Journal of Vascular Surgery最新文献

{"title":"An Audit of Physical Waste and Fluoroscopy Energy Consumption in Vascular Surgery and Suggestions for the Future.","authors":"Omar Moussa Pasha, Aidan Rowe, David P Ebertz, Alexander Harvey, Saideep Bose, Michael Williams, Catherine Wittgen, Matthew R Smeds","doi":"10.1016/j.jvs.2025.03.186","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.186","url":null,"abstract":"<p><strong>Objectives: </strong>Hospitals are responsible for 4-5% of global greenhouse gas production and are significant contributors to climate change. We sought to understand the contributions of vascular surgery to the carbon footprint of hospitals by examining emissions from fluoroscopy and physical waste across common vascular surgeries.</p><p><strong>Methods: </strong>Vascular operations at a single tertiary hospital were prospectively audited for physical waste. Additional cases from the same hospital were audited retrospectively for energy expenditure during fluoroscopy digital subtraction angiography (DSA). The fluoroscopy time (min), number of DSA runs, amplitude, and voltage were recorded, and subsequently, power (kW) and energy (kWh) were calculated. The operations were separated into cohorts based on operation: endovascular aneurysm repair (EVAR), thoracic endovascular aortic repair (TEVAR), transcarotid artery revascularization (TCAR), carotid endarterectomy (CEA), femoral endarterectomy with iliac intervention (Fem/Iliac), lower extremity bypass, endovascular lower extremity revascularization (Endo CLTI). Using a certified Greenhouse Gas Equivalencies Calculator from the US Environmental Protection Agency, total carbon dioxide emissions (CO₂e) were estimated.</p><p><strong>Results: </strong>18 vascular operations were audited for physical waste. Lower extremity bypasses produced the largest amount of CO2e from physical waste (85.75 kg CO2e, 95% CI 71.4-100.2), while the least was produced by CEA (57.22 kg CO2e, 95% CI 48.7-65.7). No significant correlation was seen between operative length and amount of waste. 97 operations were retrospectively audited for fluoroscopy energy use during DSA runs. EVAR produced the largest CO2e from DSA runs (41.11 kg, 95% CI 28.82-53.40), while the least was produced by TCAR (7.33 kg, 95% CI 5.15-9.49). When DSA CO2e were analyzed against fluoroscopy time, TEVAR produced CO2e at the highest rate of 3.63 kg/min DSA, while TCAR produced CO2e at the lowest rate of 1.37 kg/min DSA. Although no linear correlation was found between operation length and CO2e from waste (r2= 0.099), a linear correlation was found between fluoroscopy time and CO2e (r² = 0.76).</p><p><strong>Conclusions: </strong>Vascular operations, on average, generate 108.47 kg of CO2 emissions from waste and fluoroscopy, the equivalent of driving an average gasoline-powered vehicle for 278 miles. This study found a correlation between increased fluoroscopy time and CO2 emissions. It also found that the rate of emissions differs between different operations, suggesting a role in optimizing fluoroscopy and intraoperative techniques to lower emissions. Efforts to track current energy output from imaging devices, investing in efficient devices, and adjusting intraoperative settings may all play a role in decreasing vascular surgery's environmental footprint.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients Undergoing Major Amputation for Peripheral Arterial Disease are at High Risk for Developing Major Depressive Disorder and Requiring Long-Term Antidepressants.","authors":"Elizabeth Lavanga, Fadi Samaan, Jacob W Soucy, Tarik Ali, Faizaan Aziz, Faisal Aziz","doi":"10.1016/j.jvs.2025.03.185","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.185","url":null,"abstract":"<p><strong>Objectives: </strong>Amputation is an undesirable outcome of severe peripheral artery disease (PAD) which affects both the mobility and broader lifestyle of the patient. Prior studies have shown that lower extremity amputation is associated with increased risk of developing depression in the postoperative period. However, these studies are primarily single center, confined to specific populations, or do not include analysis over various timepoints. The objective of this study was to assess the association between lower extremity amputation level, level of amputation, and postoperative development of depression. This information will allow vascular surgeons to identify patients who are at a high risk for the development of depression after amputation and make the necessary psychiatric referrals.