Seminars in Vascular Surgery最新文献_第2页

Management of chronic venous insufficiency in older adults 老年人慢性静脉功能不全的处理

IF 2.4 3区医学

Seminars in Vascular Surgery Pub Date : 2025-09-01 DOI: 10.1053/j.semvascsurg.2025.06.005

Judy Li, Melissa Kumi, Cassius Iyad Ochoa Chaar

引用次数: 0

Assessment and management of chronic venous, arterial, and diabetic wounds in older adults 老年人慢性静脉、动脉和糖尿病性伤口的评估和处理

IF 2.4 3区医学

Seminars in Vascular Surgery Pub Date : 2025-09-01 DOI: 10.1053/j.semvascsurg.2025.06.007

Caitlin Dowling , Lucy Chu , Yana Etkin , Alisha Oropallo

{"title":"Assessment and management of chronic venous, arterial, and diabetic wounds in older adults","authors":"Caitlin Dowling , Lucy Chu , Yana Etkin , Alisha Oropallo","doi":"10.1053/j.semvascsurg.2025.06.007","DOIUrl":"10.1053/j.semvascsurg.2025.06.007","url":null,"abstract":"<div><div>Nonhealing wounds are increasingly prevalent, present in 1% to 2% of the global population, with higher incidence in geriatric patients. These chronic wounds pose challenges to older adult patients owing to physiologic changes that hinder healing, common medical comorbidities that promote inflammation and damage microcirculation, poor nutritional status and mobility, and psychosocial barriers to receiving care. In this literature review, the epidemiology, pathophysiology, systems costs, and management of chronic venous leg ulcers, arterial ulcers, and diabetic foot wounds in older adult patients are investigated. Evolving skin structure, pro-inflammatory cellular changes, and propensity for infection place the geriatric population at risk for all wound types. Strategies to differentiate between nonhealing wounds through physical examination, standardized tools, and patient-specific characteristics are outlined. Optimal wound care management principles for each wound type, including wound bed debridement, moisture optimization, biofilm control, and management of edema are addressed. Venous leg ulcers secondary to venous insufficiency are particularly common in older adults and often recur, requiring innovative techniques in compression and tissue substitutes. Emerging therapies, including skin grafts, hyperbaric and topical oxygen, and bedside imaging devices, are discussed. Finally, older adult patients are susceptible to social circumstances that place them at risk for suboptimal wound care and poor healing. The combination of access gaps to regular caretakers, immobility, nociceptive and neuropathic pain, and frailty must be acknowledged and addressed in older adult patients with wounds. The aims of this literature review were to clarify these factors to consolidate awareness and to advocate for a multidisciplinary approach to wound care management.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 281-290"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perioperative Evaluation and Risk Stratification of the Elderly Patient Undergoing Vascular Intervention 老年血管介入患者围手术期评价及风险分层

IF 2.4 3区医学

Seminars in Vascular Surgery Pub Date : 2025-09-01 DOI: 10.1053/j.semvascsurg.2025.06.003

Christina L. Cui , Arash Fereydooni , Shipra Arya , Laura M Drudi

{"title":"Perioperative Evaluation and Risk Stratification of the Elderly Patient Undergoing Vascular Intervention","authors":"Christina L. Cui , Arash Fereydooni , Shipra Arya , Laura M Drudi","doi":"10.1053/j.semvascsurg.2025.06.003","DOIUrl":"10.1053/j.semvascsurg.2025.06.003","url":null,"abstract":"<div><div>The surgical management of elderly patients has become increasingly important as the population ages in the U.S. and globally, and the incidence of cardiovascular risk factors continues to rise. Geriatric surgical patients face heightened surgical risks due to age-related physiological changes, which may extend beyond comorbidities, best described as geriatric syndromes. A thorough geriatric evaluation involves examining risk factors for these syndromes, which includes an extensive review of the patient’s medical history, frailty assessment, nutritional evaluation, medication review, and evaluation of social support. The goal of this assessment is not to deem patients “safe” or “unsafe” for surgery, but to evaluate their risk levels and identify opportunities for prehabilitation prior to surgery. This approach necessitates collaboration between surgical teams and a comprehensive perioperative team that includes geriatricians. This narrative review aims to analyze the components of a geriatric evaluation and identify subsequent actions for patients at increased risk of postoperative complications and identify areas for innovation as it relates to vascular care in aging populations.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 209-218"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Complex aortic repair in older adults 老年人复杂主动脉修复

IF 2.4 3区医学

Seminars in Vascular Surgery Pub Date : 2025-09-01 DOI: 10.1053/j.semvascsurg.2025.07.002

Maha Haqqani, Hans Boggs, Jordan R. Stern

引用次数: 0

Management and outcomes of thoracic dissection in older adults 老年人胸夹层的处理和结果

IF 2.4 3区医学

Seminars in Vascular Surgery Pub Date : 2025-09-01 DOI: 10.1053/j.semvascsurg.2025.06.004

