Journal Of Vascular Surgery Research Articles

Current role of physician-modified endovascular grafts for fenestrated endovascular aortic aneurysm repair

Fenestrated endovascular aortic aneurysm repair (FEVAR) is becoming the preferred treatment option for complex aortic aneurysms. In the United States, the limited access to fenestrated endografts delayed the adoption of FEVAR. Physician-modified endovascular grafts (PMEGs) were the answer to such limitations. In this issue of the Journal of Vascular Surgery, Hemingway et al1 review their initial experience with the use of modified Treo devices. They report acceptable 30-day outcomes and early technical and clinical success.

Adding more fuel to the atherectomy fire

In this issue of the Journal of Vascular Surgery, Brown et al1 publish data from the 2014 Medicare Provider Utilization and Payment Data Public Use File showing a rapid increase in the use of peripheral vascular interventions (PVI) in many hospital referral regions. This shift was significantly correlated with changes in PVI payments, which were mostly driven by changes in atherectomy payments, and most prominent among office-based laboratories (OBLs). Overall, their data show that physicians who practice in OBLs are much more likely to use atherectomy and receive higher reimbursement than physicians that practice in the hospital setting, and that the rapid increase in PVI use we have seen in recent years is driven largely by high reimbursement behaviors.

Selected Abstracts from the August Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the August Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

A view through the looking glass at chronic total occlusions

In the current issue of the Journal of Vascular Surgery, we consider the utility of contrast-enhanced ultrasound (CEUS) in the evaluation of chronic total occlusions (CTO) of the femoropopliteal arterial segment.1 In their manuscript, Allan and Delaney1 describe a proof-of-concept study in applying CEUS imaging to assess CTO vascularity. This is a unique take on the applicability of CEUS in the characterization of arterial disease. The concept of echo signal enhancement using an intravenously administered contrast agent is not new, as the technique was initially described decades ago.

Professionalism in (vascular) surgery: What does it mean?

A publication in the August 2020 issue of the Journal of Vascular Surgery, “Prevalence of unprofessional social media content among young vascular surgeons,” brought the concept of professionalism in the vascular surgery community to the forefront. In response to the methodology used in the article, and the definitions of professionalism, a global backlash from health care providers and lay people ensued. The article has since been retracted; however, its publication highlighted the need to reexamine current definitions and philosophies surrounding professionalism in medicine and surgery that may be discriminatory and exclusive. The term professionalism has no standard definition as evidenced by varying definitions among different societies and organizations. The lack of a structured, universally accepted definition of professionalism in the medical and surgical communities has resulted in no standard by which to measure the actions of physicians and surgeons. The definition of professionalism need not be complex and should not vary among specialties and societies. In its most simplistic form, the core definition of “professionalism” embedded in the volumes of publications, guidelines, and charters that exist on the subject of professionalism in medicine is respect. We propose a tiered approach to define professionalism in medicine that builds on fundamental principles of respect and inclusivity, and includes actionable steps at three levels: (1) individual, (2) organizational, and (3) societal. Through this approach, any physician, regardless of specialty, practice type or location, can apply these concepts to ensure they consistently embody what it means to be “professional.”

Developing cultural competency and maximizing its effect in vascular surgery

The April 2010 issue of the Journal of Vascular Surgery was a supplemental edition commissioned in response to the pressing issue of the day: persistent disparities in the health care outcomes of patients with vascular disease and the lack of diversity, inclusion, and equity in the vascular surgery (VS) workforce and leadership. The issue, titled “Diversity in Vascular Surgery: Adapting to America's New Face,” exemplified the reflexive nature of institutions to provide aspirational responses to the complex problem of inequity but lacking the insight to provide sustainable material solutions to these problems.

Selected Abstracts from the July Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the July Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Assessment of self-reported financial conflicts of interest in vascular surgery studies

Objective/BackgroundWith increased collaboration between surgeons and industry, there has been a push towards improving transparency of conflicts of interest (COIs). This study aims to determine the accuracy of reporting of COIs among studies in major vascular surgery journals. MethodsA literature search identified all comparative studies published from January 2018 through December 2018 from three major United States vascular surgery journals (Journal of Vascular Surgery, Vascular and Endovascular Surgery, and Annals of Vascular Surgery). Industry payments were collected using the Centers for Medicare and Medicaid Services Open Payments database. COI discrepancies were identified by comparing author declaration statements with payments found for the year of publication and year prior. ResultsA total of 239 studies (1642 authors) were identified. Two hundred twenty-one studies (92%) and 669 authors (63%) received undisclosed payments when utilizing a cut-off payment amount of $250. In 2018, 10,778 payments (totaling $22,174,578) were made by 145 companies. Food and beverage payments were the most commonly reported transaction (42%), but accounted for only 3% of total reported monetary values. Authors who accurately disclosed payments received significantly higher median general payments compared with authors who did not accurately disclose payments ($56,581 [interquartile range, $2441-$100,551] vs $2361 [interquartile range, $525-$9,699]; P < .001). When stratifying by dollar-amount discrepancy, the proportions of authors receiving undisclosed payments decreased with increasing payment thresholds. Multivariate analysis demonstrated that first and senior authors were both significantly more likely to have undisclosed payments (odds ratio, 2.0; 95% confidence interval, 1.1-3.6 and odds ratio, 2.9; 95% confidence interval, 1.6-5.2, respectively). ConclusionsThere is a significant discordance between self-reported COI in vascular surgery studies compared with payments received in the Centers for Medicare and Medicaid Services Open Payments database. This study highlights the need for increased efforts to both improve definitions of what constitutes a relevant COI and encourage a standardized reporting process for vascular surgery studies.

