Abstract:
BACKGROUND:Overtreatment and overuse of resources are leading causes of rising health care costs. Identification and elimination process of low value services is important in reducing such costs. At many institutions it is routine to send excised plaque after carotid endarterectomy (CEA) for pathology evaluation. With more than 140,000 CEAs performed annually in the United States, this represents an opportunity for potential cost savings. We set out to examine the cost and clinical use of pathology evaluation of plaque after CEA. METHODS:We performed a retrospective review of patients undergoing CEA at a single institution from 2016 to 2019. Patients were excluded if they had a prolonged postoperative length of stay or if they had a preoperative stroke. Demographics, perioperative outcomes, and billing costs were recorded. RESULTS:We identified 82 total CEAs, of which 42 were excluded according to the aforementioned exclusion criteria. We reviewed 40 CEAs. Mean age of this cohort was 67.2 (±8.3) years. Most (72.5%) were asymptomatic at the time of admission, whereas 27.5% presented with a transient ischemic attack. Mean postoperative length of stay was 1.8 days. The primary insurers were 39.5% private, 39.5% Medicare, and 21.1% Medicaid. Mean total charges for the hospitalization were $83,367 (±$42,874). Of this total, professional fees were $3,512 (±$980) and facility fees were $80,395 (±$42,886). Mean pathology charges were $285 (±$88). The pathology professional fee was $61 (±$27), which represented 1.82% (±0.88) of the professional costs. Reimbursement for the facility pathology charge was $229 (±$57) and for the professional pathology charge was $25 (±$14). All plaque samples were submitted for gross examination and hematoxylin and eosin staining. The correlation rate for the clinical and pathologic diagnosis was 100%. The pathology reports simply read "atherosclerotic plaque" and "calcific plaque" in 32.5% and 45% of samples. For the remaining plaques, 12.5% and 10% of reports also noted fibrosis and degenerative changes, respectively. There were no clinical implications or decisions made based on the pathology reports. Cost of pathology evaluation was on average $285, with an average reimbursement of $235. With 140,000 CEAs done annually, this represents a potential $32.9-$39.9 million saved to the health care system. CONCLUSIONS:Pathology evaluation of carotid plaque incurs significant costs to the health care system with no clear value for the postoperative care of the patient. Hospital policy regarding mandatory pathologic examination and surgeon preferences regarding plaque analysis should be more closely examined.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Mendez L,Zhao Q,Elsadawi M,Farber A,Bowden A,Sharpe C,Schulze R,Siracuse JJdoi
10.1016/j.avsg.2020.04.065subject
Has Abstractpub_date
2020-08-01 00:00:00pages
208-212eissn
0890-5096issn
1615-5947pii
S0890-5096(20)30407-6journal_volume
67pub_type
杂志文章abstract::Although retrograde vertebral artery flow was described over 100 years ago, its relationship to symptoms remains unclear. We documented 43 patients who were found by duplex scanning to have reverse flow in the vertebral artery. Of this group, seven patients (16%) were found to have symptoms described as typical for th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015293
更新日期:1991-07-01 00:00:00
abstract::This case report describes a pediatric patient with mycotic aneurysms of both posterior tibial arteries and the right peroneal artery associated with an episode of endocarditis. To our knowledge, this case represents the first reported occurrence of multiple mycotic aneurysms of the tibioperoneal arteries. It is also ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900240
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:The management of hepatic artery aneurysms has evolved largely because of changes in etiology and presentation, and advances in endovascular therapy. Although many case reports have been published on the condition, few have been from developing countries and few have compared patient outcomes after angioembo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.08.018
更新日期:2013-08-01 00:00:00
abstract::Renal ischemia remains a vexing issue in the repair of suprarenal abdominal aortic aneurysms (SR-AAAs). Multiple reconstruction methods have been described, including fish-mouth anastomoses, renal artery reimplantation, and aortorenal interposition grafts. We present an alternative method of SR-AAA repair that minimiz...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-6602-5
更新日期:2005-09-01 00:00:00
abstract::Patients with limb-threatening ischemia and a paucity of ipsilateral greater saphenous vein for conduit represent a challenge for lower extremity revascularization. We present four patients with limited autogenous conduit who underwent hybrid revascularization using the Silverhawk atherectomy device and infrapopliteal...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2007.07.008
更新日期:2007-11-01 00:00:00
