Daniel Johnston

Office-based endovascular suite is safe for most procedures.

OBJECTIVE This study was conducted to identify the safety of endovascular procedures in the office endovascular suite and to assess patient satisfaction in this setting. METHODS Between May 22, 2007, and December 31, 2012, 2822 patients underwent 6458 percutaneous procedures in an office-based endovascular suite. Demographics of the patients, complications, hospital transfers, and 30-day mortality were documented in a prospective manner. Follow-up calls were made, and a satisfaction survey was conducted. Almost all dialysis procedures were done under local anesthesia and peripheral arterial procedures under conscious sedation. All patients, except those undergoing catheter removals, received hydrocodone and acetaminophen (5/325 mg), diazepam (5-10 mg), and one dose of an oral antibiotic preprocedure and three doses postprocedure. Patients who required conscious sedation received fentanyl and midazolam. Conscious sedation was used almost exclusively in patients having an arterial procedure. Measurements of blood urea nitrogen, creatinine, international normalized ratio, and partial thromboplastin time were performed before peripheral arteriograms. All other patients had no preoperative laboratory tests. Patients considered high risk (American Society of Anesthesiologists Physical Status Classification 4), those who could not tolerate the procedure with mild to moderate conscious sedation, patients with a previous bad experience, or patients who weighed >400 pounds were not candidates for office based procedures. RESULTS There were 54 total complications (0.8%): venous, 2.2%; aortogram without interventions, 1%; aortogram with interventions, 2.7%; fistulogram, 0.5%; catheters, 0.3%; and venous filter-related, 2%. Twenty-six patients required hospital transfer from the office. Ten patients needed an operative intervention because of a complication. No procedure-related deaths occurred. There were 18 deaths in a 30-day period. Of patients surveyed, 99% indicated that they would come back to the office for needed procedures. CONCLUSIONS When appropriately screened, almost all peripheral interventions can be performed in the office with minimal complications. For dialysis patients, outpatient intervention has a very low complication rate and is the mainstay of treatment to keep the dialysis access patent. Venous insufficiency, when managed in the office setting, also has a low complication rate. Office-based procedural settings should be seriously considered for percutaneous interventions for arterial, venous, and dialysis-related procedures.

On Twin Edge Colorings of Graphs

Abstract A twin edge k-coloring of a graph G is a proper edge coloring of G with the elements of Zk so that the induced vertex coloring in which the color of a vertex v in G is the sum (in Zk) of the colors of the edges incident with v is a proper vertex coloring. The minimum k for which G has a twin edge k-coloring is called the twin chromatic index of G. Among the results presented are formulas for the twin chromatic index of each complete graph and each complete bipartite graph

PC190. Improving the Retrieval Rate of Inferior Vena Cava Filters: Impact of Inferior Vena Cava Filter Retrieval in the Office Endovascular Center

AAA, Abdominal aortic aneurysm; CAS, carotid artery stenting; CEA, carotid endarterectomy; EVAR, endovascular aortic repair; IQR, interquartile range; PVI, percutaneous peripheral vascular intervention; VW comorbidity score, Van Walraven comorbidity score. There were <0.001% of cases missing weekend admission data, <0.1% of cases were missing patient age or sex, <0.2% of cases were missing primary payor data, <1.5% of cases were missing elective status, and 19.9% of cases were missing race data. b P values are from Pearson c tests or Wilcoxon rank-sum test, as appropriate Fig. Totals filtered implanted. OEC, Office endovascular center. Journal of Vascular Surgery Abstracts e225 Volume 67, Number 6

Optimizing Your Vascular Practice: How to Communicate With Referring Doctors, Increase Referrals, and Work With Cardiologists and Interventional Radiologists

After the fellowship in vascular surgery is completed there is the daunting task of going into practice and succeeding. There are various tools that one can use to succeed in practice and also work closely with other specialists. The key to success is marketing and innovation. Using the two together any vascular surgeon can succeed. Marketing has multiple facets not to be confused with advertising. Total marketing revolves around the surgeon. It involves personal attributes, running of the office, behavior in the hospital, working with other physicians, and using advertising channels. Innovation is required as the art and science of the specialty continues to evolve. Vascular surgeons need to be on the cutting edge of providing latest technology as well as latest methods of delivering care.