Effects of Timing of Repair on Mortality Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury.

Background: Blunt thoracic aortic injuries (BTAIs) are traditionally treated as emergencies with most fixed within 24 hours of arrival by thoracic endovascular aortic repair (TEVAR) regardless of grade of injury. However, the optimal timing of repair remains debated.

Methods: All patients with Grade 2 and 3 BTAI enrolled in the Aortic Trauma Foundation prospective multicenter registry from 2015 to 2022 were categorized dependent on timing of repair (early repair [ER] < 24 hours, late repair > 24 hours).

Factors Associated With Tobacco Cessation Advice Recall and Quit Rates in Vascular Surgery Patients. A Single Center Study.

Objectives: Smoking is an important modifiable risk factor in all vascular diseases and verbal advice from providers has been shown to increase rates of tobacco cessation. We sought to identify factors that will improve tobacco cessation and recall of receiving verbal cessation advice in vascular surgery patients at a single institution.

Methods: The study is a retrospective cohort study.

A Survey of Vascular Surgery Program Directors: Perspectives following USMLE Step 1 Conversion to Pass/Fail and Virtual Only Interviews.

Background: Step 1 of the United States Medical Licensing Examination (USMLE), a historically important factor in the selection of vascular surgery residents and fellows, transitioned to completely pass/fail on January 26, 2022. Due to the COVID-19 pandemic, residency and fellowship interviews were conducted virtually during the 2020-21 and 2021-22 application cycles. Given these significant changes in the evaluation of candidates for residency training, we sought to understand vascular surgery program directors' (PDs) perspectives regarding the change in step 1 scoring and use of virtual interviews as well as determine which factors will assume importance when applying to vascular surgery training programs in the future.

Contemporary management and outcomes of peripheral venous aneurysms: A multi-institutional study.

Objective: Extremity venous aneurysms result in the risk of pulmonary embolism (PE) and chronic venous insufficiency. At present, owing to the rarity of these aneurysms, no consensus for their treatment has been established. The purpose of the present study was to review the presentation, natural history, and contemporary management of extremity venous aneurysms.

Depression screening in patients with vascular disease.

Objectives: Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4 month period.

Outcomes after endovascular reintervention for aortic interventions.

Objective: Endovascular reinterventions are often performed after previous open or endovascular aortic procedures. We used the GREAT (Global Registry for Endovascular Aortic Treatment) database to compare the outcomes between these groups. We also compared reintervention of any type with a group of patients who had undergone primary endovascular abdominal aortic aneurysm repair (EVAR).

Acute Limb Ischemia Secondary to Patent Foramen Ovale-Mediated Paradoxical Embolism: A Case Report and Systematic Review of the Literature.

Background: Paradoxical embolism is the translocation of a thrombus originating in the systemic venous circulation into the arterial circulation through a cardiac defect, most commonly a patent foramen ovale (PFO). PFO exists in 15-35% of the adult population. The most common manifestation is cerebrovascular accident; acute limb ischemia is much rarer.

Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination.

Background: The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied.

A multi-institutional experience in adventitial cystic disease.

Background: Adventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database.

Methods: Using a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia.

Perspectives of Decisional Surrogates and Patients Regarding Critical Illness Genetic Research.

Background: Critical illness research is challenging due to disease severity and because patients are frequently incapacitated. Surrogates called upon to provide consent might not accurately represent patient preferences. Though commonplace, genetic data collection adds complexity in this context.

The use of cryopreserved aortoiliac allograft for aortic reconstruction in the United States.

Background: Aortic infections, even with treatment, have a high mortality and risk of recurrent infection and limb loss. Cryopreserved aortoiliac allograft (CAA) has been proposed for aortic reconstruction to improve outcomes in this high-risk population.

Methods: A multicenter study using a standardized database was performed at 14 of the 20 highest volume institutions that used CAA for aortic reconstruction in the setting of infection or those at high risk for prosthetic graft infection.

