2024 WVS Abstracts View

Name: Mohamed sabry Gwed

Address: imam saud st riyadh
saudia arabia
riyadh, riyadh 25698
Saudi Arabia

Will this author present: Yes

Email: drsabry955@yahoo.com

Cell: 966577420178

Abstract Title: Endovenous Non- Thermal Treatment Of Varicose Vein By Using Cyanoacrylate Glue

Abstract Body:

Introduction: non-thermal treatment of varicose vein which do not require using tumescent anaesthesia decrease the risk of nerve damage and still highly effective method .
Patients and Methods: This is a prospective study conducted on 35 cases presented by chronic venous insufficiency. Duplex as- sessment was done. Cyanoacrylate glue was used in all cases for occlusion .Follow up was done immediately and at three and six months.
Results: this study applied on 35 patients and 38 limbs, 28 females and 7 patients were male, with a mean age 26.3±8.3years,clin- ical presentation from C2-C6, The occlusion rate was 100% immediately and 96% at 3 months and at 6 months was 92.5%.
Conclusion: Treatment of varicose vein with cyanoacrylate is the least invasive technique with a successful and promising method with minimal side effects.

Relevant History and Physical Exam:

chronic venous insufficiency.

Relevant Test Results:

duplex scan showed GSV reflux

Teaching points, lessons learned …..

Treatment of varicose vein with cyanoacrylate is the least invasive technique with a successful and promising method with minimal side effects.

Do you have Grant Support? Please explain:  

no

Has this material been previously published? Yes

If Yes, Where? surgical chronicles

Name: Whitney Teagle

Address: Division of Vascular Surgery, University of Washington
1959 NE Pacific St Main Hospital, 7th floor
Seattle, WA 98195
United States

Will this author present: Yes

Email: teaglewh@uw.edu

Cell: 12063160193

Abstract Title: Women have higher morbidity and mortality following repair of complex aortic aneurysms, likely due to symptomatic presentation and more extensive aneurysms

Abstract Body:

Objective: Prior studies have found disparities in outcomes by sex following repair of abdominal aortic aneurysms. However, little is known about the disparities in outcomes following endovascular repair of complex abdominal aortic aneurysms (cAAA). This study aims to assess differences in presentation and outcomes by sex following endovascular repair of cAAA.

Methods: All patients with cAAA treated in the Vascular Quality Initiative database from 2010–2022 were included. Demographics, comorbidities, and operative details were compared by sex. Perioperative outcomes and long-term survival were then assessed using univariable and adjusted analysis.

Results: 4671 patients were treated for cAAA, including 74% men and 26% women. Women tended to be older and had higher rates of COPD, but lower rates of coronary artery disease and lower baseline creatinine (all p<0.001). Women more commonly presented symptomatic, ruptured, and had more thoracoabdominal aneurysms (vs. juxtarenal) on presentation than men (all p<0.001). Women had higher 30-day and long-term mortality compared to men (Figure 1). This trend persisted after adjustment (Table 1). Major morbidities were also more common among women, including cardiac complication, respiratory complication, access site complication, intestinal ischemia, stroke, and leg and spinal cord ischemia (all p<0.01). Reintervention and prolonged length of stay were more common among women (p<0.001). Importantly, after adjustment for symptom status, extent, and comorbidities, only reintervention and prolonged length of stay were more common among women (Table 1). Adverse outcomes were driven by symptom status and aneurysm extent as compared to sex.

Conclusion: Women have higher morbidity and mortality following endovascular cAAA repair. However, this is driven by urgent presentation and a more extensive aneurysm at the time of repair. Efforts to screen women and provide earlier treatment may provide opportunity to address this disparity.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Name: Ashtin Wilhelmstoetter

Address: 330 S Michigan Ave
#1705
CHICAGO, IL 60604
United States

Will this author present: Yes

Email: ashtinjeney@gmail.com

Cell: 5094990643

Abstract Title: Rare Case of Left Ovarian Vein Transposition in patient with Ehlers Danlos Syndrome

Abstract Body:

