Society For Vascular Medicine Research Articles

Original Research Abstracts Presented at the Society for Vascular Medicine’s Vascular Scientific Sessions: Washington, DC September 7–10, 2023

Original Research Abstracts Presented at the Society for Vascular Medicine’s Vascular Scientific Sessions: Washington, DC September 7–10, 2023

Editorial introductions.

Editorial introductions.

Diversity, Equity, and Inclusion Task Force initiatives within the Society for Vascular Medicine: Current status and future challenges

Diversity, Equity, and Inclusion Task Force initiatives within the Society for Vascular Medicine: Current status and future challenges

How German vascular surgeons and angiologists judge walking exercise for patients with PAD.

Background: To determine the physician's perspective and perception on walking exercise as well as barriers in guideline-directed best medical treatment of patients with lower extremity peripheral arterial disease (PAD). Patients and methods: All members of the German Society for Vascular Surgery and Vascular Medicine and of the German Society for Angiology - Society for Vascular Medicine with valid email address were invited to participate in an electronic survey on walking exercise for treatment of intermittent claudication that was developed by the authors. Results: Amongst 3910 invited participants, 743 (19%) provided valid responses (33% females, 84% vascular surgery, 15% angiology). Thereof, 65% were employed by non-university hospitals, 16% by university institutions, and 18% by outpatient facilities. A mean of 14 minutes were spent per patient to counsel and educate, while only 53% responded they had enough time in everyday clinical practice. While 98% were aware of the beneficial impact of structured exercise training (SET) on pain free walking distance and 90% advise their patients to adhere to SET, only 44% provided useful guidance to patients to find local SET programmes and merely 42% knew how to prescribe SET as service that can be reimbursed by medical insurances. Approximately 35% knew a local SET programme and appropriate contact person. Health-related quality of life was assessed in a structured way by only 11%. Forty-seven percent responded that medical insurances should be responsible to implement and maintain SET programmes, while only 4% held hospital physicians responsible to achieve this task. Conclusions: This nationwide survey study amongst vascular specialists illustrates the current insufficient utilisation of SET as an evidence-based therapeutic cornerstone in patients with lower extremity PAD in Germany. The study also identified several barriers and flaws from the physician's perspectives which should be addressed collectively by all health care providers aiming to increase the SET use and eventually its' impact on patients with PAD.

Aortic dissection secondary to giant cell arteritis.

British Journal of Hospital MedicineEarly view Case ReportAortic dissection secondary to giant cell arteritisConnor Cotton, Sarah Chatharoo, Pankaj ChaturvediConnor CottonCorrespondence to: Connor Cotton; E-mail Address: [email protected]Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Sarah ChatharooDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Pankaj ChaturvediDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this authorConnor Cotton; Sarah Chatharoo; Pankaj ChaturvediPublished Online:17 Apr 2023https://doi.org/10.12968/hmed.2022.0529AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Agard C, Ponge T, Fradet G et al.. Giant cell arteritis presenting with aortic dissection: two cases and review of the literature. Scand J Rheumatol. 2006;35(3):233–236. https://doi.org/10.1080/03009740500395252 Crossref, Medline, Google Scholarde Boysson H, Espitia O, Samson M et al.. Giant cell arteritis-related aortic dissection: a multicenter retrospective study. Semin Arthritis Rheum. 2021;51(2):430–435. https://doi.org/10.1016/j.semarthrit.2021.03.001 Crossref, Medline, Google ScholarEvans JM, O'Fallon WM, Hunder GG. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis: a population-based study. Ann Intern Med. 1995;122(7):502. https://doi.org/10.7326/0003-4819-122-7-199504010-00004 Crossref, Medline, Google ScholarHiratzka LF, Bakris GL, Beckman JA et al.. Faculty opinions recommendation of 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/sir/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13): e266–369. https://doi.org/10.1161/CIR.0b013e3181d4739e Medline, Google ScholarKermani TA, Warrington KJ, Crowson CS et al.. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis. 2013;72(12):1989–1994. https://doi.org/10.1136/annrheumdis-2012-202408 Crossref, Medline, Google ScholarMackie SL, Dejaco C, Appenzeller C et al.. British society for rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology. 2020;59(3):e01–e23. https://doi.org/10.1093/rheumatology/kez672 Crossref, Medline, Google ScholarNayar AK, Casciello M, Slim JN, Slim AM. Fatal aortic dissection in a patient with giant cell arteritis: a case report and review of the literature. Case Rep Vasc Med. 2013;2013:1–4. https://doi.org/10.1155/2013/590721 Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 17 April 2023 Information© MA Healthcare LimitedAcknowledgementsThe authors would like to thank Sarah Gardner, Library and Information Service, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Knowledge, Doncaster, for her help with the literature search.PDF download

