR) is a safe minimally invasive option for patients with carotid artery stenosis who are not appropriate candidates for carotid endarterectomy (CEA). Many physicians have not yet adopted this technique in the management of carotid artery stenosis. The aim of this study is to explore overall outcomes of carotid revascularization based on physicians' practices in the Vascular Quality Initiative (VQI).

Medicare Patients with Symptomatic Carotid Disease Requiring Carotid Revascularization are Likely to Have Delayed Access: An Analysis of a Multicenter Surgical Data.

Background: The Society for Vascular Surgery guidelines recommend carotid revascularization within 14 days of symptom onset for neurologically stable stroke patients. However, in the United States, insurance status may affect surgical timing, although large-scale studies are lacking. Using the Vascular Quality Initiative database, we evaluated the impact of insurance status on surgical wait times for patients with symptomatic carotid disease.

The effect of preoperative smoking status on carotid endarterectomy outcomes in asymptomatic patients.

Objective: The current medical landscape lacks comprehensive data regarding the impact of preoperative smoking status on both short and long-term outcomes for patients undergoing carotid endarterectomy (CEA). This study seeks to elucidate the influence of smoking cessation on in-hospital and long-term outcomes in this patient population.

Methods: Data were collected from the Vascular Quality Initiative for all asymptomatic patients who underwent CEA from 2016 to 2023.

Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery.

Objective: Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.

The effect of neuraxial versus general anesthesia on outcomes of infrainguinal bypasses in Vascular Quality Initiative-Medicare-Linked database.

Background: Neuraxial anesthesia (NA) has been hypothesized to decrease postoperative complications and reduce mortality. However, studies regarding the impact of anesthesia type on outcomes of infrainguinal bypass (IIB) have demonstrated mixed results. In this multi-institutional study, we aimed to investigate the association of neuraxial anesthesia (NA) versus general anesthesia (GA) and perioperative and one-year outcomes of IIBs.

An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR).

Background: Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics.

The impact of diabetes mellitus on the outcomes of revascularization for chronic limb-threatening ischemia in the BEST-CLI trial.

Objective: Several observational studies have demonstrated an association between diabetes mellitus (DM) and above-ankle amputation after lower extremity revascularization (LER). However, data from prospective randomized trials is lacking. This analysis compares the outcomes of patients with and without DM enrolled in the Best Endovascular vs Best Surgical Therapy in patients with Chronic Limb-Threatening Ischemia (BEST-CLI) trial.

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are associated with improved amputation-free survival in chronic limb-threatening ischemia.

Background: In the Heart Outcomes Prevention Evaluation study, investigators found that ramipril was associated with improved survival as well as decreased MI and stroke rates in patients with peripheral arterial disease. Nonetheless, their effect on chronic limb-threatening ischemia (CLTI)-specific outcomes is unclear. We aim to assess the effect of ACEIs/ARBs on amputation-free survival in patients with CLTI undergoing peripheral vascular intervention (PVI) in a Medicare-linked database.

Postoperative outcomes in patients with anemia undergoing carotid revascularization.

Background: Preoperative anemia is associated with worse postoperative morbidity and mortality after major vascular procedures. Limited research has examined the optimal method of carotid revascularization in patients with anemia. Therefore, we aim to compare the postoperative outcomes after carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR) among patients with anemia.

Transcarotid artery revascularization outperforms transfemoral carotid artery stenting regardless of aortic arch type or degree of atherosclerosis.

Objective: The Centers for Medicare and Medicaid Services now approve reimbursement for transfemoral carotid artery stenting (TFCAS) in the treatment of standard-risk patients with carotid artery occlusive disease. TFCAS in patients with complex aortic arch anatomy is known to be challenging with worse outcomes. Transcarotid artery revascularization (TCAR) could be a preferable alternative in these patients owing to avoiding the aortic arch and using flow reversal during stent deployment.

Outcomes of Thoracic and Complex Endovascular Aortic Repair in Patients with Renal Insufficiency.

Background: Thoracic endovascular aortic repair (TEVAR) and complex endovascular aneurysm repair (cEVAR) are effective and minimally invasive treatment options for preventing rupture and decreasing mortality of aortic aneurysms. Patients with renal insufficiency are prone to worse postoperative cardiovascular morbidity and mortality due to the atherosclerosis burden as well as increased levels of angiotensin II. Nonetheless, knowledge about the outcomes of aortic stent graft therapy in patients with chronic kidney disease (CKD) or dialysis is scarce.

30-Day Risk Score for Mortality and Stroke in Patients with Carotid Artery Stenosis Using Artificial Intelligence Based Carotid Plaque Morphology.

Background: The gold standard for determining carotid artery stenosis intervention is based on a combination of percent stenosis and symptomatic status. Few studies have assessed plaque morphology as an additive tool for stroke prediction. Our goal was to create a predictive model and risk score for 30-day stroke and death inclusive of plaque morphology.

Analysis of Surgeon and Center Case Volume and Stroke or Death after Transcarotid Artery Revascularization.

Background: It has been suggested that the annual hospital volume of cases may affect the number of adverse events after carotid endarterectomy (CEA). We aim to study the associations between hospital as well as surgeon volume and the risk of stroke or death after transcarotid artery revascularization (TCAR).

Study Design: Retrospective review of the Vascular Quality Initiative data of patients undergoing TCAR from 2016 to 2021.

Multicenter Study on Physician-Modified Endografts for Thoracoabdominal and Complex Abdominal Aortic Aneurysm Repair.

Background: Physician modified endografts (PMEGs) have been widely used in the treatment of complex abdominal aortic aneurysm and thoracoabdominal aortic aneurysm, however, previous data are limited to small single center studies and robust data on safety and effectiveness of PMEGs are lacking. We aimed to perform an international multicenter study analyzing the outcomes of PMEGs in complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms.

Methods: An international multicenter single-arm cohort study was performed analyzing the outcomes of PMEGs in the treatment of elective, symptomatic, and ruptured complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms.