JVS-vascular insights最新文献

{"title":"Vascular laboratory workshop increases medical student understanding of vascular diagnostic studies and promotes interest in vascular surgery specialty","authors":"Aman Kankaria BS ,&nbsp;Aidan Wiley BA ,&nbsp;John Yokemick RVT ,&nbsp;Jaycen Culp RVT ,&nbsp;Brajesh K. Lal MD ,&nbsp;Sarasijhaa K. Desikan MD","doi":"10.1016/j.jvsvi.2024.100086","DOIUrl":"10.1016/j.jvsvi.2024.100086","url":null,"abstract":"<div><h3>Objective</h3><p>The rising prevalence of vascular pathology and its associated costs in the United States burdens the health care system. This study tackles the impending shortage of vascular surgeons by examining ways to increase medical students’ interest and competence in vascular surgery. It assesses the impact of a two-session vascular laboratory (VL) workshop on medical students’ understanding of vascular pathologies, their ability to interpret VL studies, and their interest in pursuing a career in vascular surgery.</p></div><div><h3>Methods</h3><p>Approval was obtained for this survey-based study from the Institutional Review Board at the University of Maryland School of Medicine. The study involved two cohorts: the VL group (n = 30), consisting of medical students that participated in the VL workshop during their vascular surgery rotation, and the control group (n = 25) consisting of medical students on a General Surgery (GS) rotation not exposed to the VL workshop. The VL group attended two workshops that included lectures, hands-on training, and clinical shadowing. After the workshops, they completed surveys assessing their understanding of vascular pathologies and VL assessments. The GS group, recruited via email, also completed surveys evaluating their exposure to vascular surgery and understanding of VL studies. Both groups were assessed using subjective and objective multiple-choice questions.</p></div><div><h3>Results</h3><p>Following the VL workshop, the vast majority of the VL group reported greater confidence with understanding, ordering, and performing vascular lab testing. Conversely, 72% (n = 18/25) of the GS cohort self-reported little to no confidence in their understanding of the VL or ability to determine the appropriate VL study based on indication. The VL group demonstrated significantly better performance on objective questions related to vascular pathologies compared with the GS group. Both groups expressed a desire for inclusion of VL education within their preclinical years (49/55; 89.1%). Finally, two-thirds (20/30; 66.7%) of the VL group reported a significant increase in their interest in vascular surgery following the workshop.</p></div><div><h3>Conclusions</h3><p>A two-session VL workshop significantly enhances medical student confidence in utilizing diagnostic tools for assessing vascular pathology and fosters interest in vascular surgery. Implementing such workshops during preclinical education may provide earlier exposure, more research opportunities, and potentially increase medical student interest in pursuing vascular surgery as a career. Additionally, it may improve the competence of graduating medical students in diagnosing and treating vascular patients across all specialties. These findings emphasize the importance of innovative educational approaches to address the growing demand for vascular care in the United States.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000345/pdfft?md5=8cf9501581d69413492b2332e8867b7d&pid=1-s2.0-S2949912724000345-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic therapy following lower extremity endovascular revascularization: The results of a survey of vascular specialists","authors":"Marissa C. Jarosinski MD ,&nbsp;Katherine M. Reitz MD, MSc ,&nbsp;Yekaterina Khamzina MD ,&nbsp;Nathan L. Liang MD, MSc ,&nbsp;Natalie D. Sridharan MD, MSc ,&nbsp;Edith Tzeng MD","doi":"10.1016/j.jvsvi.2024.100153","DOIUrl":"10.1016/j.jvsvi.2024.100153","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Antithrombotic therapy improves endovascular intervention outcomes for peripheral artery disease. However, there are limited data guiding the choice and duration of these adjuvant therapies. Thus, we explored current antithrombotic prescribing preferences among vascular interventionalists, hypothesizing that there are varied and inconsistent