A Quantitative Analysis of Publication Trends in Vascular Surgery and a Comparative Analysis with Interventional Radiology.

Background: Since its recognition as an independent surgical subspecialty, vascular surgery has experienced rapid growth in both surgical volume and research productivity. Trends in vascular surgery research have not been well characterized. Understanding how research in the field has evolved in comparison to interventional radiology can offer insights into evolving interests and discrepancies between the specialties.

Retrograde Endovascular With Intimal Re-Entry Through Endarterectomy: The REWIRE Technique.

Objective: Hybrid lower extremity revascularization has been well described, typically consisting of common femoral endarterectomy (CFE) followed by direct patch puncture and endovascular treatment of any distal disease. We describe a modified technique that obviates the need for endovascular re-entry and simplifies treatment at the proximal and distal endpoints.

Methods: The REWIRE technique begins with retrograde arterial access via a patent tibial, pedal or femoropopliteal vessel.

Risk factors for spinal cord injury and complications of cerebrospinal fluid drainage in patients undergoing fenestrated and branched endovascular aneurysm repair.

Objective: Spinal cord injury (SCI) is one of the most devastating complications of thoracoabdominal aortic aneurysm (TAAA) repair. Cerebrospinal fluid drainage (CSFD) is routinely used to prevent and to treat SCI during open TAAA repair. However, the risks and benefits of CSFD during fenestrated-branched endovascular aneurysm repair (F/B-EVAR) are unclear.

Carbon Dioxide Angiography in the Treatment of Transplant Renal Artery Stenosis.

Background: Transplant renal artery stenosis (TRAS) is a serious complication associated with graft loss. Selective carbon dioxide angiography allows for effective diagnosis and therapy with the use of minimal to no contrast agent. This study sought to evaluate the efficacy of the adjunctive use of carbon dioxide angiography in the treatment of TRAS.

Safety and Effectiveness of Percutaneous Axillary Artery Access for Complex Aortic Interventions.

Background: The aim of this study is to evaluate the safety and effectiveness of percutaneous axillary artery access in patients requiring upper extremity large sheath access during complex aortic interventions.

Methods: Consecutive patients who had percutaneous axillary artery access with a large-bore sheath during endovascular thoracoabdominal aortic artery aneurysm repair within an Food and Drug Administration-approved, physician-sponsored investigational device exemption study or visceral artery interventions during other complex aortic interventions were included in the study. All patients had percutaneous axillary artery ultrasound-guided access and deployment of 2 Perclose ProGlide devices (Abbott Vascular, Santa Clara, CA) prior to introduction of a large sheath.

Impact of provider characteristics on use of endovenous ablation procedures in Medicare beneficiaries.

Objective: The objective of this study was to assess the association between provider characteristics and intensity of endovenous therapy (EVT) utilization in the Medicare population.

Methods: The Medicare Provider Utilization and Payment Data Public Use Files (2012-2014) were queried to construct a database of providers performing EVT using laser or radiofrequency ablation techniques for treatment of lower extremity venous reflux. A utilization index (UI; EVT procedure per patient treated per year) was calculated for each provider, and median services per county were determined.

Safety and Effectiveness of Retrograde Arterial Access for Endovascular Treatment of Critical Limb Ischemia.

Background: Retrograde arterial access (RA) of the popliteal, tibial, or pedal arteries may facilitate endovascular treatment of complex infrainguinal lesions in patients with critical limb ischemia (CLI). Here, we assess the safety and efficacy of this technique.

Methods: A retrospective review of prospectively collected institutional data (consecutive M2S entries) was performed to identify patients with CLI undergoing peripheral vascular intervention from February 2012 through December 2017.

Transradial interventions in contemporary vascular surgery practice.

Objectives: Upper extremity arterial access is often required for endovascular procedures, especially for antegrade access to the visceral aortic branches. Radial arterial access has been shown previously to have low complication rates, and patients tolerate the procedure well and are able to recover quickly. However, transradial access remains relatively uncommon amongst vascular surgeons.

Analysis of the Learning Curve and Patient Outcomes of Endovascular Repair of Thoracoabdominal Aortic Aneurysms Using Fenestrated and Branched Stent Grafts: Prospective, Nonrandomized, Single-center Physician-sponsored Investigational Device Exemption Clinical Study.

Objective: To evaluate the outcomes and learning curve of fenestrated and branched endovascular repair (F/BEVAR) of thoracoabdominal aneurysms.

Summary Of Background Data: Endovascular aneurysm repair has reduced morbidity and mortality compared with open surgical repair. However, application to thoracoabdominal aneurysm repair remains limited by procedural complexity and device availability.

Prophylactic Inferior Vena Cava Filter Utilization and Risk Factors for Nonretrieval.

Purpose: Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval.

Methods: A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed.

Risk Factors for Suboptimal Utilization of Statins and Antiplatelet Therapy in Patients Undergoing Revascularization for Symptomatic Peripheral Arterial Disease.

Background: The objective of this study was to identify risk factors for suboptimal medical therapy (defined as reported antiplatelet and statin use) among patients undergoing lower extremity bypass (LEB) and peripheral vascular interventions (PVIs) for symptomatic peripheral arterial disease (PAD).

Methods: The Vascular Study Group of Greater New York (VSGGNY) database was used to identify all patients undergoing PVI or LEB for PAD (2011-2013). Bivariate analyses were performed to identify characteristics of patients who were not prescribed statins and/or antiplatelet agents before revascularization.

Impact of Provider Characteristics on Outcomes of Carotid Endarterectomy for Asymptomatic Carotid Stenosis in New York State.

Background: The purpose of this study is to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State.