Venous Compression Syndromes (CS) have various clinical presentations which are often misdiagnosed, leading to delayed treatment. Nutcracker syndrome (NCS) and May-Thurner Syndrome (MTS) are two rare compression syndromes (CS). Pelvic congestion syndrome (PCS) is often associated with NCS, whereby the increased left renal vein pressure gradient causes gonadal vein valvular incompetence, resulting in pelvic varicosities, congestion, and pelvic pain. Concurrent PCS and NCS has historically been treated with renal vein transposition and gonadal vein ligation. However, reports have described successful treatment of these two pathologies with left ovarian vein transposition. There are scarce reports in the literature describing these venous pathologies in patients with connective tissue disorders, like Ehlers Danlos Syndrome (EDS). A cumulative effect of these venous CS and EDS has been suggested, and may be associated with inferior post-operative surgical outcomes. The literature is significantly lacking consensus guidelines in managing this unique patient population. To date there are no reports of managing patients with EDS who are diagnosed with PCS and NCS. This case report describes a 24-year-old woman with a complicated medical history of complex regional pain syndrome (CRPS), restless leg syndrome (RLS), postural orthostatic tachycardia syndrome (POTS), anxiety and depression, irritable bowel syndrome, and EDS who presented with right flank pain and hematuria, as well as pelvic pain and heaviness significantly worsened with menstruation. She had radiographic evidence of compression of the left renal vein, a dilated left ovarian vein and compression of the left common iliac vein. She underwent a venogram with IVUS and pressure gradients confirming PCS, NCS and mild to moderate MTS. She underwent a left ovarian vein to IVC transposition without complication. No treatment was performed on the left iliac vein as this was clinically asymptomatic. Post-operatively, the patient experienced significant pain relief, and the majority of her pain symptoms related to NCS and PCS had resolved. This is the first case report describing successful surgical management of NCS and PCS in a patient with EDS. This case further highlights the lack of research evaluating the management and outcomes of these venous CS, specifically in patients with connective tissue disorders.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Anna Louise Pouncey

Address: 10th Floor, QEQM, St Mary’s Campus,
Praed Street
London, London W2 1NY
United Kingdom

Will this author present: Yes

Email: a.pouncey@imperial.ac.uk

Cell: 07912651686

Abstract Title: Does Sex Play a Role in Surgical Selection for Abdominal Aortic Aneurysm Repair?

Abstract Body:

Background:
Women are ~25% less likely to receive an abdominal aortic aneurysm (AAA) repair. This study explored whether patient sex, or alternative attributes, (which, differ by sex,) influence the likelihood of surgical selection.

Methods:
In-depth interviews with aortic surgeons and a consensus panel were used to identify attributes and levels for a discrete choice experiment: sex, age, AAA size, anaesthetic risk, hostile AAA neck/access anatomy, and patient anxiety. Aortic surgeons were recruited and asked to indicate treatment preference ((1) repair vs. not, (2) endovascular vs. open) for 16 scenarios. Data were analysed using logistic regression, adjusting for multiple choice observations.

Results:
182 aortic surgeons completed 3254 scenarios. Repair was selected for 67.9% of cases, 60.2% (1339/2223) of which were endovascular. AAA size (OR 1.26 (95%CI:1.24-1.29) and female sex (OR 2.32 (95%CI:1.87-2.88) increased the likelihood of surgical selection. Increasing age (OR 0.95 (95%CI:0.95-0.96), per-year), severe anaesthetic risk (OR 0.36 (95%CI:0.27-0.48)) and hostile anatomy (OR 0.45 (95%CI:0.33-0.60)) reduced the likelihood of surgical selection. Women were also more often offered endovascular rather than open repair (OR 1.50 (95%CI:1.31-1.73)). On examination of age-sex interaction, while age had no significant effect on selection for AAA repair for men, an increase in age was associated with a reduction in the likelihood of AAA repair for women, such that, all else being equal, the positive selection effect associated with being a woman was negated from the age of 83 years.

Conclusion:
Female sex, in isolation, was associated with an increased likelihood of surgical selection and significantly increased surgeon’s preference for less invasive (endovascular) repair. The likelihood of surgical selection decreased with age for women but not men.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

This work was supported by an NIHR doctoral fellowship.

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Anna Pouncey

Address: 10th Floor, QEQM,
St Mary’s Hospital,
London, London W2 1NY
United Kingdom

Will this author present: Yes

Email: a.pouncey@imperial.ac.uk

Cell: +447912651686

Abstract Title: Sex-Specific Comparison of Vascular Morphology and Thrombus Burden using Fully Automated Volume Segmentation

Abstract Body:

Background
Women with an infrarenal abdominal aortic aneurysm (IRAAA) are less likely to meet instructions for use (IFU) criteria for endovascular repair (EVAR) and more likely to suffer technical and thromboembolic complications. Anatomical sex-differences likely contribute. but previous comparisons using IRAAA diameter do not account for the smaller aortic calibres in women. Adjustment for aortic size index and concomitant cardiovascular disease burden may provide more accurate comparison.

Methods
Multi-centre retrospective cohort study using fully automatic volume segmentation (FAVS) to examine pre-operative imaging for elective IRAAA repairs (2013-2023). Nearest-neighbour propensity score matching was used, adjusting for aortic size index (ASI), cardiovascular risk factors, medications, and repair-type. Pre-specified morphological variables, aortic wall thrombus (AWT) index and “within-IFU” criteria for neck and access were compared between sexes.