treatment practices among providers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We developed and distributed a de-identified RedCap survey via Twitter and email to Vascular Quality Initiative members (February 2023). Multiple-choice questions queried antithrombotic agents and treatment durations for a clinical vignette (a claudicant on 81 mg aspirin and statin) with different arterial disease locations (iliac, femoropopliteal, or tibial vessels) and different revascularization strategies (angioplasty or stenting, with and without drug-coating). Antithrombotic options included monotherapies with antiplatelet agents or low-dose rivaroxaban; dual therapies with aspirin combined with a P2Y12 inhibitor (dual antiplatelet therapy, DAPT) or low-dose rivaroxaban (dual pathway inhibition or DPI); or triple therapy with aspirin, a P2Y12 inhibitor, and low-dose rivaroxaban. Options for therapy duration included 30, 90, 180, and 365 days, or indefinitely.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 199 respondents (17% female, 68% White race, 63% academic, 88% vascular surgery). Across all treatment scenarios, respondents selected DAPT (n = 171/199; 86%) in at least one revascularization scenario, followed by aspirin monotherapy (n = 83/199; 42%) and DPI (n = 49/199; 25%). Therapy choice did differ by both anatomic location and revascularization strategy (&lt;em&gt;P&lt;/em&gt; &lt; .05). DAPT was most selected following femoropopliteal revascularization (n = 165/199, 83%) and bare metal stenting (n = 162/198, 82%). However, aspirin monotherapy was most selected following iliac level revascularization (n = 52/197; 26%) and following percutaneous transluminal angioplasty at any level (n = 51/182; 28%). DPI was most selected following tibial revascularization (n = 39/184; 21%) and following percutaneous transluminal angioplasty (n = 38/182; 21%). Among those who selected DAPT, the 90-day (n = 99/171; 58%) duration was preferred. Those who selected DPI favored indefinite treatment durations (n = 34/49; 69%). Indefinite DAPT and DPI therapy were more commonly selected for distal level revascularization (&lt;em&gt;P&lt;/em&gt; &lt; .05). Rivaroxaban utilization was limited secondary to cost (n = 108/178; 61%), lack of demonstrated effectiveness (n = 75/178; 42%), and concern for safety and bleeding (n = 27/178; 15%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Following lower extremity endovascular treatment of peripheral artery disease, a 90-day duration of DAPT remains the most commonly selected antithrombotic regimen despite the emergence of DPI as an evidence-based antithrombotic therapy. The variability in provider prefer","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A spotter's guide to endovascular endograft recognition","authors":"Andrew Huang MD,&nbsp;Bailey Coursen PA-C,&nbsp;Craig Brown MD,&nbsp;Nicholas Osborne MD,&nbsp;Jonathan Eliason MD","doi":"10.1016/j.jvsvi.2024.100145","DOIUrl":"10.1016/j.jvsvi.2024.100145","url":null,"abstract":"<div><div>Since the first endovascular aneurysm repair of abdominal aortic aneurysms in the 1980s, there has not only been exponential growth of procedures performed per year, but also rapid proliferation of stent grafts. With the resultant growth in revision and explant procedures on these grafts, we developed this guide to aid trainees in surgery and radiology in identifying these grafts. Our goal with this spotter's guide is to allow the identification of key features from commonly implanted devices radiographically, such as points of fixation, radiopaque markers, and stent patterns. The operative approach for the treatment of endograft complications, including endoleak embolization, aortic cuff extension, laser fenestration, limb extension, and endograft explant is often dramatically impacted by the type of endograft and its individual device characteristics. The intent of this guide is to aid practitioners in identifying endovascular aneurysm repair endografts of all ages, even those that have not been implanted in years.