Abstract:
INTRODUCTION:Within the context of healthcare system reform, the cost efficacy of lower extremity revascularization remains a timely topic. The impact of an individual patient's socioeconomic status represents an under-studied aspect of vascular care, especially with respect to longitudinal costs and outcomes. The purpose of this study is to examine the relationship between socioeconomic status and clinical outcomes as well as inpatient hospital costs. METHODS:A retrospective femoropopliteal revascularization database, which included socioeconomic factors (household income, education level, and payor status), in addition to standard demographic, clinical, anatomical, and procedural variables were analyzed over a 3-year period. Patients were stratified by income level (low income [LI] <200% federal poverty level [$42,400 for a household of 4], and higher income [HI] >200% federal poverty level) and revascularization technique (open vs endovascular) and analyzed for the endpoints of primary assisted patency, amortized cost-per-day of patency, and limb salvage. Data were analyzed with univariate and multivariate techniques. RESULTS:A total of 187 cases were identified with complete data for analysis, 146 in the LI and 41 in the HI cohorts. LI patients differed from HI patients by mean age (66.2 +/- 1.0 vs 61.8 +/- 1.5 years, P = .04), high school graduate rate (51.4% vs 85.4%, P < .001), presence of tissue loss (30.1% vs 14.6%, P = .05), female gender (43.7% vs 22.0%, P = .01) and preoperative statin use (45.8% vs 75.6%, P < .001). There were no differences with respect to other comorbidities including smoking status, presence of diabetes, renal insufficiency, anatomic factors or treatment modality (open vs endovascular). Ninety-seven patients underwent endovascular revascularization. The following outcomes were noted in the endovascular subset of LI and HI patients respectively: primary assisted patency (66% vs 71%, P = NS) and 12-month cost-per-day of patency ($166.30 +/- 77.40 vs $22.45 +/- 12.45, P = .05). Ninety-eight patients underwent open revascularization, with the following outcomes in LI and HI patients respectively: primary assisted patency (78% vs 86%, P = NS) and 12-month cost-per-day of patency ($319.43 +/- 225.44 vs $40.47 +/- 4.63, P = .07). Of the 77 patients with critical limb ischemia, 19 underwent eventual amputation. Multivariate analysis demonstrated that income above 100% of the federal poverty line was protective against limb loss (odds ratio 0.06, 95% confidence interval 0.01-0.51, P < .001). CONCLUSION:Income level correlates with advanced presentation, advanced age, and lack of statin use. Although primary assisted patency rate is not affected by income status, an increased cost-per-day of patency and inferior limb salvage is found in lower income patients.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Durham CA,Mohr MC,Parker FM,Bogey WM,Powell CS,Stoner MCdoi
10.1016/j.jvs.2010.04.011subject
Has Abstractpub_date
2010-09-01 00:00:00pages
600-6; discussion 606-7issue
3eissn
0741-5214issn
1097-6809pii
S0741-5214(10)00905-5journal_volume
52pub_type
杂志文章abstract::The pedigrees were constructed of 43 patients (probands) who underwent resection of an abdominal aortic aneurysm. Seven probands (16.2%) had a first-degree relative (parent, sibling, child) known to have had an abdominal aortic aneurysm (multiplex family). To determine the prevalence of undiagnosed abdominal aortic an...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1991.25382
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:The effects of a new long-term subcutaneous vascular access device were studied in access-challenged patients who were poor candidates for fistulas or grafts due to venous obstruction. Bacteremia rates, patency, and function of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device (Hemosphere Inc, M...
journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.jvs.2009.04.014
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVE:This study explored the long-term outcomes of arteriovenous fistulas treated with vonapanitase (recombinant human elastase) at the time of surgical creation. METHODS:This was a randomized, double-blind, placebo-controlled trial of 151 patients undergoing radiocephalic or brachiocephalic arteriovenous fistula...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jvs.2016.08.101
更新日期:2017-04-01 00:00:00
abstract::We report two patients with a carotid body paraganglioma that extended to the skull base, a position that is surgically inaccessible by means of a traditional lateral cervical approach. In both patients we were able to remove the lesion by performing a double mandibular osteotomy. Both patients underwent preoperative ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.11.086
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:Distal cerebral embolization is a known complication of carotid interventions. We prospectively investigated whether subclinical microembolization seen on postoperative magnetic resonance imaging (MRI) leads to cognitive deficits in patients undergoing carotid revascularization procedures. METHODS:Patients u...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.05.092
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:The goal of abdominal aortic aneurysm (AAA) repair is the prevention of rupture. Exclusion of the infrarenal AAA by means of operation or endovascular graft placement is an alternative therapy to achieve this goal. However, thrombosis of the excluded aneurysm sac does not always occur and further intervention...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70034-0
更新日期:1999-12-01 00:00:00
abstract:PURPOSE:We present a review of 35 patients who underwent an operation for subclavian (n = 18) or axillary (n = 17) vessel injury. In some patients, both an artery and a vein were damaged, resulting in a total of 30 arterial and 16 venous injuries. METHODS:The wounding source included a gunshot (n = 19), a stab wound (...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70268-x
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Arterial disease in women will become a major issue in the near future. METHODS:A systemic review of existing literature was retrospectively conducted to collect information on the three most common entities of vascular disease: carotid atherosclerotic, abdominal aortic aneurismal, and lower extremity arter...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2007.07.057
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Successful cannulation is an important prerequisite for a functional arteriovenous fistula (AVF). Reasons for unsuccessful cannulation of an AVF are multifactorial and poorly evaluated. In our experience, a needle access segment (NAS) with a length of 10 cm, <5 mm deep from the skin surface, and >6 mm diamet...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.10.063
更新日期:2016-04-01 00:00:00
abstract:PURPOSE:The aim of this study was to seek a relationship between the morphologic features of abdominal aortic aneurysms and the feasibility of endoaortic grafting. METHODS:Between June 1995 and January 1996, 86 patients were prospectively studied with contrast-enhanced spiral computed tomographic scans, which provided...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(97)70184-8
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:The application of thoracic endovascular aortic repair (TEVAR) has changed treatment paradigms for thoracic aortic disease. We sought to better define specific treatment patterns and outcomes for type B aortic dissection treated with TEVAR or open surgical repair (OSR). METHODS:Medicare patients undergoing t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.12.047
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to evaluate the difference in outcomes after endovascular intervention in patients with complicated type B aortic dissection (TBAD) based on ethnicity and blood pressure control. METHODS:Between 2012 and 2016, there were 126 patients who underwent endovascular procedures for c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.10.083
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:Hostile infrarenal neck characteristics are associated with complications such as type Ia endoleak after endovascular aneurysm repair. Aortic neck angulation has been identified as one such characteristic, but its association with complications has not been uniform between studies. Neck angulation assumes tri...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2015.08.110
更新日期:2016-03-01 00:00:00
abstract::In this report, we present a patient who developed an infected femoral artery after repuncture cannulation for carotid angioplasty and intraluminal stenting. The case was complicated by persistent bacteremia and a delay in diagnosis before it was managed successfully with an autogenous replacement graft and appropriat...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.119398
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:The Walking Impairment Questionnaire (WIQ) is used to estimate walking impairment in patients with peripheral artery disease; however, it faces frequent errors when self-completed and is complex to score. We aimed to validate an alternative, easily scored four-item tool, the Walking Estimated-Limitation Calc...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2013.03.039