abstract::We present a case of totally robotic ligation of the inferior mesenteric artery (IMA) for treatment of a persistent endoleak from the IMA into the aneurysm sac after endovascular aneurysm repair (EVAR). An 84-year-old male underwent EVAR with a Gore Excluder stent graft for an asymptomatic infrarenal abdominal aortic ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.02.019
更新日期:2009-03-01 00:00:00
abstract::Cervical aortic arch (CAA) is a rare vascular malformation which sometimes accompanies other cardiovascular malformations. Surgical approaches such as a lateral thoracotomy and a median sternotomy are selected depending on the position and type of aneurysm and other associated malformations. We herein report the case ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2007.07.028
更新日期:2008-01-01 00:00:00
abstract::A 75-year-old immunosuppressed man presented with fever and central abdominal pain 3 weeks after having positive blood cultures for Salmonella enteritidis. A computed tomography scan demonstrated a contained perforation of a nonaneurysmal abdominal aorta. Salmonella aortitis was suspected, and given his recent history...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.11.019
更新日期:2015-05-01 00:00:00
abstract::Bier spots represent a benign vascular mottling characterized by multiple irregular white macules along the extensor surfaces of the arms and legs. They have been reported in a variety of diverse conditions with no consistent disease association. We have identified a novel association between these physiologic anemic ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2014.07.005
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to explore whether preoperative white blood cell (WBC) count may predict 30-day mortality and long-term survival following surgery for abdominal aortic aneurysm (AAA). Secondarily, we wanted to assess the potential sex differences in WBC in these patients. METHODS:The study ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.08.028
更新日期:2017-05-01 00:00:00
abstract::The aim of this article is to describe a new open surgical technique for revascularization of renal arteries. Several interventions for surgical revascularization of renal arteries have been proposed. We suggest to perform an alternative technique if the described inflow vessels are not suitable because of severe athe...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.03.051
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:We performed a systematic review and meta-analysis to examine whether patients with intermittent claudication can benefit from endovascular treatment (EVT). METHODS:A prespecified search strategy was used to identify relevant studies in the MEDLINE, Embase, and Cochrane databases. A total of 10 different ra...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.avsg.2013.05.022
更新日期:2014-05-01 00:00:00
abstract::We undertook a prospective evaluation to prove a new mechanical thrombectomy device, the shredding embolectomy thrombectomy catheter (S.E.T. catheter), for the treatment of patients with acute lower-limb ischemia. The study evaluated the success, patency, mortality, limb salvage, and complication rates for 51 patients...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900278
更新日期:1999-07-01 00:00:00
abstract::Despite the improvement in endovascular techniques, one aspect of aneurysmal disease that continues to be challenging is the management of aortoiliac aneurysms. Sacrificing the hypogastric artery (HGA) for effective treatment is not without sequelae, which may include buttocks claudication, colonic ischemia, spinal co...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2014.10.019
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Controversy exists about technique of repair for ruptured abdominal aortic aneurysms (rAAA). We studied rAAA treated at a single tertiary center from 2005 to 2015 to determine operative morbidity and mortality in open and endovascular aortic aneurysm repair (EVAR) of rAAA. METHODS:All rAAA (n = 144) treated...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.10.073
更新日期:2020-07-01 00:00:00
abstract::Behçet's disease is a chronic recurrent inflammatory disorder that affects many organs. A 48-year-old man with known Behçet's disease was admitted to the emergency department with aggravating severe back pain and left lower quadrant pain. A contained rupture of infrarenal abdominal aortic aneurysm (AAA) was discovered...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.05.011
更新日期:2010-02-01 00:00:00
abstract::A patient presenting with urinary retention was found to have progressive spinal cord ischemia subsequent to an end-to-side aortobifemoral bypass for atherosclerotic disease. This serves as a vivid reminder of the possibility of this complication even in ischemic disease and that urinary retention may be the initial s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02000153
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:The aim of the study is to determine whether performing endovascular aortic aneurysm repair (EVAR) in a dedicated vascular hybrid operating room (OR) is associated with a decreased patient radiation and contrast dose compared with mobile C-arm imaging in a conventional OR. METHODS:This is a retrospective st...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.04.019
