Annals of vascular surgery最新文献

{"title":"On The Cover","authors":"","doi":"10.1016/S0890-5096(24)00266-8","DOIUrl":"10.1016/S0890-5096(24)00266-8","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141637925","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":"Analysis of High-Risk Factors and Mortality Prediction of Ruptured Abdominal Aortic Aneurysm","authors":"","doi":"10.1016/j.avsg.2024.05.044","DOIUrl":"10.1016/j.avsg.2024.05.044","url":null,"abstract":"<div><h3>Introduction</h3><p>Ruptured abdominal aortic aneurysms (RAAAs) are among the most dangerous emergencies in vascular surgery, with a high death rate and numerous risk factors influencing perioperative death. Therefore, identifying the critical risk factors for RAAAs is crucial to increasing their survival rate. Our aim was to identify those risk factors from a wide range of parameters.</p></div><div><h3>Methods</h3><p>Retrospective analysis of hospitalized RAAA patients treated at this center between May 2004 and January 2023. After comparing the preoperative data of patients who survived and those who died, high-risk characteristics influencing the perioperative care of RAAA patients were identified, and logistic regression analysis was carried out. The mean follow-up time was 45.34 months.</p></div><div><h3>Results</h3><p>During the study period, a total of 155 patients (average age 67.4 ± 71.93 years, 123 (78.85%) males, 32 (20.51%) females) were enrolled. The patients participating in the group were divided into survival group (<em>n</em> = 123) and death group (<em>n</em> = 27). The main differences included hemodynamic instability (51.9% vs 28.5%; <em>P</em> = 0.019), sudden cardiac arrest (14.8% vs 1.6%; <em>P</em> = 0.010), deterioration of consciousness (40.7% vs 17.1%; <em>P</em> = 0.007), renal impairment (22.2% vs 2.4%; <em>P</em> = 0.001), and chronic kidney disease (18.5% vs3.2%; <em>P</em> = 0.010). There is also a history of cancer (Ca) (18.5% vs 4.1%; <em>P</em> = 0.021). Risk factors for endovascular aneurysm repair (EVAR) include diastolic blood pressure ≤50 mm Hg (36.4% vs 8.0%; <em>P</em> = 0.025), renal function impairment (18.2% vs 0; <em>P</em> = 0.015), and chronic kidney disease (27.3% vs 4.0%; <em>P</em> = 0.028). Risk factors for open surgical repair (OSR) include diastolic blood pressure ≤50 mm Hg (40.0% vs 6.3%; <em>P</em> = 0.014). Finally, the previously mentioned statistically significant factors were analyzed by logistic regression analysis, and it was found that diastolic blood pressure ≤50 mm Hg, cardiac arrest, renal function damage, and Ca history were independent risk factors. We followed 123 individuals and 14 were lost to follow-up, with an overall survival rate of 43.8%.</p></div><div><h3>Conclusions</h3><p>Hemodynamics, which includes shock, blood pressure, cardiac arrest, deterioration of consciousness, and other conditions, are the primary risk factors for the perioperative death of a ruptured abdominal aortic aneurysm. Simultaneously, diastolic blood pressure ≤50 mm Hg was found to be associated with risk factors for OSR, whereas renal function impairment, chronic renal illness, and diastolic blood pressure ≤50 mm Hg were associated with the risk for EVAR.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709224","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":"Review of Scoring Systems for Predicting 30-Day Mortality in Ruptured Abdominal Aortic Aneurysm","authors":"","doi":"10.1016/j.avsg.2024.05.041","DOIUrl":"10.1016/j.avsg.2024.05.041","url":null,"abstract":"<div><h3>Background</h3><p>Ruptured abdominal aortic aneurysms (rAAAs) are a serious disease that can lead to high mortality; thus, their early prediction can save patients' lives. The aim of this study was to compare the accuracies of various models for predicting rAAA mortality—including the Glasgow Aneurysm Score, Vancouver Scoring System, Dutch Aneurysm Score, Edinburgh Ruptured Aneurysm Score (ERAS), and Hardman index—based on rAAA treatment outcomes at our institution.</p></div><div><h3>Methods</h3><p>Between 2016 and 2022, we retrospectively analyzed the early outcome data—including 30-day mortality—of patients who underwent emergency surgery for rAAA at our institution. Receiver operating characteristic curve analysis was performed to compare the aneurysm scoring systems for mortality using the area under the receiver operating characteristic curve (AUC).</p></div><div><h3>Results</h3><p>The AUC was better for the ERAS (0.718; 95% confidence interval, 0.601–0.817) than for the other scoring systems. Significant differences were observed between ERAS and Hardman indices (difference: 0.179; <em>P</em> = 0.016). No significant differences were found among the Glasgow Aneurysm Score, Vancouver Scoring System, and Dutch Aneurysm Score predictive risk models.