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Caitlin W Hicks, Besma Nejim, Tammam Obeid, Satinderjit S Locham, Mahmoud B Malas
BACKGROUND: Primary carotid stenting (PCS) has been shown to be feasible and safe in small series, but real-world outcomes in a large multicenter data set have yet to be explored. We aimed to compare outcomes for PCS (PCS+) vs conventional carotid artery stenting (CAS) with angioplasty (PCS-) using a national database. METHODS: We analyzed all CAS cases in the Vascular Quality Initiative (VQI) database (2005-2016) using univariable and multivariable logistic regression to assess the effect of PCS on outcomes...
February 1, 2018: Journal of Vascular Surgery
Caitlin W Hicks, Besma Nejim, Satinderjit Locham, Hanaa D Aridi, Marc L Schermerhorn, Mahmoud B Malas
BACKGROUND: The U.S. Centers for Medicare and Medicaid Services (CMS) has defined a set of high-risk criteria to help define patients who are appropriate for carotid artery stenting (CAS), but these criteria have never been validated. We aimed to validate the CMS high-risk criteria in a nationally representative cohort of patients undergoing CAS and carotid endarterectomy (CEA). METHODS: All patients undergoing CAS (with embolic protection) or CEA in the Vascular Quality Initiative (VQI) database (2013-2016) were included...
January 17, 2018: Journal of Vascular Surgery
Jeffrey J Siracuse, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Denis Rybin, Gheorghe Doros, Salvatore T Scali, Marc L Schermerhorn
OBJECTIVE: Endovascular aneurysm repair (EVAR) can be performed through percutaneous or surgical access. Our goal was to assess the difference in perioperative outcomes based on access type in a real-world setting. METHODS: The Vascular Quality Initiative (VQI) database was queried for EVAR. Univariable analysis and multivariable analysis were used to determine the independent effect of access type. RESULTS: There were 8340 (64%) and 4747 (36%) EVAR procedures performed through percutaneous and surgical access (3395 [72%] transverse and 1352 [28%] vertical incisions)...
January 13, 2018: Journal of Vascular Surgery
Thomas W Cheng, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Myriam Castagne, Denis Rybin, Stephen J Raulli, Jeffrey J Siracuse
OBJECTIVE: Length of stay (LOS) is commonly used to gauge hospital resource utilization and can affect hospital profit margin. Other fields of surgery have showed that operations performed close to the weekend have longer LOS and higher patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes compared to those treated before the weekend. METHODS: The Vascular Quality Initiative database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017...
December 5, 2017: Annals of Vascular Surgery
Allan M Conway, Khalil Qato, Laurie R Mondry, Guillaume J Stoffels, Gary Giangola, Alfio Carroccio
BACKGROUND: Open surgical repair remains the "gold standard" treatment for chronic type B aortic dissection (cTBD) with aneurysm. Thoracic endovascular aortic repair (TEVAR) has gained popularity in recent years for the treatment of thoracic aortic diseases, including cTBD. We assessed the effectiveness of TEVAR in the treatment of cTBD using the Vascular Quality Initiative (VQI) database. METHODS: The VQI registry identified 4713 patients treated with TEVAR from July 2010 to November 2015, including 125 repairs for cTBD...
November 17, 2017: Journal of Vascular Surgery
Sarah E Deery, Thomas F X O'Donnell, Katie E Shean, Jeremy D Darling, Peter A Soden, Kakra Hughes, Grace J Wang, Marc L Schermerhorn
OBJECTIVE: We aimed to compare perioperative morbidity and mortality and late survival among black, white, and Asian patients undergoing intact abdominal aortic aneurysm (AAA) repair. METHODS: We identified all patients undergoing intact, infrarenal AAA repair in the Vascular Quality Initiative (VQI) from 2003 to 2017. We compared in-hospital outcomes by race using the Fisher exact and Kruskal-Wallis tests. Multivariable logistic and linear regression models of perioperative outcomes adjusted for differences in demographics, comorbidities, hospital volume, and procedure...
