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Davies MG. Commentary: Is Prophylactic Paving of Highly Calcified Femoropopliteal Occlusions All It's Cracked Up to Be? J Endovasc Ther 2018; 25:343-344. [PMID: 29633661 DOI: 10.1177/1526602818767965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baer-Bositis HE, Hicks TD, Haidar GM, Sideman MJ, Pounds LL, Davies MG. Outcomes of reintervention for recurrent symptomatic disease after tibial endovascular intervention. J Vasc Surg 2018. [PMID: 29525414 DOI: 10.1016/j.jvs.2017.11.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Tibial interventions for critical limb ischemia are now commonplace. Restenosis and occlusion remain barriers to durability after intervention. The aim of this study was to examine the patient-centered outcomes of open and endovascular reintervention for symptomatic recurrent disease after a primary isolated tibial endovascular intervention. METHODS A database of patients undergoing isolated primary lower extremity tibial endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with recurrent critical ischemia (Rutherford 4 and 5) were identified. Outcomes in this cohort were analyzed, and three groups were defined: endovascular reintervention (ie, a repeated tibial or pedal endovascular intervention), bypass (bypass to a tibial or pedal vessel), and primary amputation (ie, above- or below-knee amputation) on the ipsilateral leg. Patient-oriented outcomes of clinical efficacy (absence of recurrent signs or symptoms of critical ischemia, maintenance of ambulation, and absence of major amputation), amputation-free survival (survival without major amputation), and freedom from major adverse limb events (above-ankle amputation of the index limb or major reintervention, such as new bypass graft or jump or interposition graft revision) were evaluated after the reintervention. RESULTS There were 1134 patients (56% male; average age, 59 years) who underwent primary tibial intervention for critical ischemia, and 54% presented with symptomatic restenosis and occlusion. Of the 513 patients with recurrent disease, 58% presented with rest pain and the remainder with ulceration. A repeated tibial endovascular intervention was performed in 64%, open bypass in 19%, and below-knee amputation in 17%. Bypass was employed in patients with a good target vessel, venous conduit, and good pedal runoff. Patient-centered outcomes were better in the bypass group compared with the reintervention group (amputation-free survival, 45% ± 9% vs 27% ± 9% [P < .01]; major adverse limb events, 50% ± 9% vs 31% ± 9% [P < .05]; clinical efficacy, 60% ± 7% vs 30% ± 9% [P < .01], mean ± standard error of the mean at 5 years). CONCLUSIONS Tibial interventions for critical ischemia are associated with a high rate of reintervention. In patients with good target vessel, venous conduit, and good pedal runoff, bypass appears more durable than repeated tibial endovascular intervention.
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Baer-Bositis HE, Hicks TD, Haidar GM, Sideman MJ, Pounds LL, Davies MG. Outcomes of tibial endovascular intervention in patients with poor pedal runoff. J Vasc Surg 2017; 67:1788-1796.e2. [PMID: 29248245 DOI: 10.1016/j.jvs.2017.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Tibial interventions for critical limb ischemia are now commonplace. The aim of this study was to examine the impact of pedal runoff on patient-centered outcomes after tibial endovascular intervention. METHODS A database of patients undergoing lower extremity endovascular interventions at a single urban academic medical center between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (Rutherford 5 and 6) were identified. Preintervention angiograms were reviewed in all cases to assess pedal runoff. Each dorsalis pedis, lateral plantar, and medial plantar artery was assigned a score according to the reporting standards of the Society for Vascular Surgery (0, no stenosis >20%; 1, 21%-49% stenosis; 2, 50%-99% stenosis; 2.5, half or less of the vessel length occluded; 