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between aortic pathology, surgeon experience, and regional variability on use of intravascular ultrasonography during thoracic endovascular aortic repair","authors":"John J. Squiers MD ,&nbsp;Jasjit K. Banwait PhD ,&nbsp;Dan Neal MS ,&nbsp;Salvatore T. Scali MD ,&nbsp;William P. Shutze MD","doi":"10.1016/j.jvsvi.2023.100047","DOIUrl":"10.1016/j.jvsvi.2023.100047","url":null,"abstract":"<div><h3>Objective</h3><p>Intravascular ultrasound (IVUS) is a useful adjunct to obtain precise intraluminal measurements during thoracic endovascular aortic repair (TEVAR), but IVUS examination is not routinely used by all surgeons or centers during TEVAR. We sought to identify patient- and system-related factors that influence the decision to use IVUS examination during TEVAR.</p></div><div><h3>Methods</h3><p>A retrospective review of the Vascular Quality Initiative (VQI) database was performed to identify all patients undergoing TEVAR from 2015 to 2019. Multivariable logistic regression modeling with three-fold repeated cross-validation was performed to identify predictors of IVUS use during TEVAR. Association of IVUS use with contrast volume and radiation exposure was also assessed.</p></div><div><h3>Results</h3><p>A total of 12,414 patients undergoing TEVAR met the inclusion criteria. Of these, IVUS examination was used in 41.3% of cases (n = 5121). IVUS use was more common in younger patients with fewer comorbidities; however, IVUS examination was also more commonly deployed in symptomatic patients and those with a higher preoperative American Society of Anesthesiology classification. IVUS examination was use in 80% (n = 3385/4213) TEVAR procedures performed for type B aortic dissection, which accounted for 50% of total IVUS use and only 11% of cases during which IVUS examination was not used (n = 822/7293) (<em>P</em> &lt; .01). In multivariable analysis, the strongest independent predictor of IVUS use was aortic dissection (odds ratio, 13.7; 95% confidence interval, 11.7-16.3; <em>P</em> &lt; .001, with aortic aneurysm as the reference). Surgeon years of independent practice experience was not associated with IVUS use, but when accounting for clustering on physicians and geographic regions, these variables explained 15% of the variance observed in the final risk-adjusted model. After adjustment for confounding factors, IVUS use was associated with a significant decrease in fluoroscopy time and contrast volume (both <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>The decision to use IVUS examination during TEVAR is most heavily influenced by aortic pathology. Although surgeon experience was not associated with the decision to use IVUS examination, there was substantial variation in IVUS examination use among individual surgeons and VQI regions. IVUS use was associated with decreased contrast administration and fluoroscopy use but did not appear to have an impact on survival or re-intervention. Although aortic dissection was strongly associated with IVUS use, a significant number of TEVAR for dissection were performed without IVUS examination. Further research is warranted to identify the barriers to IVUS use as well as the risks and benefits of IVUS use during TEVAR so that quality benchmarks can be established and resource use is improved.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912723000442/pdfft?md5=62fbf8ef2ab477e0339351ad6a78fb26&pid=1-s2.0-S2949912723000442-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interacting with best practice advisory (BPA) notifications in the electronic medical record significantly improves screening rates for abdominal aortic aneurysms","authors":"Kaylah Pinkney BS ,&nbsp;Amin Mohamed Ahmed MD ,&nbsp;Saideep Bose MD ,&nbsp;Matthew Breeden MD ,&nbsp;Matthew R. Smeds MD","doi":"10.1016/j.jvsvi.2023.100037","DOIUrl":"10.1016/j.jvsvi.2023.100037","url":null,"abstract":"<div><h3>Objective</h3><p>Best practice advisory notifications (BPAs) have become an integral part of many electronic medical record (EMR) systems. These communications alert providers to recommended therapy or screenings for patients depending on factors found within the EMR. Our goal was to evaluate the impact of BPAs on the rate of abdominal aortic aneurysm (AAA) screening in patients who met guidelines for screening in a single-center EMR.