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Determinants for non-attendance in abdominal aortic aneurysm (AAA) screening 不参加腹主动脉瘤(AAA)筛查的决定因素
Pub Date : 2024-03-01 DOI: 10.1016/j.jvsvi.2024.100070
Saira Mauland Mansoor, J. J. Jørgensen, Tonje Grønvold, J. Hisdal, Toril Rabben
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引用次数: 0
Room for improvement in patient compliance during peripheral vascular interventions 患者在外周血管介入治疗期间的依从性有待提高
Pub Date : 2024-02-01 DOI: 10.1016/j.jvsvi.2024.100059
C. Png, L. Boitano, Sunita D. Srivastava, A. Mohapatra, Junaid Malek, Jordan R. Stern, M. Eagleton, A. Dua
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引用次数: 0
The use of artificial intelligence in three-dimensional imaging modalities and diabetic foot disease – a systematic review 人工智能在三维成像模式和糖尿病足病中的应用--系统综述
Pub Date : 2024-02-01 DOI: 10.1016/j.jvsvi.2024.100057
Manal Ahmad, Matthew Tan, Henry Bergman, J. Shalhoub, Alun H Davies
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引用次数: 0
Regarding “Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion from SCAI/AVF/AVLS/SIR/SVM/SVS” 关于 "血管内超声在外周动脉和深静脉介入中的应用:SCAI/AVF/AVLS/SIR/SVM/SVS的多学科专家意见"
Pub Date : 2024-02-01 DOI: 10.1016/j.jvsvi.2024.100055
B. Tonnessen, Bernadette Aulivola
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引用次数: 0
An Assessment of Racial Diversity in Vascular Surgery Educational Resources 血管外科教育资源的种族多样性评估
Pub Date : 2024-02-01 DOI: 10.1016/j.jvsvi.2024.100056
Aman A. Kankaria, Natalie T. Chao, Rana O. Afifi, Sarasijhaa K. Desikan
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引用次数: 0
European Carotid Surgical Trial-based diameter measurement using B-mode ultrasound imaging to quantify low-grade carotid artery stenosis: the QUAMUS study 利用 b 型超声成像技术,基于 ecst 测量颈动脉直径,量化低级别颈动脉狭窄:quamus 研究
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100061
Frédéric Giauffret MD , Fabien Hocq MD , Sophie Lafond PhD , Aurélie Autret MS , Antoine Elias MD

Background

Identification of carotid atherosclerotic lesions with no hemodynamic effect on Doppler ultrasound examination is a common situation. Although the use of B-mode ultrasound examination has been recommended to assess this type of lesion, there is no validated examination procedure to date for quantifying low-grade carotid stenosis.

Methods

We conducted a single-center prospective study (QUAntification Morphologique en UltraSonographie [QUAMUS] study) to assess the reproducibility of B-mode ultrasound quantification of low-grade internal carotid artery stenosis using the European Carotid Surgical Trial (ECST) measurement method. We included consecutive patients with <50% North American Symptomatic Carotid Endarterectomy Trial carotid stenosis identified by the University of Washington duplex criteria (ie, maximum systolic velocity of <125 cm/second at a Doppler angle of 50°-60°). The examination was carried out and interpreted independently, blindly, and successively by two operators according to a precise methodology based on the measurement of cross-sectional diameter in B-mode and calculation of the stenosis percentage according to the ECST method. The primary objective was to assess the measurement concordance of the stenosis percentage for a difference not exceeding 10% between the two operators. The secondary objective was to assess concordance in relation to examination quality.

Results

Among the 86 patients included, 159 atherosclerotic carotid arteries were eligible and 157 could be explored (feasibility of 98.74%). The conditions were considered as good by the two operators in 69.43% of cases and poor in 2.55%. The concordance of the stenosis percentage measurement for a maximum difference of 10% between the two operators was 89.17% (95% confidence interval, 83.23-93.56) with a Lin concordance correlation coefficient of 0.87 (95% confidence interval, 0.82-0.90). Under examination conditions estimated as good, average, and poor, the concordance was 95.37%, 78.95%, and 60.00%, respectively.

Conclusions

Our study shows that ECST-based B-mode ultrasound measurement of low-grade carotid stenosis is reliable and can be performed in routine practice in most patients with a measurement variation of <10% using a simple standardized examination procedure.