更新日期:2019-11-01 00:00:00
abstract::Marjolin's ulcer is an aggressive form of squamous cell carcinoma that develops over time from chronic wounds and scars, including burns and chronic venous stasis ulcers. The incidence of malignant transformation is low, resulting in a delay in diagnosis and increased morbidity and mortality in these patients. We repo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2013.06.002
更新日期:2013-11-01 00:00:00
abstract::We report the early results of a series of 86 femoropopliteal bypass operations in which a 5 mm diameter thin wall polytetrafluoroethylene (Gore-Tex) prosthesis was used. Sixty-five bypasses were implanted in men and 21 in women. Thirty bypasses were done in conjunction with an aortic bifurcation graft and 18 patients...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)61981-X
更新日期:1986-09-01 00:00:00
abstract::Hypogastric aneurysm is rare, often asymptomatic, but associated with high mortality if it ruptures. Given the deep location of the artery and proximity to critical anatomical structures (i.e., ureter, bladder, and rectum), open surgical repair carries high morbidity and mortality compared with an endovascular approac...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.04.069
更新日期:2020-10-01 00:00:00
abstract::Aneurysm of the pancreaticoduodenal artery arcade has a well-documented association with occlusion of the celiac axis. The etiology of celiac occlusion is most commonly atherosclerotic disease. Occlusion or severe stenosis of the celiac artery secondary to a median arcuate ligament is less frequently encountered, and ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2013.06.030
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:The frequency of the occurrence of adverse events associated with carotid artery stenting (CAS) is usually low, but serious adverse events such as cerebral hyperperfusion syndrome (CHS) may occur. Real-time monitoring is ideal for the early detection of adverse events during the surgical procedure. This stud...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.10.034
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Arterial revascularizations can present significant challenges when vessels are disadvantaged and advances in technology present the surgeon with innovative opportunities. A number of studies have used the GORE® Hybrid Vascular Graft (GHVG), and we have been using this device in arterial revascularizations s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2019.12.002
更新日期:2020-07-01 00:00:00
abstract::The objective of this study was to compare patency rates following the repair of popliteal aneurysms according to the site of inflow, material of bypass graft and quality of distal runoff. Seventy bypasses were performed over an 11-year period. Autogenous saphenous vein was used in 53 procedures (75.7%) and prosthetic...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-003-0062-6
更新日期:2004-01-01 00:00:00
abstract::The long-term impact of retroperitoneal aortic exposure regarding wound complications in all patients and erectile dysfunction in men was studied in a consecutive group of 107 patients (81 males and 26 females). Postoperative wound complications were classified into the following groups: none, flank bulge, hernia, and...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9014-2
更新日期:2006-03-01 00:00:00
abstract::Arterial aneurysm formation occurs in 15 to 20% of patients with Takayasu's disease. The timing of surgical intervention of these aneurysms is controversial. A case of ectasia of the descending thoracic aorta in a patient with Takayasu's disease is presented. The diagnosis and timing of surgical intervention of aneury...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02133055
更新日期:1991-09-01 00:00:00
abstract::Vascular injury sustained during neurosurgical procedures is surprisingly rare, especially considering the anatomic proximity of major blood vessels to the vertebral column. Mortality rates are high if the injury is not recognized and definitive management is delayed. Case reports include massive hemorrhage, arteriove...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02002344
更新日期:1996-01-01 00:00:00
abstract::Since the introduction of endovascular stent grafts at our institution we have used intraoperative intravascular ultrasound (IVUS) to definitively determine stent graft size. In this study, expected stent graft size, based on preoperative helical CT scan measurements, was compared with the actual final size, based on ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910067
更新日期:2000-07-01 00:00:00
abstract::This study was undertaken to evaluate the ability of intraoperative duplex scanning during infrainguinal vein bypass to identify technical abnormalities and to determine the relation between intraoperative scan result and early primary graft patency. We retrospectively reviewed of 78 consecutive intraoperative duplex ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900257
更新日期:1999-05-01 00:00:00