Annals of vascular surgery最新文献

{"title":"Early Opioid Use and Postoperative Delirium Following Open Abdominal Aortic Aneurysm Repair","authors":"","doi":"10.1016/j.avsg.2024.07.090","DOIUrl":"10.1016/j.avsg.2024.07.090","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative delirium is a common complication following open abdominal aortic aneurysm repair (OAR). Opioids have been found to contribute to delirium, especially at higher doses. This study assessed the impact of early postoperative opioid analgesia on postoperative delirium incidence and time to onset. We hypothesized that higher early postoperative opioid utilization would be associated with increased postoperative delirium incidence.</p></div><div><h3>Methods</h3><p>This was a retrospective analysis of OAR cases at a single quaternary care center from years 2012–2020. The primary exposure was oral morphine equivalents use (OME), calculated for postoperative days 1–7. A cut point analysis using a receiver operator curve for postoperative delirium determined the threshold for high OME (OME&gt;37 mg). The primary outcome was postoperative delirium incidence identified via chart review. Multivariable logistic regression was performed for postoperative delirium and adjusted for covariates meeting <em>P</em> &lt; 0.1 on bivariate analysis.</p></div><div><h3>Results</h3><p>Among 194 OAR cases, 67 (35%) developed postoperative delirium with median time to onset of 3 days (IQR = 2–6). Patients with postoperative delirium were older (74 years vs. 69 years), more frequently presented with symptomatic AAA (47% vs. 27%) and had a higher proportion of comorbidities (all <em>P</em> &lt; 0.05). Cases with high OME utilization on postoperative day 1 (55%) were younger (69 vs. 73 years), less frequently had an epidural (46% vs. 77%), and more frequently developed delirium (42% vs. 25%, all <em>P</em> &lt; 0.05). Epidural use was associated with a significant decrease in OME utilization on postoperative day 1 (33 vs. 83, <em>P</em> &lt; 0.01). Postoperative delirium onset was later in those with high OME use (4 vs. 2 days, <em>P</em> = 0.04). On multivariable analysis, high OME remained associated with postoperative delirium (Table II).</p></div><div><h3>Conclusions</h3><p>High opioid utilization on postoperative day 1 is associated with increased postoperative delirium and epidural along with acetaminophen use reduced opioid utilization. Future study should examine the impact of opioid reduction strategies on outcomes after major vascular surgery.</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/S0890509624004801/pdfft?md5=ec2387bf64fa6c510c84839b0e6f96c1&pid=1-s2.0-S0890509624004801-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787093","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}

{"title":"Contemporary National Incidence and Outcomes of Acute Limb Ischemia.","authors":"Marissa C Jarosinski, Jason N Kennedy, Stuthi Iyer, Edith Tzeng, Mohammad Eslami, Natalie D Sridharan, Katherine M Reitz","doi":"10.1016/j.avsg.2024.06.032","DOIUrl":"10.1016/j.avsg.2024.06.032","url":null,"abstract":"<p><strong>Background: </strong>Acute limb ischemia (ALI) is a morbid and deadly diagnosis. However, existing epidemiologic studies describing ALI predate the introduction of the Affordable Care Act in 2010 and direct oral anticoagulants in 2011. Thus, we synergized the National Inpatient Sample (NIS) and United States Census to define contemporary trends in the incidence, treatment, and outcomes of ALI in the US.</p><p><strong>Methods: </strong>We included emergent admissions of adults with primary diagnosis of lower extremity ALI in survey-weighted NIS data (2005-2020). Mann-Kendal trend test evaluated ALI incidence (primary outcome), anticoagulation usage, insurance coverage, revascularization type, and in-hospital amputation/death. Multivariable logistic regression quantified covariate associations with in-hospital amputation/death.