</p></div><div><h3>Conclusions</h3><p>Among the models for predicting mortality in patients with rAAA, the ERAS model demonstrated the highest AUC value; however, significant differences were only observed between ERAS and Hardman indices. This study may help develop strategies for improving rAAA prediction.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624004400/pdfft?md5=dd7516d2037a8c10ee641e9877020f10&pid=1-s2.0-S0890509624004400-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709041","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 Experience of the Neo-Aortoiliac System (NAIS) Procedure: A Case Series with Review of the Literature","authors":"","doi":"10.1016/j.avsg.2024.05.033","DOIUrl":"10.1016/j.avsg.2024.05.033","url":null,"abstract":"<div><h3>Objectives</h3><p>Aortic graft infection (AGI) is a life-threatening complication that can result in death, amputation, sepsis, aorto-enteric fistula, and pseudoaneurysm formation. After explantation of the infected graft, options for reconstruction include extra-anatomic bypass or in-line reconstruction using antibiotic-coated prosthetic graft, cryopreserved allograft, or a neo-aortoiliac system (NAIS) using autogenous femoral veins. While the NAIS procedure has shown promising results, there is relatively limited clinical experience due the magnitude and morbidity of the surgery. In this study, we reviewed our single-center experience using the NAIS procedure and performed a systematic review of the contemporary literature more than the past decade.</p></div><div><h3>Methods</h3><p>A retrospective review was performed on all patients undergoing NAIS reconstruction with autogenous femoral vein conduits at a single institution from 2010 to 2022. Pubmed, Embase, and Cochrane Library databases were queried for studies published from 2012 to 2022 to identify those reporting on outcomes of patients undergoing the NAIS procedure. Outcome variables included early and late mortality, major complications including amputation, graft or conduit related complications, re-infection, and re-intervention. Additional variables collected include patient demographics, operative technique, and follow up.</p></div><div><h3>Results</h3><p>There were 14 patients included in our case series with 30-day mortality of 21%. At a mean follow up of 22 months, complication rate was 64.3%, re-intervention rate was 14.3%, re-infection rate was 7.1%, and amputation rate was 7.1%. On review of the literature, 12 studies ultimately met criteria to be included in analysis with a combined total of 368 patients. Pooled averages included 30-day mortality of 9.0%, re-intervention rate of 20.5%, re-infection rate of 5.6%, and amputation rate of 6.5%.</p></div><div><h3>Conclusions</h3><p>The NAIS procedure for management of AGI is a formidable procedure with significant early mortality and morbidity. This treatment should be considered in the context of other revascularization options for management of an AGI.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632498","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":"Independent Factors Influencing Changes in Baroreceptor Sensitivity after Carotid Endarterectomy","authors":"","doi":"10.1016/j.avsg.2024.06.008","DOIUrl":"10.1016/j.avsg.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Carotid endarterectomy (CEA) is a well-established standard therapy for patients with symptomatic or asymptomatic high-grade carotid stenosis. The aim of carotid endarterectomy is to decrease the risk of stroke and avoid relevant functional loss. However, carotid endarterectomy is known to be associated with hemodynamic dysregulation. In this study we compared eversion CEA (E-CEA) and conventional CEA (C-CEA) regarding postoperative blood pressure values as well as preoperative and postoperative baroreceptor sensitivity in the first 7 days after surgery. The aim was to find possible factors influencing changes in baroreceptor sensitivity.</p></div><div><h3>Methods</h3><p>Patients (111 patients were enrolled, of which 50 patients received C-CEA and 61 patients E-CEA) were prospectively enrolled in this study. For the measurement of baroreceptor sensitivity, a noninvasive Finometer measuring device from Finapres Medical System B.V. (Amsterdam, The Netherlands) was used. Measurements were performed 1 day before surgery (PRE), directly after surgery (F1), on day 1 (F2), day 2 (F3), and on day 7 (F4) postoperatively.</p></div><div><h3>Results</h3><p>Postoperative blood pressure values were significantly higher in the E-CEA group on the day of surgery (F1) (<em>P</em> &lt; 0.001) and on day 1 (F2) (<em>P</em> &lt; 0.001). From day 2 (F3, F4) postoperatively, no significant difference was found between the 2 groups. The invasive blood pressure measurement in the postoperative recovery room showed significantly higher systolic blood pressure values in the E-CEA group (<em>P</em> = 0.001). The need of acute antihypertensive therapy was significantly higher in the recovery room in the E-CEA group (<em>P</em> = 0.020). With regard to changes in baroreceptor sensitivity, significantly lower baroreceptor sensitivity (BRS) values were recorded in the E-CEA group at 1 day (F2) postoperatively (<em>P</em> = 0.005). The regression analysis showed that the applied surgical technique and the patient’s age were significant factors influencing changes in baroreceptor sensitivity.