Contemporary indications for open abdominal aortic aneurysm repair in the endovascular era.

Objective: Despite the emergence of endovascular aneurysm repair (EVAR) as the most common approach to abdominal aortic aneurysm repair, open aneurysm repair (OAR) remains an important option. This study seeks to define the indications for OAR in the EVAR era and how these indicatioxns effect outcomes.

Methods: A retrospective cohort study was performed of all OAR at a single institution from 2004 to 2019.

Estimated annual health care expenditures in individuals with peripheral arterial disease.

Objective: The clinical impact of peripheral arterial disease (PAD) is well characterized and is associated with significant morbidity and mortality. Health care-related expenditures among individuals with PAD, particularly for patients, are not well described.

Methods: Health care-related expenditure data from the 2011 to 2014 Agency for Healthcare Research and Quality Medical Expenditure Panel Surveys were analyzed for individuals with a diagnosis of PAD compared with U.

High dose-rate brachytherapy for the treatment of lower extremity in-stent restenosis.

Objective: Historically, edge stenosis and late thrombosis limited the effectiveness of adjunctive endovascular brachytherapy (EVBT) for in-stent restenosis (ISR) after percutaneous transluminal angioplasty (PTA) and stenting. We evaluated an updated protocol of PTA and EVBT for ISR among patients with lower extremity occlusive disease.

Methods: This is a retrospective, single-center review of patients treated with PTA and EVBT for ISR in the iliac and femoropopliteal segments between 2004 and 2012.

Concurrent venography during first rib resection and scalenectomy for venous thoracic outlet syndrome is safe and efficient.

Objective: Surgical treatment of acute axillosubclavian vein thrombosis from venous thoracic outlet syndrome (VTOS) traditionally involves first rib resection and scalenectomy (FRRS) followed by interval venography and balloon angioplasty. This approach can lead to an extended need for anticoagulation and a separate anesthesia session. We present outcomes for FRRS with concurrent venography.

Perivascular adipose adiponectin correlates with symptom status of patients undergoing carotid endarterectomy.

Background And Purpose: Recent symptoms stand as a major determinant of stroke risk in patients with carotid stenosis, likely reflective of atherosclerotic plaque destabilization. In view of emerging links between vascular and adipose biology, we hypothesized that human perivascular adipose characteristics associate with carotid disease symptom status.

Methods: Clinical history, carotid plaques, blood, and subcutaneous and perivascular adipose tissues were prospectively collected from patients undergoing carotid endarterectomy.

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection.

The thickened intimal flap present in cases of chronic aortic dissection can present a challenge to attempts at endovascular stent graft treatment performed for subsequent aneurysmal degeneration by precluding adequate landing zones for the endograft and by constraining the endograft from full expansion. In this report we describe our technique and outcome for longitudinal endovascular fenestration of chronic aortic dissection flaps to facilitate endovascular stent graft treatment for thoracic aortic aneurysms developing after aortic dissection.

Ruptured and unruptured mycotic superior mesenteric artery aneurysms.

Aneurysms of the superior mesenteric artery (SMA) and branches thereof are uncommon but have a high rate of rupture and mortality relative to other visceral artery aneurysms. Historically, the predominant etiology has been infectious; with a renewed rise in intravenous drug abuse rates in the last decade, we hypothesize a resurgence in septic embolic complications may occur in the coming years. Here, we describe the presentation and management of 2 cases of intravenous drug users presenting with infectious endocarditis and SMA main trunk and branch aneurysms, one of which was ruptured.

Preventable mortality after common urological surgery: failing to rescue?

Objective: To assess in-hospital mortality in patients undergoing many commonly performed urological surgeries in light of decreasing nationwide perioperative mortality over the past decade. This phenomenon has been attributed in part to a decline in 'failure to rescue' (FTR) rates, e.g.

Predictors and consequences of unplanned hospital readmission within 30 days of carotid endarterectomy.

Objective: In the United States, vascular surgeons frequently perform carotid endarterectomy (CEA). Given the resource burden of unplanned readmission (URA), we sought to identify the predictors and consequences of URA after this common vascular surgery procedure to identify potential points of intervention.

Methods: Using a prospective single-institution database, we retrospectively identified consecutive patients undergoing CEA (2001-2011).

