Abstract:
BACKGROUND:Carotid revascularization for asymptomatic carotid artery stenosis (ACAS) has become increasingly controversial in the past few decades as the best medical therapy has improved. The aim of this study was to assess and define contemporary trends in the rate of carotid revascularization procedures for ACAS in the United States and to characterize outlier physicians performing a higher rate of asymptomatic revascularization compared to their peers. METHODS:We used 100% Medicare fee-for-service claims to identify all patients who were newly diagnosed with ACAS between 01/2011-06/2018. Patients with symptomatic carotid artery stenosis, those with prior carotid revascularization, and surgeons who performed ≤10 CEAs during the study period were excluded. We used a hierarchical multivariable logistic regression model to evaluate patient and physician characteristics associated with undergoing a carotid endarterectomy or carotid artery stent procedure within 3 months after the initial diagnosis of ACAS. We also assessed temporal trends in carotid revascularization rates over time using the Cochran-Armitage Trend Test. RESULTS:Overall, 795,512 patients (median age 73.9 years, 50.9% male, 87.6% white) had a first-time diagnosis of ACAS during the study period, of which 23,481 (3.0%) underwent carotid revascularization within 3 months. There was a significant decline in overall carotid artery revascularization rates over time (2011: 3.2% vs. 2018: 2.1%; P < 0.001). The median and mean physician-specific carotid revascularization rates were 2.0% (IQR 0.0%-6.3%) and 4.7% ± 7.1%, respectively. Three-hundred and fifty physicians (5.2%) had carotid revascularization rates ≥19%, which was more than 2 standard deviations above the mean. After adjusting for patient-level characteristics, physician-level variables associated with carotid revascularization for newly diagnosed ACAS included male sex (adjusted OR 1.59, 95% CI 1.35-1.89), more years in practice (≥31 vs. <10 years, aOR 1.64, 95% CI 1.32-2.04), rural practice location (aOR 1.34, 95% CI 1.18-1.52), Southern region practice location (versus Northeast, aOR 1.54, 95% CI 1.39-1.69), and lower volume of ACAS patients (lower versus upper tertile, aOR 2.62, 95% CI 2.39-2.89). Cardiothoracic surgeons had a 1.52-fold higher odds of carotid revascularization compared to vascular surgeons (95% CI 1.36-1.68), whereas cardiologists and radiologists had lower intervention rates (both, P < 0.05). CONCLUSIONS:The current early revascularization rate for newly diagnosed ACAS is <5% among proceduralists in the United States, and has been decreasing steadily since 2014. There are particular physician-level characteristics that are associated with higher rates of carotid revascularization that cannot be fully contextualized without high-level contemporary outcomes data to guide decision making in ACAS.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Sorber R,Clemens MS,Wang P,Makary MA,Hicks CWdoi
10.1016/j.avsg.2020.08.118subject
Has Abstractpub_date
2020-09-03 00:00:00eissn
0890-5096issn
1615-5947pii
S0890-5096(20)30799-8pub_type
杂志文章abstract::Resection and graft replacement of the vena cava for malignant disease is rarely performed, often because of the advanced tumor stage. Since August 1987 we have selectively performed caval replacement in conjunction with tumor resection in 11 patients. Three patients had superior vena cava reconstruction (SVCR) and ei...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02042660
更新日期:1993-01-01 00:00:00
abstract::Most physicians are aware of the important role that platelets play in thrombus formation. The mechanisms that regulate platelet function are now understood at the molecular level. The same biologic processes that control platelet participation in the hemostatic process also allow platelets to interact with the vessel...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02001017
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abstract::Mesenteric arterial branch aneurysms are rare. Giant, multiple, mesenteric branch artery aneurysms are even more uncommon, and only a few reports exist in the literature. We describe a 73-year-old asymptomatic female found to have an abdominal bruit and subsequently diagnosed with multiple mesenteric branch artery ane...
journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2007.03.009
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abstract:BACKGROUND:The acute aortic arch angle and narrow aortic diameter in young patients may lead to bird-beak configuration and excessive oversizing of the stent graft in thoracic endovascular aortic repair (TEVAR) for blunt traumatic thoracic aortic injury (BTTAI). Little is known about the association of these factors an...
journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2018.02.001
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abstract::Although the histologic effects of balloon catheter thromboembolectomy in arteries are well described, little is known about its effects on arterialized vein grafts. A chronic canine model was used to compare the intimal hyperplasia that develops following balloon catheter thrombectomy versus thrombolytic therapy when...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900091
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abstract::CO2 laser open endarterectomy of small atherosclerotic vessels appears feasible. Under the conditions described, the endarterectomized arterial wall is not smooth but the thrombogenicity of the laser-treated surface is low, and the endothelial healing rapid. These advantages are to be weighed against the consequence o...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60703-6
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abstract::The purpose of this retrospective study was to evaluate the immediate and long-term outcome of video-assisted thoracoscopic sympathectomy for idiopathic palmar hyperhidrosis. Between January 1996 and December 2000, a total of 67 patients underwent 102 sympathectomy procedures with excision of the sympathetic chain bet...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/s10016-001-0312-4
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02143854
更新日期:1995-09-01 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
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.08.014
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abstract::Endofibrosis of the external iliac artery is a rare cause of performance-limiting claudication in elite athletes. We describe a 47-year-old male competitive cyclist and a 52-year-old female former international triathlete, with unilateral and bilateral external artery occlusions, respectively, who presented with disab...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
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abstract:BACKGROUND:Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lac...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.05.059
更新日期:2020-01-01 00:00:00
abstract::The purpose of this review is to define animal models of chronic venous disease and to demonstrate how animal studies can impact our understanding and treatment of this disorder. To this end an extensive literature search was conducted highlighting potential animal models of chronic lower extremity venous disease. Sci...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/s100169900190
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Carotid endarterectomy (CEA) is the gold standard for treatment of carotid artery stenosis. CEA can be challenging, even technically impossible. Prosthetic carotid bypass grafting is a proven and safe alternative when CEA is hazardous. An alternative technique that is prosthetic carotid bifurcation resection...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.05.025
更新日期:2015-11-01 00:00:00
abstract::Beginning in April 1989, we have performed eight upper thoracic chemical sympathectomies by transthoracic endoscopy. The indications were occlusive arterial disease in four patients and Raynaud's syndrome and palmar hyperhidrosis in two patients each. Transthoracic endoscopy was performed under general anesthesia, thr...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02008799
更新日期:1992-07-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.10.004
更新日期:2018-05-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.05.134
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abstract:BACKGROUND:Neuromuscular electrical stimulator (NMES) devices increase blood flow to the lower limb by a process of intermittent muscular contraction initiated by a transdermal stimulus to the common peroneal nerve. However, its effects on localized microvascular blood supply to lower limb wounds are unknown. This stud...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.07.030
更新日期:2020-08-05 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
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.06.010
更新日期:2020-01-01 00:00:00
abstract::Rarely, internal carotid artery (ICA) patency is maintained above a common carotid artery occlusion (CCAO) through collateral flow of the ipsilateral external carotid artery or an aberrant ICA branch. Several small series report excellent results of ICA revascularization in relieving cerebral ischemic symptoms in thes...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
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journal_title:Annals of vascular surgery
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.01.023
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journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2015.11.017
更新日期:2016-05-01 00:00:00
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journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2007.10.003
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abstract:BACKGROUND:Almost 80% of patients with end-stage renal disease (ESRD) initiate dialysis via a central venous catheter (CVC). CVCs are associated with multiple complications and a high cost of care. The purpose of our project is to determine the impact of early cannulation arteriovenous grafts (ECAVGs) on quality of car...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
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abstract:BACKGROUND:Ligation and division of the saphenofemoral junction (L/D SFJ) can protect against the danger of venous thromboembolism (VTE) associated with greater saphenous vein (GSV) radiofrequency ablation (RFA). Although this procedure is regarded as clean from an infection standpoint, surgical site infection (SSI) ca...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.10.013
更新日期:2012-07-01 00:00:00
abstract::The combined presence of an inflammatory abdominal aortic aneurysm and a horseshoe kidney is a rare event with only one reported case in previously published data. We present a case of a horseshoe kidney with a concomitant 6-cm inflammatory abdominal aortic aneurysm and a 3.6-cm right iliac artery aneurysm repaired th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2010.09.019
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)61447-7
更新日期:1987-12-01 00:00:00
abstract::Vascular anomaly is a general term that includes all vascular malformations, vascular tumors, and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most co...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.02.040
更新日期:2019-08-01 00:00:00