3, more than half the vessel length occluded). A foot score (dorsalis pedis + medial plantar + lateral plantar + 1) was calculated for each foot (1-10). Two runoff score groups were identified: good vs poor, <7 and ≥7, respectively. Patient-oriented outcomes of clinical efficacy (absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (survival without major amputation), and freedom from major adverse limb events (above-ankle amputation of the index limb or major reintervention [new bypass graft, jump/interposition graft revision]) were evaluated. RESULTS There were 1134 patients (56% male; average age, 59 years) who underwent tibial intervention for critical ischemia, with a mean of two vessels treated per patient and a mean pedal runoff score of 6 (47% had a runoff score ≥7). Overall major adverse cardiac events were equivalent at 30 days after the procedure in both groups. At 5 years, vessels with compromised runoff (score ≥7) had significantly lower ulcer healing (25% ± 3% vs 73% ± 4%, mean ± standard error of the mean [SEM]) and a lower 5-year limb salvage rate (45% ± 6% vs 69% ± 4%, mean ± SEM) compared with those with good runoff (score <7). Patients with poor pedal runoff (score ≥7) had significantly lower clinical efficacy (23% ± 8% vs 38% ± 4%, mean ± SEM), amputation-free survival (32% ± 6% vs 48% ± 5%, mean ± SEM), and freedom from major adverse limb events (23% ± 9% vs 41% ± 8%, mean ± SEM) at 5 years compared with patients with good runoff (score <7). CONCLUSIONS Pedal runoff score can identify those patients who will not achieve ulcer healing and patient-centered outcomes after tibial intervention. Defining such subgroups will allow stratification of the patients and appropriate application of interventions.
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Huang BY, Hicks TD, Haidar GM, Pounds LL, Davies MG. An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants. J Vasc Surg 2017; 66:1892-1901. [DOI: 10.1016/j.jvs.2017.08.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
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Davies MG, Hicks TD, Haidar GM, El-Sayed HF. Outcomes of intervention for cephalic arch stenosis in brachiocephalic arteriovenous fistulas. J Vasc Surg 2017; 66:1504-1510. [DOI: 10.1016/j.jvs.2017.05.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/16/2017] [Indexed: 11/28/2022]
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Cheun T, Hicks TD, Haidar GM, Pounds LL, Sideman MJ, Davies MG. Upper Extremity Endovascular Interventions for Symptomatic Vascular Access-Induced Steal Syndrome. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cheun T, Haidar GM, Hicks TD, Pounds LL, Sideman MJ, Davies MG. Implications of Early Failure of Isolated Tibial Interventions. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baer HE, Haidar GM, Hicks TD, Sideman MJ, Sheehan MK, Pounds LL, Rodriguez R, Kaushik D, Davies MG. Outcomes of Resection for Renal Cell Carcinoma with Extensive Inferior Vena Caval Thrombus. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chitragari G, Laux AT, Hicks TD, Davies MG, Haidar GM. Rare Presentation of a Syphilitic Aneurysm of the Infrarenal Aorta with Contained Rupture. Ann Vasc Surg 2017; 47:279.e13-279.e17. [PMID: 28887247 DOI: 10.1016/j.avsg.2017.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
We report, to our knowledge, the first case of a rare syphilitic infrarenal aortouniiliac aneurysm with contained rupture that presented with midepigastric abdominal pain. Review of the patient's medical history revealed untreated syphilis and poorly treated congestive heart failure. Given his comorbidities, the patient was treated with an emergent endovascular aneurysm repair. His 30-day postoperative recovery period was uneventful, and follow-up imaging revealed complete resolution of the aneurysms. Syphilitic infrarenal aortic aneurysm is currently considered a rare entity in this era of antibiotics. The present article provides a brief case report and short review of literature pertaining to syphilitic aortic aneurysms.