Results
From 1026 patients, 128 women were matched to 512 men. Women and matched-men had similar ASI (3.33 [2.94,3.79] vs 3.26 [2.88,3.68], p=.300) and no difference vessel stenosis, calcification, or tortuosity. Women had greater relative-thrombus burden (AWT index: thoracic aorta, p=.010; superior mesenteric artery, p<.001), and were less likely to be within-IFU for neck criteria (13.38% vs 12.50%, p.002), due to shorter, narrower, more angulated necks (39.92o [30.61,50.55] vs 34.73 [26.21,43.86], p<.001). Visceral and access artery diameters were smaller (p<.001), meaning women less often met IFU-access criteria (45.31% vs 18.95%, p<.001).

Conclusions
Adjustment for ASI and cardiovascular disease burden did not mitigate sex-specific differences in AWT index, neck angulation or vessel diameters. Therefore, sex-specific device design is key to reduce inequity for EVAR.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

The work was supported by the Women’s Vascular Summit and an NIHR doctoral Fellowship.

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Nidhi Reddy

Address: 6299 Crooked Stick Circle
Stockton, CA 95219
United States

Will this author present: Yes

Email: nidhi.reddy6818@cnsu.edu

Cell: 2096392483

Abstract Title: Thoracobifemoral Bypass for Radiation-Induced Paravisceral Aortic Stenosis

Abstract Body:

Introduction:
Wilms tumor is one the few childhood cancers that is more common in girls than in boys.1 Treatment includes chemotherapy, surgical resection, and occasionally radiation therapy.
We present a case of a 56-year-old with disabling claudication secondary to radiation-induced paravisceral aortic stenosis with successful revascularization and resolution of claudication.

Case Description:
A 56-year-old man presented with complaints of disabling claudication at 50 feet. Notably, he was treated for a childhood Wilms tumor via left nephrectomy and radiation therapy. Since then, he had developed progressive advanced atherosclerosis of his paravisceral aorta. Pre-operative CTA identified near occlusion of the aorta just below the level of the SMA (Figure 1). Given the concern for a reoperative and irradiated field, we elected to proceed with a thoracobifemoral bypass for revascularization.

Briefly, bilateral common femoral arteries were exposed in the standard fashion. The left epigastric vein was doubly ligated with mobilization of the inguinal ligament to create an adequate pocket for the bifurcated graft. A left anterolateral thoracotomy was performed through the seventh interspace and the thoracic aorta was exposed. An 18mm gelweave tube graft, that was previously sewn to an 18mm bifurcated graft, was tunneled from the left groin through the diaphragm above the spleen to fashion an end-to-side anastomosis. The right limb was tunneled over the inguinal ligament to the right groin. The left limb was sewn end-to-side, followed by a right limb end-to-side anastomosis. A pleural flap was utilized for coverage of the proximal anastomosis. The patient tolerated the procedure well and recovered without complication. Follow-up evaluation at 6 months revealed continued relief of claudication symptoms without evidence of graft complication (Figure 2).

Discussion:
Unlike typical atherosclerotic lesions, radiation-induced stenosis often involves extensive fibrotic changes and altered vascular anatomy, increasing the challenge of both open and endovascular interventions.2,3 Rates of curative therapy for Wilms tumor are high, and despite its rarity, underscores the importance of addressing late vascular effects of radiation therapy in childhood cancer survivors. The successful outcome of this case highlights one strategy, but further investigation to identify revascularization approaches for patients with a history of radiation is warranted.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

CC supported by NHLBI Ruth L. Kirschstein National Research Service Award 5T32HL094293-14

Has this material been previously published? No

If Yes, Where?

Name: Neha Sunkara

Address: 13810 Windcrest Summit Ln
Houston, TX 77059
United States

Will this author present: Yes

Email: nesunkar@utmb.edu

Cell: 8327687796

Abstract Title: Early Nutrient Supplementation for Postmenopausal Women: Mitigating Peripheral Artery Disease Risks

Abstract Body:

Peripheral artery disease (PAD) represents a significant health burden, particularly among postmenopausal women. Postmenopausal women face an increased risk of developing PAD due to lipid dysfunction and immune-modulating nutrient (IMNs) deficiencies caused by hormonal changes such as estrogen decline. Recent studies have identified vitamin D and omega-3 fatty acids as immune-modulating nutrients, which possess antioxidant and anti-inflammatory properties that mitigate the risk of PAD. This literature review examines the predisposition of postmenopausal women to PAD due to their increased susceptibility for lipid metabolic disorders and immune-modulating nutrient deficiencies resulting in atherosclerosis and vascular dysfunction.

Postmenopausal women experience a decline in estrogen levels resulting in dyslipidemia, characterized by elevated LDL cholesterol levels and decreased HDL cholesterol levels and IMN deficiencies. This dyslipidemic profile contributes to the development and progression of atherosclerosis, a key pathological process underlying PAD. Elevated LDL cholesterol levels promote the deposition of cholesterol within arterial walls, initiating the inflammatory cascade and endothelial dysfunction. Additionally, decreased levels of HDL cholesterol compromise its anti-inflammatory, antioxidant, and vasodilatory properties against atherosclerosis.