</p><p><strong>Methods: </strong>48,568 adult patients who underwent PAD-related lower extremity amputation were identified from the TriNetX Research database following exclusion of those with preoperative depression or use of antidepressants. Propensity score matching was used to develop comparable major amputation (Above- and Below-Knee Amputations) (I) and minor amputation cohorts (Toe and foot amputations) (II), yielding two groups each with 14,853 patients. Primary outcomes included postoperative diagnosis of major depressive disorder (MDD), prescription of antidepressants, and mortality. Outcomes were analyzed at 6-month and 1-year timepoints.</p><p><strong>Results: </strong>Analysis at 6 months demonstrated that major amputation was associated with a higher risk of developing MDD (6.3% vs 4.6%, p-value <0.001) and requiring antidepressants (26.8% vs 15.8%, p-value <0.001) when compared with minor amputation. At 1 year, the incidence of MDD, antidepressant prescriptions, and mortality was 7.7% vs. 6.4% (p <0.001), 28.6% vs. 18.5% (p <0.001) and 20.7% vs. 12% (p <0.001), respectively. Additionally, the 1-year mortality rate was 10.8% vs 21.5% vs 20.7% for the Minor, Minor Followed by Major, and Major amputation groups, respectively. The incidence of MDD diagnosis and antidepressant prescriptions was 5.8% vs 11.4% vs 7.7% (p<0.001) and 16.9% vs 32% vs 28.6% (p<0.001), for the Minor, Minor Followed by Major and Major amputation groups, respectively CONCLUSIONS: The prevalence of MDD and antidepressant medication requirements increases over time in the postoperative period for both major and minor amputees. Patients who underwent major amputations and major amputations after minor amputations were more likely to experience postoperative MDD and require antidepressant prescriptions than patients who underwent minor amputation alone. This suggests that vascular surgeons should understand the high incidence of depression in patients undergoing major amputations and should have a low threshold for referral of major amputees to psychiatric experts in the postoperative period.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Native or Graft Abdominal Aortic Infection managed with Orthotopic Xeno Pericardial Grafts or Cryopreserved Allograft: A French bicentric comparative study.","authors":"Lucas Battistella, Ramla Kireche, Jean Baptiste Ricco, Thibaut Boisroux, Jason Shourick, Xavier Chaufour, Ludovic Canaud, Aurélien Hostalrich","doi":"10.1016/j.jvs.2025.03.182","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.182","url":null,"abstract":"<p><strong>Background: </strong>The ideal substitute for in situ reconstruction of aortic graft or native aortic infection has yet to be defined. Though recognized as resistant to infection, cryopreserved arterial allograft (Allograft) presents problems of availability when treating emergent cases, with the risk of long-term aneurysmal degeneration. Commercially available bovine pericardial (Pericard) appears as an alternative, with promising results in the recent literature. The goal of this study was to compare the results of these two substitutes.</p><p><strong>Material and methods: </strong>Between January 2010 and December 2023, we conducted, a retrospective observational study in two tertiary centers, including all patients having undergone in situ surgery for aortic graft or native aortic infections with reconstruction by Allograft or Pericard. Survival, reinterventions and reinfections were analyzed according to the Kaplan-Meier method and Cox regression model.</p><p><strong>Results: </strong>All in all,169 patients were included in the study with 103 aortic graft infections (60.9%), 33 aortic endograft infections (19.5%) and 33 native aortic infections (19.5%). Allograft was used in 111 patients (65.7%) and Pericard in 58 (34.3%). The two groups were comparable as regards preoperative risk factors, types of index surgery, and infectious agents, with 41 (24.8%) patients with an aortoenteric fistula. There was no significant difference in postoperative complications. Median follow-up was 18 months [IQR: 4-44 months]. At 24 months, survival was comparable, with 68±4% for Allograft and 68±6 for Pericard, as was reinfection-free survival with 80±4% for Allograft versus 83±6% for Pericard (p = .722). Reintervention-free survival at 2 years was likewise comparable: 86±4% for Allograft versus 77±8% for Pericard (p = .419).