</p></div><div><h3>Conclusions</h3><p>In this study we could confirm higher blood pressure levels after E-CEA in the first 2 days after surgery. Additionally, we identified 22 factors possibly influencing baroreceptor sensitivity: surgical technique and age. Based on the data obtained in this study, hemodynamic dysregulation after CEA (E-CEA, C-CEA) is temporary and short-term. Already after the second postoperative day, there was no significant difference between the E-CEA and E-CEA groups, this effect remained stable after 7 days.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624004035/pdfft?md5=d373094914e45cd0490fe414d7391885&pid=1-s2.0-S0890509624004035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632499","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":"Reintervention Rate after Treatment with the INCRAFT AAA Ultra–Low-Profile Stent Graft System","authors":"","doi":"10.1016/j.avsg.2024.05.023","DOIUrl":"10.1016/j.avsg.2024.05.023","url":null,"abstract":"<div><h3>Background</h3><p>The INCRAFT stent graft system is an ultra–low-profile endograft for the exclusion of infrarenal aortic aneurysms. In the market approval studies, an increased rate of device-related complications was observed and the endograft was approved with mandated postmarketing investigations. Our aim was to analyze mid-term outcomes of a real-world patient cohort treated with the INCRAFT endograft.</p></div><div><h3>Methods</h3><p>Consecutive patients treated with the INCRAFT endograft between February 2015 and December 2022 at a single institution were included. In accordance with the Society for Vascular Surgery reporting standards, safety endpoints were reported and outcome endpoints included reinterventions, technical success, aortic-related and overall-mortality, endoleak, stent fracture, and endograft migration &gt;5 mm.</p></div><div><h3>Results</h3><p>Eighty patients (85% male) with a mean age of 76 ± 7 years were included. Fifty-two patients (65%) were treated within the endograft's instruction for use. Mean aortic diameter was 59 ± 10 mm and 91% of the procedures were performed percutaneously. Mean follow-up (FU) was 37 ± 25 months and there was no aortic- or procedure-related mortality. Reinterventions occurred in 25 patients (31%) with a freedom from reintervention at 1, 3, and 5 years of 84%, 66%, and 55%. The most frequent reinterventions were limb graft stenting (23%) and type II endoleak embolization (14%). Limb occlusion rate was 9% and in 3 patients (4%) distal endograft migrations &gt;5 mm occurred. Persisting type II endoleaks were observed in 29% and aneurysm diameter was stable in 41% and had shrunk in 38%. Three type III endoleaks (4%) developed during FU and 4 open conversions (5%) were necessary. No known risk factors, including treatment outside instruction for use, were predictive for reinterventions.</p></div><div><h3>Conclusions</h3><p>Treatment of infrarenal aortic aneurysms with the INCRAFT stent graft system was safe and successful. Nevertheless, a substantial rate of reinterventions was necessary during FU to maintain endograft patency and prevent aneurysm growth.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624004059/pdfft?md5=febc6f5306832813c8d0a83e8a68a41c&pid=1-s2.0-S0890509624004059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632501","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":"A Bibliometric Analysis on Adherence to Reporting Standards for Endovascular Treatment of Chronic Lower Extremity Peripheral Artery Disease","authors":"","doi":"10.1016/j.avsg.2024.06.013","DOIUrl":"10.1016/j.avsg.2024.06.013","url":null,"abstract":"<div><h3>Background</h3><p>The treatment of chronic limb-threatening ischemia (CLTI) involves a broad spectrum of therapies including many new and emerging techniques. To standardize the results of studies examining this pathology and to allow critical analysis and comparison between studies, the Society for Vascular Surgery (SVS) recommended reporting standard guidelines for the endovascular management of CLTI in 2016. Research studies that do not adhere to complete reporting standards are often more ambiguous in impact and external validity, leading to bias and misinformation that has potentially damaging effects on clinical decision-making. We thus sought to examine adherence to and factors associated with noncompliance with these recommended guidelines.