Contemporary predictors of extended postoperative hospital length of stay after carotid endarterectomy.

Introduction: Hospital length of stay (LOS) contributes to costs. Carotid endarterectomy (CEA) is performed frequently by vascular surgeons, making contemporary CEA LOS rates and predictors vital knowledge for quality evaluation and cost containment initiatives.

Methods: Using a prospective single-institution database, we retrospectively identified consecutive patients undergoing CEA from 2001 to 2011.

The intensity and variation of surgical care at the end of life: a retrospective cohort study.

Background: Although the extent of hospital and intensive-care use at the end of life is well known, patterns of surgical care during this period are poorly understood. We examined national patterns of surgical care in the USA among elderly fee-for-service Medicare beneficiaries in their last year of life.

Methods: We did a retrospective cohort study of elderly beneficiaries of fee-for-service Medicare in the USA, aged 65 years or older, who died in 2008.

Rates and patterns of death after surgery in the United States, 1996 and 2006.

Background: Nationwide rates and patterns of death after surgery are unknown.

Methods: Using the Nationwide Inpatient Sample, we compared deaths within 30 days of admission for patients undergoing surgery in 1996 and 2006. International Classification of Diseases codes were used to identify 2,520 procedures for analysis.

In-hospital death following inpatient surgical procedures in the United States, 1996-2006.

Background: Over the past decade, improvements in perioperative care have been widely introduced throughout the United States, yet there is no clear indication that the death rate following surgery has improved. We sought to evaluate the number of deaths after surgery in the United States over a 10-year period and to evaluate trends in postoperative mortality.

Methods: Using the National Hospital Discharge Survey, we identified patients who underwent a surgical procedure and subsequently died in the hospital within 30 days of admission.

Esophagectomy outcomes at low-volume hospitals: the association between systems characteristics and mortality.

Objective: To evaluate the association between systems characteristics and esophagectomy mortality at low-volume hospitals

Background: High-volume hospitals have lower esophagectomy mortality rates, but receiving care at such centers is not always feasible. We examined low-volume hospitals and sought to identify characteristics of those with better outcomes.

Methods: Using national data from Medicare and the American Hospital Association, we studied 4498 elderly patients who underwent an esophagectomy from 2004 to 2007.

Measuring the range of services clinicians are responsible for in ambulatory practice.

Rationale, Aims And Objectives: At present, the range of services delivered in a health system is not known. Currently there are no accepted methods for defining the scope of ambulatory care. Therefore we used data from the electronic medical record and billing system of a large non-profit multi-specialty group practice to measure the number of different diagnoses that clinicians managed as well as the number of different medications, laboratory tests, imaging studies, referrals and procedures ordered.

Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals.

Use of the World Health Organization's Surgical Safety Checklist has been associated with a significant reduction in major postoperative complications after inpatient surgery. We hypothesized that implementing the checklist in the United States would generate cost savings for hospitals. We performed a decision analysis comparing implementation of the checklist to existing practice in U.

The importance of prevention of calciphylaxis in patients who are at risk and the potential fallibility of calcimimetics in the treatment of calciphylaxis for patients with secondary hyperparathyroidism.

A 43-year-old African American with end-stage renal disease (ESRD) associated with membranous nephropathy and a previously failed renal transplant had received cinacalcet to treat his secondary hyperparathyroidism. Serum calcium and phosphorus levels remained within normal limits, and serum parathyroid levels had dropped significantly following treatment initiation. However, within 7 months, the patient experienced extensive necrotic bilateral medial thigh ulcers.

Babesiosis in the immediate postoperative period after splenectomy for trauma.

Background: In an immunocompetent host, Babesia microti has not been reported as a cause of postoperative fever.

Methods: Case report and literature review.

Results: A 52-year-old woman living on Martha's Vineyard developed postoperative fever after splenectomy for trauma.

Predictors of survival and length of stay in burn patients older than 80 years of age: does age really matter?

Predictors of survival and length of stay (LOS) in the advanced elderly with burn injuries is not well studied. Because of progress in burn wound and critical care, we hypothesized that a contemporary analysis would show improved outcomes. Clinical data were collected on 45 consecutive patients older than 80 years of age that were treated for burn injury at our institution during the past 10 years.