Journal Of Vascular Surgery Research Articles

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

Continue the search for the ideal nonautogenous arterial conduit while we still can

In the current issue of the Journal of Vascular Surgery, we learn of the latest development in arterial conduits in patients without adequate autogenous tissue for revascularization.1 In their article outlining their phase II trial of the human acellular vessel (HAV), Gutowski and his long list of coauthors with senior author Lawson describe their first-in-man experience with this “novel regenerative surgical therapy.”

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

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

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

Selected Abstracts from the August 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: Editors: Peter Gloviczki and Peter F. Lawrence

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

Impact of Social Media Mentions on the Academic Citations Three Years After Publication in a Vascular Surgery Journal

To utilize available data within social media platforms such as Facebook and Twitter to examine the prevalence of academic citations of vascular surgery literature. Limited data are present on the topic of social media effect on literature within surgical subspecialties and as a result the significance of its impact on the exposure of meaningful publications.

Barriers to Follow-up for Patients With Aortic Dissection in an Academic Tertiary City Hospital

Proper follow-up after diagnosis and treatment of aortic dissection (AD) is important. Secondary problems like aneurysmal degeneration leading to rupture, stenosis, evolution of the dissection flap, and aortic remodeling can develop after treatment. Patients often have various barriers that hinder them from following up with their vascular or cardiothoracic surgeon. We sought to identify compliance with and barriers to surveillance in this population of patients. Retrospective chart review of 400 patients with AD between 2008 and 2018 at Thomas Jefferson University Hospital was performed. Of 400 patients, 313 had AD (DeBakey type I, II, or III). Demographics and risk factors were identified and recorded. After Institutional Review Board approval was obtained, patients were surveyed by telephone using an AD questionnaire assessing the type of intervention they had (open, endovascular, or medical) and whether they had seen a surgeon after treatment of their AD. Patients unable to follow up were questioned about obstacles to care. Descriptive statistics were calculated and reported on the basis of 100 preliminary patient records that were surveyed of 313. At the time of the survey, 88 patients were alive. Average age at the date of presentation to the hospital was 61.5 ± 14.9 years, with male predominance of 60%. Among these patients, 24% had DeBakey type I, 16% had type II, and 60% had type III; 33% were managed by open operation, 14% by endovascular approach, and 53% medically as deemed appropriate by diagnoses. Ninety-five patients were called (5 had missing contact information); 60 (63.2%) patients responded, 34 (35.7%) could not be reached, and 1 (1.1%) refused to participate. Twenty-five (26.3%) had been to their surgeon, and 35 (36.8%) did not follow up. Of 95 patients, 55 (57.9%) reported that they understood the need for follow-up, and 5 were unaware of the need for further care. Patients reported lack of escort (3.6%), anxiety related to diagnosis (3.6%), chronic medical illness (7.1%), age-related weakness (1.2%), lack of transportation (4.8%), transportation costs (2.4%), employment obligations (1.2%), inability to pay for visits (7.2%), and scheduling issues (9.5%). The remaining patients thought they did not need to see their surgeon (44%). Preliminary data show that a majority of patients do not seek follow-up with a surgeon after the diagnosis and management of AD. It is crucial that there are guidelines in place to address issues of access to care and to prevent potential future complications in these patients. Survey of all patients will be completed before the Vascular Annual Meeting.

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

The impact of organized multidisciplinary care on limb salvage in patients with mild to moderate WIfI ischemia grades

The impact of organized multidisciplinary care on limb salvage in patients with mild to moderate WIfI ischemia grades

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

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

The 100 most-cited articles on chronic venous disease: a bibliometric analysis.

ObjectiveTo use bibliometric analysis to understand characteristics and trends in the research on chronic venous disease (CVD), which affects patients’ quality of life by causing pain, swelling, and ulceration.MethodsWe searched the Thomson Reuters Web of Science citation indexing database to identify the 100 most-cited manuscripts on CVD. The resulting articles were analyzed by title, author, institution, topic, year of publication, and country of origin.ResultsThe Journal of Vascular Surgery published the most manuscripts on CVD (n = 36) and was the most-cited journal (n = 5356). The United Kingdom was the country with the greatest number of publications (n = 32). Imperial College London was the institution with the highest number of publications (n = 6). Endovenous thermal ablation was the most widely studied research specialty (n = 30).ConclusionsOur analysis showed that the majority of CVD research is carried out in Western countries, and that the number of research studies is increasing in line with recent advances in CVD.