</p></div><div><h3>Methods</h3><p>A literature database search was conducted to include all clinical trials, randomized controlled trials, and retrospective comparative studies written in English examining the endovascular treatment of peripheral artery disease (PAD)/CLTI from January 2020 to August 2022. Systematic reviews, case reports, and meta-analysis were excluded. The manuscripts were reviewed for adherence with the SVS guidelines (overall and by guideline subcategories based on demographics, treatment methods, and outcomes), and factors associated with this adherence were determined. These data were used to calculate descriptive and comparative statistics.</p></div><div><h3>Results</h3><p>Fifty-four manuscripts were identified from this time frame. On average, articles reviewed reported on 42.0% of the SVS reporting standards (range, 25.0–65.2%, Fig 1) with 74.1% of articles (<em>n</em> = 40) not adhering to at least 50.0% of the standards. Manuscripts most completely followed guidelines regarding “patient factors” and were least likely to demonstrate adherence to the description of CLTI and study complications. Within the guideline subcategories, complete adherence to guidelines was not demonstrated in any manuscript in stent trials, disease outcome measures, technical outcome measures, patient factors and critical limb ischemia description, and complete adherence rates within the other subcategories was low (range, 5.6–18.6%). Studies conducted within the United States and those with industry sponsorship were more likely to adhere to &gt;50% of the reporting standards (<em>P</em> &lt; 0.05). Journal impact factor, year of publication, and number of authors had no correlation to the percent adherence to guidelines in specific categories or adherence overall.</p></div><div><h3>Conclusions</h3><p>Adherence to reporting standard guidelines for endovascular treatment of lower extremity PAD specifically outlined by the SVS is suboptimal regardless of the quality of the journal the research is published in. Increasing adherence to reporting standards to provide a framework for comparison of studies across techniques used should be prioritized by authors, journal editors, and vascular societi","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632497","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 Role of Platelets and Aneurysm Thrombus in the EVAR Post Implantation Syndrome","authors":"","doi":"10.1016/j.avsg.2024.05.024","DOIUrl":"10.1016/j.avsg.2024.05.024","url":null,"abstract":"<div><h3>Background</h3><p>Post implantation syndrome (PIS) is a well-defined entity with unclear etiology, complicating a number of patients with abdominal aortic aneurysms treated with endovascular aortic repair (EVAR). The aim of this study was to assess the platelets’ role and the influence of aneurysmal sac thrombus volumes in the development of PIS. A retrospective analysis of prospectively collected data was performed, and 76 patients who were treated by EVAR (2011–2013) were studied. Aneurysms with endoleak were not included in the study. Based on the criteria for systemic inflammatory response syndrome (SIRS), 17 patients (22%) developed PIS (which is considered a SIRS analogue), while 59 (78%) did not.</p></div><div><h3>Methods</h3><p>The 2 groups were compared in relation to the following parameters: baseline platelet count (PLT), decrease of platelet count (PLT drop), volume of the arterial flow before the procedure (V flow), volume of thrombus of the aneurysm (V thromb), ratio of thrombus volume to aneurysm sac volume (V ratio), and the volume of newly formed thrombus (V new). Volume flow measurements were calculated by Osirix software preoperatively and in the first month postoperatively. Parametric and nonparametric techniques (unpaired <em>t</em>-test, Mann-Whitney <em>U</em> test) were used accordingly.</p></div><div><h3>Results</h3><p>Baseline platelets absolute count was greater in the PIS group (239,000 ± 17,000) versus the non-PIS group (194,000 ± 6,900, <em>P</em> = 0.004), and the PLT drop was larger in the PIS group (74,000 ± 15,600 versus 45,000 ± 5,300, <em>P</em> = 0.019). No difference was found regarding the aneurysm volumes (V flow, V thromb, V ratio, and V new) between the 2 groups.</p></div><div><h3>Conclusions</h3><p>Platelets, in terms of their absolute baseline count and their decrease after the procedure, seem to be an important factor in developing PIS after EVAR. Further, more tailored studies are needed to elucidate the role of platelets and flow or thrombus volumes in the development of PIS.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632502","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":"Letter of Recommendation Characteristics Associated with Interview Offer to a Vascular Surgery Residency Program","authors":"","doi":"10.1016/j.avsg.2024.05.030","DOIUrl":"10.1016/j.avsg.2024.05.030","url":null,"abstract":"<div><h3>Background</h3><p>Letters of recommendation (LOR) are considered by program directors (PDs) to be an integral part of the residency application. With the conversion of United States Medical Licensing Examination (USMLE) Step 1 to a binary pass/fail outcome, LORs will likely have higher important in the application process moving forward. However, their utility in securing an interview for a particular applicant remains undetermined. This study aims to identify the applicant and LOR characteristics associated with an interview invitation.