</p><p><strong>Results: </strong>Of the 582,322,862 estimated hospitalizations in the NIS, 227,440 met the inclusion criteria (mean age 68.80 years, 49.94% women, 76.66% White). ALI incidence peaked in 2006 (7.16/100,000 person-years) but has declined since 2015 to 4.16/100,000 person-years in 2020 (p_trend = 0.008). Endovascular revascularization, anticoagulation, and Medicaid coverage increased, while self-pay insurance decreased (p_trend < 0.05). Amputation rates significantly decreased from 8.04 to 6.54% (p_trend = 0.01) while death rate remained at 5.59% (p_trend = 0.16) over the study period. Prehospitalization anticoagulation was associated with decreased amputation (adjusted odds ratio [aOR] = 0.74 (95% confidence interval [CI] 0.65-0.84)) and death (aOR = 0.50 (95% CI 0.43-0.57)). When controlling for covariates, women had a higher risk of death (aOR = 1.17 (95% CI 1.07-1.27), P < 0.0001), while Black patients had a higher risk of amputation (aOR = 1.24 (95% CI 1.10-1.41), P < 0.0001).</p><p><strong>Conclusions: </strong>Our US population based epidemiological study demonstrates that ALI incidence and in-hospital amputation rates are decreasing, while mortality remains unchanged. We further highlight the ongoing need for ALI investigation specifically as it relates to access to care, antithrombotic therapy use, treatment strategy, and strategies to combat gender and racial disparities.</p>","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":"141787067","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":"The Use of Clot Strength as a Predictor of Thrombosis in Peripheral Artery Disease","authors":"","doi":"10.1016/j.avsg.2024.06.041","DOIUrl":"10.1016/j.avsg.2024.06.041","url":null,"abstract":"<div><h3>Background</h3><p>Graft/stent thrombosis is the leading cause of amputation in patients over 60, and while dual antiplatelet therapy is the standard of care, there is a significant variability in platelet response and limited guidance on measuring effectiveness. Thromboelastography with platelet mapping (TEG-PM) can objectively detail an individual's coagulation profile, namely the strength of the clot and its response to antiplatelet medication. Although TEG-PM has been used for predicting postoperative bleeding and assessing platelet dysfunction in traumatic brain injury, its application in thrombosis diseases such as peripheral artery disease remains unexplored. The aim of this observational study was to determine if objective measures of clot strength could predict a high clinical risk of thrombosis.</p></div><div><h3>Methods</h3><p>Patients &gt;60 years with peripheral artery disease undergoing revascularization were prospectively evaluated from 2021 to 2023. They were clinically followed for 1 year to detect any thrombotic events. TEG-PM was used to objectively evaluate coagulation profiles in patients at 1, 3, 6, and 9 months. These follow-up periods were chosen based on studies showing that 1–3 month intervals in the first year after lower extremity revascularization optimize therapy and risk control. The TEG-PM data preceding a thrombotic/stenotic event in patients with thrombosis was compared to the last known well TEG-PM event in those without a thrombotic/stenotic event. We stratified the groups based on the occurrence of thrombosis/stenotic events. Descriptive statistics were applied to characterize each group and a chi-square test was conducted to assess the variance between both groups. An unpaired <em>t</em>-test was run to identify differences in platelet function. Receiver operating characteristic analysis was performed to determine the optimal TEG-PM cutoff for predicting a higher risk of thrombosis.</p></div><div><h3>Results</h3><p>One hundred and fifty-eight patients were analyzed, from whom 28 (17.7%) experienced a thrombotic event. The thrombosis cohort exhibited significantly greater MA_ADP, MA_Fibrin, and MA_Thrombin [50.2 vs. 40.0, <em>P</em> &lt; 0.05], [18.19 vs. 14.64, <em>P</em> &lt; 0.05], and [63.8 vs. 58.5, <em>P</em> &lt; 0.05], respectively, indicative of greater clot strength. By receiver operating characteristic analysis, the optimal predictor cut-off for MA_ADP, indicating a higher risk of thrombosis, was &gt;42 mm [<em>P</em> &lt; 0.05] with 82% sensitivity and 50% specificity.</p></div><div><h3>Conclusions</h3><p>An increase in clot strength was found to be predictive of thrombosis/stenosis within 30 days. Using a MA_ADP cut-off greater than 42 mm might serve as an alternative approach to tailor the use of antiplatelet medication, potentially reducing the risk of thrombosis.