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Addala D, Shrimanker R, Davies MG. Non-invasive ventilation: initiation and initial management. Br J Hosp Med (Lond) 2017; 78:C140-C144. [DOI: 10.12968/hmed.2017.78.9.c140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Baer HE, Hicks TD, Haidar GM, Sheehan MK, Sideman MJ, Pounds LL, Davies MG. Getting to Choosing Wisely: The Value of a PE Clinical Decision Tool to Enhance Appropriateness of Care. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.05.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Strosberg DS, Oriowo BA, Davies MG, El Sayed HF. The Role of Endovascular In Situ Revascularization in the Treatment of Arterial and Graft Infections. Ann Vasc Surg 2017; 42:299.e15-299.e20. [DOI: 10.1016/j.avsg.2016.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
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Davies MG, Davies MG, Hicks TD, Sheehan MK, Pounds LL, Sideman MJ. VESS19. Upper Extremity Interventions for Critical Ischemia. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baer-Bositis HE, Hicks TD, Haidar GM, Sideman MJ, Pounds LL, Davies MG. Outcomes of Isolated Tibial Endovascular Intervention for Rest Pain in Patients on Dialysis. Ann Vasc Surg 2017; 46:118-126. [PMID: 28479421 DOI: 10.1016/j.avsg.2017.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tibial interventions for critical limb ischemia are frequent in patients with end-stage renal disease (ESRD) presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient-centered outcomes following tibial endovascular Intervention for rest pain. METHODS A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with rest pain (Rutherford 4) were identified. Patients with claudication (Rutherford 1 to 3) and tissue loss (Rutherford 5 and 6) were excluded. Patients were categorized by the presence or absence of ESRD. Patient-orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (AFS; survival without major amputation), and freedom from major adverse limb events (MALEs; above ankle amputation of the index limb or major reintervention new bypass graft, jump/interposition graft revision) were evaluated. RESULTS A total of 829 patients (56% male, average age 59 years; 658 nonhemodialysis [non-HD] and 171 HD) underwent isolated tibial intervention in one leg for rest pain. Technical success was 99% with a median of 2 vessels treated per patient. There was no difference in the distribution of Trans-Atlantic Inter-Society Consensus I lesions, but both the modified Society for Vascular Surgery (SVS) runoff score and the pedal runoff score were worse in the HD group. The 30-day major adverse cardiac events and 30-day MALEs were equivalent in both groups. CE was 38 ± 9% and 19 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Overall, AFS was 45 ± 8% and 18 ± 9% at 5 years for the non-HD and HD groups, respectively (P < 0.01). Freedom from MALE was 41 ± 9% and 21 ± 8% at 5 years for the non-HD and HD groups, respectively (P < 0.01). CONCLUSIONS Patients with ESRD who present with rest pain have equivalent short-term outcomes to those not on dialysis but do not achieve long-term satisfactory CE and AFS after isolated tibial intervention for rest pain.
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Baer-Bositis HE, Haider GM, Hicks TD, Pounds LL, Sideman MJ, Davies MG. Outcomes of Tibial Endovascular Intervention in Patients with ESRD on Dialysis. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lu T, Loh TM, El-Sayed HF, Davies MG. Single-center retrospective review of ultrasound-accelerated versus traditional catheter-directed thrombolysis for acute lower extremity deep venous thrombosis. Vascular 2017; 25:525-532. [DOI: 10.1177/1708538117702061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic anticoagulation remains the standard for acute lower extremity (LE) deep venous thrombosis (DVT), but growing interest in catheter-directed thrombolysis (CDT) and its potential to reduce the incidence of post-thrombotic syndrome (PTS) has led to advent of ultrasound-accelerated CDT (US-CDT). Few studies to date have examined the outcomes of US-CDT against traditional CDT (T-CDT). Methods This is a retrospective, single-center review of all patients treated for acute LE DVT over a five-year period with either US- and T-CDT. Patients were stratified based on demographics, presentation, co-morbidities, risk factors, and peri-procedural data. Results Seventy-six limbs in 67 patients were treated; 51 limbs in 42 patients were treated with US-CDT, and 25 limbs in 25 patients were treated with T-CDT. Adjuncts include: pharmacomechanical thrombolysis ( n = 28 vs. 20, p = 0.04), angioplasty ( n = 22 vs. 18, p = 0.11), stenting ( n = 30 vs. 6, p ≤ 0.001), and IVC filter insertion ( n = 5 vs. 0, p = 0.07). Mean lysis times were 21 ± 1.7 and 24 ± 1.8 h for US- and T-CDT, respectively ( p = 0.26). Thirty (25 ultrasound, 5 traditional) limbs had complete lysis. Thirty-one (22 ultrasound, 9 traditional) limbs had incomplete lysis. Fifteen (4 ultrasound, 11 traditional) limbs had ineffective lysis ( p = 0.002 in favor of ultrasound). Four patients (3 US-CDT, 1 T-CDT) had recurrent ipsilateral thrombosis within 30 days ( p = 0.60). By Kaplan-Meier analysis, there were no significant difference between primary patency, primary-assisted patency, secondary patency, re-thrombosis, and recurrent symptoms at 6, 12, and 24 months. Conclusion US-CDT does not significantly improve mid-term patencies but results in greater acute clot burden reduction in patients with acute LE DVTs compared to T-CDT, which may be beneficial in reducing the long-term incidence of PTS.
