Annals of vascular surgery
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Comparative Study
Complexity of Aortic Arch Anatomy Affects the Outcomes of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting.
Transcarotid artery revascularization (TCAR) has been shown to have half the rates of transient ischemic attack (TIA), stroke, and death compared with transfemoral carotid artery stenting (TFCAS). Successful outcomes of TFCAS require careful patient selection. The aim of this study was to determine the outcomes of TFCAS versus TCAR in both simple (type I) and complex (type II and III) aortic arches. ⋯ TCAR has improved outcomes of TIA/stroke/death compared with TFCAS in both simple and complex aortic arch anatomy. In simple aortic arches, there is no difference in neurologic outcomes between both approaches. In complex arch anatomy, TCAR has fewer strokes.
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Comparative Study
Open Abdominal Aortic Aneurysm Repair Is Associated with Higher Mortality Among Nonobese Patients and Higher Risk of Deep Wound Infections Among Obese Patients.
Prevalence of obesity in the United States is increasing. The impact of obesity on outcomes after endovascular and open abdominal aortic aneurysm (AAA) repair is largely unknown. The purpose of this analysis was to compare the postoperative outcomes between obese and nonobese patients after these operations. ⋯ Nonobese patients have high mortality after open AAA repair, and obese patients have higher incidence of deep wound infections after open AAA repair. For patients deemed appropriate anatomic candidates, EVAR should be preferred for nonobese patients to improve mortality and for obese patients to reduce the incidence of deep wound infections.
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Comparative Study
Hospital Volume Impacts the Outcomes of Endovascular Repair of Thoracoabdominal Aortic Aneurysms.
Few centers in the United States have the expertise to manage patients with a thoracoabdominal aortic aneurysm (TAAA). The purpose of this study is to use a nationally representative vascular database to assess the role of hospital volume on outcomes in patients undergoing endovascular repair for TAAA. ⋯ Our study demonstrates significantly lower morbidity and mortality in high volume hospitals performing cEVAR for TAAA, despite operating on older patients with more complex TAAA types. This is likely due to better rescue phenomenon in addition to more experienced operators. Complex endovascular repair of TAAA can be performed safely in high volume aortic centers of excellence.
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Comparative Study
Digital Footprint of Vascular Surgery Training Programs in the United States and Canada.
The digital footprint of vascular residency and fellowship programs may have an impact on an applicant's likelihood of selecting a given program. This may include content and accessibility of a particular program's website as well as its social media presence. The goal of this study is to evaluate the online presence of all accredited vascular surgery training programs in the United States and Canada. ⋯ The overall digital footprint of the majority of training programs in the United States was small, unlike their Canadian counterparts. Although the vast majority of websites for vascular surgery training programs were accessible via simple internet searches, they lacked information that could have been important to applicants. Additionally, the significant underuse of social media platforms by American vascular surgery programs indicated a potential missed opportunity to target the millennials who make up most of the applicant pool to these programs.
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COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.