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

The rectus femoris muscle flap is an underused tool in the vascular surgeon's armamentarium

Mrs Havercamp aFictitious.aFictitious. presents to clinic at 4:00 pm today for an unscheduled appointment. She is a 67-year-old obese diabetic woman who is 10 days status post right common femoral endarterectomy with Dacron patch angioplasty and retrograde iliac stenting for rest pain. Today, she reports increasing pain and drainage from the groin wound. On examination, there is erythema and dehiscence of the skin edges. Cloudy fluid emanates from the wound. I sigh. “Mrs Havercamp, when was the last time you had anything to eat or drink?” Groin wound complications—alarmingly common, occasionally lethal. Amputation may result, but regardless of the outcome, a significant commitment of time, effort, and cost ensues for the patient and the surgeon. That muscle flaps are a valuable adjunct in the treatment of groin wound complications is incontrovertible. Virtually every vascular surgeon has rotated a sartorius flap, usually with success. But what if the sartorius flap fails? or is unavailable? Most of us will have exhausted our toolbox and require the assistance of a plastic surgeon colleague. Indeed, there are myriad reports of other types of muscle flaps used in the management of groin wounds—tensor fascia lata, gracilis, anterolateral thigh myocutaneous, rectus femoris, rectus abdominis, and others. Common among these reports is that they are performed by plastic surgeons in the majority of cases. This study by Ryer and colleagues1Ryer E.J. Garvin R.P. Kapadia R.N. Jorgensen B.D. Green J.O. Fluck M. et al.Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions.J Vasc Surg. 2020; 71: 905-911Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar describes 24 rectus femoris flaps performed exclusively by vascular surgeons for treatment of complex groin wounds after femoral artery reconstruction. As expected, obesity, diabetes, and chronic real disease were common in this cohort of patients, and more than half of the surgical procedures were performed in fields previously operated on. Outcomes were largely favorable and comparable to other publications for patient survival and limb salvage. There were no instances of flap necrosis, nor were any complications related to flap rotation identified. The technique for creation of these flaps is described and is straightforward. The authors acknowledge a potential disadvantage of the rectus femoris flap: a decrement in knee extension strength. The authors did not attempt to quantify it, and they appear to dismiss its importance among chronically ill patients who engage in little strenuous activity. On the contrary, maintaining all residual strength among these patients whose reserve is marginal may be critically important to maintaining mobility. This study sheds no light on this issue. In addition, harvesting and rotating this flap almost certainly take more time than creating a sartorius flap and do involve a fairly generous counterincision in the thigh. Nevertheless, I suspect that these potential downsides practically have little impact. Will I abandon the sartorius flap? Certainly not, and I suspect the authors will not either. There is clearly a role for this simple flap under the right circumstances. Will I add the rectus femoris flap into my own armamentarium? Absolutely. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructionsJournal of Vascular SurgeryVol. 71Issue 3PreviewGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Full-Text PDF

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

The asymptomatic octogenarian and carotid endarterectomy—While we await the results of CREST-2

Currently there is no definitive level I evidence regarding the appropriate management of asymptomatic moderate to severe carotid artery stenosis in the octogenarian patient. In this 5-year review of National Surgical Quality Improvement Program registry data, exceptional “real-world” results are reported with use of carotid endarterectomy (CEA) in this growing cohort.1Glousman B.N. Sebastian R. Macsata R. Kuang X. Yang A. Patel D. et al.Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians.J Vasc Surg. 2020; 71: 518-524Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The combined stroke and death rate was 2% at 30-day follow-up (stroke rate 1%!), with the authors stating that “age alone should not interdict this modality.” As the authors acknowledge, the most notable limitations of this study are the significant preoperative selection bias apparent in the octogenarians undergoing CEA and the considerably larger number of younger patients studied (nearly five times more) than octogenarians. Other factors include that approximately 25% of all of the study subjects were treated with CEA for only 50% to 79% carotid stenosis, lack of use of standard preoperative carotid imaging or grading criteria for selection to undergo CEA, 30-day follow-up only, and absence of data regarding preoperative cardiovascular risk stratification to determine fitness for surgery. Despite the noted limitations of the database used, the authors have demonstrated that with proper selection and execution, results with use of CEA in the fit octogenarian with asymptomatic carotid artery stenosis can be equivalent to those obtained in younger patients. Whereas this is clearly not level I evidence, it does again confirm that properly applied CEA remains an extremely safe and efficacious treatment modality even in octogenarians. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenariansJournal of Vascular SurgeryVol. 71Issue 2PreviewCarotid endarterectomy (CEA) is the gold standard to prevent a recurrent stroke in symptomatic patients with carotid stenosis. However, in the modern era, the benefit of CEA in asymptomatic octogenarian patients has come into question. This study investigates real-world outcomes of CEA in asymptomatic octogenarians. Full-Text PDF