Estrogen-induced lipid dysfunction also predisposes postmenopausal women to IMN deficiencies, specifically vitamin D and omega-3 fatty acids. Vitamin D deficiencies have been known to play a role in endothelial dysfunction, impaired arterial dilation, and increased arterial stiffness, all of which are risk factors for PAD. Omega-3 fatty acid deficiencies disrupt vasodilatory and anti-thrombotic cardiovascular effects resulting in vascular dysfunction. Deficiencies in omega-3 also lead to increased production of inflammatory cytokines, increased adhesion molecules on blood vessels, and decreased lipid metabolism resulting in atherosclerosis.

In conclusion, early supplementation of IMNs, such as omega-3 fatty acids and vitamin D, in postmenopausal women emphasizes the importance of addressing nutritional factors alongside traditional therapeutic strategies for improved vascular outcomes in postmenopausal women. Recognizing the impact of IMNs on vascular health enables vascular surgeons to adopt a preventative mindset, potentially reducing the prevalence and severity of PAD in this vulnerable population.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Thomas Williams

Address: Vascular Endovascular and Transplant Surgery, Te Whatu Ora – Waitaha Canterbury
2 Riccarton Avenue
Christchurch, Canterbury 4710
New Zealand

Will this author present: Yes

Email: thomas.williams@cdhb.health.nz

Cell: +64277461334

Abstract Title: Support for a trial of early endovascular aortic aneurysm repair in women in New Zealand, Australia and America

Abstract Body:

Background:
Small AAA rupture rates are almost four times higher in women compared to men, and best available data suggests that women’s rupture risk at 4.2cm diameter equals that at 5.5cm for men (1). A global randomised control trial (WARRIORS) is underway to determine the potential benefit of earlier endovascular repair in women.

Purpose:
The aim of this study was to determine support for a randomised trial of early endovascular aortic aneurysm repair vs routine surveillance, in women, in New Zealand, Australia and America.

Methods:
A survey invitation was distributed by ANZSVS and the Vascular Quality Initiative in USA.

Results:
Responses were received from 22 (4 women) vascular surgeons in NZ, 35 (7 women) in Australia, and 93 (27 women) in USA. 21/22 (96%) NZ, 27/34 (79%) Australian, and 87/93 (94%) USA respondents supported randomisation of women with small asymptomatic infra-renal AAA to early endovascular repair or standard care. Respondents supported randomisation in the most relevant age range of 65-84 years (figure 1a). Most surgeons were willing to randomise women with AAA of antero-posterior ultrasound diameter 4.5-5.4cm, but there was reduced support for randomisatoin at 4.0-4.4cm compared to 4.5-4.9cm (figure 1b). Respondents in USA were more willing to randomise high risk women, 81% in USA, Vs 50% in NZ and 41% in Australia, (figure 1c).

More NZ than Australian respondents reported their unit utilised a standard size threshold for endovascular repair of women’s AAA (21/22, 96% Vs 20/34, 59%, p=0.003), and men’s AAA (NZ 21/22, 96% Vs Australia 24/34, 71%, p=0.022). NZ respondents were more likely to agree that improved guidelines are needed for management of women’s AAA (NZ 19/21, 91%, Vs Australia 22/33, 67%, p=0.046). NZ surgeons were also more likely to agree that ethnicity-specific guidelines are needed (NZ 15/21, 71%, vs Australia 7/32, 22%, p<0.001).

Conclusion:
There is agreement that better evidence is needed to guide women’s AAA management, and amongst respondents there is very strong support for a trial of early endovascular repair of asymptomatic infra-renal AAA in women in USA, NZ and Australia.

Relevant History and Physical Exam:

NA

Relevant Test Results:

NA

Teaching points, lessons learned …..

NA

Do you have Grant Support? Please explain:  

Te Whatu Ora – Emerging Researchers Grant – Government funding for a seperate research project

Has this material been previously published? Yes

If Yes, Where? European Journal of Vascular & Endovascular Surgery – DOI:https://doi.org/10.1016/j.ejvs.2024.02.006

Name: Joanna Shaw

Address: UCLA Department of Surgery, Division of Vascular Surgery
10833 Le Conte Ave #72
Los Angeles, California 90024
United States

Will this author present: Yes

Email: jfshaw@mednet.ucla.edu

Cell: 8459052031

Abstract Title: Sex Disparities in Outcomes of Resuscitative Balloon Occlusion of the Aorta (REBOA): Results from the American Association of Surgery for Trauma (AAST) Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) Trial

Abstract Body:

Introduction/Purpose:
Female patients who undergo major vascular surgery in the elective setting have higher rates of procedural complications and more severe chronic disease at presentation. Sex differences in REBOA outcomes have not been previously studied.

