Annals of vascular surgery最新文献

{"title":"Associations between Type 2 Diabetes Mellitus, Metabolic Traits, and Abdominal Aortic Aneurysm: A Cross-Ethnic Mendelian Randomization Analysis.","authors":"Zelin Niu, Long Cao, Wei Guo, Hongpeng Zhang","doi":"10.1016/j.avsg.2024.07.105","DOIUrl":"10.1016/j.avsg.2024.07.105","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that type 2 diabetes mellitus (T2DM) may protect from abdominal aortic aneurysm (AAA). However, it is unclear whether a causal relationship exists between these 2 conditions and, if so, whether it remains consistent among racial groups.</p><p><strong>Methods: </strong>Cross-ethnic Mendelian randomization (MR) was used to examine the causal relationships between T2DM, metabolic traits, and AAA. Inverse variance weighted (IVW) was the primary analysis tool, supplemented by MR-Egger, weighted median, and MR Pleiotropy RESidual Sum and Outlier. Heterogeneity and horizontal pleiotropy were assessed using the Cochran's Q test and MR-Egger intercept, respectively.</p><p><strong>Results: </strong>According to IVW, an inverse correlation between T2DM and AAA was detected in Europeans (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.84-0.99; P = 0.034) and East Asians (OR 0.87, 95% CI 0.77-0.99; P = 0.038). Fasting glucose was inversely associated with AAA in Europeans (OR 0.56, 95% CI 0.33-0.96; P = 0.034) but not in East Asians. In Europeans, fasting insulin was a risk factor for AAA (OR 3.03, 95% CI 1.53-6.01; P = 0.001), while 2-hour glucose was protective (OR 0.67, 95% CI 0.49-0.91; P = 0.011). Glycated hemoglobin (HbA1c) had no effect. Insufficient instrumental variables prevented the evaluation of the relationships of fasting insulin, HbA1c, and 2-hour glucose with AAA in East Asians.</p><p><strong>Conclusions: </strong>T2DM protects against AAA in Europeans and East Asians. The effects of different glucose metabolism characteristics on AAA may inform AAA treatment.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Volumetric Evaluation of Stent-Assisted Balloon-Induced Intimal Disruption and Relamination of Aortic Dissection (STABILISE) in Acute Type B Aortic Dissection.","authors":"Mariano Ezequiel Casciaro, Damian Craiem, Salma El Batti, Jean-Marc Alsac","doi":"10.1016/j.avsg.2024.07.101","DOIUrl":"10.1016/j.avsg.2024.07.101","url":null,"abstract":"<p><strong>Background: </strong>To quantify the volumetric aortic remodeling of patients with acute type B aortic dissection treated with the stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique.</p><p><strong>Methods: </strong>All patients with acute type B aortic dissection operated with the STABILISE technique between 2014 and 2017 with preoperative, postoperative, and >12 months (follow-up) computed tomography scans were included in this study. True lumen and total aortic volume were accurately assessed in the thoracic and abdominal portions with a semiautomatic three-dimensional tool. Associations with long-term adverse events were estimated.</p><p><strong>Results: </strong>Seventeen patients were measured at preoperative, postoperative, and a mean follow-up of 19 ± 8 months. The false lumen to total volume ratio decreased on average from 63% to 18% after STABILISE (P < 0.001) and remained around 12% at follow-up. These remodeling was more pronounced in the thoracic aorta (7%) than in the abdominal aorta (28%). The trend in aortic size growth was stronger for volumes than for maximum areas or diameters (P < 0.001, P < 0.05, and P < 0.05, respectively). Adverse events were identified in 4 patients during a long-term follow-up of 76 ± 18 months. The only aortic size variable assessed preoperatively that was associated with undesirable events was the total volume of the abdominal aorta (P < 0.05).</p><p><strong>Conclusions: </strong>A volumetric analysis of dissected aortic size after the STABILISE procedure allowed accurate quantification of mid-term aortic remodeling and helped to identify the abdominal aortic volume as a preoperative variable associated with undesirable long-term events.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Surgical Outcomes of Carotid Endarterectomy: Assessing the Impact of Consultant versus Trainee Cases on Patient Care and Surgical Training.","authors":"Celso Nunes, Luís Antunes, Catarina Lopes, João O'neill Pedrosa, Eduardo Silva, Manuel Fonseca","doi":"10.1016/j.avsg.2024.07.098","DOIUrl":"10.1016/j.avsg.2024.07.098","url":null,"abstract":"<p><strong>Background: </strong>This study assesses the impact of having a surgical trainee performing a carotid endarterectomy (CEA) procedure on the postoperative rates of stroke and death.</p><p><strong>Methods: </strong>In this observational retrospective study, consecutive patients, who underwent CEA between May 01, 2016, and July 31, 2022, were entered into a retrospectively collected database. Patients were stratified into 2 categories - consultant-led cases and trainees-led cases. Primary outcomes were 30-day stroke rate, and 30-day morbimortality. A sub analysis was performed after grouping the patients in whether there was a neurological event in the previous 6 months - symptomatic or asymptomatic.