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Bavare CS, Street TK, Peden EK, Davies MG, Naoum JJ. Stent Grafts Can Convert Unusable Upper Arm Arteriovenous Fistulas into a Functioning Hemodialysis Access: A Retrospective Case Series. Front Surg 2017; 4:13. [PMID: 28289682 PMCID: PMC5326796 DOI: 10.3389/fsurg.2017.00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/13/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Not all newly created arteriovenous fistulas (AVFs) successfully mature and develop into a functioning access for hemodialysis. Percutaneous transluminal angioplasty (PTA) and balloon-assisted maturation (BAM) have been utilized to either treat flow-limiting stenoses or to promote and accelerate maturation. We hypothesized that unusable upper arm AVFs can be rescued by conversion to a functional access using the percutaneous placement of a stent graft (SG). Methods Clinical data on 12 patients with an early non-usable upper arm AVF underwent percutaneous revision using SGs. There were six brachial–cephalic, three brachial–basilic, and three brachial–brachial vein transposition AVFs. Results All patients had either at least two or more stenoses (>2 cm) within the fistula conduit, or a long segment stenosis (>4 cm) in combination with shorter segment stenoses. Nine patients had failed PTA. Three patients had failed BAM at outside access centers. All patients were referred for failure to achieve access cannulation and concomitant hemodialysis through the AVF. SGs were placed retrograde toward the arterial anastomoses and ranged in diameter (6, 7, and 8 mm in four, seven, and one patients, respectively). The average length of the SG was 10 cm (range 5–15 cm). All SGs were post-balloon dilated at the time of placement. All AVFs were salvaged, and patients were able to maintain functional use of their access with cannulation occurring through the SG. The primary patency rate at 6 and 12 months was 91% [95% confidence interval (CI), 56–98%] and 65% (95% CI, 32–87%), respectively (n = 11 and 5 at risk, respectively). The secondary patency rate at 6 and 12 months was 100 and 72% (95% CI, 46–93%), respectively (n = 11 and 7 at risk, respectively). Conclusion This report outlines a successful initial experience using SGs to rescue, preserve, and convert an unusable upper arm AVF into a functioning hemodialysis access.
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Baer-Bositis HE, Hicks TD, Haider GM, Pounds LL, Sideman MJ, Sheehan MK, Davies MG. Outcomes of Tibial Endovascular Interventions in Patients with Poor Pedal Runoff. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2016.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davies MG, El-Sayed HF. Outcomes of native superficial femoral artery chronic total occlusion recanalization after failed femoropopliteal bypass. J Vasc Surg 2017; 65:726-733. [DOI: 10.1016/j.jvs.2016.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/19/2016] [Indexed: 11/15/2022]
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Baer-Bositis HE, Hicks TD, Haider GM, Sideman MJ, Sheehan MK, Pounds LL, Davies MG. Outcomes of Reintervention after Tibial Endovascular Intervention. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2016.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davies MG. Invited commentary. J Vasc Surg 2016; 64:1834. [PMID: 27871498 DOI: 10.1016/j.jvs.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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Kim BJ, Valsangkar NP, Liang TW, Murphy MP, Zimmers TA, Bell TM, Davies MG, Koniaris LG. Impact of Integrated Vascular Residencies on Academic Productivity within Vascular Surgery Divisions. Ann Vasc Surg 2016; 39:242-249. [PMID: 27671458 DOI: 10.1016/j.avsg.2016.