背景在多普勒超声检查中发现颈动脉粥样硬化病变但对血流动力学无影响的情况很常见。方法我们进行了一项单中心前瞻性研究(QUAntification Morphologique en UltraSonographie [QUAMUS] 研究),使用欧洲颈动脉外科试验(ECST)测量方法评估 B 型超声量化低级别颈内动脉狭窄的可重复性。我们连续纳入了根据华盛顿大学双工标准(即在多普勒角度为50°-60°时,最大收缩速度为125厘米/秒)确定的<50%北美症状性颈动脉内膜剥脱术试验颈动脉狭窄患者。检查由两名操作员按照精确的方法独立、盲法和连续地进行解读,该方法基于 B 型测量横截面直径,并根据 ECST 方法计算狭窄百分比。首要目标是评估两名操作员在狭窄百分比测量上的一致性,两者之间的差异不得超过 10%。结果 在纳入的 86 名患者中,符合条件的有 159 条动脉粥样硬化颈动脉,其中 157 条可以进行探查(可行性为 98.74%)。两名操作员认为条件良好的占 69.43%,条件较差的占 2.55%。两名操作员对最大相差 10%的血管狭窄百分比测量的一致性为 89.17%(95% 置信区间,83.23-93.56),林氏一致性相关系数为 0.87(95% 置信区间,0.82-0.90)。结论我们的研究表明,基于 ECST 的 B 型超声波测量低级别颈动脉狭窄是可靠的,可以在常规实践中使用简单的标准化检查程序对大多数患者进行测量,测量误差为 10%。
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引用次数: 0
Practical and ethical challenges of maintaining vascular access in chronic kidney disease: A qualitative interview study 慢性肾病患者维持血管通路的实践和伦理挑战:定性访谈研究
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2023.100050
Farhad R. Udwadia MBE, MD , Danielle Cohen BSc , Ningzhi Gu MD , Alexa Mordhorst MD , Tomas Skala RN , York N. Hsiang MBChB, MHSc, FRCSC , Jonathan Misskey MD, MHPE, FRCSC

Objective

Chronic kidney disease affects 16.8% of adults in the United States, for which hemodialysis is most commonly used for renal replacement therapy. Although emphasis with the Fistula First Initiative has historically focused on the prioritization of autogenous arteriovenous access, higher rates of maturation failure and access dysfunction have prompted a reappraisal of this approach in the literature and clinical practice. Oftentimes, frail or medically complex patients with dysfunctional access are subjected to a large number of surgical procedures to maintain or reestablish patency. The influence of arteriovenous fistula (AVF) dysfunction and repetitive reintervention on patient experience and quality of life remains largely unexplored in contemporary literature.

Methods

Using a provincial database of renal failure patients (Patient-Reported Outcomes Measurement Information System [PROMIS]), we selected patients who had undergone five or more interventional procedures (open or endovascular) to maintain vascular access within a 20-year period from a single institution. Semistructured interviews were conducted with these patients and analyzed qualitatively using the constant comparative approach.

Results

Seventeen patients who met the inclusion criteria were recruited from across British Columbia. The cohort included patients from both genders (10 male, 7 female) between the ages of 52 and 87 years old. Four major thematic categories were identified; treatment values, impact of disorder, disposition toward AVF and impact of repeated interventions. Survival was the primary theme in the treatment values category (11/17), with reduction in dialysis frequency being secondary. Within impact of disorder, loss of independence was the primary theme (14/17), with psychological impact being secondary. Displeasure with the high rates of failure emerged as the primary theme (15/17) in disposition toward AVF, with pain with use (8/17) and inadequate informed consent (8/17) as secondary themes. Finally, for impact of repeated interventions, the primary theme was interruption to daily life (12/17). Overall, only 8 of 17 patients expressed satisfaction with their AVF.

Conclusions

These findings highlight that repeated interventions to maintain fistula patency pose significant disruption to patient's quality of life. Rates and impacts of fistula failure need to be explained thoroughly to patients during their informed consent process, moving toward a more patient-centered, individualized and holistic approach to vascular access over a ubiquitous fistula-first approach in all cases.

