Vascular Surgery Literature Research Articles

Identifying barriers and facilitators to follow-up after endovascular aortic repair (EVAR): Qualitative study design and protocol

Endovascular aortic repair (EVAR) is now first line therapy for most patients with abdominal aortic aneurysms (AAA) as it reduces perioperative morbidity and mortality compared to open surgery. However, up to 40 % of patients do not undergo recommended follow-up, increasing risk of subsequent rupture. Risk factors for loss to follow-up have been studied retrospectively, however, qualitative studies assessing perceived barriers and facilitators to follow-up have not been performed and there are few qualitative protocols within the vascular surgery literature. This article presents a qualitative descriptive study protocol aimed at understanding and improving post-operative follow-up adherence after EVAR developed through an iterative process based on the Theoretical Domains Framework of behavior change. Steps include:•Selection of target behavior and study design•Development of study materials, sampling/recruitment strategy, and data collection•Qualitative data analysis and reporting findingsWe demonstrate the feasibility of this study by pilot testing of the semi-structured interview guides on a small group of patients, healthcare providers, and key personnel. This protocol aims to describe key stakeholder experiences within the healthcare system that will ultimately serve as the basis for future multi-institutional research piloting intervention strategies to improve EVAR follow-up.

Changing Trends in the International Contributions to the Vascular Surgery Literature

Changing Trends in the International Contributions to the Vascular Surgery Literature

The measurable impact of a diversity, equity, and inclusion editor on diversifying content, authorship, and peer review participation in the Journal of Vascular Surgery

ObjectiveWomen and minorities remain under-represented in academic vascular surgery. This under-representation persists in the editorial peer review process which may contribute to publication bias. In 2020, the Journal of Vascular Surgery (JVS) addressed this by diversifying the editorial board and creating a new Editor of Diversity, Equity, and Inclusion (DEI). The impact of a DEI editor on modifying the output of JVS has not yet been examined. We sought to determine the measurable impact of a DEI editor on diversifying perspectives represented in the journal, and on contributing to changes in the presence of DEI subject matter across published journal content. MethodsThe authorship and content of published primary research articles, editorials, and special articles in JVS were examined from November 2019 through July 2022. Publications were examined for the year prior to initiation of the DEI Editor (pre), the year following (post), and from September 2021 to July 2022, accounting for the average 47-week time period from submission to publication in JVS (lag). Presence of DEI topics and women authorship were compared using χ2 tests. ResultsDuring the period examined, the number of editorials, guidelines, and other special articles dedicated to DEI topics in the vascular surgery workforce or patient population increased from 0 in the year prior to 4 (16.7%) in the 11-month lag period. The number of editorials, guidelines, and other special articles with women as first or senior authors nearly doubled (24% pre, 44.4% lag; P = .31). Invited commentaries and discussions were increasingly written by women as the study period progressed (18.7% pre, 25.9% post, 42.6% lag; P = .007). The number of primary research articles dedicated to DEI topics increased (5.6% pre, 3.3% post, 8.1% lag; P = .007). Primary research articles written on DEI topics were more likely to have women first or senior authors than non-DEI specific primary research articles (68.0% of all DEI vs 37.5% of a random sampling of non-DEI primary research articles; P < .001). The proportion of distinguished peer reviewers increased (from 2.8% in 2020 to 21.9% in 2021; P < .001). ConclusionsThe addition of a DEI editor to JVS significantly impacted the diversification of topics, authorship of editorials, special articles, and invited commentaries, as well as peer review participation. Ongoing efforts are needed to diversify subject matter and perspective in the vascular surgery literature and decrease publication bias.

Radial arterial access is a safe alternative to brachial artery and femoral artery access for endovascular lower extremity peripheral arterial disease

