Journal of vascular surgery
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It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. ⋯ Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.
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Plasma 25 hydroxycholecalciferol (vitamin D) deficiency has been associated with adverse cardiovascular outcomes in epidemiologic studies. Chronic kidney disease is associated with loss of 1α-hydroxylase and consequently vitamin D deficiency. We hypothesized that vitamin D deficiency was associated with increased mortality and increased vascular access failure in patients undergoing permanent vascular access for end-stage renal disease. ⋯ Vitamin D deficiency is highly prevalent in patients undergoing vascular access procedures. Patients who are deficient in vitamin D have worse survival and worse vascular access outcomes. Further study is warranted to assess whether aggressive vitamin D repletion will improve outcomes in this population.
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Comparative Study
Outcomes reported by the Vascular Quality Initiative and the National Surgical Quality Improvement Program are not comparable.
The Vascular Quality Initiative (VQI) and National Surgical Quality Improvement Program (NSQIP) have emerged as the primary vascular surgery quality measurement tools with the purpose of evaluating perioperative outcomes and assessing hospital and physician quality. VQI uses self-reporting to capture all index vascular procedures during the inpatient period. NSQIP employs nurse abstractors to capture a sample of procedures and covers 30-day events. We hypothesize that patients undergoing lower extremity bypass (LEB) will exhibit high concordance for preoperative variables and low concordance for postoperative variables between these data sets. ⋯ VQI and NSQIP demonstrate substantial concordance for most preoperative variables and poor concordance for most postoperative variables, even at identical collection periods. This discordance is a result of differences in data collection methods and variable definitions. On the basis of these findings, VQI and NSQIP data sets cannot be used to directly compare risk-adjusted patient outcomes between institutions.
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In the United States, vascular surgeons frequently perform carotid endarterectomy (CEA). Given the resource burden of unplanned readmission (URA), we sought to identify the predictors and consequences of URA after this common vascular surgery procedure to identify potential points of intervention. ⋯ The 30-day URA rate after CEA is low (6.5%). Prior coronary artery bypass grafting and in-hospital postoperative occurrence of stroke, bleeding/hematoma, and congestive heart failure identify those at increased risk of URA, and URA signals increased long-term risk of postoperative mortality.
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The objective of this study was to report on the incidence of left arm ischemia, left arm function, and quality of life after thoracic endovascular aortic repair (TEVAR) by stent grafting with and without coverage of the left subclavian artery (LSA). ⋯ TEVAR is associated with a low risk of peri-interventional left arm ischemia. During long-term follow-up, secondary LSA revascularization is uncommon. Coverage of the LSA has no impact on left arm function and quality of life, probably with the exception of physical health scores in patients with TAI.