Journal of vascular surgery
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Multicenter Study Comparative Study Observational Study
Treatment choice and survival after ruptured abdominal aortic aneurysm: A population-based study.
The objective of this study was to clarify whether the findings of the randomized studies of repair method (open aortic repair [OAR] vs endovascular aneurysm repair [EVAR]) concerning short-term and midterm survival for ruptured abdominal aortic aneurysms (RAAAs) could be confirmed in a contemporary, nationwide, and unselected population. ⋯ An OAR/EVAR practice for RAAA is not superior to an OAR-only practice with respect to survival at short-term or midterm follow-up. The results are even compatible with an advantage of OAR-only practice vs OAR/EVAR practice for both follow-up periods. There is no extra benefit for either female or elderly patients with an OAR/EVAR practice.
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Sexual harassment is defined as unwelcome behaviors or obscene remarks that affect an individual's work performance or create an intimidating, hostile, or offensive environment. It is known to be more pervasive in male-dominated workplaces and flourishes in a climate of tolerance and culture of silence. We sought to examine its prevalence in faculty of vascular surgery training programs, to identify factors associated with occurrence, to determine reporting barriers, and to identify any gender bias that exists. ⋯ A significant number of faculty of vascular surgery training programs have experienced workplace sexual harassment. Whereas most are aware of institutional reporting mechanisms, very few events are reported and <60% of respondents feel comfortable reporting to departmental or divisional leadership. Female vascular surgeons believe gender influences hiring, promotion, compensation, and assumptions of life goals. Further work is necessary to identify methods of reducing workplace sexual harassment and to optimize gender disparity in vascular surgery practice.
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There is a growing body of literature raising concerns about the long-term durability of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), suggesting that long-term outcomes may be better after open AAA repair. However, the data investigating these long-term outcomes largely originate from early in the endovascular era and therefore do not account for increasing clinical experience and technologic improvements. We investigated whether 4-year outcomes after EVAR and open repair have improved over time. ⋯ Four-year survival improved in more recent years after EVAR but not after open repair. This finding suggests that midterm outcomes after EVAR are improving, perhaps because of technologic improvements and increased experience, information that should be considered by surgeons and policymakers alike in evaluating the value of contemporary EVAR and open AAA repair.
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Ever since the first positive test was identified on January 21, 2020, Washington State has been on the frontlines of the coronavirus disease 2019 (COVID-19) pandemic. Using information obtained from Italian surgeons in Milan and given the concerns regarding the increasing case numbers in Washington State, we implemented new vascular surgery guidelines, which canceled all nonemergent surgical procedures and involved significant changes to our inpatient and outpatient workflow. The consequences of these decisions are not yet understood. ⋯ The COVID-19 pandemic has changed every aspect of "normal" vascular surgical practice in a large academic institution. New practice guidelines effectively reduced operating room usage and decreased staff and trainee exposure to potential infection, with the changes to clinic volume not resulting in an immediate increase in emergency department or inpatient consultations or acute surgical emergencies. These changes, although preserving resources, have also reduced trainee exposure and operative volume significantly, which requires new modes of education delivery. The lessons learned during the COVID-19 pandemic, if analyzed, will help us prepare for the next crisis.