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:This study aimed to determine predictors and outcomes associated with bleeding or anemia requiring transfusion (BAT) after fenestrated or branched endovascular aneurysm repair (FB-EVAR). METHODS:Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to investiga...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2019.02.059
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD) and is the major cause of ischemic amputation in the United States. Risk factors and the associated incidence and prevalence of CLI have not been well described in the general population. This ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.03.290
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:The Zenith Fenestrated Endovascular Graft (ZFEN; Cook Medical, Bloomington, Ind) has expanded the anatomic eligibility of endovascular aneurysm repair (EVAR) for complex abdominal aortic aneurysms (AAAs). Current data on ZFEN mainly consist of single-institution experiences and show conflicting results. There...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2018.08.192
更新日期:2019-06-01 00:00:00
abstract::Lower limb arteriovenous (AV) access creation can be attempted in patients where upper limb options are exhausted. Utilization of the great saphenous vein as a conduit for AV access has been limited due to its small diameter and resistance to dilatation. Lower limb AV fistulas today are mostly either prosthetic grafts...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.06.082
更新日期:2013-12-01 00:00:00
abstract:INTRODUCTION:Racial disparities in open thoracic aortic aneurysm repair have been well documented, with black patients reported to suffer from poor outcomes compared with their white counterparts. It is unclear whether these disparities extend to the less invasive thoracic endovascular aortic repair (TEVAR). This study...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.10.087
更新日期:2020-12-02 00:00:00
abstract::We present a case report of simultaneous pulmonary emboli and paradoxical embolism to the cerebellum causing a stroke and severe ischemia to the left leg. This patient had risk factors for thromboembolic events that included autoimmune disease, cancer, and recent pelvic surgery. The presence of a perforate foramen ova...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.03.063
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:Despite the increased cardiovascular morbidity and mortality risk of patients with peripheral arterial disease, previous worldwide studies have documented undertreatment of cardiovascular risk factors in such patients. METHOD:The ATTEST study was an observational cross-sectional epidemiologic study. Patients...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.04.002
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates ass...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jvs.2017.05.122
更新日期:2017-11-01 00:00:00
abstract::A 65-year-old woman was evaluated for acute right lower-extremity ischemia secondary to embolization from atrial fibrillation and subtherapeutic anticoagulation. Her symptoms quickly evolved in a dynamic fashion to involve multiple vascular beds, including a transient ischemic attack, abdominal pain secondary to mesen...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.10.066
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:Acute kidney injury (AKI) has been identified as a common complication after fenestrated and branched endovascular aneurysm repair (F/BEVAR), occurring in 5% to 29% of patients. Predictors of AKI and its impact on long-term outcomes remain unknown. We sought to identify independent predictors of AKI and its e...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.09.034
更新日期:2020-07-01 00:00:00
abstract::Thirty-nine reoperations in 38 patients with recurrent symptoms of neurogenic thoracic outlet syndrome were performed by the supraclavicular approach. Scarring around the brachial plexus was the primary cause in 59% of procedure, whereas in 41% of reoperations residual osseous and soft tissue anomalies were identified...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(94)70027-3
更新日期:1994-04-01 00:00:00
abstract:PURPOSE:The efficacy of autogenous infrainguinal reconstruction for patients with varying degrees of chronic renal insufficiency was reviewed because it has not been well defined. METHODS:Pertinent data were retrieved from hospital records and the vascular registry for all patients with chronic renal insufficiency (se...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1993.42889
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Carotid artery stenting (CAS) leads to frequent embolic brain lesions; their source has not been clearly identified yet. In order to investigate this phenomenon, we have evaluated embolic brain lesions (BL) after CAS and correlated them with aortic arch (AA) characteristics. METHODS:The AAs of 59 patients u...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.08.014
更新日期:2009-01-01 00:00:00
abstract::Non-uniform terminology in the world's venous literature has continued to pose a significant hindrance to the dissemination of knowledge regarding the management of chronic venous disorders. This VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of th...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,实务指引
doi:10.1016/j.jvs.2008.09.014
更新日期:2009-02-01 00:00:00
abstract::In a series of six patients, a single-bar anterior external fixator was used to treat combined vascular and orthopedic injuries of the leg. This method of external fixation facilitated operative vascular exposure without sacrificing bony stability or alignment. It may be the preferred method of external fixation for t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1987-10-01 00:00:00