Tetrahydrocannabinol vape-associated cannabis arteritis in a patient with minimal tobacco exposure.

Thromboangiitis obliterans (TAO) is an inflammatory vasculopathy that often presents in young men with substantial tobacco use. Cannabis arteritis is the cannabis-associated counterpart, but there remains controversy over its classification due to overwhelming concurrent tobacco use. A 31-year-old man developed lifestyle-limiting claudication that coincided with vaping high-potency tetrahydrocannabinol.

Streamlining Preoperative Evaluation for Dialysis Access: A Pilot Study.

Background: Outpatient in-person clinic evaluation is the standard consultation practice for an initial referral for hemodialysis (HD) access. However, most factors predicting the complexity of first-time access surgery can be determined from history rather than physical exam. This study compares the outcomes of patients undergoing first-time arteriovenous fistula creation screened with a standardized preoperative phone interview and no preoperative clinic visit (SPEEDY group) to those opting for a standard in-person clinic visit.

Clinical factors associated with ultrashort length of stay in patients undergoing lower extremity bypass for peripheral arterial disease.

Background: Length of stay (LOS) is a major driver of cost and resource utilization following lower extremity bypass (LEB). However, the variable comorbidity burden and mobility status of LEB patients makes implementing enhanced recovery after surgery pathways challenging. The aim of this study was to use a large national database to identify patient factors associated with ultrashort LOS among patients undergoing LEB for peripheral artery disease.

Development of hyperacute high-output heart failure at access creation.

High-output heart failure can occur in patients undergoing hemodialysis via permanent access. We have described two cases of hyperacute high-output heart failure. Two patients with multiple previous failed access attempts presented for redo access.

Successful bilateral popliteal-plantar bypasses for polyarteritis nodosa induced ischemia.

Polyarteritis nodosa (PAN) is a rare vasculitis that can cause peripheral ischemia. We present the case of a 49-year-old man who developed PAN causing toe gangrene and severe rest pain in one foot and claudication of the contralateral foot. He was treated with immunosuppression and underwent popliteal-plantar artery bypass with resolution of rest pain and subsequent amputation of his mummified toe.

Distal revascularization and interval ligation for dialysis access-related ischemia is best performed using arm vein conduit.

Objective: Distal revascularization and interval ligation (DRIL) is an effective approach to the management of hemodialysis access-related ischemia that offers both symptom relief and access salvage. The great saphenous vein (GSV) has been the most commonly used conduit. However, the use of an ipsilateral arm vein will allow for performance of the operation with the patient under regional anesthesia and might result in lower harvest site morbidity than the GSV.

Regional Market Competition is Associated with Aneurysm Diameter at the Time of EVAR.

Background: Local market competition has been previously associated with more aggressive surgical decision-making. For example, more local competition for organs is associated with acceptance of lower quality kidney offers in transplant surgery. We hypothesized that market competition would be associated with the size of an abdominal aortic aneurysm (AAA) at the time of elective endovascular aneurysm repair (EVAR).

Contemporary Outcomes following Redo Autogenous Infrainguinal Bypass.

Background: Revascularization after lower extremity bypass failure poses many challenges. Despite nearly 7 decades of experience with lower extremity revascularization, there is little data on the success of redo bypass particularly when autogenous conduit is utilized. The purpose of this study is to review outcomes of redo infrainguinal bypass constructed solely of autogenous vein.

Complete versus partial excision of infected arteriovenous grafts: Does remnant graft material impact outcomes?

Objective: Infected arteriovenous grafts necessitate intervention to obtain source control. However, excising the graft material can be challenging and can lead to complications. Leaving a cuff of graft at the sites of anastomosis allows for the avoidance of potential risks.

Comparison of forearm versus upper arm basilic transposition arteriovenous fistulas demonstrates equivalent satisfactory patency.

Objective: In accordance with the Kidney Disease Outcomes Quality Initiative recommendations, attaining autogenous hemodialysis access, specifically via creation of radiocephalic arteriovenous fistulas (AVF), brachial-basilic (BB)-AVF, or brachial-cephalic AVFs, is preferred for mortality and morbidity benefits over catheter access in patients with end-stage renal disease. The aim of this study is to determine the suitability of forearm basilic vein transposition (FBVT) fistulas as an alternative access option by comparing outcomes with those of BB-AVFs.

