Lala R. Hussain

Efficacy in Deep Vein Thrombosis Prevention With Extended Mechanical Compression Device Therapy and Prophylactic Aspirin Following Total Knee Arthroplasty: A Randomized Control Trial

BACKGROUND Aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism (VTE) prophylaxis protocol for low-risk total knee arthroplasty (TKA) patients. The purpose of this study is to examine whether there is a difference in deep vein thrombosis (DVT) occurrence after a limited tourniquet TKA using aspirin-based prophylaxis with or without extended use of mechanical compression device (MCD) therapy. METHODS One hundred limited tourniquet TKA patients, whose DVT risk was managed with aspirin 325 mg twice daily for 3 weeks, were randomized to either using an MCD during hospitalization only or extended use at home up to 6 weeks postoperatively. Lower extremity duplex venous ultrasonography (LEDVU) was completed on the second postoperative day, 14 days postoperatively, and at 3 months postoperatively to confirm the absence of DVT after treatment. RESULTS The DVT rate for the postdischarge MCD therapy group was 0% and 23.1% for the inpatient MCD group (P < .001). All DVTs resolved by 3 months postoperatively. Patient satisfaction was 9.56 (±0.82) for postdischarge MCD patients vs 8.50 (±1.46) for inpatient MCD patients (P < .001). CONCLUSION Limited tourniquet TKA patients who were mobilized early, managed with aspirin for 3 weeks postoperatively, and on MCD therapy for up to 6 weeks postoperatively experienced superior DVT prophylaxis than patients receiving MCD therapy only as an inpatient (P < .05). The 0% incidence of nonsymptomatic DVTs prevented by aspirin and extended-use MCD further validates this type of prophylaxis in low DVT risk TKA patients.

Early Findings With Vacuum-Assisted Thrombectomy for Acute Limb Ischemia

Objective: Few data exist to accurately describe the difference in characteristics, management, and outcomes of patients with premature peripheral arterial disease (PPAD), defined as patients <50 years old at the time of intervention. Our goal was to use Vascular Quality Initiative (VQI) data to investigate differences between PPAD patients and nonPPAD patients who had lower extremity vascular interventions. Methods: All VQI patients from the infrainguinal bypass and peripheral vascular intervention (PVI) modules between 2010 and 2015 were included. Patients were divided into two groups: <50 years old (PPAD group) and

Preoperative Panel Testing for Hereditary Cancer Syndromes Does Not Significantly Impact Time to Surgery for Newly Diagnosed Breast Cancer Patients Compared with BRCA1/2 Testing

50 years old (non-PPAD group). The patients’ demographics, comorbidities, procedure indications, and outcomes at longterm follow-up were compared. Outcomes analyzed included patency, limb salvage, symptom recurrence, need for reintervention, and survival. Long-term follow-up is defined in the VQI as 9 to 21 months. Results: Data from 5411 PPAD patients and 99,630 non-PPAD patients were analyzed. PPAD patients were more commonly African American, female, and smokers at the time of the procedure (all P < .01). PPAD patients underwent infrainguinal bypass more frequently than non-PPAD patients did (29.1% vs 25.2%; P < .01). PPAD patients undergoing infrainguinal bypass had higher rates of postoperative revision (21.5% vs 13.2%; P > .001) and major amputation (9.6% vs 6.5%; P < .001; Table). For PPAD patients undergoing PVI, rates of major amputation were higher as well (6.6% vs 4.6%; P < .001; Table). On adjusting for significant comorbidities, medications, and previous interventions, PPAD patients were still found to have significantly increased odds of major amputation after infrainguinal bypass (odds ratio, 1.45; P < .004) and PVI (odds ratio, 1.57; P < .001). Conclusions: PPAD patients experienced higher rates of postoperative revision after infrainguinal bypass and major amputation after both infrainguinal bypass and PVI. Although limited data sets such as the VQI do not lend themselves to more discrete examination, it seems reasonable to avoid lower extremity intervention in PPAD patients until it is deemed urgent or emergent because of poorer outcomes in this group.