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luation of therapy-requiring endoleaks in endovascular aortic repair surveillance.Objective National rankings of hospitals rely on outcomes-based evaluation to assess the performance of surgical programs, particularly those performing high-risk elective surgical procedures such as open aortic repair. There exist various classification systems for tracking outcomes, but increasingly the ICD-10 based Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) are utilized as a publicly reported comparison measure of hospital quality performance. We sought to critically evaluate the accuracy of the existing vehicles to assess open aortic repair outcomes in an established program. Methods This is a case-control study of patients who underwent open abdominal aortic aneurysm (AAA) repair at the Johns Hopkins Medical Institutions from 2004-2018. Patient characteristics and outcomes were collected as part of a prospectively maintained retrospective database. For each case, hemorrhagic, cardiac, respiratory, renal, wound and thromboembolic complications were identified using the to its stringent definition of renal injury. We conclude PSI should not form the basis of grading hospital performance when comparing clinically relevant complications among open aortic surgery programs.Objectives Reconstruction of infected aortic cases has shifted from extra-anatomical to insitu. This study reports the surgical strategy and early outcomes of abdominal aortic reconstruction in both native and graft related aortic infection with in situ xenopericardial grafts. Methods 21 consecutive patients (mean age 69 years, 20 male), between July 2017 and September 2019, undergoing abdominal xenopericardial in situ reconstruction of native aortic (4), endovascular (4) or open (13) graft aortic infection are included in the analysis. All repairs were performed on an urgent basis, but none were ruptured. All patients were followed-up with clinical and biological evaluation, ultrasound at 3 months and CT scan at 6 months and 1 year. Results Technical success was 100%, 8 patients were treated with xenopericardial tubes, 13 with bifurcated grafts. Thirty day mortality was 4.7% (n=1 death due to pneumonia with respiratory hypoxic failure in critical care.). Six patients (28%) developed acute kidney injury, 4 (1terventions.Objectives A patient's body mass index (BMI) can affect both peri- and postoperative outcomes across all surgical specialties. Given that obesity and end-stage renal disease (ESRD) are growing in prevalence, we aimed to evaluate the association between BMI and outcomes of upper extremity arteriovenous (AV) access creation. Methods A retrospective single-institution review was conducted for AV access creations from 2014-2018. Patient demographics, comorbidities, and AV access details were recorded. BMI groups were defined as normal weight (NW) (18.5-24.9kg/m2), overweight (OW) (25-29.9kg/m2), obese (OB) (30-39.9kg/m2), and morbidly obese (MO) (>40kg/m2). Perioperative complications and long-term outcomes including access maturation (defined as access being used for hemodialysis (HD) or surgeon judgment that access was ready for use in patients not yet on HD), occlusion, and reintervention were evaluated. Results A total of 611 upper extremity AV access creations were performed on patients who were NW (29.6%), 6, 95% CI 1.12-2.16), and MO (HR 1.69, 95% CI 1.1-2.58) (P=.02) relative to NW BMI. BMI was not independently associated with long-term readmission or survival. Conclusions Obesity is associated with higher rates of AV access failure to mature and reintervention. Surgeons performing access creation on obese patients must consider this for planning and setting expectations. Weight loss assistance may need to be incorporated into treatment algorithms.Objective Type II endoleaks are the most common type of endoleaks after EVAR and may cause late sac expansion and rupture. To prevent this, prophylactic embolization of aortic side branches has been suggested. The aim of this review was to assess the current evidence for this prophylactic treatment and its association with sac size enlargement, as well as rate of and re-intervention for type II endoleaks. Methods This was a systematic review and meta-analysis following the PRISMA guidelines. The MEDLINE and Scopus databases were used to search for related articles until March 2019. After screening, original studies reporting outcome comparing prophylactic embolization to those undergoing EVAR without prophylactic embolization were included. An assessment of the quality of the included studies, as well as data extraction, was performed by two independent observers. Statistical analysis was performed using ReviewManager 5.3. Results 3,777 publications were identified. After eliminating duplicated entries, reviectomy, died after IMA embolization due to ischemic colitis. Conclusions This systematic review and meta-analysis suggest that prophylactic aortic side branch embolization may be associated with lower rate of sac enlargement, incidence of type II endoleaks and re-interventions. However, high-quality unbiased studies are lacking in this field, and this review and meta-analysis may be affected by selection bias and residual confounders remaining in the retrospective studies. To conclude whether prophylactic embolization should be routinely performed, a prospective, randomized trial would be required.Introduction and Objectives Volume-outcome relationships in surgery have been well established. Recent studies have shown that high-volume surgeons provide improved outcomes performing open abdominal aneurysm repairs. The hypothesis of this study is that high-volume surgeons provide superior short and midterm outcomes performing elective open aortic operations when compared to