</p><p><strong>Conclusion: </strong>A pericardial substitute offers the possibility of in situ aortic reconstruction without problems of availability and with mid-term results comparable to those achieved with aortic allografts. Further studies with long-term follow-up are needed to validate the absence of late reinfection and to confirm pericardial substitute patency.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variations in Antithrombotic Prescriptions and Evaluation of Extended Clopidogrel Therapy After Lower Extremity Revascularization for Peripheral Artery Disease.","authors":"Nicholas Wells, Dana Alameddine, Uday Dhanda, Lydia Tran, David Silva, Martin Slade, Raul J Guzman, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2025.03.183","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.183","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The optimal antithrombotic combination and duration after open surgical or endovascular lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) lacks consensus. This study examines the variability of antithrombotic prescriptions in a tertiary care center, highlighting challenges in related research. The duration of the various prescriptions was captured and this study focused on studying the impact of duration of clopidogrel therapy on patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The electronic medical records of patients with PAD undergoing LER were reviewed. All antithrombotic prescriptions after initial LER were abstracted by pharmacists. Demographics and clinical characteristics of patients who received clopidogrel after initial LER were evaluated. Comparison of patients who received extended clopidogrel therapy (&gt; 12 months) compared to limited clopidogrel therapy (≤ 12 months) was performed. Perioperative and long-term outcomes were compared and analysis focused on Major Adverse Limb Events (MALE), Major Adverse Cardiac Events (MACE), and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,954 patients received 17 different perioperative antithrombotic combinations and 101 combinations over long-term follow up. Clopidogrel was the most commonly used medication in 69.8% (N=1,363). Among patients treated with clopidogrel after LER, 69.5% (N=947) received extended therapy (&gt;12 months). Patients who received extended clopidogrel therapy were more likely to have had a prior endovascular procedure (21.8% vs 15.2%, P=0.005), while those who received limited therapy (≤12 months) were older (72 vs 69, P&lt;0.001) and more likely to have congestive heart failure (21% vs 14%, P=0.001) and chronic renal insufficiency (22.2% vs 15.6%, P&lt;0.004). Patients in the extended therapy group were more likely to be treated for claudication (57.5% vs 46.1%, P&lt;0.001) compared to patients with limited therapy but there was no difference in revascularization strategies. Kaplan-Meier curves showed significantly higher overall survival, MALE-free survival, and MACE-free survival in patients with extended clopidogrel therapy without difference in freedom from MALE or MACE. Cox regression demonstrated independent association of limited clopidogrel therapy with mortality (HR=1.93[1.6-2.31]), mortality or MALE (HR=1.32[1.14-1.53]), and mortality or MACE (HR=1.39[1.2-1.62]). The duration of clopidogrel therapy was not associated with bleeding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The number of unique prescription combinations found in this study highlights real-world variations in antithrombotic therapy after revascularization for patients with PAD. Extended clopidogrel therapy was associated with improved survival compared to limited therapy in this analysis without increase in bleeding. Observational studies on antithrombotic therapy are limited by extensive variations and factors affecting prescriptio","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Mobility Prediction Models to Real World Patients with Major Amputations.","authors":"Leigh Ann O'Banion, Caroline Runco, Carolina Aparicio, Jessica P Simons, Karen Woo","doi":"10.1016/j.jvs.2025.03.181","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.181","url":null,"abstract":"<p><strong>Background: </strong>Outcome prediction models have become commonplace and are promoted to aid in counseling patients. The aim of this study is to evaluate the performance of existing mobility prediction models for post-major amputation (MA) patients in a real world, socioeconomically disadvantaged population.