</p><p><strong>Results/conclusions: </strong>Trainees-led cases had significantly longer clamping times and higher rates of stroke in asymptomatic patients compared with consultant-led cases. Patient's safety should be our top priority. Any practice leading to a significantly increased rate of postoperative stroke must be discontinued. Training protocols and adequate supervision must ensure that trainees possess the necessary skills and knowledge to safely and effectively perform CEA procedures, thereby prioritizing patient safety.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Proximal Fixation on Aneurysm Neck Evolution after Endovascular Treatment of Infrarenal Aneurysms","authors":"","doi":"10.1016/j.avsg.2024.07.092","DOIUrl":"10.1016/j.avsg.2024.07.092","url":null,"abstract":"<div><h3>Background</h3><p>We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore &amp; Associates, Flagstaff, Ariz) with infrarenal fixation (IRF).</p></div><div><h3>Methods</h3><p>Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011–2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards.</p></div><div><h3>Results</h3><p>139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; <em>P</em> &lt; 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; <em>P</em> = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; <em>P</em> = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; <em>P</em> &lt; 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; <em>P</em> = 0.001). Oversizing &gt;15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67–28.4; <em>P</em> = 0.007).</p></div><div><h3>Conclusions</h3><p>A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediabetes and the risk of peripheral artery disease: a meta-analysis.","authors":"Yan Zhang, Bo Song, Yifan Wang, Yu Sun","doi":"10.1016/j.avsg.2024.06.045","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.06.045","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) is a significant vascular condition that can lead to severe complications, including limb ischemia and cardiovascular events. This meta-analysis aims to evaluate the association between prediabetes, an intermediate state between normoglycemia and diabetes, and the risk of developing PAD.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, EMBASE, and Web of Science databases was conducted to identify relevant cohort studies up to April 12, 2024. Data extraction was performed independently by two reviewers, and any discrepancies were resolved by consensus. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model to account for heterogeneity among studies.</p><p><strong>Results: </strong>A total of eight cohort studies comprising 90133 participants were included in the meta-analysis. The pooled analysis revealed that individuals with prediabetes had a significantly higher risk of PAD compared to those with normoglycemia (RR = 1.27, 95% CI: 1.13-1.42, p < 0.001; I² = 55%). Subgroup analyses indicated that the association was stronger in prediabetes defined by mildly elevated hemoglobin A1c (RR: 1.47) compared to those defined by impaired fasting glucose (RR: 1.21) or impaired glucose tolerance (RR: 1.17, p for subgroup difference < 0.001). In addition, a stronger association was observed for studies reporting clinically diagnosed PAD compared to studies that included asymptomatic PAD (RR: 1.32 versus 0.92, p for subgroup difference = 0.02).</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates a significant association between prediabetes and an increased risk of PAD in generally community-derived population.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polygenic Risk Score Informed Clinical Model for Improving Abdominal Aortic Aneurysm Screening","authors":"","doi":"10.1016/j.avsg.2024.06.036","DOIUrl":"10.1016/j.avsg.2024.06.036","url":null,"abstract":"<div><h3>Background</h3><p>Abdominal aortic aneurysm (AAA) is a complex disease with environmental and genetic risk factors. Polygenic risk scores (PRSs) based on disease-specific risk-associated single nucleotide variants (SNVs) have demonstrated effectiveness in stratifying individual-level disease risk for cardiovascular diseases. This prospective cohort study assessed associations of PRS of AAA (PRS_AAA) with risk of incident AAA, analyzed the effectiveness of a combined clinical-genetic risk model, and explored the clinical utility of the model in identifying high-risk individuals for AAA screening.</p></div><div><h3>Methods</h3><p>PRS_AAA was calculated using 911,440 SNVs and PRS of coronary artery disease was calculated using 2,324,683 SNVs derived from mixed ancestry genome-wide association studies. The UK Biobank was used as the study cohort. All individuals with complete genetic data available and no diagnosis of AAA at the time of recruitment were included in the analysis and followed prospectively to assess for incident AAA. A PRS-informed clinical model, Prob-AAA, was developed using clinically significant variables and PRS_AAA.