Methods:
Retrospective data query from the AORTA database for patients who underwent REBOA using 7 French sheaths from 2016-2022. Demographics, physiology, and outcomes were examined. Implemented univariate and multivariate analyses including Chi-square, Fisher’s exact test, independent sample t-testing and multivariate logistic regression.

Results:
1,144 patients received REBOA (276 female, 868 male). 75% were male, mean age 43 +/- 18 and mean injury severity score (ISS) of 33 +/- 15. Admission Glasgow Coma Scale (GCS) was 7 +/- 5 and systolic blood pressure (SBP) at time of aortic occlusion was 59 +/- 38. Overall, female patients presented less frequently but with higher ISS (p=0.02) and head and chest abbreviated injury scores (AIS) (p=0.007, p=0.02). There were no significant differences in reported history of peripheral vascular disease, time to definitive hemorrhage control, survival to REBOA removal, or vascular complications such as pseudoaneurysm, hematoma, traumatic AV fistula, or distal embolism. There was no in-hospital mortality difference on initial multivariate analysis, however logistic regression demonstrated significantly higher in-hospital mortality in female patients who received REBOA when corrected for other demographic and physiologic variables (OR=32, p=0.03).

Conclusion:
Patients who receive REBOA are critically ill. Female patients who receive REBOA do not have significantly more access related complications compared to male patients, or more severe chronic vascular disease on presentation.

Relevant History and Physical Exam:

n/a

Relevant Test Results:

n/a

Teaching points, lessons learned …..

n/a

Do you have Grant Support? Please explain:  

No grant support at this time.

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Olga Bakayev

Address: 147 Maujer Street
Brooklyn, NY 11206
United States

Will this author present: Yes

Email: dr.olga.bakaev@gmail.com

Cell: 215-554-1118

Abstract Title: Effect of Previous Pregnancies on Venous Insufficiency.

Abstract Body:

Our study aims to clarify the relationship between multiparity and venous insufficiency in women, addressing gaps¹ and controversies² in the existing literature
The retrospective, non-randomized, observational study was approved by NYU Langone Health’s Institutional Review Board. We called 977 female patients older than 18, who underwent venous mapping duplex for any reason from 01.19.2020 to 01.19.2023 in the Total Vascular Care clinic. The convivence sampling from the patients was surveyed from February 2023 to December 2023. Survey content pertained to demographics, obstetric history, and vascular disease risk factors. The most recent duplex results were collected from patients’ clinical charts by researchers. Multivariate analysis was conducted using IBM SPSS software. Patients were categorized into groups according to maternal age at first delivery (<17 years; 18–28 years; 29–39 years; < 40 years)³ and number of pregnancies (nulliparous; multiparous; grand multigravida; great grand multipara)⁴. Controls for smoking, diabetes, hypertension, and complications related to pregnancy were incorporated within the model.
Using computer-assisted telephone interviews, 379 participants were contacted and a total of 102 patients (26.9%) consented. Patient’s mean age was 63 years (24-92 years) and most women reported being retired or living on social assistance (42%). Gravida ranged widely from no previous pregnancies to twelve (mean n=1.9) with complications. Over half of participants reported a risk factor for vascular disease (67%) with clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction of three or more (55%). Duplex scans revealed obliteration in the great saphenous vein (57%) and superficial saphenous veins (31%) in most cases. The multivariate analysis concluded that increasing multiparity predicted symptom severity and the presence of venous insufficiency on venous mapping (OR 1.01 95% CI 0.83–1.11, p < 0.05; OR 1.25 95% CI 1.05–1.83, p < 0.05). No protective factors were identified.
The research's sensitive topic may have lowered participation rates, potentially affecting the data's representativeness and the study's generalizability. Weak associations were found between the number of deliveries and venous severity symptoms, highlighting the complexity of these relationships. The risk of venous insufficiency on venous mapping significantly increased with higher multiparity. However, correlation does not equal causation, necessitating further analysis to uncover underlying mechanisms

Relevant History and Physical Exam:

Clinical manifestation, Etiologic factors, Anatomic distribution, Pathophysiologic dysfunction, and Venous Clinical Severity Score

Relevant Test Results:

venous mapping duplex

Teaching points, lessons learned …..

The study highlights the need for personalized management and prevention strategies for multiparous women.
We learned the necessity of approaching sensitive topics with tact to enhance study participation and data quality, ensuring research reflects a diverse population.