</p><p><strong>Methods: </strong>A retrospective review of patients with MA secondary to peripheral arterial disease from 2016-2022 was performed. Patients who were non-ambulatory pre-MA or with contralateral MA were excluded. 3 published prediction models were investigated: 1) AmpPredict (predicts 1 yr mobility) and 2) AMPSIMM, (predicts degree of mobility with prosthesis at 1 yr), both derived from Veteran's Affairs (VA) data; and 3) a Vascular Quality Initiative (VQI) data-derived model (predicts 1 yr mobility). Predicted mobility rates vs actual mobility rates were compared.</p><p><strong>Results: </strong>The study cohort consisted of 126 patients, 71% male, 60% non-white race, with a mean state Area Deprivation Index of 9/10. Baseline characteristics were significantly different between the study and derivation cohorts. Actual mobility at 1 yr was 43%. Of the 38 patients with an AmpPredict 1 yr mobility of ≥70%, 45% actually achieved mobility. Of 101 patients with a \"high\" predicted probability from the VQI score (≥71%), 48% achieved mobility. The mean difference between AmpPredict and VQI for a given patient was 36% (range 1-81). AMPSIMM predicted 87% of patients would be community (vs home) ambulators at 1 yr and 32% of patients actually achieved community ambulation (Sens 91%, Spec 14%, PPV 33%, NPV 79%).</p><p><strong>Conclusion: </strong>Published models dramatically overestimated the likelihood of mobility in our patient cohort. This may be related to demographics/comorbidities of our cohort being significantly different from the derivation cohorts. We recommend caution when applying prediction models to a population with significantly different characteristics from the population used to derive the model.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of radiation exposure in endovascular treatment of chronic limb-threatening ischemia by arterial access and GLASS classification.","authors":"Dorelly Tanayra Martínez Del Carmen, Carlos Martínez Rico, Pablo Saldaña Gutiérrez, Sílvia Jovells-Vaqué, Elena Iborra Ortega","doi":"10.1016/j.jvs.2025.03.184","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.184","url":null,"abstract":"<p><strong>Background: </strong>Endovascular therapy for the treatment of chronic limb-threatening ischemia (CLTI) continues to evolve with the development of new techniques and devices. However, data on radiation dose during CLTI revascularization using two different types of C-arms remains limited.</p><p><strong>Objective: </strong>The objective of this study was to analyze radiation dose parameters during revascularization of CLTI, considering arterial access and GLASS classification, using two different types of C-arms.</p><p><strong>Methods: </strong>A cross-sectional, non-randomized study of endovascular procedures was performed for the revascularization of CLTI. All procedures were performed percutaneously in two different C-arm devices: mobile (MCA) and hybrid room (HR). Procedures were stratified according to GLASS classification. The arterial accesses included antegrade femoral, contralateral femoral, brachial, and double arterial access (defined as the combination with the retrograde access). Dosimetric parameters, including Air-Kerma Area Product (KAP), fluoroscopy time (FT), Cumulative Air Kerma (CAK), and contrast volume, were collected.</p><p><strong>Results: </strong>During the period from July 2020 to September 2023, 465 procedures were performed on 373 patients. Mean patient age was 73.4 years (SD: 11.24 years; range: 37-99 years). The median CAK for antegrade access was significantly higher in HR compared to MCA (6.08 Gy vs 3.33 Gy; p < .001). However, the median FT was lower in HR compared to MCA (795.13 s vs 981 s; p = .039). The mean KAP was significantly higher for contralateral access (19.22 Gy·cm² vs 13.29 Gy·cm²; p = .028) and double arterial access (17.4 Gy·cm² vs 7.35 Gy·cm²; p = .012) in HR compared to MCA. For all three GLASS categories, the mean KAP was significantly higher in HR compared to MCA (p < .05).