ObjectiveRadial artery access is a well-described technique that has proven to be safe and efficacious in percutaneous cardiac intervention. This technique has been used with increased frequency in the treatment of lower extremity peripheral arterial disease (LE-PAD); however, the overall safety has not yet been well described in the vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access (BA) in the treatment of PAD. MethodsThe Vascular Quality Initiative database was used to identify all patients who underwent single site percutaneous access (retrograde femoral access [FA], BA, radial access [RA]) for treatment of LE-PAD from September 2016 through September 2019. Patients who underwent multiple access sites for intervention were excluded. Primary outcome was significant access site complications (ASCs), defined as those requiring treatment (blood transfusion, interventional treatment, or surgical treatment). Minor ASCs were also reported. ResultsThe cohort comprised 61,203 patients (270 RA, 1210 BA, and 59,723 FA) with an average age of 68 years and who were 59.6% male. The RA and BA groups had higher rates of prior endarterectomy or bypass compared with the FA group (66.7% RA; 86.0% BA; 50.2% FA; P < .001). RA was more often used for single-segment treatments (82% vs 74% [P < .020] and more aortoiliac arterial segments (59.6% vs 21.0% [P < .001]). ASC occurred in 1329 patients (2.7%), including minor ASC (996 [1.6%]) and significant ASC (333 [0.54%]). Significant ASC were less common after FA and RA compared with BA (RA, 1 [0.37%]; FA, 307 [0.51%]; BA, 25 [2.1%]; P < .001). On multivariate analysis, BA was the strongest predictor of significant ASC (odds ratio, 2.75; 95% confidence interval, 1.73-4.36; P < .001). Significant ASC was no different after RA compared with FA (odds ratio, 0.60; 95% confidence interval, 0.08-4.33; P = .616). Other factors independently associated with significant ASC were sex, age, diabetes, chronic obstructive pulmonary disease, dialysis, and closure device use. ConclusionsRA as the primary access vessel for endovascular treatment of LE-PAD is safe when compared with other traditional access sites. When FA is not possible or desirable, the radial approach may provide suitable access to treatment with a better safety profile than BA.

An Analysis of Spin in Vascular Surgery Randomized Controlled Trials With Statistically Nonsignificant Primary Outcomes

Spin is the manipulation of language that distorts the interpretation of objective findings. The purpose of the present study was to describe the characteristics of spin found in statistically nonsignificant randomized controlled trials (RCTs) comparing carotid endarterectomy to carotid artery stenting for carotid stenosis (CS) and endovascular aneurysm repair to open repair for abdominal aortic aneurysms (AAAs) because they represent a significant portion of vascular surgery literature.

Radial Artery Access is a Safe Alternative to Brachial Artery and Femoral Artery Access for Endovascular Lower Extremity Peripheral Arterial Disease

Radial artery access is a technique proved to be safe for percutaneous cardiac interventions. It has been used with increasing frequency in the treatment of lower extremity peripheral arterial disease. However, the overall safety has not yet been well described in the vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access in the treatment of peripheral arterial disease.

The Persistent Publication Glass Ceiling: An Analysis of Female Authorship Trend in Vascular Surgery

Prior research in vascular surgery has identified significant gender disparities in leadership positions. Publication serves as an indicator of academic performance, which is an important factor in promotions, salaries, grants, and tenure. This study aims to evaluate female authorship in vascular surgery literature.

Radial Artery Access Is a Safe Alternative to Brachial Artery and Femoral Artery Access for Endovascular Lower Extremity Peripheral Arterial Disease

Radial artery access is a well-described technique that has proven to be safe and efficacious in percutaneous cardiac intervention. This technique has been used with increased frequency in the treatment of lower extremity peripheral arterial disease (LE-PAD); however, the overall safety has not yet been well described in vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access in the treatment of PAD.

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.

Three-dimensional printing for preoperative planning of renal artery aneurysm surgery

A 37-year-old woman, G2P2, presented to her local surgeon with a stabbing, right-sided abdominal pain, not associated with nausea or vomiting, that became progressively worse over several days. Her medical history included severe hypertension during her two pregnancies, which did not return to normal after her second pregnancy. Her current medications included olmesartan-hydrochlorothiazide, labetalol, and folic acid. Her serum creatinine was 0.56 mg/dL, and no hematuria was detected on urinalysis. A computed tomography angiography scan showed a right prehilar renal artery aneurysm, 21 × 16 × 17 mm that originated from the distal right renal artery and continued as the upper pole segmental artery. The base of the aneurysm incorporated the origin of a common trunk artery, which subsequently bifurcated into the segmental right middle and lower pole arteries (A). Indications for repair of the renal artery aneurysm in this patient included difficult-to-control hypertension, abdominal pain, and an aneurysm >2 cm in a patient of childbearing age. Owing to the complexity of the branched vessels, we reconstructed computed tomography data of the patient's aneurysm and reproduced a three-dimensional (3D) anatomic model using the rapid prototyping (RP) technique. The 3D model was used for accurate prediction of vascular anatomy, for optimal teaching of surgical skills, and for patient counseling (B and C). The patient underwent an open repair of the renal artery aneurysm using a reversed, bifurcated right great saphenous vein graft (D). Her postoperative course was unremarkable, with normal renal function, and she was discharged on postoperative day 6. Her antihypertensive medications were discontinued postoperatively. A renal artery duplex ultrasound scan confirmed a patent bypass graft. Written consent was obtained from the patient for publication of this report. The use of an anatomic model produced by 3D printing or the RP technique has been described for successful surgical planning of aortic valve replacement after previous coronary bypass grafting1Sodian R. Schmauss D. Markert M. Weber S. Nikolaou K. Haeberle S. et al.Three-dimensional printing creates models for surgical planning of aortic valve replacement after previous coronary bypass grafting.Ann Thorac Surg. 2008; 85: 2105-2108Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar and complex aortic arch surgery.2Schmauss D. Juchem G. Weber S. Gerber N. Hagl C. Sodian R. Three-dimensional printing for perioperative planning of complex aortic arch surgery.Ann Thorac Surg. 2014; 97: 2160-2163Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar The integration of RP techniques with a reconstruction based on computer-aided design model 3D medical imaging data provides a complementary tool for making a truly patient specific replica of the structure with high accuracy.3Håkansson A. Rantatalo M. Hansen T. Wanhainen A. Patient specific biomodel of the whole aorta - the importance of calcified plaque removal.Vasa. 2011; 40: 453-459Crossref PubMed Scopus (35) Google Scholar To our knowledge, this is the first implementation and clinical application in complex reconstruction of a renal artery aneurysm described in the vascular surgery literature.