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

RETRACTED: Prevalence of unprofessional social media content among young vascular surgeons

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the authors, the Editor-in-Chief and the Senior Editor of the Journal of Vascular Surgery. This article has been retracted in accordance with the Committee on Publication Ethics (COPE) Retraction Guidelines because the authors did not have permission to use the Association of Program Directors in Vascular Surgery (APDVS) directory of program directors and trainees to conduct research. In addition, the methodology, analysis and conclusions of this article were based on published but not validated criteria, judging a series of behaviors including attire, alcohol consumption, controversial political and religious comments like abortion or gun control, in which significant conscious and unconscious biases were pervasive. The methodology was in part predicated on highly subjective assessments of professionalism based on antiquated norms and a predominantly male authorship supervised the assessments made by junior, male students and trainees. The authors did not identify biases in the methodology, i.e., judging public social media posts of women wearing bikinis on off-hours as “potentially unprofessional”. The goal of professionalism in medicine is to help ensure trust among patients, colleagues and hospital staff. However, professionalism has historically been defined by and for white, heterosexual men and does not always speak to the diversity of our workforce or our patients. The Editors deeply regret the failures in the Journal’s peer review process which allowed this paper to be published. The Editors and the review process failed to identify errors in the design of the study, to detect unauthorized use of the data, and to recognize the conscious and unconscious biases plaguing the methodology. For this, we express our most sincere apology.

Does Social Media have an Impact Factor?

Introduction: Social media is now an everyday part of modern life including medicine. There are an increasing number of healthcare professionals and institutions using social media in their clinical and academic practice1. One study alone in 2011 showed 90% of doctors used social media personally and 65% professionally2. Twitter provides a platform for signposting users to the most current and useful material and provide scope for alternative metrics. Historically, a healthcare professional would use the journal impact factor (JIF) of a journal to select the most appropriate to subscribe to and read, however in today's digital society, Twitter provides the ability to see updates across a range of journals and for the clinician to select what is most relevant for them. We therefore performed an observational study to assess whether there was a correlation between Twitter follower numbers (TFN) and JIF. Methods: A search of 10 popular general medicine, general surgery, vascular surgery and interventional radiology journals was performed, namely: Nature, The New England Journal of Medicine, The Lancet, The British Medical Journal (BMJ), The British Journal of Surgery, Circulation, European Journal of Vascular and Endovascular Surgery, Journal of Vascular Surgery (JVS), Journal of Vascular Interventional Radiology and CardioVascular and Interventional Radiology (CVIR). The 2017 JIF stated on their website as of 4th April 2019 was recorded. Of these 7 cited 2017 Journal Citation Reports3 as the source. The JVS and CVIR both stated a JIF that matched 2017 Journal Citation Reports3 but did not cite the source on website. The BMJ had a published 2017 JIF (23.562) that did not match the Journal Citation Reports (23.259)3 [Table 1]. A search of the journals on Twitter was made and the number of followers as of 15:15 GMT on 5th April was noted. Bivariate regression analysis of the TFN as a function of the JIF was undertaken using Minitab 18 statistical software. For the purpose of the analyses the JIF as per the journal website was used, as the minor variations indicated would be likely to have any major impact on the outcomes. Results: There was a visible impression that the higher the JIF the higher the TFN [Table 1]. However, there was low correlation between the JIF and number of followers (adjusted R-sq= 20.76%, p=.104; Graph 1), with occasional low JIF journals also having a large number of followers as noted in the graph outliers. Conclusion: Whilst journals with high JIF clearly had higher TFN, we could find no causal link to suggest that social media following was indeed impacted upon by the impact factor directly. This is likely due to confounding factors particularly the fact that the number of followers will be from a varied background and much higher than that of the number of actual directly contributing authors who are also journal followers, which then via individual and subsequently journal citation impact may possibly have a more direct correlation, but that is outside of the scope of the current analysis.Table 1Journal Impact Factors and Twitter followingGraph 1Scatterplot: correlation between TFN.and JIF.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Endovascular Management of a Saccular Aneurysm in the Supra-Sma Region of Aorta Occluding the Celiac Trunk, in a Patient with Behcets Disease