</p></div><div><h3>Methods</h3><p>We reviewed all patients who triggered a BPA alert for AAA screening from December 2018 to December 2021 in a single tertiary academic setting. The BPA alerts the provider when closing the chart when a patient meets the criteria for AAA screening based on the United States Preventive Services Task Force recommendations of screening male patients aged 65 to 75 years with a smoking history. Provider responses to these triggers were analyzed, and the predictors of response to the advisory and its impact on AAA screening for individual patients within 6 months of the alert was evaluated.</p></div><div><h3>Results</h3><p>Over this period, 1292 patients triggered the BPA for AAA screening. After excluding deceased patients, 1205 patients were included in the final analysis. Providers interacted with rather than dismissed the BPA in 20.4% of patients. The overall screening rate in this patient cohort was 28.28%. Interacting with the BPA significantly increased the odds of being appropriately screened for a AAA (odds ratio, 2.48). A higher number of visits and BPA triggers correlated with increased odds of undergoing screening for AAA (odds ratios, 1.08 and 1.02, respectively). Additionally, patients who underwent screening were younger in age and more often African American as compared with other races. The presence and number of comorbid conditions were not associated with screening rates, although hyperlipidemia was associated with positive response to BPA.</p></div><div><h3>Conclusions</h3><p>The overall rate of appropriate AAA screening is low, despite the presence of BPAs. Positively interacting with rather than dismissing the BPA is correlated with an increased rate of appropriate AAA screening. Providers were more likely to screen patients if the patient was younger, had more health care system visits, or if the trigger was delivered more often to members of the health care team. Further study is needed to evaluate provider factors that will result in an increased adherence to recommended screening guidelines.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294991272300034X/pdfft?md5=5e925ee9e1c2aafa5ed61ad164ceae8c&pid=1-s2.0-S294991272300034X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139293269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study design of the VenaSeal Spectrum Program: Two randomized controlled trials and one single-arm prospective study of a cyanoacrylate closure system to treat early to advanced chronic venous disease","authors":"Kathleen Gibson MD ,&nbsp;Sue Kim DPM ,&nbsp;Yun Peng MS ,&nbsp;Sara Ortiz BS ,&nbsp;Manjit Gohel MBChB, MD","doi":"10.1016/j.jvsvi.2024.100124","DOIUrl":"10.1016/j.jvsvi.2024.100124","url":null,"abstract":"<div><h3>Background/Objective</h3><p>Chronic venous disease (CVD) affects &gt;25% of adults in developed countries. It is usually a progressive disease; if left untreated, can lead to advanced disease such as venous ulceration. The VenaSeal Spectrum Program compares the VenaSeal closure system (VenaSeal) to the global standards of care for CVD: endothermal ablation and surgical stripping. It also investigates VenaSeal's usefulness for patients with venous leg ulcers (VLUs). A key component of this clinical program was to measure and quantify patient satisfaction with treatments related to discomfort, healing time, and effectiveness, which often has been overlooked in CVD research. This article describes the rationale and design of the VenaSeal Spectrum Program for patients with CVD.</p></div><div><h3>Methods</h3><p>VenaSeal Spectrum is a prospective, postmarket, clinical trial program reporting outcomes from the periprocedural period through 5 years after treatment with VenaSeal. VenaSeal Spectrum has enrolled 506 participants at 32 sites in 10 countries requiring treatment for symptomatic Clinical, Etiological, Anatomical, and Pathophysiological Classification (CEAP) 2-6 CVD involving the truncal saphenous vein(s). The program is composed of three studies. Two randomized controlled trials compare VenaSeal ablation with either surgical stripping or endovenous thermal ablation in patients with symptomatic CEAP 2-5 disease. A single-arm prospective study investigates participants with active VLUs (CEAP 6) treated with VenaSeal. The unique primary end points for both randomized trials include both periprocedural and postprocedural patient treatment satisfaction measured by a new questionnaire (VenousTSQ) at 30 days post procedure and elimination of clinically relevant superficial truncal reflux in the target vein at index procedure. The primary end point for the VLU study is time to ulcer healing through 12 months. Secondary end points, which are more familiar to clinicians in this disease space, include time to return to work, complication rates, patient-reported outcome measures, and closure rates.