</p><p><strong>Conclusions: </strong>Antegrade access showed lower KAP compared to the rest of the arterial accesses. Infrainguinal revascularizations performed in HR involve higher levels of KAP, with significant differences in all types of arterial access.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rupture after previous endovascular abdominal aortic aneurysm repair: a meta-analysis and meta-regression analysis of factors influencing perioperative mortality.","authors":"Georgios Koudounas, Vangelis Bontinis, Stefanos Giannopoulos, Alkis Bontinis, Apostolos Tassiopoulos, Christos D Karkos","doi":"10.1016/j.jvs.2025.02.048","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.02.048","url":null,"abstract":"<p><strong>Objective: </strong>To document the clinical presentation, management, and outcome of patients presenting with late rupture of abdominal aortic aneurysm (AAA) after previous endovascular repair (EVAR) and to investigate which factors may influence the perioperative mortality.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of relevant studies was undertaken to February 2024 in conformity with the PRISMA guidelines. We included studies reporting on either endovascular or open surgical repair (OSR) of late rupture (>30 days) after previous EVAR. The primary endpoint was perioperative (in-hospital or 30-day) mortality. A random effects meta-analysis was conducted and a meta-regression was subsequently performed to examine the impact of several variables on perioperative mortality.</p><p><strong>Results: </strong>Thirty studies (743 patients, 746 ruptures) were included. The cumulative incidence of rupture-post-EVAR during a mean 5-year follow-up was 1.5%. Mean time from the index EVAR to rupture was 48 (range 16-81) months. The mean compliance to follow-up was 68% (95% confidence interval [CI] 58-77) and 32% (95% CI 24-40) of the cases had at least one previous aneurysm-related reintervention. Type I and III endoleaks were the predominant causes of rupture (88%). About a third of the patients (37%; 95% CI 28-47) were hemodynamically unstable. Of those undergoing an operation, 247 (38%) patients were managed endovascularly and 409 (62%) by OSR. The pooled perioperative mortality was 29.5% (30 studies; 95% CI 23.8-35.8) and was significantly lower in the endovascular subgroup (20 studies; risk ratio [RR] 0.62; 95% CI 0.44-0.86). Meta-regression demonstrated that perioperative mortality appears to fall in recent years (-0.0545; p=0.04), to decrease in larger series in the endovascular subgroup (-0.0375; p=0.01), and to be significantly higher when total endograft explantation is required in the OSR subgroup (0.0121, p=0.03).</p><p><strong>Conclusions: </strong>Late rupture after previous EVAR is a devastating event with a considerable risk for death. An endovascular approach is associated with a significantly lower perioperative mortality and should be preferred whenever feasible. When open surgery is required, total endograft explantation carries a higher mortality and, therefore, preserving functional parts of the endograft should be encouraged.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Radiation Exposure Learning Curves for Vascular Surgery Trainees During Fluoroscopically Guided Interventions.","authors":"Antonio Solano, Michael Shih, Andrea Klein, Michael C Siah, Gerardo Gonzalez-Guardiola, Khalil Chamseddin, Vivek Prakash, Aaron Wagner, Mirza S Baig, Carlos H Timaran, Jeffrey Guild, Melissa L Kirkwood","doi":"10.1016/j.jvs.2025.03.178","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.178","url":null,"abstract":"<p><strong>Objective: </strong>The volume of fluoroscopically guided interventions (FGIs) performed by vascular surgeons has increased significantly nationwide, however appropriate and timely radiation safety training varies by institution. Vascular surgery trainees often learn radiation safety techniques concurrently with learning the art of vascular surgery. Given the concern for occupational hazards throughout clinical training, we sought to determine the radiation dose exposure to trainees, faculty surgeons and patients during FGIs according to level of training.