Prophylactic Transversely Hemisected Sartorius Flap for High-Risk Groin Dissections in Vascular Surgery-A Case Series.

Groin wound dehiscence and infection are a common complication of femoral artery exposure. In patients with prosthetic conduits placed in the groin, these complications can lead to graft infection or anastomotic dehiscence with hemorrhage. Sartorius flaps can be useful in preventing graft infections or anastomotic breakdown in the setting of wound infections.

COVID-19 associated rhabdomyolysis leading to major amputation in the absence of macrovascular thrombosis.

A 50 year old patient presented with bilateral lower extremity weakness, lethargy, and dyspnea. Nasopharyngeal swab was positive for SARS-CoV-2. She progressed to acute hypoxemic respiratory failure and hemodynamic instability requiring intubation, pressor support, and hemodialysis.

Repair of a high-flow superficial femoral arteriovenous fistula using a bell-bottom iliac limb endoprosthesis.

A 50-year-old patient had presented with recalcitrant right lower extremity venous stasis ulceration, atrial fibrillation, and congestive heart failure. He had a history of a gunshot wound to the right thigh >30 years previously, which had been managed without surgery. Computed tomography angiography indicated a fistulous communication between the right superficial femoral artery and vein with massively dilated right iliofemoral venous and arterial systems.

Conservative Management of Non-Infected Diabetic Foot Ulcers Achieves Reliable Wound Healing and Limb Salvage in the Setting of Mild-Moderate Ischemia.

Background: The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system has been validated to predict wound healing among patients with critical limb threatening ischemia (CLTI). Our goal was to analyze the use of a previously reported conservative wound care approach to non-infected (foot infection score of zero), diabetic foot ulcers with mild-moderate peripheral arterial disease enrolled in a conservative tier of a multidisciplinary limb preservation program.

Methods: Veterans with CLTI and tissue loss were prospectively enrolled into our Prevention of Amputation in Veterans Everywhere (PAVE) program.

Analysis of Traumatic Axillo-Subclavian Vessel Injuries: Endovascular Management is a Viable Option to Open Surgical Reconstruction.

Background: In traumatic axillo-subclavian vessel injuries, endovascular repair has been increasingly described, despite ongoing questions regarding infection risk and long-term durability. We sought to compare the clinical and safety outcomes between endovascular and surgical treatment of traumatic axillo-subclavian vessel injuries.

Method: A search query of the prospectively maintained PROOVIT registry for patients older than 18 years of age with a diagnosis of axillary or subclavian vessel injury between 2014-2019 was performed at a Level 1 Trauma Center.

Arteriovenous fistula maturation: Physical exam versus flow study.

Purpose: The purpose of this study was to determine the utility of routine duplex flow study 4 to 6 weeks after primary AVF creation and to compare physical exam against a duplex flow study in predicting fistula maturation. A surveillance algorithm was established to evaluate the naïve fistula after primary creation.

Methods: This was a single institution retrospective review of 155 veterans with primary autogenous AVF creation from 2016 to 2018.

PATENCY-2 trial of vonapanitase to promote radiocephalic fistula use for hemodialysis and secondary patency.

Objective: Arteriovenous fistulas created for hemodialysis often fail to become usable and are frequently abandoned. This prospective trial evaluated the efficacy of vonapanitase, a recombinant human elastase, in increasing radiocephalic fistula use for hemodialysis and secondary patency.

Methods: PATENCY-2 was a randomized, double-blind, placebo-controlled trial in patients on or approaching the need for hemodialysis undergoing radiocephalic arteriovenous fistula creation.

5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry.

Patient frailty indices are increasingly being utilized to anticipate post-operative complications. This study explores whether a 5-factor modified frailty index (mFI-5) is associated with outcomes following below-knee amputation (BKA). All BKAs in the vascular quality initiative (VQI) amputation registry from 2012-2017 were reviewed.

True Superficial Temporal Artery Aneurysm Presenting as a Delayed Traumatic Pseudoaneurysm: A Case Report and Review of Literature.

A rare case of a true temporal artery aneurysm is presented with review of the literature.

A conservative approach to select patients with ischemic wounds is safe and effective in the setting of deferred revascularization.

Objective: The Wound, Ischemia, and foot Infection classification system has been validated to predict benefit from inmediate revascularization and major amputation risk among patients with peripheral arterial disease. Our primary goal was to evaluate wound healing, limb salvage, and survival among patients with ischemic wounds undergoing revascularization when intervention was deferred by a trial of conservative wound therapy.

Methods: All patients with peripheral arterial disease and tissue loss are prospectively enrolled into our Prevention of Amputation in Veterans Everywhere limb preservation program.

Association between Preoperative Indications and Outcomes after Major Lower Extremity Amputation.

Despite aggressive limb salvage techniques, lower extremity amputation (LEA) is frequently performed. Major indications for LEA include ischemia and uncontrolled infection (UI). A review of the national Vascular Quality Initiative amputation registry was performed to analyze the influence of indication on outcomes after LEA.

Who is treating venous disease in America today?

Objective: This study examined the specialty, board certification, and training of physicians who are treating venous disease in the United States.

Methods: Internet searches were performed to identify the websites of physicians who treat venous disease in large metropolitan areas. The websites of large multistate venous corporations were also searched.

Immediate Carotid Endarterectomy Is Associated with Higher Risk in Symptomatic Patients.

