JVS-vascular insights最新文献

Background

Augmented reality (AR) superimposes computer-generated content to a real-world environment through multitudinous devices, and is used across multiple training fora. Its use in vascular surgery education is yet to be formally investigated. The aim is to assess feasibility and effectiveness of remote teaching of vascular anastomosis skills enhanced by AR in the form of the HoloLens2 Head-Mounted Display technology with traditional in-person skills teaching. A remote trainer used video, gestures and images superimposed over participants' field of vision via the HoloLens2 to teach the skills.

Methods

Twenty-eight participants underwent a preassessment performing an end-to-end vascular anastomosis on an artificial vessel. They were allocated randomly to an AR or in-person group, and underwent two teaching sessions. Individuals were asked to complete a postsession feedback form and assessment (video recorded and anonymized). The videos were marked by two blinded, independent assessors using the Objective Structured Assessment of Technical Skills (OSATS) scoring.

Results

There was an overall improvement in both cohorts in OSATS score after the intervention by +7.083 in the in-person group and +8.275 in the AR. Independent t test was performed and a P value of .422 was obtained, indicating no statistically significant difference in the change in OSATS scores when comparing the skills teaching received in-person with that through AR.

Conclusions

Remote teaching enhanced by AR is feasible and effective for the teaching of vascular surgical anastomosis skills and noninferior to in-person teaching. There is scope for development of the use of AR in vascular surgical skills training.

Objective

A novel disruption index (DI) designed to measure impact of scientific research has been developed. However, the DI metric has not yet been applied to vascular surgery peer-reviewed publications. We hypothesized that vascular surgery-specific disruptive articles would increase over time with the advent of new surgical and technological advancements.

Methods

The Journal of Vascular Surgery was queried from its inception in 1984 to 2014 to identify the top 100 most disruptive publications. The DI ranges from −1 to 1, where negative scores represent developmental and positive scores indicate disruptive publications. Most impactful papers were identified and defined as being in both the 100 most cited and disruptive lists of publications.

Results

When the top 100 most cited publications were categorized by vascular disease, aortic research was the most frequently highly cited publication (42%). Low correlation was found between DI and citation, controlling for time after publication (R² = 0.0096; P = .78). Among the 100 most disruptive papers, publications discussing the field of vascular surgery as a unique subspecialty were the most common category of publication (24%). Narrowing down the 100 most disruptive publications with 50 or more citations (n = 30), aortic (37%) and venous (20%) publications were the most common. Among this group of publications, aortic papers were most disruptive between 1993 to 1997, and venous papers were most disruptive in the more recent years between 2001 to 2005. Eight papers were identified as being most disruptive and included topics of publication of aortic (n = 4), venous (n = 2), carotid (n = 1), and endovascular (n = 1) research, with an average DI of 0.14 and citation count between 174 and 712.

Conclusions

This is the first application of the DI to the field of vascular surgery. Although citation count is a vital metric, there remains limitations in its ability to measure impact. DI should be used in conjunction with citation count to provide a holistic analysis of publication impact. Additionally, the DI can identify shifting paradigms and innovations unique to vascular surgery and help guide education on impactful studies.

Objective

Atherosclerosis underlies the most common etiologies of mortality worldwide, resulting in nearly 10 million deaths annually. In atherosclerosis, inflammation, metabolic factors, and hemodynamics cause the accumulation of extracellular lipids and the formation of plaques in the tunica intima of specific arteries. Atherosclerotic plaques primarily form in the coronary and carotid arteries, the aorta, and the peripheral arteries of the lower extremities. Although a common conceptual model of atherogenesis across these arteries has evolved over decades, there is a limited understanding of the important differences in regional atherosclerotic disease.

Methods

This review summarizes clinical studies, meta-analyses, and case reports to compare and contrast the impact, risk, plaque features, and clinical management of carotid, coronary, and femoral atherosclerosis in humans.

