Role Of Vascular Surgery Research Articles

Evaluating the Effectiveness of an Online Targeted Education Programme on Vascular Surgery Aimed at Early Postgraduate Doctors.

Introduction Mind The Bleep (MTB) is a junior doctor-led online education organisation that produces free open-access medical education (FOAMed) resources. This paper describes MTB vascular surgery online education programme. The target audience was early postgraduate doctors completing a rotation in vascular surgery. The aims were to increase participant confidence in basic vascular surgery topics and better prepare them for their role in vascular surgery. Methods Speakers included foundation doctors, vascular speciality registrars, consultant vascular surgeons, and a vascular nurse specialist. Post-webinar feedback surveys presented as a five-point Likert scale were used to assess the effectiveness of the course. Wilcoxon signed-rank tests were used to analyse the data. Results Over three months, from March to June 2022, nine one-hour targeted education sessions were conducted, with a total of 564 participants. Post-session feedback was obtained from 364 participants (64.6%). There was a significant increase in the participants' level of confidence in the topic seen across all sessions (p <0.05). The participants rated webinars highly in the domains of engagement (mean 4.31), helpfulness of the content (mean 4.50), and interest (mean 4.39). From the cohort, 200 participants provided feedback on whether attending the webinar better prepared them for a vascular surgery rotation, with 66.5% (n = 133) reporting yes. Conclusion The MTB vascular surgery online education program successfully increased participants' confidence and their preparedness for a role in vascular surgery. As a result, it is a useful adjunct to undergraduate surgical education.

The role of vascular surgery and suction thrombectomy in a community hospital's pulmonary embolism response team

IntroductionNumerous pulmonary embolism response teams (PERT) have emerged to direct management of pulmonary embolism in hospitalized patients; few of these teams consist of vascular surgeons. MethodsThis study presents a single-center retrospective review aimed at evaluating the outcomes of patients who underwent suction thrombectomy by vascular surgeons within the timeframe of 2022 to 2023. Differences in preoperative and postoperative outcomes were compared using a samples t-test for continuous data. Statistical analyses were performed using JASP Team 2022, JASP (Version 0.16.3) [Computer software]. A p value < 0.05 was considered significant. Results50 patients were assessed that underwent suction thrombectomy. The majority of patients were female (64 vs 36 %). Ages ranged from 26 to 94 and the mean was 65 years old. The majority of patients were Black or African American (62 %). The majority of patients (52 %) had moderate right heart strain (RHS) preoperatively. There were no postoperative wound infections or bleeding complications. All-cause mortality within 30 days was 2 %; procedure-related or pulmonary embolism-related mortality was 0 %. ConclusionSuction thrombectomy remains a safe option for management of pulmonary embolism; a PERT can successfully comprise vascular surgeons as the primary proceduralists.

The role of vascular surgery in intraoperative emergency consultations

Aim: Vascular surgery is an important part of the multidisciplinary approach to surgical treatments, and vascular surgeons are often called on intraoperatively to provide immediate assistance to their colleagues. Our aim was to describe the extent of assistance provided during emergency intraoperative consultations at a single tertiary academic centre. Material and Methods: We reviewed the records of patients who were consulted intraoperatively in our hospital over a period of approximately 4 years (January 1, 2017-December 31, 2020) and organized the data collected. Results: 40 emergency intraoperative consultations were identified. 55% of the patients were female, with an average age of 48.83 years. The most frequently consulted subspecialty was obstetrics and gynecology (32%). Index cases were elective/nonurgent (90%), most involving tumor resection (77.5%). The primary reason for vascular consultation was revascularization (37.5%). The primary blood vessel and anatomic field of intervention were categorized. Most cases (50%) included preservation of blood flow, including primary arterial repair (20%) and ligation of the bleeding vessels (20%) in the first choice. Postoperative mean length of stay was 13 days, with a 30-day mortality of 5.1%. Conclusion: Using a wide variety of skills and techniques, vascular surgeons strive to respond to urgent open surgical consultations in various anatomical sites. Our study provides evidence to the wide range of knowledge and skills required for modern vascular surgeons and the place of the subspecialty in the core services offered in a multidisciplinary approach.

