Journal of Vascular Surgery – September 2017 Audiovisual Summary

Abstract

Welcome to the September issue of the Journal of Vascular Surgery. We have selected four papers that highlight the September issue and each is available for free for the month. The first article is an important paper, entitled the “Impact of surgeon and hospital experience on outcomes of abdominal aortic aneurysm repair in New York State” by Meltzer and colleagues from Cornell. The authors used the New York State database to determine the impact of hospital size and physician volume and experience on morbidity and mortality of elective and ruptured aneurysms, when repaired by both endovascular and open surgery. From 2000 to 2011, 18,842 patients underwent abdominal aortic aneurysm (AAA) repair by a vascular surgeon. With intact AAAs, 26% underwent open surgical repair (OSR) and 74% underwent endovascular aneurysm repair (EVAR), while for ruptured AAAs, 64% underwent OSR and 36% underwent EVAR. The authors concluded that for intact AAA, the surgeon's volume was an important factor for OSR outcomes, and low facility volume was associated with worse outcomes after EVAR, while for ruptured AAA, low-volume surgeons and low-volume facilities had worse outcomes after OSR but not after EVAR. The interaction between the surgeon's volume and the hospital's volume is complex and varies based on the acuity of presentation and treatment modality. The next paper, by Kristensen and colleagues from Denmark, is entitled “Metformin treatment does not affect the risk of ruptured abdominal aortic aneurysms.” Based on the knowledge that diabetes has a protective role in the development and rupture of abdominal aortic aneurysms through matrix molecule accumulation, they hypothesized that metformin use for diabetes treatment, which reduces matrix molecule accumulation, may reverse the protective role of diabetes on the development and course of aneurysms. Using the nationwide Danish registry data, the authors identified 362 cases of ruptured abdominal aortic aneurysm (RAAA) from 1998 to 2013; 22% of patients were long-term metformin users, compared with 29% of controls. They found a statistically nonsignificant, but protective, effect of long-term metformin use toward RAAA. The authors concluded that metformin use does not increase the risk of RAAA among individuals with diabetes. The Editors' Choice and CME paper for the month is “Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education” by McDermott and colleagues. They conducted a study to determine whether blacks with lower extremity peripheral artery disease have faster functional decline than whites with peripheral artery disease (PAD). Patients from Chicago medical centers with PAD were observed every 6 to 12 months for mobility impairment by the 6-minute walk test and becoming unable to walk up and down a flight of stairs. Of 1162 PAD participants, 26% were black. Among 711 PAD participants who walked 6 minutes continuously at baseline, black race was associated with becoming unable to walk 6 minutes continuously. This association was attenuated after adjustment for income and education. Among 844 participants without baseline mobility impairment, black participants had a higher rate of mobility loss, which was also attenuated after adjustment for income and education, as well as physical activity. The authors concluded that black PAD patients have higher rates of mobility loss and that these differences appear related to differences in socioeconomic status and physical activity. The last paper highlighted for the month is “Current practice of thoracic outlet decompression surgery in the United States,” by Rinehardt and colleagues from the University of Wisconsin. Since thoracic outlet syndrome (TOS) and its management are relatively controversial topics, the authors reported on the current state of TOS surgery among hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients who underwent first or cervical rib resection as their index procedure from 2005 to 2014, and whose constellation of diagnosis and procedure codes identified them as having neurogenic, arterial, or venous TOS, had procedure characteristics and 30-day incidence of specific complications, including nerve injury, reported. The authors identified 1431 patients in the NSQIP database undergoing an operation for TOS: 83% for neurogenic TOS; 3% for arterial TOS; and 12% for venous TOS. Vascular surgeons performed 90% of procedures. Only 0.3% of patients demonstrated evidence of nerve injury and the rate of bleeding requiring transfusion was also low at 1.4%. The risk was increased in patients with a higher American Society of Anesthesiologists classification, those whose procedure was for non-neurogenic symptoms, and those whose procedure took longer to complete. The authors concluded that surgeons who advocate the surgical management of TOS and their patients can be reassured that such intervention is associated with an extremely low risk of disability resulting from iatrogenic nerve injury and major bleeding events. We hope you enjoy the JVS this month. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJmZmFmMzBjMGU5OWU1OGUyNzYwMTMzMjdjMzU3YWJjYiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NDY5MDM2fQ.iDILTOiawh3KgcA8lFPYNmLjiAWDHcsMpz2ilBnG5osSCuxsnCESNgIvUpffZRPM1tp1uNDZU7zYsdiY7bfz10x2YGHMrdQXEFxN8wt7RphecQXCWxFsgRMWiMR6yfGJTWBlNbft5Tpxh98mMvnMIQMDuOiZUVENNaKecDtftUkLa_O-6W-ANmcDpX7PPkFP2cdENbBG0FV6Reo59VWLhxmuzbhBxSAIsoQMMTk7fyquy7npjv3Jig_pGWdQXluuYw-GTYxsyOI2Sza1HycPu93Q4BhDZxS99uq6fHM42uccKxsKIbMn_6cNBQ9A3bSIgEACX3MEPt2KqsxNHjtu2A Download .mp4 (114.5 MB) Help with .mp4 files Video