Results

Common risk factors, such as smoking and diabetes, influence disease risk differently across vascular beds. In addition, biological variables demonstrate a region-specific relationship with disease as peripheral atherosclerosis is most heritable, and male sex increases the risk of coronary and carotid, but not peripheral artery disease. The pathology of atherosclerotic lesions also varies between vascular territories. Specifically, carotid plaques are primarily lipid rich, whereas coronary plaques more commonly include fibrotic components with lipid-rich features, and femoral plaques are predominantly fibrocalcific. Clinically, interventional outcomes are worst in the carotid arteries and response to medical therapies, particularly statins, is not consistent across diseased regions, even within individual patients.

Conclusions

Atherosclerosis manifests in site-specific ways with regional differences in susceptibility and treatment response. Despite advances in the scientific understanding and clinical management of atherosclerosis, little is known about the mechanisms determining vessel-specific disease patterns and risk. Further research is needed urgently to delineate factors controlling plaque initiation and progression specific to vascular beds.

When examining the United States surgical workforce, a shortage of approximately 30,000 surgeons is predicted by 2030. This shortage is attributed to the increasing surgical needs of the nation’s aging population and the increased rate of retirement in the surgeon workforce. As such, the surgeon workforce will rely on Millennials and Generation Z to grow and expand their role in health care. To address these changes, the Society for Vascular Surgery (SVS) established the Young Surgeons Section (YSS) in 2022 after formal approval by the Society’s Executive Board. The YSS Steering Committee set forth in 2022 with an initial charge focused on identifying the needs of this demographic, beginning to develop educational content focused on early career surgeons, providing and advocating for leadership opportunities within the SVS, and assisting the Society in its membership recruitment efforts. The goal of this report is to provide the context under which the YSS was started, outline the major accomplishments of the Section over its first 2 years, and to begin to discuss the needed next steps for the SVS to ensure continued engagement.

Objective

This study was an inferential analysis aimed to estimate 30-day episode care costs associated with four contemporary endovascular therapies indicated for the treatment of deep vein thrombosis (DVT).

Methods

Source data were extracted from a systematic literature review of publications that reported outcomes after DVT intervention with mechanical thrombectomy (MT), aspiration thrombectomy with capital equipment (AT), ultrasound-facilitated catheter-directed thrombolysis (US-CDT), and rheolytic thrombectomy (RT). Case reports or series with fewer than 10 subjects, interim or subanalyses, and pediatric patients were excluded. Total episode care costs were defined as the sum of device and therapeutic costs, acute care costs, and contingent costs (ie, comprised bleeding, acute kidney injury, and readmissions) through 30 days.

Results

Through July 2023, 45 studies representing 2581 patients informed the analysis. The total episode cost per patient was estimated at $10,682, $14,073, $16,177, and $19,669 for MT, AT, US-CDT, RT, respectively. Device costs constituted the largest component of total episode costs at $8228, $9105, $5883, and $8862, respectively. Thrombolytic medications were a more significant driver of cost for US-CDT ($2982) and RT ($2412), relative to MT ($22) and AT ($931). Acute care costs included primary and adjunctive procedure suites, hospital stay, and intensive care unit monitoring and were estimated at $1723, $2875, $4014, and $4416, respectively. Contingent costs were estimated at $709, $1163, $3298, and $3980, respectively.

Conclusions

Endovascular strategies for the treatment of acute DVT that avoided thrombolytics saw shortened length of stay, reduced the need for intensive care unit level care, and minimized postprocedure bleeding and 30-day readmissions. These factors favored MT with the lowest episode costs.

Objective

This narrative review aims to analyze the role and efficacy of different methods of intraoperative neuro-monitoring during carotid endarterectomy.

Methods

Articles were collected from online databases, searching ‘carotid endarterectomy,’ intraoperative neuro monitoring,’ and ‘intraoperative neurological monitoring,” from 1999 to 2023.