Methods: The New York Statewide Planning and Cooperation System database was utilized to identify patients undergoing CEA from 2004 to 2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases.

Patient-reported Quality of Life after Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

Background: The purpose of this study is to assess patient-reported physical and emotional well-being during follow-up after endovascular repair of thoracoabdominal aortic aneurysm (TAAA).

Methods: All patients were treated in the context of a physician-sponsored investigational device exemption clinical study for patients at high risk for open TAAA repair. The short form 36 (SF-36) instrument was administered preoperatively, and at 1, 6, and 12 months.

Impact of surgeon and hospital experience on outcomes of abdominal aortic aneurysm repair in New York State.

Objective: This study aimed to assess the impact of the surgeon's and hospital's experience on the outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) of intact and ruptured abdominal aortic aneurysms (AAAs) in New York State.

Methods: New York Statewide Planning and Research Cooperative System data were used to identify patients undergoing AAA repair from 2000 to 2011. Characteristics of the provider and hospital were determined by linkage to the New York Office of Professions and National Provider Identification databases.

Safety and Effectiveness of a "Percutaneous-First" Approach to Endovascular Aortic Aneurysm Repair.

Background: Percutaneous endovascular aneurysm repair (PEVAR) has been increasingly used in the endovascular treatment of abdominal aortic aneurysms. Furthermore, the percutaneous approach can be used with minimal sedation and local anesthesia in most cases. The purpose of this study was to assess the safety and effectiveness of a "percutaneous first" approach to femoral access for EVAR.

Utility and safety of axillary conduits during endovascular repair of thoracoabdominal aneurysms.

Objective: Endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs) with branched and fenestrated stent grafts often requires upper extremity arterial access for antegrade delivery of bridging covered stents into the visceral arteries. Axillary, brachial, and radial artery approaches have been described, but data on the safety and utility of the different approaches remain limited. We have preferentially used axillary artery conduits for upper extremity arterial access during endovascular repair of TAAA and describe our technique and report our experience herein.

Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York.

Objective: In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY).

Methods: Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG.

Infraclavicular first rib resection for the treatment of acute venous thoracic outlet syndrome.

Objective: Venous thoracic outlet syndrome (VTOS) is most commonly treated by transaxillary, supraclavicular, or paraclavicular approaches, based on surgeon preference. However, we have adopted an infraclavicular approach to VTOS as the surgical pathology is in the anterior costoclavicular space. We hypothesize that this approach, combined with catheter-directed thrombolysis (CDT) with venoplasty as needed, provides safe and effective treatment of patients with an acute presentation of VTOS.

Safety and Effectiveness of Adjunctive Intra-Arterial Abciximab in the Management of Acute Limb Ischemia.

Background: Contemporary endovascular management of acute limb ischemia (ALI) generally consists of tissue plasminogen activator (tPA) based catheter-directed thrombolysis (CDT) with or without pharmacomechanical thrombectomy (PMT). Although abciximab (Reopro), a GPIIb/IIIa receptor antagonist, is widely used in coronary revascularization, its safety and effectiveness in the treatment of ALI are unknown. Here, we review our contemporary experience with the endovascular management of ALI and assess the safety and effectiveness of abciximab.

Characterizing the evolution of perioperative outcomes and costs of endovascular abdominal aortic aneurysm repair.

Objective: The purpose of this study is to characterize the evolution in perioperative outcomes and costs of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) by detailing changes in adjusted outcomes and costs over time.

Methods: National Inpatient Sample (2000-2011) data were used to evaluate patient characteristics, outcomes, and perioperative costs for elective EVAR performed for intact AAA. Outcomes were adjusted for patient demographics and comorbidities, and hospital factors by multivariate analysis.

Indocyanine Green Angiography Aids in Prediction of Limb Salvage in Vascular Trauma.

Background: In cases of severe vascular trauma, traditional means for assessing viability using Doppler and angiography can have limited application. Indocyanine green angiography (ICGA) allows for a rapid qualitative assessment of tissue perfusion that serves as an important adjunct to these traditional methods, which can also be particularly helpful in guiding therapy.

Methods/results: We present a case of complicated ankle fracture with severe vascular compromise, which illustrates the role of ICGA as an assessment tool to guide therapy and decision-making in cases of acute limb threat.

Impact of "Do Not Resuscitate" Status on the Outcome of Major Vascular Surgical Procedures.

Background: Patients with Do Not Resuscitate (DNR) orders may still be offered surgery that aims to prolong or improve quality of life. The widely accepted approach of "required reconsideration" mandates that patients and surgeons discuss perioperative risks and expected outcomes in the context of the patient's values and preferences. However, surgical outcomes in this patient population have not been well-defined.

Endovascular approach to acute hemorrhage in locally advanced breast cancer.

We report a case of a woman with recurrent axillary fungating breast cancer who developed catastrophic hemorrhage from tumor erosion of her axillary artery. This was treated successfully with endovascular placement of a covered arterial stent. We discuss the suitability of endovascular therapy for patients with advanced malignancy given its lower morbidity in this population with decreased life expectancy.

Endovascular recanalization of iliocaval and inferior vena cava filter chronic total occlusions.

Inferior vena cava filter (IVCF) placement is associated with increased risk of deep venous thrombosis. This may result from filter obstruction by trapped emboli or in situ thrombosis of the IVCF, followed by caval thrombus propagation, and may be associated with significant morbidity. Here, we describe a technique and early results of endovascular recanalization of IVCF chronic total occlusions in five patients with complete chronic total occlusions of a previously implanted IVCF, the inferior vena cava, and the bilateral iliofemoral venous systems.