Con: Lumbar Drains Should Routinely Be Placed by a Landmark Approach and Not by Fluoroscopic Guidance for Elective Thoracic Aortic Repairs

SPINAL CORD ISCHEMIA (SCI) after thoracoabdominal aortic repair is a well-known complication of both open and endovascular surgery, with reported rates as high as 5%-to-21% after open repair. 1 Gravereaux EC Faries PL Burks JA et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysm. Jour of Vasc Surg. 2001; 34: 997-1003 Abstract Full Text Full Text PDF PubMed Scopus (260) Google Scholar Resultant morbidity, including paraparesis and paraplegia, are devastating, and a fair amount of research has gone into developing strategies for mitigating SCI-related complications. Cerebrospinal fluid drainage (CSFD) with the placement of lumbar drains (LDs) is considered the current recommendation for both prevention and treatment of SCI in high-risk patients. 2 Coselli JS LeMaire SA Koksoy C et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002; 35: 631-639 Abstract Full Text Full Text PDF PubMed Scopus (520) Google Scholar ,3 Hiratzka LF Bakris GL Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010; 121: e266-e369 Crossref PubMed Scopus (1914) Google Scholar While there is some controversy over the utility of CSFD for endovascular repairs, it is still a widely accepted practice that is performed frequently for patients at high risk of developing SCI postrepair. 4 Isaak RS Furman W. Con: Patients at risk for spinal cord ischemia after thoracic endovascular aortic repairs should not receive prophylactic cerebrospinal fluid drainage. J Cardiothorac Vasc Anesth. 2015; 29: 1381-1383 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Protocols regarding the placement of LDs can vary by institution, whereby some centers may routinely use imaging guidance for the procedure. In this review, the authors examine the specifics of using fluoroscopic guidance for the preoperative placement of LDs in patients who are at a high risk of developing SCI after thoracoabdominal aortic repair. It is the authors’ belief that the universal use of fluoroscopic guidance is unnecessary, potentially harmful, confers additional expense, and is unsupported by the current body of evidence.

Putting Hemodynamics at the Center: A Systemic Approach to Teaching Vascular Ultrasound

A systemic framework for teaching vascular sonography that is centered on hemodynamics is useful to unify the initial test-by-test approach that developed with the pioneering and expansion of the field. Vascular sonography education is most powerful when taught with a system-level view of the circulation that connects how vascular anatomy (form) and physiology (function) are inextricably linked with hemodynamics (flow). Furthermore, understanding hemodynamic principles is key to using waveform morphology as a diagnostic tool. Teaching a system-based, hemodynamic-centered perspective aligns with the objectives of the recent Consensus Statement on Doppler Waveforms by the Society for Vascular Medicine and the Society for Vascular Ultrasound and equips the vascular sonography student to recognize, understand, and appropriately document vascular findings.

Endovascular Specialist Competencies for Chronic Limb-Threatening Ischemia: What's in Your Toolbox?

In 2004, the Society for Cardiovascular Angiography and Interventions (SCAI), American College of Cardiology, American College of Physicians, Society for Vascular Medicine and Biology (SVMB, now “SVM”), and the Society for Vascular Surgery (SVS) co-published the first Clinical Competence Statement on Vascular Medicine and Catheter-based Peripheral Vascular Interventions.1 This consensus document outlined the minimum education, training, experience, and cognitive skills required to competently evaluate and treat patients with arterial, venous, and lymphatic disease.

Readability of patient educational materials in venous thrombosis: analysis of the 2021 ESVS guidelines and comparison with other medical societies information.

In order for patients to comprehend health related information, it must be written at a level that can be readily understood by the intended population. During 2021 the European Society for Vascular Surgery (ESVS) published a sub-section about information for patients into its Guidelines on the Management of Venous Thrombosis. Nine readability measures were used to evaluate the patient educational material regarding venous thrombosis published by seven medical societies: ESVS, Society for Vascular Medicine (SVM), Society for Vascular Surgery (SVS), Vascular Society for Great Britain and Ireland (VS), Australia and New Zealand Society for Vascular Surgery (ANZSVS), Canadian Society for Vascular Surgery (CSVS) and American Heart Association (AHA). The mean reading grade level (RGL) for all the 58 recommendations was 10.61 (range 6.4-14.5) and the mean Flesch Reading Ease (FRE) was 56.10 (51.3-62.9), corresponding to a "fairly difficult" reading level. The mean RGL of the ESVS recommendations (11.45, 95% CI, 9.90-13.00) was significantly higher than the others. Post-hoc analysis determined a significant difference between the ESVS and the SVS (10.86, 95% CI, 9.84-11.91) recommendations (P=0.005). All the patient's education information published by the medical societies presented a RGL higher than recommended. The fifteen sub-sections of the information for patients included into the ESVS clinical guidelines presented a mean RGL above 9.5 points, revealing that no one (0%) was written at or below the recommended GRL. The mean FRE was 47.63 (28.2-61.6), corresponding to a "difficult" reading level. Venous thrombosis patient educational materials produced by leading medical societies have readability scores that are above the recommended levels. The innovative patient's information included into the ESVS venous thrombosis guidelines represents an important advance in the amelioration of the medical information for patients, but their readability should be improved to adapt the understanding to the general population.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Extracranial Cerebrovascular System.

Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA trial)

Patients undergoing endovenous thermal ablation for great or small saphenous vein reflux with concomitant phlebectomy who wore compression hose had lower pain scores in the first postoperative week. The 206 patients in this prospective study were randomized to 1 week of stockings vs no stockings. One half of the patients were women, and the average age was ∼50 years. C2-C3 disease was present in 71% and C4-C5 disease in 29%. Pain and clinical scores were assessed at 2 weeks and 6 months after ablation. Patients who had undergone ablation plus phlebectomy and who had also worn compression stockings had better pain scores at 1 week. However, the differences were not statistically significant at 6 months. No differences were found in the ecchymosis rates, venous occlusion rates, interval to a return to usual activities, or quality of life scores between the two groups. Interesting that compression stocking did not show a difference in patients who had undergone ablation alone. They did show a benefit as an adjunct for pain control for those who had undergone phlebectomy in the same setting. This finding is consistent with the 2019 American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology guidelines, which recommend the use of compression after thermal ablation (grade 2C, weak recommendation, low-quality or very-low-quality evidence) but for an unspecified duration. In this study, most patients had stopped wearing their stockings (section titled “Compliance”) after 7 days. Perhaps most of the pain and discomfort had resolved within this period and the added discomfort from the stockings was prevalent. I have found that patients appreciate the support of compression stockings after ablation and phlebectomy compared with elastic bandages (ACE wraps; 3M Co, Saint Paul, Minn), which can bunch or slide, causing an almost tourniquet-like effect. However, a patient could experience difficulty in donning stockings over fresh phlebectomy incisions, depending on the extent of the procedure.

Interpretation of Peripheral Arterial and Venous Doppler Waveforms: A Consensus Statement From the Society for Vascular Medicine and Society for Vascular Ultrasound Test CME

Interpretation of Peripheral Arterial and Venous Doppler Waveforms: A Consensus Statement From the Society for Vascular Medicine and Society for Vascular Ultrasound Test CME

Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound.

This expert consensus statement on the interpretation of peripheral arterial and venous spectral Doppler waveforms was jointly commissioned by the Society for Vascular Medicine (SVM) and the Society for Vascular Ultrasound (SVU). The consensus statement proposes a standardized nomenclature for arterial and venous spectral Doppler waveforms using a framework of key major descriptors and additional modifier terms. These key major descriptors and additional modifier terms are presented alongside representative Doppler waveforms, and nomenclature tables provide context by listing previous alternate terms to be replaced by the new major descriptors and modifiers. Finally, the document reviews Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report.

Interpretation of Peripheral Arterial and Venous Doppler Waveforms: A Consensus Statement From the Society for Vascular Medicine and Society for Vascular Ultrasound

This expert consensus statement on the interpretation of peripheral arterial and venous spectral Doppler waveforms was jointly commissioned by the Society for Vascular Medicine (SVM) and the Society for Vascular Ultrasound (SVU). The consensus statement proposes a standardized nomenclature for arterial and venous spectral Doppler waveforms using a framework of key major descriptors and additional modifier terms. These key major descriptors and additional modifier terms are presented alongside representative Doppler waveforms, and nomenclature tables provide context by listing previous alternate terms to be replaced by the new major descriptors and modifiers. Finally, the document reviews Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report.

Erratum à « Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV) » [J. Med. Vasc. 44 (2019) 28–70

Erratum à « Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV) » [J. Med. Vasc. 44 (2019) 28–70

First International Consensus on the diagnosis and management of fibromuscular dysplasia.

This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD), which was commissioned by the working group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.

2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary.

Developed in Collaboration With the American Association of Cardiovascular and Pulmonary Rehabilitation, Inter-Society Consensus for the Management of Peripheral Arterial Disease, Society for Cardiovascular Angiography and Interventions, Society for Clinical Vascular Surgery, Society of Interventional Radiology, Society for Vascular Medicine, Society for Vascular Nursing, Society for Vascular Surgery, and Vascular and Endovascular Surgery Society

Rationale and design of the RECording COurses of vasculaR Diseases registry (RECCORD registry).