Risk factors for infectious complications with angio-seal percutaneous vascular closure devices.

Percutaneous vascular closure devices have become increasingly common in their use in both cardiac and peripheral vascular intervention. Our cases present the risk factors of repeat percutaneous vascular closure devices for subsequent infectious complications. A 43-year-old male underwent cardiac catheterization and closure with an Angio-Seal (St.

Prolonged success with a covered endovascular stent after emergent use in radiation-induced subclavian artery blowout: a case report.

Radiation-induced damage to the bone, soft tissues, and vasculature represents the unfortunate consequences of radiation therapy for the treatment of malignant tumors. Complications arising from irradiation are frequently challenging to manage and may be life threatening. A case is presented of a patient with a longstanding clavicular osteoradionecrosis with an acute massive hemorrhage after rupture of the subclavian artery and subsequent management with endovascular stent placement.

Limb ischemia: medical therapy trial update.

Peripheral arterial disease has a significant impact on the quality of a patient's life. Pain, fear of limb loss, increased inactivity, and poor lifestyle choices such as continued smoking further debilitate these patients. Surgical and endovascular procedures have affected this outcome for many but carry the added risk of procedural complications and mortality for this group of high-risk individuals.

Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: vascular surgical operations in women.

Background: Women with peripheral vascular disease requiring vascular operations are less well studied than their male counterparts. The surgical outcomes of female vascular patients in the Department of Veterans Affairs (VA) and private sector hospitals have not previously been compared, and their preoperative risk profile, postoperative morbidity, and mortality need to be better elucidated.

Study Design: Patients undergoing vascular operations at 14 private sector and 128 VA hospitals, from October 2001 through September 2004, had their preoperative characteristics, operative data, and 30-day postoperative morbidity and mortality compared, as part of the Patient Safety in Surgery (PSS) Study.

True lumen re-entry devices facilitate subintimal angioplasty and stenting of total chronic occlusions: Initial report.

Objective: The acute technical failure of endovascular treatment of chronic total occlusions (CTOs) is most often due to the inability to re-enter the true lumen after occlusion is crossed in a subintimal plane. This study reports our initial experience with true lumen re-entry devices in the treatment of CTOs.

Methods: Patients with treatment of CTOs were identified from our vascular registry.

Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents.

Hostile neck anatomy remains the predominant reason that patients are denied endovascular aneurysm repair (EVAR). We reviewed our experience of EVAR with use of prophylactic adjunctive proximal balloon-expandable stents in patients with hostile neck anatomy and adjunctive proximal balloon-expandable stents in patients with type I endoleaks. Of 140 patients who underwent EVAR between 2000 and 2004, we reviewed data for 19 patients in whom we used proximal balloon-expandable stents.

Infections of the aorta: case report and review of treatment.

Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic(CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta.

Infrainguinal vein graft surveillance: the criteria for intervention.

In most patients, infrainguinal vein grafts are commonly performed for limb-threatening ischemia. Once limb salvage has been achieved, most clinicians agree that regular appointments with the vascular team are important to monitor graft patency. However, the timing of these appointments and what defines an adequate examination remains debatable.

Current status of the surgical treatment of patients with carotid artery disease: the surgical management of carotid atherosclerosis.

Patients with carotid artherosclerotic disease present with a history of a neurologic event or with the presence of a bruit on physical examination. Recently, large randomized prospective studies have examined this group of patients to determine the optimal course of medical and surgical management. The data from these studies, together with the natural history of carotid disease and factors associated with stroke risk, are reviewed.

Prospective comparison of helium versus carbon dioxide pneumoperitoneum.

Background: During prolonged laparoscopic operations with carbon dioxide (CO2) pneumoperitoneum (PP), hypercapnia with significant acidosis has been reported to occur in some patients with pulmonary dysfunction. An alternate inert insufflation gas like helium (He) could avoid this problem.

Methods: This prospective, IRB-approved study compared the cardiopulmonary response in 20 patients with both CO2 and He PP.