Popliteal Artery Injury after Low-Energy Knee Dislocation in the Obese

The last decade an increasing number of Low Energy Knee Dislocations (LEKD)in obese patients have been reported in the orthopaedic and vascular surgery literature. Vascular repair in the obese can be technically challenging and is associated with more perioperative complications than in the no obese. Using a percutaneous approach to blunt injury of the popliteal artery due to LEKD in the obese patient where even more extensive soft tissue injury may complicate open repair is a novel way to avoid incisions and manipulation of the injured ischemic lower extremity.

The impact of 10 years of war on combat casualty care research

Abstract : October 7, 2011, marked the end of the 10th year of US combat operations in Iraq and Afghanistan. As in previous conflicts, these wars have led to major advances in treating combat casualties, and the advances are also being translated into injury management paradigms in civilian trauma centers. Coincident with these advances was an increase in combat casualty research directed toward identifying new methods for saving lives and reducing the long-term disability resulting from battlefield injuries. A review of the scientific literature published during this period can be used to evaluate the research on combat casualty care conducted during the recent conflicts. One approach for determining the influence of individual articles is to measure the number of citations or the acknowledgments that one article receives from another.6 Previous citation studies have focused on trauma research in general7 and on the vascular surgery literature,8 but to our knowledge, no previous citation analyses have been reported for combat casualty care. The objective of this article was to identify and assess the relative impact of the top 50 most frequently cited articles on combat casualty care published during the first 10 years of war.

Author disclosure of conflict of interest in vascular surgery journals

Advances in vascular surgery are increasingly technology-driven, and the relationships between surgeons and the medical device industry can be complex. This study reviewed conflict of interest (COI) disclosure in the vascular surgery journals regarding several selected technology-driven topics, including endovascular stent grafts (EV), carotid artery stenting (CAS), and peripheral arterial interventions (PI), to suggest further directions. Authors' COI disclosures were reviewed from all clinical papers published in 2008 and 2009 in each of six vascular surgery journals, and pertaining to three selected topics (EV, CAS, and PI). Rate of COI disclosure was evaluated as a function of journal, topic, article type (randomized trial, case series, case report, review, or meta-analysis), and authors' region of origin. Secondarily, consistency of authors' disclosure was evaluated by reviewing papers by the same author and of the same topic. Six hundred thirty-five papers were reviewed from the six journals. A COI was declared in 125 (19.7%) of these papers. This rate differed between journals (range, 3.2%-34.1%; P < .0001). Rate of disclosure did not differ between topics (range, 12.8%-21.2%; P = .12), article type (range, 14.7%-30%; P = .28), or region of origin (range, 0%-33.3%; P = .09). There were 116 instances of the same author writing papers describing the same general topic. COI disclosure was consistent in the majority of these instances (72.4%), but inconsistent in 32 cases (27.6%). The most common (P = .006) inconsistencies involved the same type of article in different journals (46.9%), or in the same journal (25%). Rates of disclosure of COI, and inconsistencies in disclosure in the vascular surgery literature are at least partially due to differences in journals' reporting policies, while a smaller proportion of these inconsistencies are due to individual author behavior. Journals should adopt a consistent requirement for a separate COI declaration where all relevant financial arrangements are disclosed.

Is carotid artery disease responsible for perioperative strokes after coronary artery bypass surgery?