Scourge of Peripheral Artery Disease in a Low-Income-Setting: The Role of Vascular Surgery

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance.&#x0D; Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon.Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery.&#x0D; Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients’ management. Vascular and or orthopedic surgery played significant role. &#x0D; Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.

Intraoperative Vascular Assistance: Essential to an Institution's Ability to Provide Surgical Care

The wide breadth of vascular surgery (VS) training enables vascular surgeons to assist in nonvascular operations and rapidly respond to urgent and emergent needs for intervention. This study aims to evaluate VS secondary operative assistance and intraoperative consultations METHODS: Retrospective review of all operative interventions with a vascular surgeon as secondary surgeon between January 1, 2011 and January 31, 2020 at a single institution. Any cases with VS as primary service were excluded. Patient demographics, operative variables, and in-hospital outcomes were evaluated. Four hundred thirty-seven patients requiring interventions necessitating VS assistance were identified, this included elective, urgent, and emergent operative cases. One hundred thirty-one cases were urgent or emergent and 306 were elective. The median age was 58.0 years (IQR: 40-68.0). Most patients were male (237, 54.2%), White (298, 68.2%), and average BMI was 29.2 +/- 8.5 with ASA ≥4 (143, 32.7%). One hundred seventy (38.9%) cases involved intraoperative consultations, whereas, 267 (61.1%) provided advance notice of need for secondary assistance. The most common services requesting consultations were spine surgery (both orthopedic and neurosurgery) (83, 19%), cardiothoracic surgery (82, 18.8%), and surgical oncology (42, 9.6%). Vascular interventions included revascularization (108, 4.7%), hemorrhage control (94, 21.5%), and exposure (131, 30%). In-hospital mortality was 12.1%. With the armamentarium of open, endovascular, and hybrid interventions, vascular surgeons are prepared to respond and intervene in nonvascular cases in the event of unexpected vascular compromise, iatrogenic injury, or challenging exposure, as well as assist in planned elective operations. This study reinforces the role of VS in an institution's ability to offer safe and prompt surgical care.

Vasculo-Behcet's Disease: Profile and Management - Single Center Experience

Background Behçet's disease (BD) is a multisystem vasculitis characterized by exacerbations and remissions with unknown etiology. Males are more affected than females with the usual onset in the third decade. Vascular involvement can occur in up to 40% of cases of BD. BD is unique among the vasculitides that it may involve all sizes and types of vessels. Objectives 1. To study the pattern of vascular involvement of Behçet's disease (BD) in the Saudi population; use of anticoagulation and its duration, thromboembolic, and major bleeding complications during anticoagulant therapy. 2. The effect of combined immunosuppression and anticoagulation treatment approach in reducing the risk of venous and arterial thromboembolism. 3. The role of vascular surgery for peripheral arterial and abdominal aortic aneurysms (AAA), and the role of immunosuppression in the treatment of pulmonary artery aneurysm (PAA) without the need for surgical intervention. Methods Twenty-three patients with confirmed vasculo-BD attending the thrombosis clinics at our tertiary care center between 2010 and 2015 were studied retrospectively and analyzed through descriptive statistics SPSS version 22. Results Demographics and pattern of vascular involvement are shown in tables 1 and 2. HLA-typing was performed for 13 patients, and HLA- B51 was positive in 7 (54%) patients tested. The acute phase reactants (ESR and CRP) were high in all 23 (100%). Hereditary and acquired thrombophilia workup was performed for all patients and only 1 (4.3%) was positive for antiphospholipid antibodies. Oral ulcers were present in all the patients, genital ulcers in 12 (52%), ocular involvement in 8 (35%), skin manifestations in 3 (13%), and arthritis in 1 (4.3%). Lower extremity vein thrombosis is the most frequent manifestation of Vasculo-BD in Saudi Arabia, followed by CVT, PAI, SVT/Budd-Chiari syndrome, IVC thrombosis, peripheral artery aneurysms, and AAA. Peripheral arterial and abdominal aortic aneurysms in 3 (13.6%), all of whom had successful vascular surgery for aneurysm repair. Inferior vena cava filter was inserted in 3 (13.6%). One patient was admitted to the intensive care unit with fulminant hepatic failure due to bilateral hepatic vein thrombosis and subsequently died. The vascular thrombosis recurrence was in 11 patients (48%, all venous) despite adherence to the prescribed anticoagulant therapy and lack of any provocation. These patients were initially treated with anticoagulant monotherapy. After combining immunosuppressive therapy to the pre-existing anticoagulant therapy, none had thrombosis recurrence. There was a complete resolution of the two patients with PAA with mono-immunosuppressant therapy and no surgical intervention. The most commonly prescribed initiation anticoagulant therapy was low molecular weight heparin (87%). Conclusion BD with vascular involvement continues to pose a major diagnostic and therapeutic challenge to physicians due to the heterogeneity of the clinical presentation and lack of the diagnostic laboratory test. Therefore, we must have a low threshold for BD in any patient with vascular thrombosis or aneurysm. Combined immunosuppressive therapy is essential in suppressing and preventing the venous and arterial recurrence attacks. Disclosures No relevant conflicts of interest to declare.