Do you have Grant Support? Please explain:  

None

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Sasha Suarez

Address: 63 John Street
Quincy, Massachusetts 02171
United States

Will this author present: Yes

Email: ssuarez@mgh.harvard.edu

Cell: 5082805155

Abstract Title: Using the Antiplatelet Coagulation Exactness Algorithm to Personalize Antiplatelet Therapy in Post Revascularization in PAD Patients: A Pilot Study

Abstract Body:

Objectives
Thrombotic rates post-revascularization in PAD is 18-20% and women experience disproportionately higher rates of amputation compared to male counterparts. The aim of this single arm, interventional pilot study was to demonstrate that tailoring antiplatelet medication using our novel Antiplatelet Coagulation Exactness (ACE) algorithm to guide antiplatelet therapy reduces arterial thrombotic rates in PAD patients post-revascularization.

Methods
This is a single arm, prospective, interventional pilot study conducted from June 2023 to December 2023 comparing historical rates of thrombosis/stenosis using standard of care (SOC) dual antiplatelet therapy (DAPT) to thrombotic/stenotic event rates in patients using the ACE algorithm. Patients undergoing endovascular revascularizations for PAD were included. Patients on anticoagulation were excluded. Thromboelastography with platelet mapping (TEG-PM) was performed at baseline and the ACE algorithm guided antiplatelet therapy (Fig. 1). Serial perioperative TEG-PM analyses were performed at 1-week(W), 1-month(M), 2M, 3M, and 6M and medications tailored accordingly. Thrombotic/stenotic events over a 6-month period were recorded. Statistical analysis was performed using ANOVA to identify differences in platelet function and Fischer’s test for events rates.

Results
Over the pilot study period, a total of 34 patients met study criteria. Eleven(32%) patients were females, and 23(68%) were male. Platelet inhibition in males at baseline was 20.54% and it significantly increased after using ACE algorithm for the rest of the follow-up visits at 1W, 1M, 2M, 3M, 6M [20.54% vs 45.33% vs 61.9% vs 60.8% vs 55.34% vs 60.77%, p<0.0002] respectively. Platelet inhibition in females at baseline was 29.59%, and also increased after the use of ACE algorithm [29.59% vs 55.7% vs 58.51% vs 53.68% vs 44.11% vs 49.54%, p<0.25]. Thrombotic rates in the study were 0% in females and 4% in males (Table 1) at 6 months. When compared to historical thrombotic rates, the overall rate of thrombosis was significantly lower in the ACE group. The rates of sex-specific thrombosis were also lower and trended towards significance.

Conclusions
The use of the ACE algorithm to tailor antiplatelet medication in patients post-revascularization with PAD decreases thrombotic event rates significantly and may serve as an opportune way to mitigate outcome disparities caused by inadequate thromboprophylaxis in women.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

The use of the ACE algorithm to tailor antiplatelet medication in patients post-revascularization with PAD decreases thrombotic event rates significantly and may serve as an opportune way to mitigate outcome disparities caused by inadequate thromboprophylaxis in women.

Do you have Grant Support? Please explain:  

Yes, we have NIH R21 funding.

Has this material been previously published? No

If Yes, Where?

Name: Amy Liu

Address: 2572 Sanctuary St
Lisle, IL 60532
United States

Will this author present: Yes

Email: aliu10@luc.edu

Cell: 6308859395

Abstract Title: Vessel Size is Not Associated with Poorer Outcomes in Patients with Lower Extremity Peripheral Artery Disease

Abstract Body:

Introduction: The impact of patient sex on the development and outcomes of peripheral artery disease (PAD) is not well studied. Females have worse outcomes after coronary artery bypass grafting due to smaller vessel size, but there is a paucity of research on the relationship between vessel size and outcomes in patients undergoing endovascular and open interventions for PAD.

Methods: We conducted a single-center retrospective review of 416 consecutive patients with PAD, including 179 females (43%) and 237 males (57%), who underwent computed tomography angiogram (CTA) imaging between 2010 and 2022. We reviewed CTA imaging and measured common femoral artery (CFA) area to define vessel size. Reference values of average CFA area (52.8-75.4mm^2) were used to define normal vessel size (n=164). Small vessels were defined as less than 52.8mm^2 (n=150); large vessels were defined as greater than 75.4mm^2 (n=102). Kaplan-Meier curves for patency, major amputation, and 5-year mortality were then compared. Multivariable Cox proportional hazard models were fit for patency, major amputation, and 5-year mortality.

Results: Mean CFA area was 50.6mm^2 in females and 64.5mm^2 in males (p<0.001). On univariable analysis, vessel size had no association with differences in primary, primary-assisted, or secondary patency (p=0.44, 0.84, 0.42). Larger vessels were associated with higher rates of major amputation (p=0.03) and marginally higher rates of mortality (p=0.05). There was no difference in patency or amputation rates based on patient sex, although females had significantly higher rates of 5-year all-cause mortality (p=0.03). On multivariable analysis, neither vessel size nor patient sex was associated with differences in patency, major amputation, or 5-year mortality.