Background: Guidelines recommend that patients with carotid artery stenosis ≥50% (Sx-CAS) undergo carotid endarterectomy (CEA) within 14 days of symptoms. However, perioperative risks, especially stroke, may be increased when CEA is performed within 48 hours. This study seeks to more fully evaluate the effect of timing of surgery on outcomes for Sx-CAS.

Trans-Atlantic Inter-Society Consensus Class D Aortoiliac Lesions: A Comparison of Endovascular and Open Surgical Outcomes.

The purpose of this study is to compare the clinical and safety outcomes between two groups of patients with Trans-Atlantic Inter-Society Consensus class D (TASC II D) aortoiliac occlusive disease (AIOD): those with higher-risk comorbidity who underwent endovascular reconstruction and those with lower-risk comorbidity who underwent surgical bypass. Thirty-two consecutive patients with symptomatic TASC II D AOID who underwent surgical bypass or endovascular reconstruction from 2012 to 2017 were retrospectively reviewed. Lesion characteristics, technical approach, survival, limb salvage, patency, and change in clinical symptoms were analyzed.

Early Surgical Referral for Penetrating Aortic Ulcer Leads to Improved Outcome and Overall Survival.

Background: The natural history of penetrating aortic ulcer (PAU) has been variably described and clear guidelines are lacking. We reviewed our experience with PAUs in a tertiary referral center.

Methods: Imaging reports from January 2010 to December 2017 were retrospectively searched for the diagnosis of "penetrating aortic ulcer.

Retrospective Review of Billowing Phenomenon-A Mimic of Endoleak Following Placement of Endologix Covered Stent for the Treatment of Abdominal Aortic Aneurysm.

Background: Billowing is a unique computed tomography (CT) finding of the Endologix stent graft where a rim of contrast is observed outside the stent's endoskeleton but still contained within the graft cover. The purpose of this study is to evaluate the incidence and clinical outcome of billowing following an Endologix stent-graft placement.

Methods: All patients who underwent abdominal aortic aneurysm (AAA) repair with endovascular placement of an Endologix stent graft from January 2002 to September 2013 and who were followed with imaging were included in the study.

Arteriovenous Hybrid Graft with Outflow in the Proximal Axillary Vein.

Background: The patency of long-term hemodialysis access in end-stage renal disease patients remains a significant challenge. Often these patients are affected with limited venous outflow options, requiring limb abandonment, and creation of new access in the contralateral arm. Vascular surgeons are familiar with the exposure of the proximal axillary artery via an infraclavicular incision.

Placement of Upper Extremity Arteriovenous Access in Patients with Central Venous Occlusions: A Novel Technique.

Background: Central venous occlusion is a common occurrence in patients with end-stage renal disease. Placement of upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins is often not an option. Avoidance of lower extremity vascular access can decrease morbidity and infection.

Carotid duplex ultrasound changes associated with left ventricular assist devices.

Background: Carotid duplex ultrasound (CDUS) is often used as a screening test in cardiac patients. Significant cardiac dysfunction may affect the accuracy of CDUS because of alterations in the cardiac cycle. Left ventricular assist devices (LVADs) are frequently implanted as a bridge to cardiac transplant.

Evaluation of superficial femoral artery remote endarterectomy for treatment of critical limb ischemia in patients with limited autogenous conduit.

Background: Many patients with critical limb ischemia require infrageniculate bypass with a prosthetic graft due to the limited availability of autogenous vein. Prosthetic grafts have been shown to have inferior patency and subject the patient to increased infection rates when compared to bypass with autogenous conduit for lower extremity revascularization. In an effort to avoid the use of prosthetic material, we evaluated the use of remote superficial femoral artery endarterectomy (RSFAE) with distal autogenous revascularization in patients with critical limb ischemia and limited conduit.

Effects of prior abdominal surgery, obesity, and lumbar spine level on anterior retroperitoneal exposure of the lumbar spine.

Objective: To evaluate the effects of prior abdominal surgery and obesity and the level of spine exposure on the technical aspects and complications of anterior retroperitoneal exposure of the lumbar spine (ARES).

Design: Retrospective review of prospective database.

Setting: Academic vascular surgery practice.

Management of lower extremity wounds in patients with peripheral arterial disease: a stratified conservative approach.

Background: Traditional wound care algorithms include aggressive detection of peripheral arterial disease (PAD) and treatment with revascularization for all patients with PAD and lower extremity wounds. Not every patient with PAD and a wound meets Transatlantic Inter-Society Consensus (TASCII) criteria for critical limb ischemia. We hypothesize that a conservative approach to selected patients with PAD and lower extremity wounds may be safe, provide acceptable limb salvage, and that failure of this approach does not translate into increased limb loss.

Preoperative carotid duplex findings predict carotid stump pressures during endarterectomy in symptomatic but not asymptomatic patients.

Background: Carotid stump pressure (CSP) is frequently measured to determine the need for shunt use during carotid endarterectomy (CEA). We hypothesized that the preoperative carotid duplex examination correlates with preoperative symptoms and intraoperative CSP.

Methods: Patients undergoing CEA over a 7-year period were identified from our vascular registry.

Arterial thrombosis and gangrene secondary to arachnidism.

Spider bites can cause local tissue damage as well as life-threatening complications. This is a case report of a female with no history of lower extremity vascular disease who presented with a spider bite on the dorsum of her foot. She developed progressive necrosis and eventually suffered limb loss despite attempts at revascularization.