Evaluation of the Statewide Variability in the Current Role of Different Specialties in Lower Extremity Endovascular Revascularization for Medicare Beneficiaries

PurposeTo evaluate the statewide variability in the role of different specialties in lower extremity endovascular revascularization (LEER) and associated submitted charges of care and actual reimbursement for Medicare beneficiaries. MethodsThe 2015 “Medicare Provider Utilization and Payment Data: Physician and Other Supplier” data includes provider-specific information regarding the type of service, submitted average charges of care, and actual average Medicare reimbursements per Healthcare Common Procedure Coding System (HCPCS) code per provider. All HCPCS codes related to LEER were identified. The role of vascular surgery (VS), interventional cardiology (IC), and interventional radiology (IR) in each HCPCS-specific intervention was investigated. ResultsIn 2015, 4113 providers submitted claims for iliac (n = 13,659), femoropopliteal (n = 52,344), and tibioperoneal (n = 32,688) endovascular revascularizations. In the facility setting, VS performed most of these procedures (52%), followed by IC (32%) and IR (8%). In the outpatient-based lab setting, the proportions were 46%, 36%, and 13%, respectively. Substantial statewide variability in the role of different specialties in LEER was noted. In Maine, Vermont, and Hawaii, all facility claims were submitted by VS, while more than 70% of the claims in Arizona and Utah were submitted by IC. The highest share of LEER for IR was observed in Montana and North Dakota (50%). There was substantial statewide variability in the submitted charges. ConclusionCurrently, less than 10% of LEER procedures are being performed by IR. The statewide variability in the submitted charges of care by providers and actual reimbursement for Medicare beneficiaries were investigated in this study.

P 038 – Effect of haptic sensory input from the wearing of cloth on gait performance

To evaluate the statewide variability in the role of different specialties in lower extremity endovascular revascularization (LEER) and associated submitted charges of care and actual reimbursement for Medicare beneficiaries.The 2015 “Medicare Provider Utilization and Payment Data: Physician and Other Supplier” data includes provider-specific information regarding the type of service, submitted average charges of care, and actual average Medicare reimbursements per Healthcare Common Procedure Coding System (HCPCS) code per provider. All HCPCS codes related to LEER were identified. The role of vascular surgery (VS), interventional cardiology (IC), and interventional radiology (IR) in each HCPCS-specific intervention was investigated.In 2015, 4113 providers submitted claims for iliac (n = 13,659), femoropopliteal (n = 52,344), and tibioperoneal (n = 32,688) endovascular revascularizations. In the facility setting, VS performed most of these procedures (52%), followed by IC (32%) and IR (8%). In the outpatient-based lab setting, the proportions were 46%, 36%, and 13%, respectively. Substantial statewide variability in the role of different specialties in LEER was noted. In Maine, Vermont, and Hawaii, all facility claims were submitted by VS, while more than 70% of the claims in Arizona and Utah were submitted by IC. The highest share of LEER for IR was observed in Montana and North Dakota (50%). There was substantial statewide variability in the submitted charges.Currently, less than 10% of LEER procedures are being performed by IR. The statewide variability in the submitted charges of care by providers and actual reimbursement for Medicare beneficiaries were investigated in this study.