October 23, 2017: Journal of Vascular Surgery
Benjamin S Brooke, Adam W Beck, Larry W Kraiss, Andrew W Hoel, Andrea M Austin, Amir A Ghaffarian, Jack L Cronenwett, Philip P Goodney
Importance: Ensuring that patients undergo surveillance imaging after surgery is a key quality metric after many vascular procedures. It is unclear whether hospital participation in a national quality improvement registry such as the Vascular Quality Initiative (VQI) achieves this goal. Objective: To determine if hospital participation in the VQI registry is associated with increased rates of surveillance imaging after vascular procedures. Design, Setting, and Participants: A quasi-experimental study used Medicare claims to study 2174 US hospitals in which 1 530 102 patients had undergone an endovascular abdominal aortic aneurysm repair (EVAR), 1 403 067 patients had undergone a lower extremity bypass (LEB) or peripheral vascular intervention (PVI), and 294 942 patients had undergone carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedures between January 1, 2007, and December 31, 2012...
October 11, 2017: JAMA Surgery
Pedro Gr Teixeira, Karen Woo, Adam W Beck, Salvatore T Scali, Fred A Weaver
Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences...
December 2017: Vascular
Peter A Soden, Sara L Zettervall, Sarah E Deery, Kakra Hughes, Michael C Stoner, Philip P Goodney, Ageliki G Vouyouka, Marc L Schermerhorn
BACKGROUND: Although many studies have demonstrated racial disparities after major vascular surgery, few have identified the reasons for these disparities, and those that did often lacked clinical granularity. Therefore, our aim was to evaluate differences in initial vascular intervention between black and white patients. METHODS: We identified black and white patients' initial carotid, abdominal aortic aneurysm (AAA), and infrainguinal peripheral artery disease (PAD) interventions in the Vascular Quality Initiative (VQI) registry from 2009 to 2014...
February 2018: Journal of Vascular Surgery
Joshua Gabel, Brice Jabo, Sheela Patel, Sharon Kiang, Christian Bianchi, Jason Chiriano, Theodore Teruya, Ahmed M Abou-Zamzam
BACKGROUND: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI). METHODS: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by the level of amputation...
September 6, 2017: Annals of Vascular Surgery
Michael Neilson, Christopher Healey, David Clark, Brian Nolan
INTRODUCTION AND OBJECTIVES: The Rapid Ruptured Abdominal Aortic Aneurysm Score (RrAAAs) was developed from Vascular Study Group of New England (VSGNE) data (649 rAAA patients, repaired both open and endovascularly), using pre-operative age, creatinine, and blood pressure. This study validates that model using the larger National Vascular Quality Initiative (VQI) dataset, and compares its performance to previous models. METHODS: The Vascular Quality Initiative (VQI) registry was queried for patients undergoing rAAA repair from 2006-2016...
September 5, 2017: Annals of Vascular Surgery
Andrea M Steely, Peter W Callas, Patrick K Hohl, David J Schneider, Randall R De Martino, Daniel J Bertges
OBJECTIVE: The objective of this study was to investigate adherence to practice guidelines for antiplatelet and statin use after postoperative myocardial infarction (POMI) and its effect on late mortality following vascular surgery in a multicenter registry. METHODS: Antiplatelet and statin use was examined in 1749 vascular surgery procedures with POMI within the Vascular Quality Initiative (VQI) from 2005 to 2015. Our primary aim was to assess cardiac medication (CM) use at discharge, defined as (1) single antiplatelet therapy (SAPT; aspirin or P2Y12 inhibitor) or dual antiplatelet therapy (DAPT; aspirin and P2Y12 inhibitor) and (2) statin therapy...
January 2018: Journal of Vascular Surgery
Danielle C Sutzko, Elizabeth A Andraska, Andrea T Obi, Mikel Sadek, Lowell S Kabnick, Thomas W Wakefield, Nicholas H Osborne
BACKGROUND: The Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR) represents a patient-centered database launched in January 2015. Previous work describing overall trends and outcomes of varicose vein procedures across the United States demonstrates a benefit from these procedures. The existing gaps in evidence to support current and future Medicare coverage of varicose vein procedures necessitate further description of clinical outcomes in patients ≥65 years old compared with the population <65 years old...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Mohammad H Eslami, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Alik Farber
OBJECTIVE: The purpose of this study is to externally validate a recently reported Vascular Study Group of New England (VSGNE) risk predictive model of postoperative mortality after elective abdominal aortic aneurysm (AAA) repair and to compare its predictive ability across different patients' risk categories and against the established risk predictive models using the Vascular Quality Initiative (VQI) AAA sample. METHODS: The VQI AAA database (2010-2015) was queried for patients who underwent elective AAA repair...