The coronary and extracranial carotid vascular beds are often simultaneously affected by significant atherosclerotic disease, and stroke is one of the potential major complications of coronary artery surgery. As a result, there is no shortage of reports in the vascular surgery literature describing simultaneous coronary and carotid artery revascularizations. Generally, these reports have found this combination of operations safe, but have stopped short of proving that it is necessary. Intuitively, simultaneous carotid endarterectomy and coronary artery bypass surgery could be justified if most perioperative strokes were the result of a significant carotid stenosis, either directly or indirectly. At first glance this appears to be a fairly straightforward issue; however, much of the evidence on both sides of the argument is circumstantial. One significant problem in analyzing outcome by choice of treatment in patients presenting with both coronary and carotid disease is the multiple potential causes of stroke in coronary bypass patients, which include hemorrhage and atheroemboli from aortic atheromas during clamping. But this controversial subject is now open to discussion, and our debaters have been given the challenge to clarify the evidence to justify their claims.

Don't all veins look alike? Comprehensively attending to diversity within the vascular surgical specialty

Prior research has established diversity as a topic of empirical analysis in the vascular surgery literature. Building on the work of previously published articles on diversity in the Journal of Vascular Surgery and elsewhere, this article engages in a broad discussion of diversity in two interrelated arenas: educational/workplace diversity and culturally competent care. Interdisciplinary review of the literature indicates that diversity is often thought of as an end-state to be accomplished. A more fruitful way to encompass the changing aspects of diversity work is to think of diversity as a set of processes that can be adjusted based on a set of interrelated goals that matter differently to different groups. In considering diversity as a process, an approach to diversity emerges that considers both independent effects of gender and race/ethnicity as well as interactive effects between the two variables to address future trends in medical education. Such trends are diagnosed and multiple courses of intervention are offered as reasonable options for future efforts. A comprehensive definition of diversity will be established in order to encompass two different arenas in which diversity concerns arise: educational diversity and culturally competent patient care. Second, a discussion of the rationales for attention to diversity among vascular surgeons will provide different avenues into a conversation about diversity in the profession. In so doing, three successful efforts will be briefly discussed: the Ohio State University's MED-Path program, the Keck School of Medicine's chair-centered approach to diversity in residency training, and the American Association of Orthopedic Surgeons' (AAOS) approach to culturally competent care.

The Open Anterior Paramedian Retroperitoneal Approach for Spine Procedures

With the advent of anterior lumbar interbody fusion and artificial disk replacement as common procedures for the treatment of many spinal problems, anterior exposure has become an increasingly popular procedure for general, thoracic, urologic, and vascular surgeons. Despite this, the body of literature describing this procedure, especially the general and vascular surgery literature, is lacking. A retrospective review of medical records was performed for patients operated on from April 2002 to March 2004. Tertiary care university hospital. In total, 64 open retroperitoneal exposures for anterior spinal approaches were performed. Thirty-five (55%) were performed on men and 29 (45%) on women. Fifty patients (78%) required lumbosacral approaches, and 14 (22%) required access to purely lumbar disk spaces. Forty-three patients underwent single-disk approaches, and 21 required access to either 2 or 3 levels. Forty patients (63%) underwent anterior lumbar interbody fusion, and 22 (34%) had a Prodisc disk replacement. We analyzed intraoperative and early postoperative complications. The average age was 43 years (range, 25-89 years), 42 and 44 years for men and women, respectively. Ninety-seven percent of all attempted retroperitoneal exposures were successful. Intraoperative complications occurred in 5 patients (8%) and included inability to mobilize the iliac veins, injury to the iliac vein, and ureteral tear. The postoperative course was complicated in 8 patients (14%) and included fever, urinary retention, spinal headache, Clostridium difficile colitis, and ileus. Open retroperitoneal exposure to the lumbar and lumbosacral vertebral bodies can be performed safely with a multidisciplinary approach that maximizes the various surgical skills of the orthopedic and vascular or general surgeon, reducing complication rates in anterior spinal surgery.

Suggested standards for reports dealing with lower extremity ischemia

Reports in the vascular surgery literature are often difficult to assess and compare with each other because of poorly defined terms, imprecise categorization, lack of indices for gauging the severity of the disease or the presence of risk factors capable of affecting outcome, and varying criteria for success or failure—in essence, a lack of standardized reporting practices. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery have appointed an ad hoc committee to deal with this problem. This report represents the recommendations of the first of its several subcommittees, that is, the one dealing with reports on lower extremity ischemia. Certain terms are defined and criteria offered for uniformly gauging the severity of disease, the findings of diagnostic studies, the types of therapeutic interventions, and the outcome of such treatments. Although future modifications may further improve on this effort, it is hoped that this committee's recommendations will help establish reporting standards for articles dealing with lower extremity ischemia.