A terapêutica antitrombótica: atual e em desenvolvimento

Thrombosis is one of the major causes of death worldwide. Continous increase in the knowledge about the pathophysiological changes associated with thrombosis led to the development of effective therapies (anti‐platelet, anticoagulant and fibrinolytics) for the prevention and treatment of the thromboembolic disease.However, better understanding of the underlying processes is still crucial for the development of more effective and safer antithrombotic drugs.The aim of this review is summarize the current treatment, as well as the new agentes and to highlight their proven or possible role in Vascular Surgery.

Pattern of Primary Vasculitis with Peripheral Ischemic Manifestations: Report of a Case Series and Role of Vascular Surgery

Pattern of Primary Vasculitis with Peripheral Ischemic Manifestations: Report of a Case Series and Role of Vascular Surgery

Hydrogen Sulfide Reduces Inflammation Following Abdominal Aortic Occlusion in Rats

Remote renal ischemia-reperfusion injury (IRI) following infra-renal aortic occlusion leads to acute kidney injury and systemic inflammation. Hydrogen sulfide is a mediator of IRI and can ameliorate tissue injury in many organ systems. Its role in vascular surgery has yet to be established. We assessed the role of hydrogen sulfide in a rodent model of aortic occlusion. Wistar rats were divided into sham, control, and treatment groups (n = 6). Inflammation was assessed using a nonrecovery protocol. The infra-renal aorta was cross-clamped for 60 min and animals were reperfused for 120 min. Ten minutes before clamp release, treatment animals received hydrogen sulfide (10, 30, or 50 μg/kg) and control animals received 0.9% saline injected into the retroperitoneum. Renal injury and histology were assessed by a recovery protocol. The procedure was identical to the nonrecovery arm but with a single dose of hydrogen sulfide (30 μg/kg) and animals were recovered for 7 days. There was no difference in animal weight between the groups (P = 0.337). In the nonrecovery arm, there was a reduction in serum levels of tumor necrosis factor alpha in sulfide-treated animals compared with controls (909 ± 98 vs. 607 ± 159 pg/mL; P = 0.0038). There was also a reduction in myeloperoxidase-positive cells in renal tissue in the sulfide-treated animals compared with controls (8 ± 4 vs. 17 ± 9; P = 0.03). There was no difference in histological injury score or endothelin-1 levels. In the recovery arm, there was no difference in renal function, Kidney Injury Molecule-1 levels, or histological injury scores. Hydrogen sulfide has systemic and renal anti-inflammatory effects in remote IRI following aortic occlusion in rats.

Early endovascular grafts at Montefiore Hospital and their effect on vascular surgery

Vascular surgery is very fortunate. It recognized the transition from open surgery to endovascular procedures as treatments for vascular disease early enough to adapt as a specialty. As a result, most vascular surgeons in North America became competent with endovascular techniques, and the survival of the specialty was assured. The endovascular graft program at Montefiore Hospital played a major role in vascular surgery's early recognition of the importance of the endovascular revolution. This article will review the history of this early endovascular graft program and how it influenced the specialty.

Laminar flow reduces cases of surgical site infections in vascular patients

IntroductionNumerous strategies are employed routinely in an effort to lower rates of surgical site infections (SSIs). A laminar flow theatre environment is generally used during orthopaedic surgery to reduce rates of SSIs. Its role in vascular surgery, especially when arterial bypass grafts are used, is unknown.MethodsA retrospective review of a prospectively maintained database was undertaken for all vascular procedures performed by a single consultant over a one-year period. Cases were performed, via random allocation, in either a laminar or non-laminar flow theatre environment. Demographic data, operative data and evidence of postoperative SSIs were noted. A separate subgroup analysis was undertaken for patients requiring an arterial bypass graft. Univariate and multivariate logistical regression was undertaken to identify significant factors associated with SSIs.ResultsOverall, 170 procedures were analysed. Presence of a groin incision, insertion of an arterial graft and a non-laminar flow theatre were shown to be predictive of SSIs in this cohort. In the subgroup receiving arterial grafts, only a non-laminar flow theatre environment was shown to be predictive of an SSI.ConclusionsThis study suggests that laminar flow may reduce incidences of SSI, especially in the subgroup of patients receiving arterial grafts.