Results

The search for an optimal intraoperative neuromonitoring technique during carotid endarterectomy is complex and still debated. Regional anesthesia, specifically ultrasound-guided cervical blocks, has become increasingly popular due to its ability to examine the awake patient. Additionally, reports suggest that regional anesthesia leads to shorter operative times, shorter postoperative stays, and less need for shunting. The primary limitations are patient compliance, particularly in cases of claustrophobia, and complications that make it difficult to access the patient’s airway. Currently, there is no definitive evidence favoring one anesthetic technique over another. Other monitoring techniques, such as electroencephalogram, cannot detect ischemia in the subcortical lobe or silent brain strokes caused by micro-embolisms. Although bispectral index is a potential tool, it may lead to false positives due to impaired cerebral perfusion during clamping. Stump pressure measurement is a direct indicator of perfusion pressure across the circle of Willis. However, the critical threshold of “adequate” perfusion is still debated. Near-infrared spectroscopy (NIRS) is a user-friendly, low-cost, noninvasive, and portable method with easily interpretable results. The critical cutoff to detect cerebral ischemia differs among market available NIRS devices; despite high negative predictive value, NIRS is still affected by a low positive predictive value. The available data on the use of routine shunting from randomized controlled trials is limited, and further studies are warranted.

Conclusions

Currently available intraoperative neuro-monitoring techniques for patients undergoing carotid endarterectomy have different uses and limitations, and a conclusive judgement cannot be reached. Future randomized studies and large real-world registries might shed light on this debated topic.

Background

Social media is a powerful tool for vascular surgeons to showcase their expertise, share their research, and network with peers and patients. However, it also requires careful consideration of ethical and professional standards and effective strategies to create and disseminate engaging content.

Objective

This article provides practical tips and recommendations for vascular surgeons who want to use social media to build their personal and professional brands. We draw on the Journal of Vascular Surgery social media guidelines, which offer best practices for the vascular surgery community based on the latest evidence and experience. We cover social media branding, choosing the right platforms, crafting your message, engaging with the audience, managing conflicts and controversies, and measuring impact and outcomes. We also provide examples of vascular surgery organizations and hashtags. By following these guidelines, vascular surgeons can leverage social media to enhance their reputation, reach, and influence in vascular surgery.

Background

The global incidence of peripheral arterial disease (PAD) is 10.5 million individuals annually. There are 113 million people affected globally, which can result in limb loss. PAD is often part of a greater set of comorbidities, including diabetes mellitus (DM), chronic kidney disease, coronary artery disease and obesity. Diabetic foot ulceration is a debilitating complication of DM that occurs owing to a combination of neuropathy, PAD, and structural biomechanical changes. Poor tissue perfusion in the context of microangiopathy can result in impaired wound healing and eventual limb loss. The combination of diabetic foot ulceration and PAD can be burdensome socially, psychologically and economically, for patients and health systems. It is, therefore, imperative to be able to identify and continuously monitor high-risk patients to aid in the prevention, monitoring, and management of these conditions in a noninvasive, easily accessible and cost-effective manner. We sought to evaluate the current evidence relating to noninvasive optical tissue perfusion assessment modalities available and their use in patients with PAD and individuals with DM. We also aimed to collate how each assessment modality worked, and its advantages and disadvantages.

Methods

A systematic literature search was conducted of the Embase and Medline (via the Ovid interface), PubMed, and Google Scholar databases for articles relating to PAD in individuals with DM. Articles were reviewed by two independent reviewers. Findings were collated for each method of tissue perfusion.

Results

In the final review, 35 articles met criteria for inclusion. The modalities discussed included photoplethysmography, spatial frequency domain imaging, hyperspectral imaging, laser Doppler, laser speckle flowgraphy, near infrared spectroscopy, thermography, photoacoustic imaging, and indocyanine green.

Conclusions

Several modalities are available for the noninvasive monitoring of tissue perfusion in individuals with DM and PAD that show promise. Their clinical applicability is an area of ongoing research.