</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":"141787101","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":"Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases","authors":"","doi":"10.1016/j.avsg.2024.06.034","DOIUrl":"10.1016/j.avsg.2024.06.034","url":null,"abstract":"<div><h3>Background</h3><p>Integrated vascular surgery residency positions have doubled more than the last decade. Studies have investigated the impact of co-existing subspecialty surgical training programs on case volume of general surgery residents (GSRs). However, no studies have explored the impact of subspecialty training on GSR operative competency. The aim of this study is to understand the impact of integrated residencies on operative performance and autonomy of GSR performing vascular procedures.</p></div><div><h3>Methods</h3><p>Autonomy and performance ratings of GSR participating in vascular surgery cases were collected from all institutions participating in the Society for Improving Medical Professional Learning application database from 2015 to 2023. Faculty and self-assessments of autonomy and performance on vascular cases performed by GSRs at programs with co-existing vascular integrated residency (VIR), vascular surgery fellowship (VSF), or no subspecialty vascular training (VX) were compared using Fisher's exact tests with Bonferroni corrections across training levels and case complexity.</p></div><div><h3>Results</h3><p>Eleven thousand one hundred seventy five assessments (26% at institutions with VIR, 46% VSF, and 28% VX) were submitted by 920 GSRs and 343 faculty. Senior GSRs at programs with VSF achieved lower autonomy than those with VIR (<em>P</em> = 0.049) or VX (<em>P</em> = 0.042) based on faculty assessment. GSRs achieved a level of “practice ready” at significantly higher rates when training at programs with VIR, and at the lowest rates with VSF (<em>P</em> &lt; 0.001). However, self-perception of autonomy and performance was highest among GSRs at programs with VX compared with VIR and VSF (<em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The presence of VIR was associated with higher achievement of “practice ready” competency and higher levels of operative autonomy among senior GSRs performing vascular procedures. Shared-learning among peers and faculty expertise in teaching resident-level trainees may contribute to this finding.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787065","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":"Supine Position Popliteal Vein Puncture Under Ultrasound Guidance Is a Feasible and Effective Strategy to Establish Venous Access","authors":"","doi":"10.1016/j.avsg.2024.06.017","DOIUrl":"10.1016/j.avsg.2024.06.017","url":null,"abstract":"<div><h3>Background</h3><p>This study aims to introduce the clinical application value of popliteal vein puncture in the supine position under ultrasound guidance and compare this method with popliteal vein puncture in the prone position.</p></div><div><h3>Methods</h3><p>Endovascular operations for nonthrombotic iliac vein lesion patients using popliteal vein access were performed during the period from July 2019 to August 2022 at the Zhongshan Hospital (Xiamen), Fudan University, and Shanghai Xuhui District Central Hospital. Patients were randomly divided into supine position group and prone position group. All of the patients were punctured under ultrasound guidance. The procedure duration time for popliteal vein puncture, visual analog scale (VAS) scores, and postoperative complications were recorded and compared between the 2 groups.</p></div><div><h3>Results</h3><p>Totally 120 patients were included in this study, in which 60 patients were enrolled in the supine position group and 60 patients were enrolled in the prone position group. The median procedure time from puncture to iliofemoral venography was 5.97 min (interquartile range 5.78 min–6.03 min) and 28.76 min (interquartile range 26.84 min–29.83 min; <em>P</em> &lt; 0.01 (in the supine position and prone position group, respectively. The median time from puncture to access sheath insertion was 5.05 min (interquartile range 4.88 min–5.13 min) and 5.03 min (interquartile range 4.93 min–5.12 min; <em>P</em> = 0.607) in the supine position and prone position groups, respectively. The median VAS value was 3 (interquartile range 2–3) and 8 (interquartile range 7–9, <em>P</em> &lt; 0.01) in the supine position and prone position groups, respectively. In the supine position group, one case of arterial branch injury was observed after operation and was successfully managed by ultrasound-guided compression.