</p></div><div><h3>Conclusions</h3><p>VenaSeal Spectrum is a rigorously designed clinical study program with a large study population and unique patient-centric end points after treatment with VenaSeal for early to advanced symptomatic CVD. The studies report on the safety, effectiveness, and patient experience outcomes including two new primary end points assessing the specific needs of patients with venous insufficiency from the periprocedural period through 5-year follow-up.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000722/pdfft?md5=956857bd40208b772e0e35cfe40452e8&pid=1-s2.0-S2949912724000722-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-five years of previous research establish that operating room utilization is an invalid metric of theatre productivity","authors":"Franklin Dexter MD, PhD, FASA,&nbsp;Richard H. Epstein MD, FASA","doi":"10.1016/j.jvsvi.2024.100118","DOIUrl":"10.1016/j.jvsvi.2024.100118","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000667/pdfft?md5=730c3119db7ea8aac62c3a710ee4b030&pid=1-s2.0-S2949912724000667-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidance to mitigate occupational risks for the pregnant vascular surgery trainee","authors":"Kathryn L. DiLosa MD, MPH ,&nbsp;Christina L. Cui MD, MAS ,&nbsp;Margaret A. Reilly MD, MS ,&nbsp;Ruojia Debbie Li MD, MS ,&nbsp;Eric B. Pillado MD, MBA, MS ,&nbsp;Guillermo A. Escobar MD ,&nbsp;Kelly Kempe MD, MS ,&nbsp;Melissa Kirkwood MD ,&nbsp;John E. Rectenwald MD, MS ,&nbsp;Palma M. Shaw MD ,&nbsp;Malachi G. Sheahan MD ,&nbsp;Jason T. Lee MD ,&nbsp;Dawn M. Coleman MD","doi":"10.1016/j.jvsvi.2024.100126","DOIUrl":"10.1016/j.jvsvi.2024.100126","url":null,"abstract":"<div><p>Increasing diversity among vascular surgeons and trainees has introduced a growing number of female trainees in vascular surgery, which necessitates the creation of guidelines that both support and protect those wishing to pursue family planning during training. The expectations of long work hours, clinical responsibilities, and radiation exposure associated with surgical training place pregnant trainees at increased risk for complications. These include intrauterine growth restriction, premature delivery, and postpartum depression. It is therefore important to establish guidelines that address the specific risks of training in vascular surgery to prioritize the health and well-being of pregnant trainees. Existing literature and recommendations surrounding support and protections for the pregnant individual and guidelines created for trainees desiring to start a family within other medical societies were reviewed and used to form the foundation for relevant recommendations to guide program directors in vascular surgery. While considering vascular surgery trainees’ unique risks and demands, guidance surrounding radiation exposure, clinical responsibilities, parental leave, and culture paradigms is described to establish minimum recommendations for training programs. Strategies to incorporate a culture of support to protect trainees are necessary to both recruit and retain talent within the field. Integration of this guidance into training programs is a crucial first step toward more successful recruitment of female talent and prevention of burnout and subsequently leading toward successful retention and satisfaction within the specialty.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000746/pdfft?md5=1a633c50456e351eb1a646e059c2ca72&pid=1-s2.0-S2949912724000746-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Need for and update on clinical trials for uncomplicated type B aortic dissection","authors":"Michael Greshan Rasiah BSc (Hons), MBBS, AICSM, ARSM, MRCS, PGCert, AKC,&nbsp;Mohamed Ahmed Abdelhalim PhD, MRCS,&nbsp;Bijan Modarai PhD, FRCS","doi":"10.1016/j.jvsvi.2024.100130","DOIUrl":"10.1016/j.jvsvi.2024.100130","url":null,"abstract":"<div><div>The mainstay of management for uncomplicated type B aortic dissection is currently optimal medical therapy, targeting blood pressure