Rumi Faizer

Variations in Abdominal Aortic Aneurysm Care: A Report from the International Consortium of Vascular Registries

Background: This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery. Methods: Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries. Results: Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland–21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland–41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland–16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries. Conclusions: Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.

Quantification of crystallinity in blends of lyophilized and crystalline MK-0591 using x-ray powder diffraction

Abstract X-ray powder diffraction was used to determine the percent crystallinity in blends of crystalline and X-ray amorphous MK-0591, a potent indirect leukotriene biosynthesis inhibitor. A linear calibration curve was obtained. Preliminary studies using powder blends of MK-0591 with pregelatinized starch, microcrystalline cellulose, and magnesium stearate demonstrated the feasibility of using this method to determine (or quantify) the percent crystallinity of MK-0591 in tablet formulations.

The Use of the Amplatzer Plug to Treat Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery

Emerging technology with endovascular techniques has expanded our armamentarium to treat the aberrant right subclavian artery. We describe a hybrid technique using an Amplatzer plug in combination with a carotid subclavian bypass to treat a patient with dysphagia lusoria.

Impact of Hospital-Acquired Infection on Long-Term Outcomes after Endovascular and Open Abdominal Aortic Aneurysm Repair

BACKGROUND We hypothesized that infectious complications after open surgery (OPEN) and endovascular repair (EVAR) of nonruptured abdominal aortic aneurysms (AAAs) negatively affected long-term outcomes. METHODS Elective OPEN and EVAR cases were selected from 2005-2007 Medicare databases, and rates of postoperative infection, readmission, and longitudinal mortality were compared. RESULTS Forty thousand eight hundred ninety-two EVARs and 16,669 OPEN AAA repairs were evaluated. Patients with OPEN developed infection during and after the index hospitalization (12.8% and 4.9%, respectively) more often than those who had undergone EVAR (3.2% and 3.9%, respectively; P < 0.0001 for both). Patients with hospital-acquired infection compared to noninfectious ones were more likely to die during the index hospitalization (odds ratio [OR]: 3.7 [95% confidence interval {CI}: 3.22-4.30]) and within 30 days after discharge (OR: 3.6 [95% CI: 2.83-4.45]). They also were more likely to be readmitted to the hospital during 30 days after index discharge (OR: 1.8 [95% CI: 1.63-1.94]). Index infections associated with the greatest readmission were urinary tract infection after OPEN and sepsis after EVAR. Hospital-acquired infection significantly increased the duration of hospital stay (14.2 ± 13.2 vs 4.0 ± 4.4 days; P < 0.0001) and total hospital charges (

Infection of an Aortic Stent Graft with Suprarenal Fixation

133,070 ±

PC028 The Effect of Rigid Stent Grafts on the Propagation of Pressures in Aortic Dissection: A Lumped-Parameter Mathematical Model of Flow Through the Descending Thoracic Aorta

136,100 vs

IP275 The Largest U.S.-Based Case Series of Endovascular and Open Treatment of Spontaneous Left Iliac Vein Rupture in the Setting of May-Thurner Syndrome

66,359 ±

Horseshoe Kidney and Inflammatory Abdominal Aortic Aneurysm: A Case Report and Literature Review

45,186; P < 0.0001). The most common infections to develop 30 days after initial discharge were surgical site infection after EVAR (1.27%) and urinary tract infection after OPEN (1.38%). CONCLUSION Hospital-acquired infections had a dramatic effect by increasing hospital and 30-day mortality, readmission rates, and hospital resource use after AAA repair. Programs minimizing infectious complications may decrease future readmissions and mortality after AAA repair.

Objective scoring systems of medical risk: a clinical tool for selecting patients for open or endovascular abdominal aortic aneurysm repair.

We report a case of an elderly man admitted with abdominal pain and fever, 5 months after endovascular aortic aneurysm repair of a suspected inflammatory abdominal aortic aneurysm. He underwent successful explantation of an infected stent graft with suprarenal fixation following extra-anatomic revascularization. After a prolonged hospitalization, he was discharged on antibiotics and at follow-up has returned to baseline activity level. Although explantation of an infected prosthesis following endovascular aortic aneurysm repair has been previously reported, our case prompted a review of the literature to evaluate mode of presentation, putative factors, and management decisions associated with reduced morbidity and mortality.

Midterm Follow-up of Inflammatory Abdominal Aortic Aneurysms Following Endovascular Repair

case of distal type I endoleak and device migration (>10 mm) of a right iliac leg component was noted during longer-term follow-up. No other limb-related endoleak, migration, component separation, or stent fracture was reported during a mean follow-up of 10.8 6 5.6 months. Conclusions: Results from this postmarket registry under routine clinical care demonstrate infrequent limb occlusions and limb-related reintervention, supporting the excellent performance of the Spiral-Z leg graft.