</p><p><strong>Methods: </strong>A prospective cohort study was performed at a university hospital to determine the median body radiation dose of trainees, attending surgeon and patients during FGIs during a 5-month period. Optically stimulated luminescence dosimeters were placed outside the lead apron at the thyroid and sternum positions for one attending surgeon and all assisting fellows performing FGIs. Cases were stratified according to fellow training stage: first 6 months in the first year (PGY6) and final six months of the second year (PGY7). Operator radiation dose was calculated based on a calibration of 80 kVp. Procedural reference air kerma (RAK), fluoroscopy time, dose area product (DAP) and patient BMI were recorded. Scatter fractions were measured with thyroid and sternum counts to DAP ratio, and DAP/RAK ratio (a surrogate for collimation and use of magnification). Paired Wilcoxon and chi-square tests were performed to identify statistical significance of training stage on radiation dose exposure and performance of radiation reduction.</p><p><strong>Results: </strong>A total of 40 FGIs were performed: 21 cases with PGY-6 fellows and 19 cases with PGY-7 fellows. Higher median thyroid and sternum radiation doses were observed for PGY-6 fellows compared to PGY-7 fellows, respectively (82 μGy [IQR 47-94] vs 44 μGy [IQR 30-57], P=0.009; 89 μGy [IQR 75-128] vs 54 μGy [IQR 48-77], P =0.007). Scatter fractions as measured by the thyroid/DAP and sternum/DAP ratios were significantly higher for first-year fellows (2 vs 1, P = 0.018; 2.64 vs 1.23, P = 0.041). There was no difference in the source to image distance or the average field size as measured by the DAP/RAK ratio.</p><p><strong>Conclusions: </strong>Trainee radiation dose exposure is higher during the first year of fellowship. Acquisition of optimal performance with fluoroscopy skills can be related to training time. The difference noted between PGY 6 and PGY 7s is likely enhanced for vascular residents (PGY 1-5) and further underscores the importance of early and thorough education in radiation safety for all trainees.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Renal Complications Following Open Juxtarenal Aortic Aneurysm Repair Adversely Impact Midterm Survival.","authors":"Priya B Patel, Alexandra Sansosti, Christina L Marcaccio, Thomas F X O'Donnell, Jeffrey J Siracuse, Karan Garg, Nicholas J Morrissey, Marc Schermerhorn, Hiroo Takayama, Virendra I Patel","doi":"10.1016/j.jvs.2025.03.179","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.179","url":null,"abstract":"<p><strong>Objective: </strong>Juxtarenal aortic aneurysms present a challenge for endovascular treatment. While renal dysfunction following open repair has been associated with lower short-term survival, the relationship between postoperative kidney function and midterm outcomes such as rupture, reintervention, and mortality remains unclear. This study investigates the association between postoperative renal function and these outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) linked to Medicare claims through the Vascular Implant Surveillance and Interventional Outcomes Network (VISION). Patients who underwent elective open repair for juxtarenal aortic aneurysms between January 2003 and December 2018 (N=1925) were included. Patients were stratified based on postoperative renal function: stable renal function; acute kidney injury (AKI), as defined by ≥0.5 mg/dL increase in baseline serum creatinine level; or need for renal replacement therapy (RRT). Primary outcomes included 5-year mortality, rupture, and reintervention, and secondary outcomes were immediate postoperative complications. Multivariable logistic regression, Kaplan-Meier analysis, and Cox regression modeling were used.</p><p><strong>Results: </strong>Among the 1925 patients, 74% had stable postoperative renal function, 21% developed AKI, and 4.9% required RRT. Worse renal outcomes were associated with longer renal ischemia times, higher proximal aortic clamping, and renal artery bypass. Postoperative, 30-day mortality was highest in the RRT group, along with higher rates of cardiac, respiratory, and intestinal ischemic complications (P<.001). Patients requiring RRT had higher risks of subsequent aortic aneurysm-related reintervention (aHR 2.4 [1.1-5.1], P=.03) and midterm (1-,3-,and 5-year follow up) mortality (aHR 2.2 [2.1-5.1], P<.001) compared to those with stable renal function. Patients with AKI also had higher midterm mortality (aHR 1.5 [1.1-2.0], P=.01). No significant differences in aneurysm rupture were observed between groups.