August 11, 2017: Journal of Vascular Surgery
Jennifer L Perri, Brian W Nolan, Philip P Goodney, Randall R DeMartino, Benjamin S Brooke, Shipra Arya, Mark F Conrad, Jack L Cronenwett
OBJECTIVE: Prior studies have suggested a relationship between operative (Op) time and outcome after major vascular procedures. This study analyzed factors associated with Op time and outcome after carotid endarterectomy (CEA) in the Vascular Quality Initiative (VQI) registry. METHODS: Elective, primary CEAs without high anatomic risk or concomitant procedures from 2012 to 2015 in the VQI were analyzed (N = 26,327, performed by 1188 surgeons from 249 centers). Multivariable analysis was used to identify patient, procedure, and surgeon factors associated with Op time and major adverse events (MAEs), categorized as either technical (ipsilateral stroke, cranial nerve injury, reoperation) or cardiac (myocardial infarction, congestive heart failure, dysrhythmia requiring treatment, surgical site infection, and death)...
October 2017: Journal of Vascular Surgery
Zachary Osborne, Kristine Hanson, Benjamin S Brooke, Marc Schermerhorn, Peter Henke, Rumi Faizer, Andres Schanzer, Philip Goodney, Thomas Bower, Randall R DeMartino
BACKGROUND: Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI). METHODS: Adults undergoing open abdominal aortic aneurysm repair (OAR) and lower extremity arterial bypass (Bypass) within VQI (2003-2016) were identified. All emergent cases, patients with preoperative hemoglobin <7 g/dL, preoperative hospitalization >1 day, or a return to operating room during the index hospitalization were excluded...
July 8, 2017: Annals of Vascular Surgery
Besma Nejim, Hanaa Dakour Aridi, Satinderjit Locham, Isibor Arhuidese, Caitlin Hicks, Mahmoud B Malas
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) considers that contralateral carotid artery occlusion puts the patients at high risk for carotid endarterectomy (CEA) and agrees to reimburse for carotid artery stenting (CAS) in these patients. However, there is a paucity of evidence that support the superiority of CAS compared with CEA in patients with contralateral carotid occlusion. METHODS: All patients who underwent CEA or CAS with contralateral carotid artery occlusion were identified in the Vascular Quality Initiative (VQI) registry between 2005 and 2016...
December 2017: Journal of Vascular Surgery
Seamus Mark McHugh, Naomi Eisenberg, Janice Montbriand, Graham Roche-Nagle
BACKGROUND: Smoking is the single most important modifiable risk factor for patients with vascular disease. The aim of this study was to determine the prevalence of smoking and cessation rates among patients undergoing vascular surgery in a Canadian center. METHODS: As part of the Vascular Quality Initiative, a prospectively maintained database was used to identify the patients undergoing vascular surgery between 2010 and 2013. Smoking prevalence data were collated preprocedure, postprocedure, and at year follow-up after intervention at a median of 13 months (mean = 14...
June 22, 2017: Annals of Vascular Surgery
Randall R DeMartino, Benjamin S Brooke, Dan Neal, Adam W Beck, Mark F Conrad, Shipra Arya, Sapan Desai, Faisal Aziz, Patrick Ryan, Jack L Cronenwett, Larry W Kraiss
OBJECTIVE: Carotid endarterectomy (CEA) has been shown to be an effective treatment for patients with asymptomatic carotid artery stenosis when perioperative stroke rates are low and patients survive long enough to benefit from the intervention. Our objective was to develop and to validate a simple risk prediction model for 30-day stroke and 1-year mortality to guide optimal selection of patients for CEA. METHODS: Asymptomatic patients undergoing first-time elective CEA within the Vascular Quality Initiative (VQI) from 2010 to 2015 were selected...
August 2017: Journal of Vascular Surgery
Lily E Johnston, Margaret C Tracci, John A Kern, Kenneth J Cherry, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Studies from large administrative databases have demonstrated associations between institutional case volume and outcomes after lower extremity bypass (LEB). We hypothesized that increased institutional and surgeon volume would be associated with improved outcomes after LEB. Using a national, prospectively collected clinical database, the objective of this study was to determine the effects of both surgeon and institutional volume on outcomes after LEB. METHODS: The Vascular Quality Initiative (VQI) was queried to identify all LEBs for critical limb ischemia or claudication between 2004 and 2014...
November 2017: Journal of Vascular Surgery
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