</p></div><div><h3>Conclusions</h3><p>Popliteal vein puncture in the supine position under ultrasound guidance is safe, significantly reduces the overall operation time without changing position, and relieves the discomfort of patients.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141722891","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":"Effect of Micronized Purified Flavonoid Fraction on Venous Hemodynamics Evaluated Using Digital Photoplethysmography in Patients with Chronic Venous Disease","authors":"","doi":"10.1016/j.avsg.2024.06.015","DOIUrl":"10.1016/j.avsg.2024.06.015","url":null,"abstract":"<div><h3>Background</h3><p>Micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available for the treatment of chronic venous disease (CVD). Photoplethysmography (PPG) is used to quantitatively measure venous hemodynamics and provide information about the overall function of the venous system. The aim of this study was to use digital PPG to evaluate the effects of MPFF on venous hemodynamics in patients with CVD.</p></div><div><h3>Methods</h3><p>Patients diagnosed with CVD at an outpatient clinic in Bursa, Turkey between February 2018 and July 2020 were assessed for inclusion in this retrospective analysis. Patients who complied with the advised treatment strategy (MPFF 1,000 mg tablets taken orally once daily and compression garments) and attended follow-up visits were included in the analysis. Digital PPG was used to measure venous refilling time (VRT) and venous pumping capacity (VPC) at diagnosis and 6 months of follow-up. The Venous Clinical Severity Score (VCSS) was also obtained at these visits, and patients completed the 20-item Chronic Venous Insufficiency Questionnaire (CIVIQ-20).</p></div><div><h3>Results</h3><p>In total, 721 patients (mean age 52 years) with C0–C4 CVD were included in the study. PPG showed that VRT and VPC increased significantly from 19.0 sec to 2.0%, respectively, at diagnosis to 27.4 and 4.9%, respectively, at 6 months (both <em>P</em> &lt; 0.05). Mean VCSS improved significantly from 7.9 at diagnosis to 3.1 at 6 months (<em>P</em> &lt; 0.05). Mean CIVIQ-20 score also improved significantly at the 6-month follow-up (20.1 vs 38.6 at diagnosis; <em>P</em> &lt; 0.01).</p></div><div><h3>Conclusions</h3><p>In patients with C0–C4 CVD, 6 months of MPFF treatment plus the wearing of compression garments was associated with statistically significant improvements in venous hemodynamic parameters measured by PPG, as well as measures of clinical severity and quality of life.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141722842","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":"The Impact of Small Artery Disease (SAD) and Medial Arterial Calcification (MAC) Scores on Chronic Wound and Amputation Healing: Can It Tell Us More?","authors":"Saranya Sundaram, Christian Barksdale, Stephanie Rodriguez, Mathew D Wooster","doi":"10.1016/j.avsg.2024.07.089","DOIUrl":"10.1016/j.avsg.2024.07.089","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In 2021, Ferraresi et al. created a novel scoring system based on the impact of small artery disease (SAD) and medial arterial calcification (MAC) on wound healing. SAD and MAC scores functioned similar to Wound, Ischemia, and foot Infection (WIfI) but with minimal resource expenditure. Despite its potential, few studies have expanded on the original dataset. We aim to validate SAD's impact and MAC's impact on wound healing outcomes and determine their utility in relation to current predictive models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Single-institution retrospective review was used to identify amputations for chronic (&gt;1 month) podiatric wounds between 2015 and 2020. Foot X-ray (MAC) or angiography (SAD) &lt; 6 months of index procedure was required. Primary outcomes included major amputation, wound healing, major adverse limb events, and amputation-free survival (AFS). Statistical analysis included chi-squared, 1-way analysis of variance, nonparametric correlation, Kaplan-Meier, Cox regression, and Akaike/Bayesian Inclusion Criteria model comparison.