</p><p><strong>Conclusion: </strong>Postoperative patients who required RRT were associated with increased midterm aortic reinterventions and mortality after open juxtarenal aneurysm repair. Patients demonstrating any degree of renal impairment were associated with higher midterm mortality risk, though rupture rates and rates of reintervention demonstrated no difference.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Postoperative Dual Antiplatelet Therapy on Outcomes of Endovascular Therapies in Patients with Chronic-Limb Threatening Ischemia in the Vascular Quality Initiative-Medicare-Linked Database.","authors":"Sina Zarrintan, Mohammed Hamouda, Munir P Moacdieh, Mahmoud B Malas, Ann C Gaffey","doi":"10.1016/j.jvs.2025.03.177","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.177","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The beneficial effects of dual antiplatelet therapy (DAPT) compared to single antiplatelet therapy (SAPT) have been well established in coronary and carotid endovascular interventions; however, no consensus exists to the role of DAPT in lower extremity endovascular therapies (ET). We aimed to investigate the impact of postoperative DAPT following ET in patients presenting with chronic limb-threatening ischemia (CLTI) in the Vascular Quality Initiative-Medicare-Linked (Vascular Implant Surveillance and Interventional Outcomes Network [VISION]) database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was a multicenter retrospective analysis of prospectively collected VQI-Medicare-Linked data. The VISION database was queried for all ETs performed for infrainguinal occlusive disease between 2011 and 2019. The patients were stratified by discharge antiplatelet regimen (DAPT vs. SAPT). SAPT patients received either aspirin or P2Y12 inhibitors whereas DAPT patients received both. The primary outcome was 1- and 5-year amputation-free survival (AFS). The secondary outcomes included 1- and 5-year overall survival, limb salvage (freedom from major amputation), and freedom from reintervention. Kaplan-Meier survival estimates and Cox regression were used for analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included two cohorts: SAPT (N=10,086, 41.7%) and DAPT (N=14,081, 58.3%). The patients in SAPT cohort were older than their DAPT counterparts and were more likely to have congestive heart failure and chronic kidney disease. While the patients in the DAPT cohort were more likely to have diabetes and coronary artery disease. In survival analyses, compared to SAPT, 1-year AFS in the DAPT cohort was 67.9% vs. 63.7% (P&lt;.001) and 5- year AFS was 30.4% vs. 24.6% (P&lt;.001). After adjusting for potential confounders, DAPT was associated with reduced hazards of major amputation or death at 1-year (adjusted hazard ratio [aHR]=0.82; 95% confidence interval [CI], 0.75-0.89; P&lt;.001) and 5-year (aHR=0.91; 95% CI, 0.84-0.99; P=0.027). DAPT was also associated with lesser hazards of death (aHR=0.90; 95% CI, 0.81-0.99; P=0.048) and major amputation (aHR=0.86; 95% CI, 0.79-0.93; P&lt;.001) at 1-year but not 5-year. Reintervention was not impacted by the antiplatelet therapy strategy. In our sub-analysis, we found superior five-year overall and amputation-free survivals in patients receiving DAPT compared to aspirin alone and also in patients receiving P2Y12 inhibitor alone compared to aspirin alone. However, the outcomes of DAPT vs. P2Y12 inhibitor alone were not significantly different.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this large Medicare-linked national analysis, we found that DAPT is associated with improved AFS up to five years following ET in patients with CLTI compared to SAPT. However, there was no difference between DAPT and P2Y12 inhibitor alone. Additionally, P2Y12 inhibitor was associated with improved AFS up to five years compared to","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}