目的 慢性肾病影响着美国 16.8% 的成年人,血液透析是最常用的肾脏替代疗法。虽然 "瘘管第一倡议 "的重点历来都是优先考虑自体动静脉通路,但成熟失败和通路功能障碍的发生率较高,这促使文献和临床实践对这一方法进行重新评估。通常情况下,身体虚弱或病情复杂且通路功能障碍的患者需要接受大量外科手术来维持或重建通路。方法利用省级肾衰竭患者数据库(患者报告结果测量信息系统 [PROMIS]),我们从一家医疗机构选取了 20 年内接受过五次或五次以上介入手术(开放或血管内)以维持血管通路的患者。我们对这些患者进行了结构化访谈,并采用恒定比较法对访谈结果进行了定性分析。该群体包括 52 至 87 岁的男女患者(男性 10 人,女性 7 人)。研究确定了四大主题类别:治疗价值、失调的影响、对 AVF 的态度和反复干预的影响。在治疗价值类别中,生存是首要主题(11/17),减少透析次数是次要主题。在失调的影响中,丧失独立性是首要主题(14/17),心理影响是次要主题。在对 AVF 的态度方面,对高失败率的不满是首要主题(15/17),使用时的疼痛(8/17)和知情同意不充分(8/17)是次要主题。最后,对于重复干预的影响,首要主题是对日常生活的干扰(12/17)。总体而言,17 名患者中仅有 8 名对他们的动静脉瘘表示满意。结论这些研究结果突出表明,为保持瘘管通畅而进行的反复干预严重影响了患者的生活质量。在患者知情同意的过程中,需要向他们彻底解释瘘管失败的比率和影响,在所有病例中,应采取更加以患者为中心、个性化和全面的血管通路方法,而不是普遍的瘘管优先方法。
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引用次数: 0
A qualitative analysis of the significance of ergonomics among vascular surgeons 血管外科医生对人体工程学重要性的定性分析
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100054
Abdul Wasay Paracha BS , Billal Alamarie BS , Ahsan Zil-E-Ali MBBS , Fadi Samaan BS , Faisal Aziz MD, FACS, DFSVS

Objective

Surgical ergonomics has become an increasingly recognized topic of discussion in surgical literature. Vascular surgery is a high-stress field with long operating hours, which can become physically challenging for surgeons. The study aims to investigate the ergonomic challenges experienced by vascular surgeons and identify current habits and rituals used for optimal ergonomics.

Methods

The qualitative assessment of vascular surgeons ergonomics was assessed using semistructured interviews. These interviews were conducted with six academic vascular surgeons who often performed open abdominal aortic aneurysm operations at a tertiary care academic medical center. The interview targeted several domains, such as preoperative habits, postoperative habits, and operating room practices. A research team member conducted all interviews, recorded, and later transcribed them. Two independent research team members cross-referenced the interview transcriptions. Thematic analysis using NVivo was performed to identify patterns and themes among the interviews given by the study participants. Differing opinions on the themes were reconciled via discussion between four researchers.

Results

The participants included three female and three male academic vascular surgeons with a mean age of 40 ± 5 years and an average of 6 ± 5 years in practice. In total, five major themes were identified in all six interviews. The themes were perception of ergonomics, preprocedural habits, postprocedural habits, the impact of surgeries on ergonomic health, and advice to future trainees. Within these five themes, there were a multitude of subthemes between the six participants. Of the six participants, two (33%) mentioned the importance of preoperative and postoperative exercise and stretching, including targeting core muscles and legs to cope with the lengthy procedural demands. Some of the comments were alarming and eye opening, for example “Oh, I think it's actually horrible. It's horrible. I know. It's killing me slow.” All six of the participants (100%) emphasized the need for optimizing the height of the surgical table, and four participants (66%) mentioned ensuring the need for proper equipment, such as loupes, during the procedure to prevent neck and back pain postoperatively. Finally, four of the participants (66%) agreed that incoming trainees must develop healthy habits, such as proper sleep hygiene, stretching, and hydration. Three participants (50%) discussed the importance of exercise to overcome the physical demands of vascular surgery and maintaining hobbies during training as coping mechanisms against mental burnout.

Conclusions

Vascular surgeons face unique ergonomic challenges daily. The findings from this qualitative study emphasize the importance of preoperative and postoperative habits, such as regular exercise and manipulation of the height of the surgical table, t

