The Society of Vascular Surgery International Scholars Program: The First Decade.

OBJECTIVE: The Society for Vascular Surgery (SVS) is a not-for-profit medical society, whose goal is to further advance in vascular health on a global scale. With its 10th anniversary in sight, we were interested in analyzing the impact of a specific scholarship given under the SVS, the International Scholars Program. Our goal was to examine the awardees' characteristics and academic productivity. MATERIALS AND METHODS: We measured the number of peer-reviewed articles, before and after the program, using PubMed® and Google Scholar® (2008-2018) of the scholarship recipients. Editorials, book chapters, letter to editor, and oral/poster presentations were excluded. A survey was sent out to assess the awardees' current status. RESULTS: The average number of applicants/year was 15.4 (standard deviation ± 6.69), with 17.5% females and a mean age of 37 ± 3.37 years, with 5.6 ± 2.30 years status post vascular fellowship. Brazil had the highest number of recipients (n = 5; 18.5%) followed by China (n = 4; 14.8%). No significant difference was noted between each country in terms of publications (P = .45), nor with after the SVS scholarship program compared to before (P = .14, 1.84 vs 2.76). The survey concluded 33% had attended a subsequent SVS meeting after the program, with 27% having presented their research (n = 15). The recipients noted the program helped adopt new practices in clinical management (n = 13, 87%), learn new procedures (n = 10, 67%), gain local/regional leadership (n = 9, 60%), and improve technical skills (n = 8, 53%). The most visited clinical sites were Massachusetts General Hospital and Mayo Clinic (n = 4, 27%). The program was given a 9.1/10 rating. CONCLUSION: The program was successful in maintaining academic productivity by continuing to publish research even after the scholarship, while teaching recipients skills to further improve their career goals. The award remains a competitive process that selects highly skilled recipients and still has much growth and progress to look forward to over the next decade.

Clinical correlation of anatomical location of non-thrombotic iliac vein lesion.

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

The Clinical Efficacy of Balloon-Assisted Maturation of Autogenous Arteriovenous Fistulae.

BACKGROUND: Delayed maturation of arteriovenous fistulae (AVF) among patients who require hemodialysis (HD) can lead to catheter sepsis with its resultant morbidity and mortality. Some have proposed that sequential balloon-assisted maturation (BAM) may accelerate the maturation times of these accesses. On the other hand, serial balloon angioplasty of normal vein may result in stenosis and delay maturation. Although the safety of BAM has been shown, direct comparison to nonmatured AVF has not been explored. Therefore, we conducted a retrospective analysis of our prospectively maintained vascular access database to compare the duration of period to AVF maturation between patients who received BAM and those who were not referred for BAM at our institution. METHODS: Prospectively collected data over a 3-year period in 194 patients who underwent AVF creation at our institution were retrospectively analyzed. The duration to maturation of the AVF was determined by comparing the period between the creation of the fistula and the first successful cannulation of the fistula. Only patients on HD were included. Patients who underwent BAM or placement of AVF at an outside institution were excluded. Follow-up consisted reviewing of postoperative AVF duplex for patency, hospital and clinic databases, HD center databases, and telephone interviews. RESULTS: Of the 194 patients who had AVF placement, 172 patients were on HD within 2 weeks of AVF placement, whereas 22 patients had AVF placed in anticipation of the need for HD. Of the 172 patients on HD within 2 weeks, 54 patients had BAM performed at our institution and 4 patients had BAM at an outside institution, whereas 114 patients were not referred for BAM. Thirty-three of these 114 patients were age and gender matched to compare to the patients who underwent BAM at our institution. At the time of this analysis, of the 54 patients who had BAM, 30 had functional AVF (19 men, 11 women; mean age, 62 years; range, 26-86 [standard deviation, SD ± 18] years). In the BAM group of functioning AVF, n = 30, the total number of procedures was 125 (range, 1-8, average 4). The overall average duration to maturation of the AVF was 119 days (SD ± 84 days) and 146 days (SD ± 157 days) P = 0.73, for BAM and non-BAM, respectively. CONCLUSIONS: These preliminary data suggest the role of BAM did not decrease maturation times of AVF and that BAM warrants further scrutiny before further adoption.

Clinical Role of the "Venous" Ultrasound to Identify Lower Extremity Pathology.

BACKGROUND: Accreditation in peripheral venous testing can be obtained based on femoropopliteal (FP) duplex ultrasound evaluation, and many laboratories limit their examination to this segment only. This simplified protocol detects acute FP deep venous thrombosis (DVT) but misses calf vein DVT, superficial venous thrombosis, chronic DVT, venous reflux, and other nonvenous findings potentially responsible for the patients' presenting conditions. A protocol limited to the FP segment results in additional unnecessary testing and can create patient dissatisfaction. We evaluated the differences in the diagnosis between a limited FP versus a complete approach to the venous ultrasound evaluation of the lower extremities in patients examined in an outpatient vascular laboratory. METHODS: A database with the complete ultrasound examinations of the lower extremity including the common femoral, deep femoral, popliteal, tibial, and peroneal veins; calf muscular veins; great and lesser saphenous veins performed in 812 consecutive patients over an 8 month period was queried. RESULTS: Acute FP DVT was found in (32 of 812) 3.94% of the patients. Chronic FP DVT was found in 6.65% (54 of 812). Acute infrapopliteal DVT was found in 4.06% (33 of 812). Chronic infrapopliteal DVT was found in 5.04% (41 of 812). Superficial venous thrombosis of lower extremities was found in 15.27% (124 of 812). In addition, deep venous insufficiency (>500 msec) was found in 49.75% (404 of 812) and superficial venous insufficiency in 31.28% (254 of 812; >500 msec). A mass (cyst, hematoma, solid mass, or aneurysm) was found in (23 cysts, 2 hematomas, 23 solid mass, 4 aneurysms) 6.4% (52 of 812). CONCLUSIONS: Limited FP ultrasound examination for acute DVT would have only detected a small percentage of the positive findings. These data suggest that a complete duplex examination can be used to further delineate the cause of outpatients' symptoms compared to the limited protocol.