Physician Modified Endografts Achieve Similar Patient Survival and Target Visceral Vessel Related Outcomes to Factory Made Fenestrated Endografts in Treating Complex Aortic Pathology.

Objective: The purpose of this study was to conduct a real-world comparison of visceral stent branch related outcomes and patient survival in physician modified endografts (PMEG) versus factory made fenestrated endografts (FMFE).

Methods: After exclusions, 544 PMEG and 1638 FMFE were identified in the Vascular Quality Initiative between 2014 and 2022. The four primary outcomes analyzed with Kaplan Meier (KM) were freedom from mortality, new onset dialysis, visceral ischemia, and visceral stent graft reintervention in follow up.

Risk Factors Contributing to 30 Day and One Year Mortality Event Scores Following Major Lower Extremity Amputation for Limb Ischemia.

Objective: The purpose of this study is to create a risk score for 30-day and one year mortality following major lower extremity amputation to facilitate clinical expectations and the identification of patients in need of heightened vigilance in longitudinal care.

Methods: In the Vascular Quality Initiative, 25,150 patients were identified who underwent lower extremity amputation. Two primary outcomes were investigated : 30 day mortality following major lower extremity amputation; and, 1 year mortality following amputation.

Risk score for two-year mortality following carotid endarterectomy performed for symptomatic stenosis.

Objective: The purpose of this study is to identify variables at the time of clinical presentation that place patients at higher risk for mortality following carotid endarterectomy (CEA) for symptomatic lesions. Further, this study will create a risk score for mortality within 2 years following CEA for symptomatic stenosis to help tailor future postoperative and long-term management by identifying patients who require heightened vigilance in postoperative care to facilitate survival.

Methods: The Vascular Quality Initiative CEA module was queried for procedures performed for symptomatic (within 180 days) carotid bifurcation stenosis.

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).

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.

Preoperative risk score for mortality within 3 years of visceral segment fenestrated endovascular aortic repair.

Objective: The purpose of this study was to create a risk score for the event of mortality within 3 years of complex fenestrated visceral segment endovascular aortic repair utilizing variables existing at the time of preoperative presentation.

Methods: After exclusions, 1916 patients were identified in the Vascular Quality Initiative who were included in the analysis. The first step in development of the risk score was univariable analysis for the primary outcome of mortality within 3 years of surgery.

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.

Carotid Endarterectomy for Asymptomatic Stenosis Based on Duplex Ultrasound Alone Achieves Equivalent Perioperative and Long-Term Outcomes Relative to Advanced Imaging Based Endarterectomy.

Background: The purpose of this study is to compare both perioperative as well as long-term outcomes of patients undergoing carotid endarterectomy (CEA) for asymptomatic carotid bifurcation stenosis based on duplex ultrasound in isolation relative to a combination of duplex and more advanced imaging.

Methods: All CEA in the VQI between January 2003 and May 2022 were queried. We identified 171,816 CEAs in the database.

Modifiable risk factors for occurrence of ipsilateral ischemic events after carotid endarterectomy beyond perioperative period.

Objective: The purpose of this study was to quantify the effects of several modifiable variables on the occurrence of stroke after the initial perioperative period for patients who had undergone carotid endarterectomy (CEA).

Methods: The primary outcome for the present study was the development of an ischemic stroke or transient ischemic attack (TIA) in the cerebral hemisphere ipsilateral to CEA after the initial hospitalization. All CEAs in the VQI between January 2003 and May 2022 were queried.

The Effect of Smoking Status on Perioperative Morbidity and Mortality after Open and Endovascular Abdominal Aortic Aneurysm Repair.

Background: This study quantifies the extent to which active tobacco smoking is deleterious toward outcomes following open and endovascular abdominal aortic aneurysm (AAA) repair.

Methods: Open and endovascular AAA repairs between January 2003 and June 2020 in the Vascular Quality Initiative were queried. Rupture, symptomatic status, and lack of 90 day follow-up were exclusions.

Risk factors for mortality within 5 years of carotid endarterectomy for asymptomatic stenosis.

Objective: The current Society for Vascular Surgery guidelines for the treatment of patients with asymptomatic carotid stenosis recommend endarterectomy for patients with >70% stenosis and acceptable surgical risk. The reduced rate of stroke with modern medical therapy has increased the importance of careful selection in deciding which patients should undergo elective carotid endarterectomy (CEA) for asymptomatic disease. It would, therefore, be very prudent to investigate preexisting variables predictive of 5-year mortality for patients meeting the criteria to undergo CEA.