The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia.

Objective: Patient selection for open lower extremity revascularization in patients with chronic kidney disease (CKD) remains a clinical challenge. This study investigates the impact of CKD on early graft failure, postoperative complications, and mortality in patients undergoing lower extremity bypass for critical limb ischemia.

Methods: The National Surgical Quality Improvement Program database was queried for all patients with critical limb ischemia from 2012 to 2015 who underwent lower extremity bypass using the targeted vascular set.

Systematic review and meta-analysis of high-pressure intermittent limb compression for the treatment of intermittent claudication.

Background: High-pressure intermittent limb compression (HPILC) has been proposed as an alternative treatment of disabling intermittent claudication. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of HPILC in improving walking distance in patients with intermittent claudication.

Methods: A search through December 31, 2016, was performed to identify all randomized controlled trials evaluating the efficacy of HPILC for the management of intermittent claudication.

Long-Term Outcomes of Fistula First Initiative in an Urban University Hospital-Is It Still Relevant?

Purpose: Dialysis access failure is a major cause of morbidity in patients with end-stage renal disease. The Fistula First Breakthrough Initiative (FFBI) dictates arteriovenous fistulae (AVFs) should be preferred over arteriovenous grafts (AVGs) as first line for surgically placed accesses. The purpose of this study was to compare patency rates of surgical dialysis accesses in our mature, urban population after the FFBI.

Mapping of superficial extremity veins: normal diameters and trends in a vascular patient-population.

Ultrasonic measurement of superficial extremity veins is a common procedure. To establish normal values for vein-size in a population of vascular patients and to assess if measurements remain unchanged over time, we analyzed a database with results of 28,130 measurements in 2420 separate saphenous and 3206 cephalic veins. Mean size of the great saphenous vein ranges from 2.

Reflux in foot veins is associated with venous toe and forefoot ulceration.

Objective: To determine the prevalence of foot vein incompetence in a group of patients with chronic venous insufficiency and to assess the association of this, with venous ulceration located on the forefoot.

Methods: A total of 20 consecutive patients (21 limbs) with active or healed venous ulceration was prospectively studied with duplex ultrasound of the superficial and plantar foot veins. In these, four extremities had venous ulceration involving the forefoot.

Improvement in the visualization of superficial arm veins being evaluated for access and bypass.

Objectives: Duplex ultrasound mapping of arm veins is being performed with increasing frequency. Unlike ultrasound testing in other areas, this has never been subjected to a gold standard invasive test to determine accuracy. Duplex mapping appears to have a good predictive value whenever large veins are demonstrated preoperatively, but its ability to accurately measure minimum-sized veins is unproven.

Impaired hyperemic response is predictive of early access failure.

The aim of this study was to demonstrate that hyperemic response is a predictor of access failure. We conducted a review of a prospective database of dialysis access patients with preoperative hyperemia studies from June 1998 to August 2002. These consisted of bilateral brachial artery pressures followed by flow velocity measurements of the brachial artery and radial artery at rest and after 3 min of arm ischemia.

Angiographic improvement after rapid intermittent compression treatment [ArtAssist] for small vessel obstruction.

A case is presented of a female ex-smoker who underwent bypass or exploration of all three below-knee arteries with failed results. Three separate arteriograms, performed at other academic institutions, demonstrated progressive, severe involvement of the pedal arteries. Therefore, the patient was prepared to undergo below-knee amputation surgery for uncontrollable rest pain and progressive necrosis of the forefoot; instead, the patient underwent 4 months of intermittent compression treatment.

High-risk carotid endarterectomy: fact or fiction.

Objective: It has been proposed that patients whose conditions do not meet North American Symptomatic Carotid Endarterectomy Trial inclusion criteria or have anatomic risk factors constitute a "high-risk" group for carotid endarterectomy (CEA) and might be candidates for primary carotid angioplasty stenting. Our objective was to review a consecutive series of isolated CEAs, identify the number of such patients at high risk, and determine whether their operations were associated with increased complication rate.

Methods: Consecutive isolated CEAs performed between June 1996 and June 2001 were reviewed.