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• W2917689872 abstract "Hi, I am Peter Gloviczki from Mayo Clinic, Editor-in-Chief of the Journal of Vascular Surgery. Thank you for viewing this video on the highlights of the best papers we published in the November issue of the Journal of Vascular Surgery. This month, the Editors' Choice article is also your CME article. It is entitled “Risk factor profile and anatomic features of previously asymptomatic patients presenting with carotid-related stroke.” The paper was written by Dr Derek Klarin and colleagues from Boston and Brighton, Massachusetts and New York, New York.1Klarin D. Cambria R.P. Ergul E.A. Silverman S.B. Patel V.I. LaMuraglia G.M. et al.Risk factor profile and anatomic features of previously asymptomatic patients presenting with carotid-related stroke.J Vasc Surg. 2018; 68: 1390-1397Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar This was a retrospective study of 3382 stroke patients who were previously asymptomatic. Seven percent of them (219 patients) were found to have ≥50% ipsilateral carotid artery stenosis or internal carotid artery occlusion. Specifically, 43% of carotid arteries had occlusion, 46.5% had >70% stenosis, and 9.5% had 50% to 70% stenosis. Surprisingly, only 50% of the patients were on antiplatelet treatment, 55% were taking statins, and 35% were taking both medications. Those who were on both antiplatelet and lipid therapy had less severe strokes than those who had any other treatment. The authors concluded that asymptomatic patients with carotid artery disease, who receive medical treatment that includes antiplatelet and lipid therapies, have less severe carotid-related stroke, but the more important message of this paper was that even patients on best medical therapy are at risk of having carotid-related stroke. This study brings additional evidence that a group of asymptomatic patients need more than just best medical therapy to treat their significant carotid artery disease. The next paper I would like to present to you is entitled “Predictors of early mortality and readmissions among dialysis patients undergoing lower extremity amputation,” written by Dr LaTonya J. Hickson and colleagues from Mayo Clinic in Rochester, Minnesota and Jacksonville, Florida, from the University of Washington in Seattle, and from Emory University in Atlanta, Georgia.2Hickson L.J. Rule A.D. Thorsteinsdottir B. Shields R.C. Porter I.E. Flemin M.D. et al.Predictors of early mortality and readmissions among dialysis patients undergoing lower extremity amputation.J Vasc Surg. 2018; 68: 1505-1516Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar In this NSQIP study, 6468 patients underwent a major amputation. Eighteen percent of them (1166 patients) were on dialysis. Thirty-day mortality was 15% in dialysis patients and it was 7% in those patients who were not on dialysis, and this difference was significant in every age group. Similarly, the readmission rate was significantly higher in dialysis patients than in patients not on dialysis. The authors recommend focused quality improvement efforts to decrease this high mortality and readmission rate in patients who are on dialysis and undergo major amputation. The next paper I would like to bring your attention to is on the “Impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome,” written by Dr Cristopher Skelly and colleagues from the University of Chicago and the Northwestern University Feinberg School of Medicine in Chicago, Illinois.3Skelly C.L. Stiles-Shields C. Mak G.Z. Speaker C.R. Lorenz J. Anitescu M. et al.Impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome.J Vasc Surg. 2018; 68: 1414-1421Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar This is a prospective observational trial of 51 adults with median arcuate ligament syndrome (MALS); 80% of the patients were female, with a mean age of 30.5 ± 12.4 years. Short-term results of laparoscopic release of the median arcuate ligament were very good; at 6 months, celiac artery hemodynamics improved and there was significant improvement in postoperative quality of life as well. It was interesting to learn that 28% of the patients had preoperative diagnoses of a psychiatric disorder, which was a significant predictor of a decreased postoperative quality of life. This study concluded that MALS patients do well early on with laparoscopic surgery and the authors emphasized that preoperatively, adults with MALS should be assessed for psychiatric disorders to better predict outcomes after surgical treatment. The final paper we would like to introduce to you is entitled “Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit,” authored by Dr Gregory J. Landry and colleagues from the Oregon Health & Science University in Portland, Oregon.4Landry G.J. Mostul C.J. Ahn D.S. McLafferty B.J. Liem T.K. Mitchell E.L. et al.Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit.J Vasc Surg. 2018; 68: 1499-1504Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Among 98 patients treated in the intensive care unit for finger ischemia, 82% of the patients were on vasoactive medications and 37% had an arterial line, and other risk factors contributing to finger ischemia included mechanical ventilation, diabetes, peripheral artery disease, dialysis, cancer, and sepsis. Five percent of the patients required finger amputation and survival in patients with finger ischemia was poor; it was 84% at 30 days, 69% at 1 year, and 59% at 3 years. Cancer was a predictor of mortality. The authors concluded that intensive care unit patients with finger ischemia have a relatively low rate of finger amputation, but mortality in this group of patients is increased, particularly if they have cancer. These were four of the many excellent papers from the November issue of the JVS. You can download them free of charge at www.jvascsurg.org. Enjoy reading all JVS journals and let us know how we can improve them more. Thank you for watching and see you next time for the Highlights of the December issue of the Journal of Vascular Surgery. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1NjA1YzE1YTQ1MTNiYmZjNGVlZjc5MWJiMWViZDkwNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3NzI5OTI0fQ.kg7eK-d9geKq6_5aYPaF8bePbtU-LOPM9SUfnD2F2qvxVDZOHCzSle4ACpAVkiQydTeb4KqV0wtn7oCbttqYpTer1gcUL5i7nYJTeVNPLLkprwc2oaSt9ico_WvufdG7c34gM8gumm2QHQh_pml_CODgNT6AiO-jJR4yR0noARsp5-EXE_48orpcn0uAt0pUkQHm4cM4Wvpc5EQ3s689sFoSY4yUqvR4tbkfiwqEE4OnQDI5Mn0ZLmafWiiwQwvCO7Urw3YaTHEkCvJFNCGhWre9_rsmPbAlUa4DHbxMA7wIEknHGedwA3qH3l-0FoDyC5lZJuyOPcMXC2bH-gzk3g Download .mp4 (109.15 MB) Help with .mp4 files Video" @default.
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• W2917689872 title "Journal of Vascular Surgery – November 2018 Audiovisual Summary" @default.
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