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 136 limbs, 67 received SAD scores (0-2) and 128 received MAC scores (0-2). SAD cohorts exhibited similar comorbidity profiles with exception of coronary disease, heart failure, and chronic kidney disease. MAC cohorts were notably disparate in prevalence of multiple conditions. High mean SAD/MAC scores were seen in severe (3-vessel) below-ankle disease (P = 0.001∗ [SAD], P = 0.041∗ [MAC]). Both SAD and MAC correlated with lower mean toe pressure (P = 0.043∗ [SAD], P ≤ 0.001∗ [MAC]), while only MAC correlated with higher overall WIfI score (P = 0.029∗). No significant procedural differences were noted. However, higher readmission rates (73.9% [2] vs. 46.9% [0], P = 0.014∗) and all-cause mortality (65.2% [2] vs. 26.0% [0], P = 0.002∗) were noted with higher MAC. Survival analysis revealed higher 1-year major amputation rates (P = 0.036∗), impaired wound healing (P &lt; 0.001∗), and lower AFS (P = 0.001∗) with increasing MAC severity. Additionally, MAC-2 patients underwent amputation at faster rates than MAC-0 patients (hazard ratio 5.25, 95% confidence interval [1.82, 9.77]) with longer times to wound healing (hazard ratio 0.21, 95% confidence interval [0.08, 0.53]). Model comparison suggested a combination of WIfI and MAC could improve accuracy of predicted time to major amputation, wound healing, and AFS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MAC scoring showed significant promise both as individual predictor and adjunct to current predictive models of long-term wound healing outcomes. Routine use of MAC scoring in chronic limb-threatening ischemia evaluation, especially when noninvasive testing is unavailable, could promote timely referral for intervention and efficient resource utilization in limited-resource or critical care settings. Furthermore investigation is necessary to determine MAC's impact on revascularization and how scoring can b","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764929","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 Outcomes of Vein Adjuncts in Distal Infrainguinal Bypass","authors":"","doi":"10.1016/j.avsg.2024.07.088","DOIUrl":"10.1016/j.avsg.2024.07.088","url":null,"abstract":"<div><h3>Background</h3><p>Autologous vein is recommended for infrainguinal bypass due to improved freedom from occlusion compared to prosthetic graft. In patients without adequate vein, a vein adjunct at the distal anastomosis has been suggested to improve patency in small studies. This study aimed to determine if performance of a distal vein adjunct was associated with improved freedom from occlusion in below-knee popliteal and tibial bypasses compared to prosthetic bypass alone.</p></div><div><h3>Methods</h3><p>A retrospective review of the Vascular Quality Initiative Infrainguinal Bypass database was conducted. Patients undergoing prosthetic-only and prosthetic with vein adjuncts were compared. Inclusion criteria included age ≥18 years, and bypass to below-knee popliteal or tibial vessels. Exclusion criteria included autologous vein conduits and prior interventions. Groups were further divided into below-knee popliteal and tibial subgroups.</p></div><div><h3>Results</h3><p>A cohort of 3,939 patients underwent bypass to the below-knee popliteal artery, with 287 (7.3%) receiving vein adjuncts. More patients were male (68.8 vs. 57.8%, <em>P</em> &lt; 0.001) and had higher rates of congestive heart failure (21.1 vs. 16.0%, <em>P</em> = 0.040) within the below-knee popliteal group. Two-year bypass occlusion was decreased in patients receiving vein adjuncts (11.6 vs. 17.1%, <em>P</em> = 0.004). A cohort of 2,378 patients underwent tibial bypass, with 473 (19.9%) receiving vein adjuncts. Within the tibial group, patients were similar in age, body mass index, race, comorbidities, and indications. Bypass occlusion (24.8 vs. 17.6%, <em>P</em> = 0.005) and amputation (20.5 vs. 15.9%, <em>P</em> = 0.048) rates at 2 years were worse for patients who did not receive a distal vein adjunct to tibial arteries.</p></div><div><h3>Conclusions</h3><p>Distal vein adjuncts are associated with improved freedom from occlusion, amputation, major adverse limb events, and overall survival when compared to bypasses performed with prosthetic graft alone for tibial bypasses within the Vascular Quality Initiative. A vein adjunct was not associated with improved freedom from occlusion in below-knee popliteal bypasses. Consideration should be given to utilization of a distal vein adjunct to improve prosthetic bypass longevity and limb salvage for patients requiring tibial bypasses.