Association of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative.

Background: Frailty in patients undergoing surgery is strongly associated with postoperative complications. The risk analysis index (RAI) is a validated model for frailty that has been shown to predict short and long-term outcomes. Through utilization of the Vascular Quality Initiative (VQI), this study examined the application of the VQI-derived RAI in acute limb ischemia (ALI) patients undergoing open bypass lower extremity revascularization.

Large bore access for transcatheter aortic valve replacement, endovascular aortic repair, and thoracic endovascular aortic repair. A review of anatomic challenges and operative considerations.

Introduction: Transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are standard and prolific procedures in the modern cardiovascular world, and appropriate delivery of these endoprostheses requires adequate understanding of the requisite large bore access. Percutaneous large bore access is the preferred route but may be accompanied by complications like thrombosis, hemorrhage, or inability to deliver the device. Anatomic limitations such as vessel tortuosity, small size, and heavy calcification may require alternative approaches for successful large bore access.

The Impact of Sociodemographic Variables on Functional Recovery following Lower Extremity Amputation.

Background: We hypothesize that sociodemographic variables, particularly disadvantaged financial environments, impact both rate of prosthetic utilization and the achievement of ambulation post major amputation.

Methods: All cases in the Vascular Quality Initiative amputation module were queried between April 2013 and January 2024. Inclusion was limited to patients who underwent below knee, through knee, and above knee amputation.

Socioeconomic disadvantage is a leading variable in risk score for major amputation following emergent infrainguinal arterial bypass surgery.

Objective: The purpose of this study was to identify patients at particularly high risk for major amputation after emergent infrainguinal bypass to help tailor postoperative and long-term patient management.

Methods: In the Vascular Quality Initiative, we identified 2126 patients who underwent emergent infrainguinal artery bypass. Two primary outcomes were investigated: major ipsilateral amputation above the ankle level during the index hospitalization and major amputation above the ankle at any time after emergent infrainguinal bypass surgery (perioperative and postdischarge combined).

Predictive Modeling for One-Year Lower Extremity Endovascular Revascularization Failure in Black Persons.

Introduction: Black persons bear a disproportionate burden of peripheral artery disease (PAD) and experience higher rates of endovascular revascularization failure (ERF) when compared with non-Hispanic White persons. We aimed to identify predictors of ERF in Black persons using predictive modeling.

Methods: This retrospective study included all persons identifying as Black who underwent an initial endovascular revascularization procedure for PAD between 2011 and 2018 at a midwestern tertiary care center.

Risk score for one-year mortality following emergent infra-inguinal bypass.

Objective: The purpose of this study is to identify variables that place patients at higher risk for mortality following emergent infra-inguinal bypass. Further, this study will create a risk score for mortality following emergent infra-inguinal bypass to help tailor postoperative and long-term patient management.

Methods: In the Vascular Quality Initiative, we identified 2126 patients who underwent emergent infra-inguinal artery bypass.

Investigation of center-specific saphenous vein utilization rates in femoral popliteal artery bypass and associated impact of conduit on outcomes.

Objective: The purpose of this study is to investigate variation in great saphenous vein (GSV) use among the various centers participating in the Vascular Quality Initiative infrainguinal bypass modules. Further, differences in outcomes in femoral-popliteal artery bypass with single segment GSV conduit vs prosthetic conduit will be documented. Center GSV use rate impact on outcomes will be investigated.

Objective assessment of physician work in infrainguinal arterial bypass surgery.

Objective: The purpose of this study is obtain robust objective data from the Vascular Quality Initiative on physician work in infrainguinal artery bypass surgery. Operative time, patient comorbidities, anatomical complexity, consequences of adverse outcomes, and postoperative length of stay all factor into procedure relative value unit assignment and physician reimbursement.

Methods: Baseline demographics and comorbidities were identified among 74,920 infrainguinal bypass surgeries in Vascular Quality Initiative between 2003 and 2022.

Fenestrated Endovascular Aortic Repair With Chimney Graft for Thoracoabdominal Aneurysm.

Thoracoabdominal aneurysms pose technical challenges for endovascular repair due to involvement of visceral and renal vessels. We report a case series of four patients diagnosed with thoracoabdominal aneurysm who underwent complex endovascular repair with Fenestrated Device and chimney grafts (FEVARCh). FEVARCh is a technically feasible approach for repair of thoracoabdominal aneurysms that involve renal, superior mesenteric, and celiac arteries for patients not appropriate for open surgical repair.

The shifting care and outcomes for patients with endangered limbs - Critical limb ischemia (SCOPE-CLI) registry overview of study design and rationale.

Background: Critical limb ischemia (CLI), the most severe form of peripheral artery disease, is associated with pain, poor wound healing, high rates of amputation, and mortality (>20% at 1 year). Little is known about the processes of care, patients' preferences, or outcomes, as seen from patients' perspectives. The SCOPE-CLI study was co-designed with patients to holistically document patient characteristics, treatment preferences, patterns of care, and patient-centered outcomes for CLI.

Computational analysis of endovascular aortic repair proximal seal zone preservation with endoanchors: A case study in cylindrical neck anatomy.

Background: Endovascular aortic repair is the common approach for abdominal aortic aneurysms, but endoleaks remain a significant problem with long-term success. Endoanchors have been found to reduce the incidence of type 1A endoleaks and can treat intraoperative type 1a endoleaks. However, little is known about the optimal number and position of endoanchors to achieve the best outcome.

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis-The PERU registry.