Conclusions: Vessel size was not demonstrated to have a significant impact on outcomes related to revascularization in patients with PAD. Because target vessel size is often a technical consideration in PAD interventions, further investigation is needed to develop guidelines to optimize therapy based on vessel size. Limitations of this study included analysis based upon CFA area only.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Fouzul Kansul

Address: 125 Spence St
College Station, Texas 77843
United States

Will this author present: Yes

Email: fouzul.k@tamu.edu

Cell: 4694281703

Abstract Title: Sex-Based Differences in Plaque Histology of Amputation Patients with Chronic Limb-Threatening Ischemia

Abstract Body:

Objectives: With the growing incidence of peripheral arterial disease (PAD) and historic underrepresentation of female patients in cardiovascular trials, a comprehensive evaluation of sex-based variances in PAD presentation is needed¹,². This study aims to evaluate sex-based differences in vessel wall composition of patients who received major lower-limb amputation to optimize personalized treatment planning and aid in the selection of endovascular devices for PAD patients.
Methods: A total of 35 lower limbs were collected from 34 end-stage patients undergoing amputation due to chronic limb-threatening ischemia. Diseased below-the-knee arteries were harvested and cross sectioned at 3-4 mm intervals. Histochemical staining was performed using Movat’s Pentachrome and hematoxylin-eosin and rings were evaluated for the following: percent stenosis (0-20%, 20-40%, 40-70%, 70-100%), chronic total occlusion (CTO) formation, luminal thrombus (acute, organizing, organized), neointimal hyperplasia (yes/no), presence of calcified plaque (yes/no), degree of calcification (I:0-25%, II:25-50%, III:50-75%, IV:75-100%), calcium localization (predominantly intimal (≥60%), predominantly medial (≥60%), or mixed), and atherosclerotic patterns (non-atherosclerotic, pathological intimal thickening, fibrous plaque, fibrocalcific plaque, fibroatheroma, thin-cap fibroatheroma). Sex-based variations in calcification severity, CTO formation, and atherosclerotic presence within the popliteal and tibial arteries were also evaluated.
Results: The 34 subjects included in this study (mean age: 71±9.4 years; 16 female patients) yielded 163 arterial segments (male:96, female:67) and 1,260 histological rings (male:765, female:495). Male and female patients were remarkably similar in multiple plaque characteristics, including degree of stenosis, calcification patterns (Figure 1), and atherosclerotic features. Luminal thrombus (Figure 2) was more prevalent in females (38.7%, male:25.0%, p=0.016). Analysis of the popliteal segments (male:28, female:25) indicated male patients had more calcification in stages III and IV (60.7% vs. 28.0%, p=0.003) and increased atherosclerotic plaque (96.4% vs.73.0%, p=0.028).
Conclusion: The sex-based disparities observed in PAD presentation may be associated with increased platelet reactivity and coagulation seen in female patients, linked to heightened prevalence of luminal thrombosis. The absence of significant differences in calcification patterns suggests that both sexes may develop similar lesion characteristics over time in end-stage PAD. Further studies are needed to evaluate the effects of luminal thrombus, severe calcification, and atherosclerotic plaque on therapeutic decision-making and endovascular treatment outcomes.

Relevant History and Physical Exam:

All patients underwent major lower limb amputation due to chronic limb-threatening ischemia.

Relevant Test Results:

Women had a higher occurrence of luminal thrombus based on histopathologic analysis of harvested vessels.

Teaching points, lessons learned …..

Sex-based differences in PAD lesion characteristics may guide therapeutic decision-making.

Do you have Grant Support? Please explain:  

This work was supported by the Houston Methodist Research Institute Clinician-Scholar program and the Jerold B. Katz Academy of Translational Science under project number 15790002 (recipient’s name: Trisha Roy).

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Sarah Beckwith

Address: 1750 W. Harrison
Jelke 769
Chicago, IL 60612
United States

Will this author present: Yes

Email: sarah_e_beckwith@rush.edu

Cell: 5012515580

Abstract Title: Syndactylization: A Surgical Revision Technique for Arteriovenous Fistula Stenosis Using In-Situ Branching Vein Patch

Abstract Body:

Objective: Management of arteriovenous fistula (AVF) stenosis and non-maturation remains a major challenge in patients requiring hemodialysis (HD) access. While endovascular intervention remains first line, surgical revision is preferable in certain circumstances and may require fewer overall interventions.1 We describe a surgical technique for the revision of AVF with mid-vein narrowing during planned brachiobasilic AVF transposition.