The prevalence of peripheral artery disease (PAD) is increasing worldwide. Revascularization procedures constitute a cornerstone of the therapy in PAD, not only in critical limb ischaemia but increasingly also in patients with intermittent claudication. The German Society of Angiology - Society for Vascular Medicine is establishing a nationwide, prospective, multicentre registry to address the lack of contemporary real life data regarding current practice of medical and interventional care in vascular patients and its subsequent long-term outcome. The RECording COurses of vasculaR Diseases registry (RECCORD registry) is an observational, prospective, multicentre, all-comers registry platform. In the initial phase, patients referred for endovascular revascularization of PAD of the lower limbs will be prospectively included and followed up for at least one year. At baseline, data on patients' demographic characteristics, comorbidities, previous peripheral interventions, medication, and clinical stage of PAD (Rutherford category), haemodynamic parameters, and procedural data including complications will be assessed. Major adverse cardiac and limb events will be recorded at planned (at six and 12 months) and at any unplanned visits. The therapeutic management will be exclusively left to the discretion of the vascular specialists. The RECCORD registry will provide a comprehensive dataset depicting the current real life practice and outcome of vascular care. The seven predefined quality indicators will be used for benchmarking the participating centres. Moreover, identifying factors promoting a favourable outcome might pave the way for an evidence-based therapeutic strategy and a dedicated therapeutic pathway for patients with PAD including patient-oriented best interventional approaches. In the future, the RECCORD registry may provide a general platform to study the courses of various defined vascular diseases in order to get detailed insights into the real life current practice of health care provided to vascular patients.

SC08.01 Impact and Management of Co-Morbidities

SC08.01 Impact and Management of Co-Morbidities

Evaluation of Inpatient Thrombophilia Pathway

Introduction:Venous thromboembolism (VTE) ranges from asymptomatic deep vein thrombosis (DVT) to fatal pulmonary emboli (PE). VTE is the third most common cardiovascular illness and cause of mortality after acute coronary syndrome and stroke. Medical societies such as American Society of Hematology (ASH), British Society for Haematology, and Society for Vascular Medicine have all created selection criteria, consistent with each other, for when to order a hereditary thrombophilia workup. Guidelines indicate that thrombophilia testing should not be offered to patients who are continuing anticoagulation treatment, or to those who have had "provoked" VTE. Examples include patients who have had a transient risk factor within the past 3 months including surgery, trauma, prolonged immobility, pregnancy or puerperium, and patients on hormonal therapy. The aims of our study is to identify the prevalence of hypercoagulable testing in our hospital, evaluate how our organization follows certain criteria for patients presenting with DVT or PE, and to calculate the economic impact of ordering these workups unnecessarily.MethodsWe conducted a retrospective chart review from July 2014 to June 2015 that identified individuals that were admitted to the hospital with a diagnosed DVT or PE detected by lower extremity doppler ultrasound or computed tomography of the lungs. Inclusion criteria included newly diagnosed patients with DVT or PE. Frequencies were calculated for sex, work-up, ethnicity, smoking, estrogen therapy, malignancy, and history of VTE. Further analysis was run using work-up as predictor variable and cross tabulated with sex, ethnicity, smoking, estrogen therapy, malignancy and history of VTE. Independent t-test were conducted between work-up and age and BMI levels.ResultsWe identified 241 patients admitted to the hospital for DVT or PE. Within this population, 57 individuals (23.7%) had the hypercoagulability pathway. A majority of the patients within this subpopulation were female (57.9%). Sensitivity analysis for the 57 individuals who underwent work-up also included 38.6% with a smoking history, 3.5% on estrogen therapy, 86% without history of malignancy, 40.4% with history of previous DVT or PE, and 89.5% of the patients being Caucasian. The average age and BMI was 55 and 32.9 respectively. No significant relationship was found between the work-up and sex (p= 0.11), ethnicity (p=.65), smoking (p=0.46), estrogen therapy (p= 0.8), without malignancy (p=.051), and history of DVT or PE (p=0.12). There was a significant relationship between age and work-up (p=0.002), with younger patients more likely to have the work-up.ConclusionOur study indicated that younger patients presenting with VTE were likely to under go work-up for thrombophilic disorders. Patients without malignancy and those who did not smoke were also more likely to undergo a work-up. In addition to this, women not on estrogen therapy were less likely to receive a work-up. Even though our results allude to inappropriate thrombophilia testing, we lack statistical significance due to our population size and patient diversity.These tests are expensive, with costs approaching $3,000 for a full thrombophilia panel. This totals around $100,000 to $160,000 of cost savings for the 53 individuals that had the work-up within the one year span. This cost analysis does not include the expense accrued by the patient for prolonged anticoagulation plus the ongoing lab costs of INR monitoring. Research should be further investigated in a larger and more diverse population for better understanding for the role of thrombophilia evaluation in the inpatient setting. DisclosuresNo relevant conflicts of interest to declare.