Objectives: We aim to describe real-world outcomes from multicenter data about the efficacy of adjunct Heli-FX EndoAnchor usage in preventing or repairing failures during infrarenal endovascular aneurysm repair (EVAR), so-called EndoSutured-aneurysm-repair (ESAR).

Methods: The current study has been assigned an identifier (NCT04100499) at the US National Library of Medicine (https://ClinicalTrials.gov).

Outcomes of chimney and fenestrated endografting using Viabahn VBX and atrium iCAST stents.

Background: The Atrium iCAST balloon expandable stent is the traditional choice of stent for chimney and fenestrated endovascular aneurysm repair (ChEVAR and FEVAR respectively). Due to the iCAST's lack of flexibility, the Gore Viabahn balloon-expandable stent (VBX; W. L.

Right-sided Upper Extremity Access for Patients Undergoing Parallel Graft Placement during Endovascular Aortic Repair is Not Associated with Increased Neurologic Events When Compared with Left Upper Extremity Access.

Background: The safety and efficacy of right axillary cannulation during complex aortic aneurysm repair for the deployment of chimney grafts is controversial; however, there are few studies that compare right and left upper extremity access. We favor the right axillary approach because of the relative ease of access to the visceral branches and the ability of surgeons and nursing staff to work on the same side of the patient, while avoiding the left sided image intensifier. We aim to demonstrate that right-sided access is equivalent or safer than left-sided access in terms of technical success and complication rates, with a focus on neurologic outcomes.

Diagnostic Colour Duplex Ultrasound for Type IIIb Endoleak.

Introduction: This report presents the treatment of an aortic endovascular aneurysm repair (EVAR) device failure, focusing on the use of colour duplex ultrasound (CDUS) to diagnose and confirm effective treatment of a type IIIb endoleak.

Report: An 89 year old man with a history of EVAR was transferred to the authors' centre with complaints of abdominal pain and a pressure sensation behind the umbilicus. A previously stable 11 cm aneurysm sac was visualised on computed tomography angiography in addition to a newly suspected type IIIb endoleak, which was confirmed via CDUS.

Gaussian Surface Curvature Mapping Indicating High Risk Type B Thoracic Aortic Dissections.

Background: Identifying fragile aortas that are more likely to lead to adverse clinical outcomes would provide surgeons with a better sense of how to balance the risks of surgical versus medical management in patients with type B dissections. We examine the progression of a type B dissection into a type A dissection in a patient and analyze changes in the Gaussian surface curvature distribution, as well as the response of the stress distribution at the lesser curve in response to pressurization. We hypothesize that examining the Gaussian curvature will provide us with a link between aortic surface geometry and the stress distribution, which is crucial to understanding the process driving aortic dissection.

Successful endovascular repair of aortic rupture caused by axillary intra-aortic balloon insertion for a Jehovah's Witness patient with situs inversus anomaly.

We report the successful endovascular repair of a rare case of aortic rupture caused by axillary intra-aortic balloon pump (IABP) insertion failure. A 38-year-old Jehovah's Witness female with situs inversus totalis was referred to our hospital for acute decompensated heart failure. We placed an axillary IABP for circulatory support.

Anatomic and clinical characterization of the narrow distal aorta and implications after endovascular aneurysm repair.

Objective: The purpose of this analysis was to compare 1-year clinical outcomes after endovascular repair of abdominal aortic aneurysms with the EXCLUDER device in patients with standard and narrow aortic bifurcations (AOBs).

Methods: Data were prospectively collected from a 1055-participant subset of the multicenter Global Registry for Endovascular Aortic Treatment (GREAT) treated for abdominal aortic aneurysm repair between August 2010 and September 2015. There were 117 patients with a narrow AOB (NB; defined as <16 mm) and 938 patients with a standard bifurcation (SB).

Current endovascular management of complex pararenal aneurysms.

Introduction: Endovascular approach to abdominal aortic aneurysm has increased in frequency over the last decade and is preferred by many practitioners and patients alike. However, its role in "complex" aneurysms with challenging anatomy, short neck length, or borderline landing zone for grafts is less well understood. Additionally, the endovascular role in complex urgent or emergent repairs has not been adequately studied.

Peripheral artery aneurysm.

Peripheral aneurysms typically present as asymptomatic incidental findings or may present with symptoms when there is local compression of other structures, such as nerves or veins, with ischemia, or rarely with rupture. Larger and symptomatic aneurysms should be repaired. Ultrasonography, computed tomography angiography, and magnetic resonance angiography can be used to define inflow and outflow and better characterize the aneurysm, particularly size and thrombus.

The intestinal environment of surgical injury transforms Pseudomonas aeruginosa into a discrete hypervirulent morphotype capable of causing lethal peritonitis.

Background: Secondary peritonitis continues to carry a high mortality rate despite the aggressive use of imaging, drainage, and antibiotics. Although host factors and microbial burden contribute to the outcome of peritonitis, we propose a role for bacterial virulence as a determinant of outcome from peritonitis. Bacterial virulence is an inducible trait that is activated in response to specific local "cues" that we have previously shown to be present in the mouse gut exposed to surgical stress and injury.

Candida albicans isolates from the gut of critically ill patients respond to phosphate limitation by expressing filaments and a lethal phenotype.

Candida albicans is an opportunistic pathogen that proliferates in the intestinal tract of critically ill patients where it continues to be a major cause of infectious-related mortality. The precise cues that shift intestinal C. albicans from its ubiquitous indolent colonizing yeast form to an invasive and lethal filamentous form remain unknown.