low-volume surgeons. Methods We evaluated patients undergoing elective open abdominal aortic aneurism repair (AAA), aorto-femoral bypass (AFB), and aorto-mesenteric bypass (AMB) by board certified vascular surgeons using The New York Statewide Planning and Research Cooperative System database from 2002 to 2014. The Contal and O'Quigley technique was used to estimate a cut point objectively and provided an estimate of significance. A division using average yearly volumes (averaged over 3 years) of >/= 7 cases and less then 7 case per year returned the highest Q statistic and this grouping was used to classify high and low provider volu pulmonary failure (p less then 0.001), sepsis (p less then 0.001) and venous thromboembolism (p less then 0.001), respectively. Abdominal abscess, acute renal failure, hemorrhage, myocardial infarction, and sepsis were associated with increased cardiovascular specific mortality after open aortic operations (p less then 0.001). Conclusions These data demonstrate that high volume surgeons performing elective open aortic operations provide reduced complications, and improved short and mid-term survival, when compared to low-volume surgeons. selleck products It also identifies clinical and post-operative variables that are associated with increased cardiovascular specific mortality. These data provide further evidence that elective open abdominal vascular surgery should be centralized to high volume surgeons.Objective To determine predictors of increased length of stay (LOS) in patients who underwent lower extremity bypass for tissue loss (LEB-TL). Methods Using 2011 to 2016 National Surgical Quality Improvement Program (NSQIP) vascular-targeted databases, we compared demographics, co-morbidities, procedural characteristics, and 30-day outcomes between patients who had expected vs extended LOS (> 75th percentile, 9 days) after non-emergent LEB-TL. We also compare factors associated with short ( 0.05). On univariate analysis, non-white race, dependent functional status, transfers, dialysis, congestive heart failure, hypertension, beta-blockers, distal bypass targets, and extended operative time were associated with extended LOS (P less then 0.05). Extended LOS was also associated with higher rates of 30-day major adverse limb and cardiac events, additional procedures related to wound care, deep vein thrombosis (DVT), pulmonary, renal, septic, bleeding and wound complications and discharge to facility, but lower 30-day readmission rates. After adjusting for covariates, the independent factors for extended LOS included dialysis, beta-blockers, prolonged operative time, re-intervention, major amputation, additional procedures related to wound care, DVT, pulmonary, renal, septic, bleeding and wound complications and discharge to facility (P less then 0.05). On the other hand, multivariable analysis showed patients with expected LOS were significantly more likely to have been of white race or readmitted postoperatively (P less then 0.05). Conclusions From 2011 to 2016, there were no significant changes in LOS. Efforts to decrease LOS without increasing readmission rates, while focusing to address some of the above identified factors including preventable postoperative complications and preexisting socioeconomic factors may improve the overall vascular care of this challenging patent population.Objective We aimed to assess the five-year safety and effectiveness outcomes of patients enrolled in the Endurant Stent Graft Natural Selection Global Post Market Registry (ENGAGE) who were treated outside the approved indications for use (IFU) of the Endurant stent graft. Methods Our primary outcome measure was 12-month treatment success, defined as successful endograft delivery and deployment and the absence of type I or III endoleak, stent migration or limb occlusion, late conversion, and AAA diameter increase or rupture. Secondary outcome measures included 30-day all-cause mortality, major adverse events, secondary procedures, technical observations, aneurysm-related mortality, and all-cause mortality within 12 months. Results Demographic characteristics of ENGAGE patients treated outside (225, 17.8%) and within (1038, 82.2%) the IFUs were similar, except that female patients comprised a much higher percentage of the outside IFU group (19.1% vs. 8.7%, p99% of all patients. The outside and within IFU group registry. Proximal necks with angulation or diameters outside the IFUs were the most common reasons for patients identified as being outside-IFU, and the cohort had increased incidence of type Ia endoleaks. Despite the challenges presented from the broad range of aortic and AAA morphologies, the Endurant stent graft showed promising five-year outcomes.The Vascular Implant Surveillance and Interventional Outcomes Network (VISION) is a Coordinated Registry Network (CRN) a member of Medical Device Epidemiology Network (MDEpiNet), a Food and Drug Administration (FDA)-supported global public-private partnership that seeks to advance the collection and use of real-world data to improve patient outcomes. The VISION Coordinated Registry Network (CRN) began in September 2015 and held its first strategic meeting on September 10, 2018, at the FDA headquarters in Silver Spring, Maryland. VISION is a collaboration of the Vascular Quality Initiative (VQI), the FDA, and other stakeholders. At this annual meeting, leaders from the FDA, VQI, industry representatives, population health researchers, and regulatory science experts gathered to discuss strategic goals and opportunities for VISION. One of the key focus areas for VISION is linkage of VQI registry data to Medicare, longitudinal data sources maintained by various states, and other relevant data sources, as a model for efficient, cost-saving, and effectual, evidence generation and appraisal.