Mid thoracic syndrome in pregnancy: a rare cause of secondary hypertension

Severe secondary hypertension in pregnancy can be complicated by maternal intracerebral haemorrhage, cardiac or renal failure, superimposed pre-eclampsia, maternal death and fetal spontaneous abortion or perinatal death. The authors present...

The advantages and disadvantages of non-surgical management of the diabetic foot

It is frequently stated that diabetic foot ulcers should be managed by a multidisciplinary team, comprising individuals who can deliver all the necessary and wide-ranging skills: medical and surgical, podiatric, nursing and orthotic. Whilst there are some data to support this multidisciplinary approach there is little to guide us in ensuring the patient is seen by the right professional for the right treatment at the right time. This article will examine the evidence supporting the most effective use of the multidisciplinary team. It will look at medical managements of ulcers including dressings, offloading and the treatment of infection, either cellulitis or osteomyelitis. By contrast, the role of surgery in offloading, and the treatment of osteomyelitis will be examined, as well as the role of vascular surgery. The most important aspect of management choice, however, is the need to focus on the needs of the person with a diabetic foot ulcer rather than simply on the treatment of the ulcer in isolation. Other complications of diabetes, which may have an effect on wound healing such as glycaemic control, renal failure and visual disturbance will be explored.Finally, there will be discussion of the relevance of outcome measure, both of ulcers as well as those more patient-centred. The ways in which these can be used to monitor individual clinical responses to treatment will be described, as well as their potential use as an aid to comparison of the effectiveness of treatment protocols adopted in different centres.

The role of vascular surgery in chronic leg ulcers: report from a specialized ulcer clinic.

Experience gained from cooperation between dermatologists and vascular surgeons in 177 patients evaluated at a joint leg ulcer clinic is reported. Patients were divided into two subgroups: (i) 86 patients with healed ulcers and (ii) 91 patients with ongoing therapy-resistant ulcers. Venous insufficiency was the most common etiology in both subgroups (87% and 55%, respectively). Of previous therapy-resistant ulcers, 71% were healed after the combined effort. The pattern of venous incompetence differed between the two subgroups; patients with isolated superficial disease constituting 68% and 26% of patients, respectively. In patients with therapy-resistant ulcers, those with isolated superficial venous insufficiency were found to have a better prognosis than those with deep venous insufficiency. Cooperation between the dermatologist and vascular surgeon is a mainstay in order to take advantage of the possibilities offered by modern vascular surgery.

The VCS clip--experimental experiences with a new vascular suture stapling device

Despite improvements in technique and suture material, vascular anastomosis is still associated with a significant rate of early (stenosis, thrombosis) and late (intimal hyperplasia) complications. Although automatic mechanical staplers were practical und comparatively safe to use, they did not play a major role in vascular surgery, probably due to the complexity and difficult handling. In an experimental study with the VCS clip system, we found a significant improvement in performing a hepatic artery anastomosis [9.2 +/- 1.5 min (VCS) vs 20.6 +/- 2.7 min (suture), P < 0.001], early patency and flow rate [150 +/- 29.1 ml/min (1.0 h)-->79.9 +/- 24.0 ml/min (24 h) (suture) vs 186 +/- 45 ml/min (1.0 h)-->162 +/- 48 ml/min (VCS), P < 0.005]. Besides easy handling, the VCS clip system allows for a fast, standardized vascular anastomosis without intimal penetration.

The development of the E. Stanley Crawford Critical Issues Forum

The development of the E. Stanley Crawford Critical Issues Forum

重症阻血肢に対する血行再建術の意義

重症阻血肢に対する血行再建術の意義

Role of Vascular Surgery in the Management of Diabetic Foot Problems

Role of Vascular Surgery in the Management of Diabetic Foot Problems