Selected Abstracts from the May Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the May Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Invited commentary

In the current issue of the Journal of Vascular Surgery, Solomon et al1 described the perioperative outcome after transfemoral carotid artery stenting (CAS) stratified by preprocedural symptomatic status with a special emphasis on outcome in patients with asymptomatic and formerly symptomatic (>180 days). In s previously reported study, the outcome after carotid endarterectomy (CEA) that stroke morbidity and mortality after CEA depended on carefully defined symptomatic status. The authors applied the same methodology to their present study on CAS using data from the National Surgical Quality Improvement Program in 9807 patients.

Doxycycline Therapy for Abdominal Aortic Aneurysm: Inhibitory Effect on Matrix Metalloproteinases.

Abdominal aortic aneurysm (AAA) is a life-threatening condition associated with smoking, aging, atherosclerosis, and destruction of the connective tissue in the abdominal aortic wall. Disturbances in the synthesis and degradation of matrix metalloproteinase (MMP) have been known to contribute to the development of AAAs. The only available treatment of AAA is surgical repair. Doxycycline, a tetracycline analog, is thought to have an inhibitory effect on MMPs. Knowing the effect of doxycycline, there may be some favorable effects of the drug to reduce the growth of small AAAs and avoid the need for invasive treatment. This article aims to determine the relationship between doxycycline and the MMPs to prevent the growth of small AAAs. We conducted our review using online resources such as PubMed, Google Scholar, The Journal of Vascular Surgery, and ResearchGate. The result of our study supports the effect of doxycycline in preventing the growth of small AAAs. We conclude that therapeutic treatment with doxycycline in patients with small AAAs can prevent the growth of aneurysms, life-threatening aneurysm rupture, and reduce the need for expensive, invasive treatment.

Selected Abstracts from the May Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the May Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Instructions for use do, and should, matter

Acute aortic dissection remains a formidable acute aortic pathology to treat. thoracic endovascular aneurysm repair has revolutionized our management of aortic dissection and the Zenith Dissection System is a major step forward in our ability to mitigate long term false lumen related sequelae. In this issue of the Journal of Vascular Surgery, Lombardi et al1 present a post hoc analysis of data from the STABLE I and II clinical trials with attention paid to the relationship between the length of proximal seal and adverse events with the Zenith Endovascular Dissection System.

Selected Abstracts from the March Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the March Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

The 100 most cited articles in the diagnosis and management of peripheral artery disease

ObjectivePeripheral artery disease (PAD) is a highly prevalent disease that places major lifestyle limitations and mortality risk on affected individuals. As the understanding of the disease has grown in the medical community, it is unknown which literature has made the greatest impact on the knowledge of PAD. We performed a bibliometric analysis using the number of citations as an indication of impact to analyze the top 100 most influential articles on PAD management. MethodsA retrospective search of the Web of Science (Thomson Reuters, New York, NY) database for English-only publications was conducted in November 2020. We identified initial references from the database using the search terms “Peripheral Arterial Disease,” “Peripheral Vascular Disease,” “Claudication,” “Critical Limb Ischemia,” “Chronic Limb Threatening Ischemia,” “Rest Pain,” “Ischemic Ulcer,” “Toe Gangrene,” “Ankle Brachial Index,” and “Leg Ischemia” in Web of Science Core Collections. Articles were ranked based on the number of citations and then analyzed based on citation count and average number of citations per year. Additional metrics included the overall average number of publications per year, the journals, journal discipline, author (including degree and gender), institution, country, topic area, and the level of evidence. ResultsThe most popular articles were published between 1959 and 2017, with 46,716 citations in total (average 27.26 citations/y). The most popular article had 2225 citations in total and was Rutherford's “Recommended standards for reports dealing with lower extremity ischemia: Revised version.” Peak years of citations were 2016, 2014, and 2018 (2753, 2674, and 2639 citations, respectively). Top journals for the most cited publications were Circulation, Journal of Vascular Surgery, and the Lancet with 21, 13, and 7 articles, respectively. A majority of articles originated from the United States (58 articles), followed by the United Kingdom (15 articles) and Germany (13 articles). Major topic areas of interest and trends in the progressive understanding of PAD were noted. Top areas of focus included surgical interventions (29%), therapeutic angiogenesis (15%), epidemiological studies in PAD (14%), and diagnosis and evaluation (13%). In the top cited literature, 48% (14/29) of surgical articles investigated endovascular interventions for PAD. ConclusionsOverall, PAD research has evolved from basic epidemiological studies to advanced management with continued investigation toward future, improved treatments for PAD.

Selected Abstracts from the February Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the February Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the January Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the January Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders

Selected Abstracts from the December Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the December Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the November Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Selected Abstracts from the November Issues of the Journal of Vascular Surgery and the Journal of Vascular Surgery: Venous and Lymphatic Disorders: Editors: Peter Gloviczki and Peter F. Lawrence

Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution

The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT.One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed.Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.