</p></div><div><h3>Results</h3><p>Four hundred eighty-one thousand one hundred 5 individuals were included in the analysis with 2,668 incident AAA cases. Incident AAA increased from 0.30 to 0.93% between the lowest and highest decile of PRS_AAA; similarly, severe AAA, requiring surgery and/or presenting with rupture, increased from 23 to 39% of incident AAA cases across deciles. PRS_AAA was a predictor of incident AAA diagnosis (hazard ratio 2.06 [1.70–2.48]) independent of other clinical risk factors including male sex, older age, and smoking history. Prob-AAA was an independent predictor of incident AAA (hazard ratio 1.92 [1.69–2.20]), and identified 9.6% of cases of incident AAA compared to only 4.2% by PRS_AAA. Current screening guidelines captured 5.7% of the overall cohort, with an incident AAA rate of approximately 3.2%. Among males not included by current guidelines, Prob-AAA identified an additional cohort, approximately 2% of the overall cohort, with a similar rate of incident AAA.</p></div><div><h3>Conclusions</h3><p>Prob-AAA, a PRS-informed clinical model for AAA, improved upon the predictive power of current, clinical risk factor–informed, screening guidelines for AAA.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Status Based on Area Deprivation Index Does Not Affect Postoperative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health-Care System","authors":"","doi":"10.1016/j.avsg.2024.06.038","DOIUrl":"10.1016/j.avsg.2024.06.038","url":null,"abstract":"<div><h3>Background</h3><p>Living conditions and socioeconomic status are known to impact individual health and access to medical care. Prior research has validated the Area Deprivation Index (ADI) tool as a measure of socioeconomic disadvantage for a given locality. Living in a neighborhood with a higher ADI score has been associated with increased rates of hospital readmission due to complications following surgery. We set forth to identify the possible associations between a patient's ADI score and postoperative endovascular aneurysm repair (EVAR) outcomes in the Veterans Health Care Administration (VHA).</p></div><div><h3>Methods</h3><p>We retrospectively analyzed the outcomes of patients who underwent EVAR from January 2010 to December 2021 at a level 1A VHA Hospital. Patient demographics and intraoperative variables were obtained. ADI score was calculated based on home addresses and resulted in a local score on a scale of 1–10 and a national percentile on a scale of 1–100. We then further stratified these patients into local and national quintile groups. Local ADI 1 included scores of 1–2, and local ADI 5 included scores of 9–10. National ADI 1 comprised scores 1–20, and national ADI 5 scored 81–100. The other scores were equally divided into ADI 2, 3, and 4. Higher ADI scores were associated with lower socioeconomic status. We identified clinical outcomes, including wound infection, respiratory failure, urinary tract infection, acute kidney injury, limb stenosis, readmission, length of stay, and subsequent reintervention rates.</p></div><div><h3>Results</h3><p>241 patients underwent EVAR over the time period examined. 57.3% (<em>n</em> = 138) of patients were in quintiles 4 and 5 for local ADI; when national ADI percentiles organized these same patients, 47.3% (<em>n</em> = 114) were in quintiles 4 and 5. Patient demographics did not vary between the local and national groups. We saw no statistically significant difference in intraoperative variables, postoperative complications, readmission, loss to follow-up, or 1-year mortality rates across ADI quintiles at the local or national level. Binary Logistic Regression showed no statistical significance for local and national ADI quintiles for hospital readmission and overall postoperative complications.</p></div><div><h3>Conclusions</h3><p>We found that there was no statistical significance between hospital readmission rates or worse surgical outcomes across local and national ADI quintiles. This suggests that the VHA resources and multidisciplinary support may improve care across neighborhoods. This comprehensive care provided at VHA may mitigate postoperative complications in patients undergoing EVARs. Further research is warranted to investigate the role of area deprivation in health care and EVAR outcomes in a veteran population.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients Experience Significant Long-Term Social and Health Challenges After Major Lower Extremity Amputation","authors":"","doi":"10.1016/j.avsg.2024.07.087","DOIUrl":"10.1016/j.avsg.2024.07.087","url":null,"abstract":"<div><h3>Background</h3><p>Major lower extremity amputation is a significant life-changing event that can have long-term implications. The goal of this study was to assess long-term medical outcomes and social determinants of health (SDH) challenges in this population.</p></div><div><h3>Methods</h3><p>A retrospective review of major lower extremity (previously mentioned ankle) amputations (2018–2022) was performed at a safety-net tertiary care center. Patients who participated in an SDH survey between 6 months and 1.5 years postoperatively were included for survey analysis. Patient demographics, comorbidities, and perioperative and long-term outcomes were analyzed.