Introduction - Behcets disease is a multisystem disorder which can present with various vascular manifestations in 12% of the patients(1). Being classified under variable vessel vasculitis, it may involve both the arteries and the veins of all sizes(2). The spectrum of presentation includes venous thrombosis, systemic or pulmonary arterial anuerysms, stenosis or occlusions. The most common vascular presentation is venous thrombosis(3). The incidence of arterial manifestations in Behcets disease is comparably less(4). The aorta is the mostly commonly involved artery reported in literature followed by the femoral artery and the pulmonary artery. Aneurysm is the most common presentation in the aorta and rupture of a large artery aneurysm is the most common cause of death(1). The pathogenesis involved is the inflammation of the vasa vasorum leading to medial destruction and fibrosis(5). Management options include open surgical repair or endovascular approach, both done under a cover of immunosuppressive regimen. In the present era, open vascular repair can be avoided as it involves a high risk of perioperative complications in view of the inflammatory pathology leading to fragile vessel walls and also due the high risk of post operative psuedoaneurysm formation(6). Endovascular treatment options for an aortic aneurysm include stent grafts or coil embolisation, with the former being the most commonly reported modality in literature(7) . Coil embolisation has been used for both saccular aneurysms of the aorta and intracranial vessels(8). Methods - We report a case of saccular aneurysm in the celiac region of the abdominal aorta of size 2.8cm anteroposterior X 2.2cm transverse X 2.1cm superioinferior, occluding the celiac trunk in an 18 year old young male with Behcets disease. On initial evaluation his systemic inflammatory markers (ESR and CRP) were raised and the SMA origin was partially occluded by acute thrombus. In view of the same he was started on steroids, immunosuppressive medications and anticoagulation. His symptoms improved well on conservative management. On one month follow up the saccular aneurysm showed significant increase in size of 3.7cm anteroposterior X 2.9cm transverse X 3.6cm superioinferior necessitating urgent intervention to prevent life threatening complications like rupture. He underwent supra-SMA aortic stenting with bare metal stent and coil embolisation of the aneurysm sac. Post operatively he was discharged on steroids and immunosupression. Results - Immediate post operative and 1st month follow up duplex showed no flow in the aneurysm sac. Conclusion - This case report exemplifies that an endovascular approach can be used to treat a saccular aneurysm of the aorta with bare metal stent and coils without the risk of distal embolisation of coils. References1)Park JH, Han MC, Bettmann MA. Arterial manifestations of Behcet’s disease. AJR Am J Roentgenol 1984; 143:821–825.2)Lie.JT, Vascular involvement in Bechets disease: arterial and venous and vessels of all sizes, J Rheumatol 1992; 19:402-10 .3)Koc Y, Gullu I, Akpek G, et al. Vascular involvement in Behcet’s disease. J Rheumatol 1992; 19:402–410.4)N. Y. Jung, S. K. Kim, E. C. Chung, H. Park, and Y. K. Cho, Endovascular treatment for rupture of intrahepatic artery aneurysm in a patient with Behcet’s syndrome,” American Journal of Roentgenology, vol. 188, no. 5, pp.W400–W402, 2007.5)A. Freyrie, O. Paragona, G. Cenacchi, G. Pasquinelli, G. Guiducci, and G. L. Faggioli, True and false aneurysms in Behcet’s disease: case report with ultrastructural observations, Journal of Vascular Surgery, vol. 17, no. 4, pp. 762–767, 1993.6)Sasaki S, Yasuda K, Takigami K, Shiiya N, Matsui Y, Sakuma M. Surgical experiences with peripheral arterial aneurysms due to vasculo-Behcet’s disease. J Cardiovasc Surg (Torino) 1998; 39:147–150.7)J. H. Park, J. W. Chung, J. H. Joh, et al., Aortic and arterial aneurysms in Behcet disease: management with stent-grafts- Initial experience, Radiology, vol. 220, no. 3, pp. 745–750, 2001.8)W. H. Kim, D. Choi, J.-S. Kim, Y.-G. Ko, Y. Jang, and W. H. Shim, “Effectiveness and safety of endovascular aneurysm treatment in patients with vasculo-Behc¸et disease,” Journal of EndovascularTherapy, vol. 16, no. 5, pp. 631–636, 2009.