Blake E. Murphy, Sara L. Zettervall

{"title":"Management and outcomes of thoracic dissection in older adults","authors":"Blake E. Murphy, Sara L. Zettervall","doi":"10.1053/j.semvascsurg.2025.06.004","DOIUrl":"10.1053/j.semvascsurg.2025.06.004","url":null,"abstract":"<div><div>Aortic dissection carries significant morbidity and mortality, particularly with involvement of the ascending aorta. The estimated prevalence of aortic dissection in the general population is between 2.0 and 3.5 per 100,000 people; the risk of which increases with age and underlying risk factors, such as hypertension, long-term tobacco use, and genetic aortopathy. The older adult population continues to increase exponentially, with people older than 65 years accounting for nearly 20% of the total population. The unique challenges associated with treating older patients include consideration of reduced physiologic reserve, increased comorbidity profiles, and clinical frailty. Although surgical repair and endovascular repair have notable survival benefits in the setting of acute aortic dissection, older patients are more frequently offered medical management alone. More recently, the proliferation and evolution of endovascular therapies has offered novel and minimally invasive treatment options for older patients with acute and chronic post-dissection thoracoabdominal aortic aneurysms. In this article, the underlying risk factors, pathophysiology, and clinical decision making for patients with acute dissection are described. In addition, the considerations for treatment of both acute and chronic aortic dissection in this unique patient population are outlined.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 3","pages":"Pages 234-242"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Introduction to Contemporary Issues in Vascular Surgery Education 血管外科教育中的当代问题导论

IF 3.3 3区医学

Seminars in Vascular Surgery Pub Date : 2025-06-01 DOI: 10.1053/j.semvascsurg.2025.04.009

M. Libby Weaver (Guest Editors) , Brigitte K. Smith

引用次数: 0

Teaching health disparities in vascular surgery training programs 血管外科培训项目中的健康差异教学

IF 3.3 3区医学

Seminars in Vascular Surgery Pub Date : 2025-06-01 DOI: 10.1053/j.semvascsurg.2025.04.005

Taylor Carter , M. Libby Weaver

引用次数: 0

Diversity, equity, and inclusivity in vascular surgical education 血管外科教育的多样性、公平性和包容性

IF 3.3 3区医学

Seminars in Vascular Surgery Pub Date : 2025-06-01 DOI: 10.1053/j.semvascsurg.2025.04.003

Chelsea Dorsey , Ashley Gordon , Maryam Hashmi , Simi Ogunnowo , Luigi Pascarella , Gabrielle Sutton , Rana Afifi

{"title":"Diversity, equity, and inclusivity in vascular surgical education","authors":"Chelsea Dorsey , Ashley Gordon , Maryam Hashmi , Simi Ogunnowo , Luigi Pascarella , Gabrielle Sutton , Rana Afifi","doi":"10.1053/j.semvascsurg.2025.04.003","DOIUrl":"10.1053/j.semvascsurg.2025.04.003","url":null,"abstract":"<div><div>The decline in diversity in medical education, following the Supreme Court’s 2023 ruling against race-based affirmative action, exacerbates existing health disparities. With decreasing enrollment of underrepresented groups in medical schools, residency attrition, and gaps in diversity, equity and inclusion (DEI) standards, urgent efforts are needed to address systemic inequities in medical training and patient care. Vascular surgery has made important progress in increasing diversity within its training programs, but there is still much work to be done to create a truly inclusive environment. While there has been growth in the representation of women within vascular surgery, the proportion of underrepresented in medicine (UriM) physicians has not kept pace. Addressing the lack of diversity in vascular surgery requires a multi-pronged approach focused on recruitment, retention, and the creation of an inclusive learning and work environment. Establishing an inclusive environment goes beyond recruitment; it requires fostering a culture where all trainees and faculty feel valued and heard. Through targeted initiatives, commitment to transparency, and systemic changes to academic and clinical environments, the field can make substantial strides in workforce diversity and in turn addressing disparities.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 184-191"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Autonomy, entrustment, self-efficacy, and decision-making: The current state of training independent surgeons 自主、委托、自我效能和决策：培养独立外科医生的现状

IF 3.3 3区医学

Seminars in Vascular Surgery Pub Date : 2025-06-01 DOI: 10.1053/j.semvascsurg.2025.04.001

Christine Kariya, Mina Boutrous, Kwame S. Amankwah

{"title":"Autonomy, entrustment, self-efficacy, and decision-making: The current state of training independent surgeons","authors":"Christine Kariya, Mina Boutrous, Kwame S. Amankwah","doi":"10.1053/j.semvascsurg.2025.04.001","DOIUrl":"10.1053/j.semvascsurg.2025.04.001","url":null,"abstract":"<div><div>Operative autonomy, entrustment, self-efficacy, and decision-making are fundamental aspects of surgical resident education. Over the past few decades, trainee operative autonomy in surgical subspecialties has been declining. Most retrospective studies evaluating clinical outcomes with increasing levels of trainee independence have found no significant rise in patient morbidity and mortality. To provide more autonomy, attendings assess their relationship with the trainee, along with the trainee's skill level, the complexity of the case, and their own confidence. Identified barriers include a desire for efficiency and expectations from patients and the hospital that the procedure be performed by the attending. Consequently, trainees can enhance their self-efficacy by fostering a relationship with the attending, demonstrating clinical competence to encourage the delegation of clinical responsibilities, and adapting to the attending’s teaching style. Techniques to improve autonomy include longitudinal evaluations of trainee independence with a variety of teaching applications and role reversal. It is essential for patients, hospital administrators, and legislators to recognize the significance of demonstrating operative independence during training to cultivate competent, self-sufficient surgeons.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"38 2","pages":"Pages 132-144"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Entrustable professional activity assessments in vascular surgery training 血管外科培训中可信赖的专业活动评估

IF 3.3 3区医学

Seminars in Vascular Surgery Pub Date : 2025-06-01 DOI: 10.1053/j.semvascsurg.2025.03.003

M. Libby Weaver , Brigitte K. Smith

引用次数: 0