Vascular Surgery: Current Status and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 April 2024) | Viewed by 2719

Special Issue Editors


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Guest Editor
Division of Vascular Surgery, University of South Florida, Tampa, FL 33620, USA
Interests: endovascular interventions; lower extremity arterial occlusive disease; aortic aneurysm pathophysiology; complex aortic aneurysm repair; vascular care

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Guest Editor
Division of Vascular Surgery, Medical University of South Carolina, Charleston, CA 29425, USA
Interests: peripheral arterial disease; aortic aneurysm; aortic dissection; carotid surgery

Special Issue Information

Dear Colleagues,

Vascular surgery is a subspecialty of surgery focusing on the treatment of the arterial and venous systems of the body outside of the coronary and skull beads. A vascular surgeon is trained to treat every artery and vein, from their patient’s neck to their toes, that lies outside of the brain and heart. This is a wide-ranging field filled with multiple pathologies, from atherosclerotic disease to aneurysmal disease and rheumatologic disease, as well as a vast array of other conditions that can affect the human vascular system. 

Vascular surgery has recently experienced a renaissance in its treatment algorithms with the introduction of minimally invasive and catheter-based techniques. This novel approach to treatment of the vascular system has opened the door for vascular surgeons to offer life-saving and curative procedures to even the most sick and frail of patients. Through this Special Issue, we hope to demonstrate and analyze the current treatment modalities for various vascular pathologies in light of recent technological advances.

Dr. Murray L. Shames
Dr. Adam Tanious
Guest Editors

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Keywords

  • vascular history
  • peripheral arterial disease
  • aortic aneurysm
  • aortic dissection
  • carotid disease

Published Papers (3 papers)