and heart rate, along with serial imaging. There is a paucity of data that informs whether early intervention with thoracic endografting in this group of patients will promote aortic remodeling and better long-term outcomes. Investigations to date, including the Investigation of Stent Grafts in Aortic Dissection (INSTEAD), INSTEAD-XL, and Acute Dissection: Stent Graft or Best Medical Therapy (ADSORB) studies, have compared thoracic endovascular aortic repair (TEVAR) with optimal medical therapy in patients with uncomplicated type B aortic dissection but have not shown a benefit for TEVAR conclusively. We discuss three major new randomized trials, which will recruit concurrently in Scandinavia (the Scandinavian trial of uncomplicated aortic dissection therapy [SUNDAY] trial), in the United States (the IMPRoving outcomes in vascular DisEase - aortic dissection [IMPROVE-AD] trial) and the United Kingdom (the Early aortic repair in patients needing endovascular surgery for type B aortic dissection [EARNEST] trial), which promise to provide conclusive, level 1 evidence to decipher whether early TEVAR in this cohort of patients in beneficial.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100130"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of lower limb angioplasty training using a virtual reality simulator among vascular surgical residents","authors":"Inez Ohashi Torres PhD ,&nbsp;Nicole Inforsato MD ,&nbsp;Sabine Wipper PhD ,&nbsp;Erasmo Simão da Silva PhD ,&nbsp;Pedro Puech-Leão PhD ,&nbsp;Nelson De Luccia PhD","doi":"10.1016/j.jvsvi.2023.100043","DOIUrl":"10.1016/j.jvsvi.2023.100043","url":null,"abstract":"<div><h3>Background</h3><p>We assessed the skill acquisition, operative competency, and confidence of vascular surgery residents during a limb angioplasty workshop and evaluated their surgical volume and retention rate at 1 year.</p></div><div><h3>Methods</h3><p>For 3 years (2018-2020), all residents and fellows in their final year of vascular residency at a teaching hospital were enrolled. Five residents in 2018 were enrolled in the control group (apprenticeship model). Twelve residents and fellows from 2019 (training group) and 2020 (coronavirus disease 2019 [COVID-19] group) were trained using the ANGIO Mentor (Simbionix Ltd, Airport City, Israel) in two workshops. The residents were evaluated using the Objective Structured Assessment of Technical Skills, simulator metrics, and a confidence questionnaire. A <em>P</em> value of &lt; .05 was considered statistically significant.</p></div><div><h3>Results</h3><p>The groups were similar in age, sex, and number of limb angioplasties performed (control group, 25.00 ± 5.52; training group, 23.16 ± 7.44; COVID-19 group, 24.50 ± 8.17; <em>P</em> = .91, Student <em>t</em> test). The residents of the training and COVID-19 groups showed significantly improved Objective Structured Assessment of Technical Skills scores after the first workshop (from 15.5 [interquartile range (IQR), 12.62-19.13] to 29.5 [IQR, 25.25-39.38]; and from 14.50 [IQR, 13.62-15.00] to 23.5 [IQR, 21.87-24]; <em>P</em> &lt; .001]; respectively) and reported confidence improvement (from a median of 3 [IQR, 3-3] to 4 [IQR, 4-5]; <em>P</em> = .01). After 6 months, the retention rate was good. During that semester, each resident performed a median of 10.50 limb angioplasties (IQR, 7.00-13.25 limb angioplasties). The second workshop did not improve either the residents' scores or their confidence. At the end of the year, the control group scored worse than did the training and control groups (control group, 23.50 [IQR, 19.00-24.50]; training group, 37.0 [IQR, 36.50-39.37]; COVID-19 group, 34.75 [IQR, 30.75-38.75]; <em>P</em> = .005, Kruskal-Wallis test). The simulation metrics did not show significant differences among the groups.</p></div><div><h3>Conclusions</h3><p>A 3-week limb angioplasty workshop can improve residents' skills and confidence. Performing 10 angioplasties per semester is sufficient to ensure the retention rate is good after 6 months, and a second workshop is unnecessary.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912723000405/pdfft?md5=ff00f9f86fe5f9a46bcb2a2b96083c8c&pid=1-s2.0-S2949912723000405-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138989666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}