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764927","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":"Identifying Risk Factors for Poor Outcomes Following Popliteal Vascular Injuries","authors":"","doi":"10.1016/j.avsg.2024.06.037","DOIUrl":"10.1016/j.avsg.2024.06.037","url":null,"abstract":"<div><h3>Background</h3><p>Popliteal artery injuries (PAIs) may have amputation rates as high as 20%. This study focuses on identifying risk factors associated with major amputations following PAIs in a large single-center cohort. Additionally, we assess the impact of repairing or ligating concomitant popliteal vein injuries.</p></div><div><h3>Methods</h3><p>A retrospective chart review encompassing 2011 to 2023 was conducted at a large urban level 1 trauma center. Patients with PAIs were included. Demographics and clinical data were analyzed, and univariate and multivariate evaluations identified significant risk factors for amputation. In patients with concomitant popliteal vein injuries, we compared outcomes between those who underwent popliteal vein repair and ligation.</p></div><div><h3>Results</h3><p>One hundred eighty eight patients with PAIs were identified; 10 underwent index amputation and were excluded. Univariate analysis followed by multivariate analysis revealed that obesity (<em>P</em> = 0.0132) and neurologic deficits on arrival (<em>P</em> = 0.0096) were associated with amputation. In the subgroup with popliteal vein injuries (<em>N</em> = 93), there was no significant difference in amputation rates between those who had vein repair (<em>P</em> = 0.21) and those who underwent ligation (<em>P</em> = 0.84) on logistic regression analysis. Likewise, popliteal vein ligation did not impact duration of fasciotomy closure (<em>P</em> = 0.20) or skin graft area (<em>P</em> = 0.48) based on linear regression analysis.</p></div><div><h3>Conclusions</h3><p>Our study suggests that major amputations following PAIs are more likely in obese patients with neurologic deficits. It also suggests that venous ligation in cases of concomitant popliteal vein injuries does not significantly impact early limb salvage rate. Further research is needed to determine the optimal approach for managing concomitant popliteal vein injuries.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787094","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":"Complications and Technical Success on Upper Limb Vascular Access for Endovascular Repair of Complex Abdominal and Thoraco-abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.avsg.2024.06.030","DOIUrl":"10.1016/j.avsg.2024.06.030","url":null,"abstract":"<div><h3>Background</h3><p>Catheterization of target vessels (TV) represented by renal visceral vessels are the crucial aspect during fenestrated and branched endovascular repair. This study aims to assess the efficacy and complications associated with upper limb catheterization during complex aneurysm endovascular surgery repair.</p></div><div><h3>Methods</h3><p>A systematic review was conducted after Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines, involving a search across PubMed, Cochrane CENTRAL, and Web of Science. Primary endpoint was represented by 30-day stroke. Secondary endpoints were target vessels’ (TVs) technical success, 30-day mortality, and local access-related complications. Meta-analyses were performed using a random-effects model.</p></div><div><h3>Results</h3><p>Sixteen observational studies encompassing 4,137 patients were included. The 30-day stroke incidence for upper limb access was 1.4% (95% CI 1.0–1.8%), which was slightly higher than lower limb, despite not statistically significant. Mortality varied between 0 and 6.8%, and local access-related complications occurred in 3.2% (95% CI 1.9–4.4%). Technical success in TV catheterization was 99.2% (95% CI 98.4–100.0%).</p></div><div><h3>Conclusions</h3><p>This systematic review and meta-analysis demonstrate the safety and efficacy of upper limb access for Fenestrated and Branched Endovascular Aortic Repair (f/b-EVAR), with low stroke risk, mortality rates, and minimal local complications. Despite the risk of bias, the findings suggest that upper limb access may be beneficial, especially in bailout situations when femoral access fails, offering valuable insights for clinical decision-making.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764925","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}