Methods: All patients who underwent creation of FBVT between 2007 and 2015 were identified retrospectively in the electronic medical record and compared with a sample of patients undergoing BB-AVF placement during this time.

Practice patterns in arteriovenous fistula ligation among kidney transplant recipients in the United States Renal Data Systems.

Background: Arteriovenous fistulas (AVF) and grafts (AVG) have been associated with significant cardiac morbidity that often improves after ligation. However, AV access ligation after kidney transplant (KT) is controversial due to concern for potential long-term allograft failure. We investigated US trends in AV access ligation after KT and the association between ligation and allograft failure.

Feasibility and Outcomes of Femoral Vein Harvest for Dialysis Access and Arterial Reconstruction.

Background: We describe the feasibility and long-term outcomes of using femoral vein (FV) for arteriovenous fistula (AVF) and lower extremity bypass (LEB) creation.

Methods: All patients undergoing AVF or LEB using autogenous FV by a single surgeon (April 2006 to September 2013) were reviewed. Perioperative (30-d) complications and long-term outcomes are described.

Removal of Noninfected Arteriovenous Fistulae after Kidney Transplantation is a Safe and Beneficial Management Strategy for Unused Dialysis Access.

Background: Renal transplant recipients often maintain their hemodialysis access in the event of future allograft failure. Patients may develop complications related to the unused dialysis access, and it also limits vein availability for phlebotomy. Accordingly, a change in the current paradigm may be warranted.

A prospective randomized study of bovine carotid artery biologic graft and expanded polytetrafluoroethylene for permanent hemodialysis access.

Objective: Arteriovenous grafts (AVGs) remain reliable substitutes for permanent hemodialysis access in scenarios that preclude the placement of native arteriovenous fistulas (AVFs). The majority of AVGs are constructed of expanded polytetrafluoroethylene (ePTFE), which is relatively inexpensive and readily available, but synthetic AVGs have poor patency rates. On the other hand, biologic grafts confer an advantage by virtue of their inherent similarity to the native human vasculature.

Bovine carotid artery biologic graft outperforms expanded polytetrafluoroethylene for hemodialysis access.

Objective: Arteriovenous grafts remain reliable substitutes for permanent hemodialysis access in patients without a suitable autogenous conduit. Advances in conduit design and endovascular management of access-related complications question the preference for synthetic conduits over biologic grafts in contemporary practice. In this study, we compared outcomes between a bovine carotid artery (BCA) biologic graft and expanded polytetrafluoroethylene (ePTFE) grafts for hemodialysis access in a recent cohort of patients.

Outcomes after open infrainguinal bypass in patients with scleroderma.

Background: There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients.

Methods: The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014.

Management of infected vascular grafts.

Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis.

Contemporary Outcomes for Open Infrainguinal Bypass in the Endovascular Era.

Background: The role of infrainguinal bypasses in this era of increasing endovascular interventions remains the subject of significant debate. In this study, we evaluate contemporary long-term outcomes of lower-extremity open revascularization for peripheral arterial disease (PAD).

Methods: We evaluated all patients who underwent infrainguinal bypass with autogenous vein conduits for claudication or critical limb ischemia in our institution between January 1st, 2007 and July 31st, 2014.

Vascular access modifies the protective effect of obesity on survival in hemodialysis patients.

Background: The protective effect of obesity on the survival of patients undergoing hemodialysis (HD) for end-stage renal disease (ESRD), described as the obesity paradox, has been established previously. Survival benefits also have been ascribed to permanent modes of HD access (fistula/graft) compared with catheter at first HD. The purpose of this study is to evaluate the impact of incident HD access type on the obesity paradox.

Lessons Learned in the Surgical Treatment of Neurogenic Thoracic Outlet Syndrome Over 10 Years.

Objective: To evaluate our extensive experience over a decade in the treatment of patients with neurogenic thoracic outlet syndrome (NTOS) who underwent first rib resection and scalenectomy (FRRS).

Methods: Patients treated with FRRS for NTOS from 2003 to 2013 were retrospectively reviewed using a prospectively maintained database.

Results: Over 10 years, 286 patients underwent 308 FRRS.