目的在外科文献中,手术工效学已成为一个日益得到认可的讨论主题。血管外科是一个手术时间长、压力大的领域,这对外科医生的体力是一个挑战。本研究旨在调查血管外科医生所经历的人体工程学挑战,并确定当前用于优化人体工程学的习惯和礼仪。方法采用半结构式访谈对血管外科医生的人体工程学进行定性评估。这些访谈的对象是在一家三级医疗学术医疗中心经常进行开放式腹主动脉瘤手术的六名血管外科医生。访谈针对多个领域,如术前习惯、术后习惯和手术室惯例。一名研究小组成员主持了所有访谈,并进行了录音和后期转录。两名独立的研究小组成员对访谈记录进行了交叉比对。使用 NVivo 进行了主题分析,以确定研究参与者访谈的模式和主题。通过四位研究人员的讨论,对主题的不同意见进行了调和。在所有六次访谈中,共确定了五大主题。这些主题分别是对人体工程学的认识、手术前的习惯、手术后的习惯、手术对人体工程学健康的影响以及对未来学员的建议。在这五个主题中,六位参与者之间还存在许多次主题。在六位参与者中,有两位(33%)提到了术前和术后锻炼和拉伸的重要性,包括针对核心肌肉和腿部的锻炼,以应对漫长的手术需求。有些评论令人震惊和大开眼界,例如 "哦,我觉得这太可怕了。太可怕了。我知道。慢得要命"。所有六名参与者(100%)都强调了优化手术台高度的必要性,四名参与者(66%)提到在手术过程中需要确保使用适当的设备,如放大镜,以防止术后颈部和背部疼痛。最后,四位与会者(66%)同意新学员必须养成健康的生活习惯,如适当的睡眠卫生、伸展运动和补充水分。三位参与者(50%)讨论了锻炼对于克服血管外科手术对体力的要求以及在培训期间保持业余爱好的重要性,认为这是应对精神倦怠的机制。这项定性研究的结果强调了术前和术后习惯的重要性,如定期锻炼和调节手术台的高度,有助于预防术后肌肉疼痛。关注并针对特定的人体工程学因素有助于减轻术后的精神和身体压力。
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引用次数: 0
The Society for Vascular Surgery Patient Safety Organization Quality Fellowship in Training (FIT) program, training the next-generation quality-focused vascular surgeons 血管外科学会患者安全组织优质培训奖学金 (FIT) 计划,培训下一代注重质量的血管外科医生
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100071
Betsy Wymer DNP, RN, CV-BC , Adam Johnson MD, MPH , James Wadzinski , Gary Lemmon MD
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引用次数: 0
A narrative review of the role of endoscopically assisted in situ bypass in the modern era of limb salvage vascular bypass 内窥镜辅助原位搭桥术在现代肢体挽救血管搭桥术中的作用综述
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100078
Mufaddal Baghdadwala MD, PhD , Alison Michels MD, PhD , Peter Brown MD, FRCSC , David Zelt MD, MSc, FRCSC , Michael Yacob MD, MEd, RPVI, FRCSC

Objective

In this narrative review, we seek to summarize key literature describing nontraditional minimally invasive in situ lower extremity bypass techniques. We describe the various historical and newer attempts and their known outcomes to date. We particularly focused on the sparsely used endoscopic-assisted in situ bypass technique.

Methods

A list of search terms and keywords relevant to novel in situ bypass techniques was identified. A retrospective review of the literature was conducted screening PubMed/MEDLINE and Scopus with a search period from January 1, 1959, to August 1, 2023.

Results

Our search yielded six previous studies that used various permutations of the novel in situ bypass techniques. Despite the relative paucity of high-quality data, the studies demonstrate that the endoscopic technique results in lower wound complications rates, shorter hospital stays, and no significant differences in outcomes compared with the traditional in situ bypass technique.

Conclusions

The endoscopic in situ bypass technique demonstrates important wound-related benefits compared with the traditional in situ technique. This minimally invasive approach is certainly in keeping with the current technical knowledge and skillset in vascular surgery. Future studies are needed to systematically compare the long-term outcomes.

目的 在这篇叙述性综述中,我们试图总结描述非传统微创原位下肢搭桥技术的主要文献。我们描述了迄今为止各种历史性和最新的尝试及其已知结果。我们特别关注了应用稀少的内窥镜辅助下原位搭桥技术。我们对文献进行了回顾性审查,筛选了PubMed/MEDLINE和Scopus,检索期为1959年1月1日至2023年8月1日。结果我们的搜索结果显示,之前有六项研究使用了新型原位搭桥技术的各种排列组合。尽管高质量的数据相对较少,但这些研究表明,内窥镜技术的伤口并发症发生率较低,住院时间较短,与传统的原位搭桥技术相比,疗效无显著差异。这种微创方法无疑符合当前血管外科的技术知识和技能。未来的研究需要对长期疗效进行系统比较。
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引用次数: 0
期刊
JVS-vascular insights
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