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/13/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Changing training paradigms in vascular surgery have been introduced to reduce overall training time. Herein, we sought to examine how shortened training for vascular surgeons may have influenced overall divisional academic productivity. METHODS Faculty from the top 55 surgery departments were identified according to National Institutes of Health (NIH) funding. Academic metrics of 315 vascular surgery, 1,132 general surgery, and 2,403 other surgical specialties faculty were examined using institutional Web sites, Scopus, and NIH Research Portfolio Online Reporting Tools from September 1, 2014, to January 31, 2015. Individual-level and aggregate numbers of publications, citations, and NIH funding were determined. RESULTS The mean size of the vascular divisions was 5 faculty. There was no correlation between department size and academic productivity of individual faculty members (R2 = 0.68, P = 0.2). Overall percentage of vascular surgery faculty with current or former NIH funding was 20%, of which 10.8% had major NIH grants (R01/U01/P01). Vascular surgery faculty associated with integrated vascular training programs demonstrated significantly greater academic productivity. Publications and citations were higher for vascular surgery faculty from institutions with both integrated and traditional training programs (48 of 1,051) compared to those from programs with integrated training alone (37 of 485) or traditional fellowships alone (26 of 439; P < 0.05). CONCLUSIONS In this retrospective examination, academic productivity was improved within vascular surgery divisions with integrated training programs or both program types. These data suggest that the earlier specialization of integrated residencies in addition to increasing dedicated vascular training time may actually help promote research within the field of vascular surgery.
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Davies MG, Haider GM, Hicks TD, ElSayad HE. WIfI Scores Predict Outcomes After Tibial Intervention in Patients With Diabetes and End-Stage Renal Disease. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Davies MG, Haider GM, ElSayad HE. Outcomes of Intervention for Cephalic Arch Stenosis in Brachiocephalic Arteriovenous Fistulas. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galaria II, Surowiec SM, Tanski WJ, Fegley AJ, Rhodes JM, Illig KA, Shortell CK, Green RM, Davies MG. Popliteal-to-Distal Bypass: Identifying Risk Factors Associated with Limb Loss and Graft Failure. Vasc Endovascular Surg 2016; 39:393-400. [PMID: 16193211 DOI: 10.1177/153857440503900503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Modern therapy, including endoluminal procedures and improved medical management, still yield less than desired results for tibial vessel occlusive disease. Despite the recent focus on these newer interventions, few modern series have evaluated the efficacy of popliteal-to-distal bypass procedures. The authors aimed to determine the efficacy of popliteal-distal bypass and to identify adverse prognostic factors for ultimate limb salvage. Eighty-seven patients (54 men; average age: 63 years) underwent 92 popliteal-distal bypasses. Duplex ultrasound was utilized to assess patency of all grafts. Data were analyzed by life-table analysis to determine patency rates at postoperative intervals. Median patient follow-up was 2.4 years. Major indications for bypass included chronic limb ischemia (86%) and disabling claudication (8%); 62% of the limbs were considered threatened, and 74% of the proximal anastomoses were above-knee. All procedures were technically successful. There were no perioperative (<30 days) deaths, and 86% of patients were alive at 5 years. Cumulative patency rates were 74% at 6 months, 70% at 2 years, and 63% at 5 years. Limb salvage rates closely paralleled patency rates. At 5 years, 62% of the affected limbs were intact; 72% of the limbs lost were associated with early (<180 days) bypass failures. Predictors of limb loss included early graft failure (84 days vs 1,288 days, p <0.0001), younger age (57 years vs 64 years, p = 0.039), history of previous ipsilateral vascular procedures (50% vs 21%, p = 0.03), heavy (>1 ppd) tobacco use (p = 0.001), and a thrombosed femoral-popliteal bypass at presentation (p = 0.002). When successful, popliteal-distal bypass is associated with excellent long-term patency and limb salvage rates. Early failures are often associated with limb loss. Heavy tobacco use, younger age, early graft failures, repeat revascularization, and presentation with a thrombosed femoral-popliteal graft are associated with limb loss.
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