</p></div><div><h3>Methods</h3><p>Letter writer (<em>n</em> = 977) characteristics were abstracted from applications (<em>n</em> = 264) to an individual integrated vascular surgery residency program over 2 application cycles. A validated text analysis program, Linguistic Inquiry and Word Count, was used to characterize LOR content. Applicant, letter writer, and LOR characteristics associated with an interview invitation were determined using multivariable analysis.</p></div><div><h3>Results</h3><p>Letter writers were 70.9% vascular surgeons (VS), 23.7% PDs, and 45.4% professors. Applicants offered an interview were more likely to come from a top 50 medical school (35.2% vs 25.8%, <em>P</em> = 0.013) and an institution with a home vascular program (45.5% vs 34.1%, <em>P</em> = 0.006). Alpha Omega Alpha membership was significantly associated with interview offer (28.4%, <em>P</em> &lt; 0.001). A greater proportion of letters from VS was associated with an interview offer (<em>P</em> &lt; 0.001) compared with letter writers of other specialties. One or more PD letters were significantly associated with an interview offer (79.55% vs 20.45%, <em>P</em> = 0.008), whereas number of letters from APDs was not significantly associated with interview offer. Letters written by away institution faculty were significantly associated with interview offer (75%, <em>P</em> &lt; 0.001), whereas nonclinical letters were not. Presence of one or more letters from a chair (57.95% vs 42.05%, <em>P</em> = 0.015) or chief (67.05% vs 32.95%, <em>P</em> = 0.028) was significantly associated with interview offer. Letters for applicants offered an interview had more references to research and teaching, which were more common in letters written by versus Letters written by PDs were more likely to use assertive, advertising language in favor of applicants. There were no significant applicant, letter writer, or LOR characteristics associated with a top 20 rank.</p></div><div><h3>Conclusions</h3><p>Successful applicants were more likely to have LORs written by VS, PDs, and those of higher academic rank with references to research and teaching.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632500","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":"Lessons Learned from Dutch Medical Disciplinary Law Regarding Aortic Aneurysm and Dissection Care","authors":"","doi":"10.1016/j.avsg.2024.04.030","DOIUrl":"10.1016/j.avsg.2024.04.030","url":null,"abstract":"<div><h3>Background</h3><p>The current study is an explanatory analysis of Dutch disciplinary law regarding aortic aneurysm and aortic dissection care. We aim to give insight in the way disciplinary judges rule on quality of care and to extract the lessons to be learned.</p></div><div><h3>Methods</h3><p>The online open-access governmental database, which includes all disciplinary rulings since 2010, was searched using search terms related to aortic aneurysm and dissection care. First, abstracts were screened for relevance. Thereafter, the full text of all remaining cases was read. Cases related to the diagnosis, treatment, or the postoperative phase of an aortic aneurysm or aortic dissection were included. Characteristics were registered and analyzed for quantitative assessment. Each case was summarized and coded for qualitative analysis.</p></div><div><h3>Results</h3><p>Forty-eight first-instance cases were included, of which 19 (40%) were founded. Reprimands (<em>n</em> = 9) and warnings (<em>n</em> = 7) were the prevailing measures. Seven out of 8 appeal cases filed by plaintiffs were unfounded. Six out of 9 appeals filed by defendants were adjudged and led to a less severe measure. Most cases concerned the subject of ‘wrong treatment/wrong diagnosis’ (75%). Whether not recognizing an aneurysm or dissection led to disciplinary culpability depended on case-specific circumstances, and much importance was attached to adequate documentation. In many complaints, an element of inadequate communication was recognized.</p></div><div><h3>Conclusions</h3><p>Patient-involvement, clear communication, and implementing changes after a mistake could increase patient satisfaction, avert complaints, and prevent time-consuming trials. Maintaining adequate documentation and having knowledge on the analytical framework of the court is beneficial when confronted with a complaint.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0890509624003935/pdfft?md5=36a368022f071924f1f3f2793881b0c0&pid=1-s2.0-S0890509624003935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619160","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}