</p></div><div><h3>Results</h3><p>There were 100 patients included. Mean age was 61.5 years and 23% were of female gender. The majority (57%) were Black race, 20% White race, and 21% Hispanic ethnicity. Comorbidities included diabetes (78%), chronic kidney disease (51%), coronary artery disease (31%), congestive heart failure (23%), previous cerebrovascular events (19%), and 37% used opioids preadmission. At baseline, the majority (62%) lived at home. Guillotine amputation was performed in 24%, with definitive amputation in the following and previously mentioned knee in 67% and 33%, respectively. Median length of stay was 7 days. Readmission at 30 days, 90 days, and 1 year was 13%, 30%, and 43% respectively. The average follow up was 839 days. At long-term follow up, 55% lived at home, 25% used opioids, and only 25% were independently ambulatory. In the SDH survey at follow up, 32% identified at least one SDH challenge, with younger patients more often affected (58 vs. 63 years, <em>P</em> = 0.031). SDH challenges consisted of food insecurity (17%), housing insecurity (13%), transportation challenges (13%), seeking employment (8%), difficulty paying for utilities (5%) and medications (4%), seeking further education (5%), and difficulty caring for family/friends (4%). On multivariable analysis, having at least one SDH challenge was independently associated with 1-year readmission (odds ratio 6.7, 95% confidence interval 1.3–35.8, <em>P</em> &lt; 0.001). Older age was associated with lower long-term independent ambulation (odds ratio 0.92, 95% confidence interval 0.85–0.99, <em>P</em> = 0.025).</p></div><div><h3>Conclusions</h3><p>After major lower extremity amputation, patients have significant medical and social challenges with fewer living at home, the majority were not independently ambulatory, and one-third having at least one SDH challenge. Improvements in long-term support including medical, social, and rehabilitation services are required for this vulnerable population.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment to: Risk Factors for Development of Incisional Hernia after Aortic Aneurysm Repair: Secondary Analysis of the OVER Randomized Controlled Trial. Let's Reinforce the Prophylactic Mesh Placement and Better Quality of Life","authors":"","doi":"10.1016/j.avsg.2024.07.086","DOIUrl":"10.1016/j.avsg.2024.07.086","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Vascular Deserts as a Guide for Limb Preservation Outreach Programs Successfully Targets Underserved Populations","authors":"","doi":"10.1016/j.avsg.2024.04.033","DOIUrl":"10.1016/j.avsg.2024.04.033","url":null,"abstract":"<div><h3>Background</h3><p>Vascular deserts, regions without vascular providers, previously described targets for limb salvage efforts. The Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks (CHAMPIONS) programs targeted regions for outreach and evaluated the population using desert maps.</p></div><div><h3>Methods</h3><p>At 2 events targeting underserved regions between 2022 and 2023, providers screened and educated participants on peripheral arterial and cardiovascular disease (PACD). Demographics and cardiovascular risk factors were collected. Using Arc geographic information system, vascular surgeons, and Vascular Quality Initiative (VQI) participating facilities were mapped with a 30-mile buffer. Participants were mapped with census data, and the healthy places index (HPI) was overlayed for population and social determinants of health data analysis in medical service study areas (MSSA), a geographical analysis unit. (Figure 1) Results were compared to prior statewide deserts.</p></div><div><h3>Results</h3><p>Outreach program participants' mean age was 56 (range 6–88); 39% were male, and the majority were Hispanic (86%). 27% had no primary care provider (PCP). 30% had diabetes, 10% undiagnosed before the event, 38% had hypertension, 40% undiagnosed prior to the event, and 21% described intermittent claudication. 81% made &lt;$30,000 annually, and 28% reported no health insurance. Similarities were observed when comparing program participant demographics to the population-level data from the targeted regions. Patients were more frequently Hispanic than other desert regions (68% vs. 36%, <em>P</em> &lt; 0.001). Compared to other vascular desert regions, the target population was more disadvantaged in all HPI domains, including economic (18 vs. 38%, <em>P</em> &lt; 0.001), education (21 vs. 39%, <em>P</em> &lt; 0.001), and transportation (30 vs. 40%, <em>P</em> &lt; 0.001). Worse education, financial, and transportation resources correspond to decreased care access due to poor literacy and travel burdens.</p></div><div><h3>Conclusions</h3><p>CHAMPIONS programs successfully targeted populations needing care based on vascular care desert maps, demonstrating that at-risk populations can be successfully identified and screened for cardiovascular disease.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624004680/pdfft?md5=d184115a31834779fd6f9ace444c8050&pid=1-s2.0-S0890509624004680-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}