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Research

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13 pages, 3246 KiB  
Article
Navigating Challenges in the Endovascular Treatment of Asymptomatic Aortoiliac Aneurysms: A 10-Year Comparative Analysis
by Khamin Chinsakchai, Natcha Ketklin, Kiattisak Hongku, Chumpol Wongwanit, Nattawut Puangpunngam, Suteekhanit Hahtapornsawan, Sasima Thongsai, Tossapol Prapassaro, Nuttawut Sermsathanasawadi, Chanean Ruangsetakit and Pramook Mutirangura
J. Clin. Med. 2023, 12(22), 7000; https://doi.org/10.3390/jcm12227000 - 9 Nov 2023
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Abstract
Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may [...] Read more.
Background: Treating an abdominal aortoiliac aneurysm (AAIA) with endovascular methods can be challenging when the internal iliac artery (IIA) is involved. Embolizing the IIA and extending the limb to the external iliac artery (IIAE + EE) to prevent a type 2 endoleak may lead to pelvic ischemic complications. To avoid these complications, strategies that preserve the IIA, such as the bell-bottom technique (BBT) and the iliac branch device (IBD), have been proposed. This study aims to compare the outcomes of these three endovascular approaches for AAIA. Methods: Between January 2010 and December 2019, 174 patients with asymptomatic AAIA were enrolled in this retrospective analysis. They were divided into two groups: 81 patients underwent non-IIAE procedures, and 93 patients underwent IIAE procedures. The iliac limb study group consisted of 106 limbs treated with the BBT, 113 limbs treated with the IIAE + EE, and 32 limbs treated with the IBD. The primary outcomes included the 30-day mortality rate and intraoperative limb complications. The secondary outcomes included postoperative pelvic ischemia, freedom from reintervention, and the overall 10-year survival rate. Results: There was no significant difference in the perioperative mortality rate between the non-IIAE group (0%) and the IIAE group (2.1%), p = 0.500. The intraoperative limb complications did not differ significantly between the BBT limbs (7.5%), the IIAE + EE limbs (3.5%), and the IBD limbs (3.1%) groups, p = 0.349. The incidence of buttock claudication was significantly greater in the bilateral IIAE + EE group compared to the unilateral IIAE + EE and non-IIAE groups (25%, 11%, and 2.5%, p-value < 0.004), and was similar to the incidence of buttock rest pain with skin necrosis (15%, 0%, and 0%, p < 0.001). During the 10-year follow-up, the BBT limbs group had a significantly lower rate of iliac limb reintervention free time than the IIAE + EE limbs and the IBD limbs groups (88.7%, 98.2%, and 93.8%, p = 0.016). There was no significant difference in the overall 10-year survival rate between the non-IIAE and IIAE groups (51.4% vs. 55.9%, p = 0.703). Conclusions: The early and late mortality rates were similar between the non-IIAE and IIAE groups. Preserving the IIA is recommended to avoid pelvic ischemic complications. Considering the higher rate of reintervention in the BBT group, the IBD strategy may be preferred for AAIA. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Status and Future Perspectives)
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9 pages, 206 KiB  
Article
The Opportunity for Impactful Integration of Vascular and Podiatric Care
by Young Kim and Kevin W. Southerland
J. Clin. Med. 2023, 12(19), 6237; https://doi.org/10.3390/jcm12196237 - 27 Sep 2023
Viewed by 791
Abstract
Background: The importance of collaboration between vascular and podiatric surgeons has been well-established. High-level partnerships are integral to the development of multidisciplinary programs and wound care centers, ultimately resulting in improved patient outcomes. This vascular–podiatric integration is not universal, however, and podiatric surgery [...] Read more.
Background: The importance of collaboration between vascular and podiatric surgeons has been well-established. High-level partnerships are integral to the development of multidisciplinary programs and wound care centers, ultimately resulting in improved patient outcomes. This vascular–podiatric integration is not universal, however, and podiatric surgery may not be aligned within a vascular surgery division at many institutions. As one such institution, we reviewed our single-center experience in order to identify opportunities for the impactful integration of vascular–podiatric patient care. Methods: Institutional electronic medical records were retrospectively reviewed for all procedures performed by vascular surgeons at a high volume, safety-net academic medical center. Data were collected on all primary and additional procedures, current procedural terminology (CPT) codes, case type (elective, urgent, emergent), surgeon specialty, and date/time of the procedures performed. CPT codes were linked to the Centers for Medicare & Medicaid Services’ Physician Fee Schedule to estimate the work relative value unit (wRVU) per procedure. Results: From 2018 to 2022, vascular surgeons performed a total of 12,206 operations, of which 1102 (9.9%) involved podiatric procedures. The most common vascular-performed podiatry procedures performed were toe amputations (38.1%, n = 420), transmetatarsal foot amputations (20.1%, n = 222), and ankle/foot debridement (16.2%, n = 178). Foot/ankle-specific procedures were identified as the primary procedure in 726 (65.9%) cases and as the adjunct procedure in 376 (34.1%) cases. A substantial proportion of podiatric procedures occurred on an urgent (n = 278, 25.2%) or emergent (n = 28, 2.5%) basis. A total of 163 (14.8%) cases occurred after hours (either before 0600 or after 1800), and 133 (12.1%) cases were performed on a holiday or weekend. Procedure-specific revenue included 4243.39 wRVU for primary procedures and 2108.08 wRVU for additional procedures performed. Conclusions: We report our single-center experience in which vascular surgeons provide a significant proportion of podiatric procedures. Our study underscores the potential for integrating podiatric surgeons within a vascular surgical division and presents opportunities for collaboration and enhanced patient care. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Status and Future Perspectives)

Review

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22 pages, 1271 KiB  
Review
Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review
by Jacob J. Gries, Takashi Sakamoto, Bing Chen, Hafeez Ul Hassan Virk, Mahboob Alam and Chayakrit Krittanawong
J. Clin. Med. 2024, 13(5), 1217; https://doi.org/10.3390/jcm13051217 - 21 Feb 2024
Viewed by 1002
Abstract
Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to perplex clinicians. Despite its low prevalence, the condition’s variable clinical presentation and elusive radiographic diagnosis can delay life-saving interventions in the acute [...] Read more.
Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to perplex clinicians. Despite its low prevalence, the condition’s variable clinical presentation and elusive radiographic diagnosis can delay life-saving interventions in the acute setting and deteriorate the quality of life of patients when left undiagnosed or misdiagnosed. Purpose: Review and summarize recent diagnostic updates and emergent intervention strategies for acute and chronic mesenteric ischemia. Methods: A narrative review of all relevant studies from January 2022 through September 2023. Results: A total of 11 studies from MEDLINE, supplemented with 44 studies from Google Scholar, were included in the review. Conclusions: Both acute and chronic mesenteric ischemia propose diagnostic and therapeutic challenges for interventionalists. Computed tomographic angiography remains the diagnostic modality of choice for both. Open surgical intervention remains the gold standard for acute mesenteric ischemia, while endovascular techniques are preferred for chronic mesenteric ischemia. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Status and Future Perspectives)
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