Methods: A 54-year-old woman with CKD5, not yet on HD, presented for planned transposition of left upper extremity brachiobasilic AVF. Pre-operative ultrasound demonstrated stenosis in distal arm measuring 4.1 mm in diameter with peripheral pulsatility. Intraoperatively, the basilic vein was dissected circumferentially with a 3 cm segment of narrowing identified near the antecubital fossa. A substantial side branch near this stenosis was preserved, dissected circumferentially, and ligated 4 cm from the branch point. After obtaining proximal and distal control, a venotomy was created through the branching vein, the basilic vein stenosis, and continued onto normal appearing vein, essentially spatulating the side branch (Fig 1). Old fibrin and thickened valves were removed from narrowed segment of basilic vein. Five-millimeter dilators easily passed peripherally and centrally beyond the narrowed segment of basilic vein. The spatulated branch, with its base left in-situ, was rotated and sutured in place using running 7-0 Prolene sutures alleviating the stricture (Fig 2). The vein was flushed with heparinized saline and the patch tied down during ongoing flow. A palpable thrill and radial pulse were present following transposition of the revised basilic vein and skin closure. The patient recovered as anticipated and was cleared for use of the brachiobasilic AVF six weeks post revision.

Conclusions: In cases of patients with AVF stenosis undergoing an open procedure, use of a branching side vein as an autologous, in-situ patch is a repair option warranting further study. This patch technique, by incorporating the base of the branching vein, further aids in increasing vessel diameter and avoids the circumferential suture otherwise required for traditional patch revision and possible restenosis due to purse stringing. This technique also maintains AVF length compared to a resection with end-to-end anastomosis or longitudinal incision and transverse suture technique.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Syndactylization is an effective revision technique for AVF stenosis and should be considered during dissection and before ligating branching veins.

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Name: Litton Whitaker

Address: 24 Hospital Ave
Danbury, CT 06810
United States

Will this author present: Yes

Email: lwhitak2@gmail.com

Cell: 6158290461

Abstract Title: Transcarotid artery revascularization learning curves differ between surgeon experience level

Abstract Body:

Introduction: There has been ensuing interest in adopting transcarotid artery revascularization (TCAR), because of its low perioperative stroke and mortality rates. We aimed to identify the case number at which there is improvement in TCAR technical proficiency, defined by skin-to-skin, fluoroscopy, and reverse flow times.

Methods: Data was collected from a deidentified database, which included all TCARs between 2017 and 2023 at one of four hospitals. Surgeons were grouped by experience level (10 years). Cases were excluded if they were converted to open, aborted, or performed by surgeons with less than five cases. All cases after the 15th were excluded to compare groups more fairly. To correct for skewed distributions, primary outcomes were log transformed prior to analysis, using linear mixed models.

Results: There were 160 cases performed by 13 surgeons included. Patients with hostile necks (23.9% vs. 9.7%, p=0.015) and contralateral occlusions (7.5% vs. 0%, p=0.0074) were operated on more frequently by surgeons with <10 years of experience. Intraoperative dissection, perioperative stroke, return to the operating room, and readmission each occurred once (0.6%) in different patients. Significance was reached at the 15th surgery for both fluoroscopy and skin-to-skin times for surgeons with 10 years of experience. No differences in reverse flow time were detected.

Discussion: At case 15, surgeons with <10 years of experience started noticing significant improvement in technical proficiency relative to their senior partners, which was neither influenced by patient characteristics nor the type of anesthesia used. Because a deidentified database was used, we were unable to investigate operative conditions that may have resulted in these differences.

Figure I. Blue and red lines represent cases performed by surgeons with 10 cases, respectively. At surgery 15, the less experienced group had shorter skin-to-skin and fluoroscopy times with a -0.36 (p=0.0017, 95% CI -0.58 to -0.14) and -0.72 (p=0.0051, 95% CI -1.21 to -0.22) difference in log scales, respectively. SEM = standard error of the mean.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Name: Kelsey Schmittling

Address: 402 N Clifton Ave
Wichita, KS 67208
United States

Will this author present: Yes

Email: kschmittling@mail.kansashsc.org

Cell: 7635163826

Abstract Title: Sex based differences in adverse hospital outcomes in patients undergoing abdominal aortic aneurysm repair

Abstract Body:

Current data shows that patients assigned female at birth (AFAB) are more likely to present with a ruptured abdominal aortic aneurysm (AAA) (1, 2), suggesting that current AAA screening guidelines (3) are insufficient. Recent studies suggest social determinants affect patients AFAB disproportionately where, of patients monitored for AAA screening with intact aneurysms, female patients were less likely to receive proactive treatment (2, 4). The aim of this study was to explore hospital outcomes and mortality in patients AFAB with a corresponding procedure code of abdominal aorta restriction. Repair by open, percutaneous, and percutaneous, endoscopic methods were aggregated for the purpose of this study. Utilizing the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample between 2018 and 2020, demographic variables and outcomes were compared between patients AFAB and those assigned male at birth (AMAB). Despite research asserting that White race is correlated with higher rate of AAA, patients AFAB were significantly more likely to be African American (9.5% versus 5.3% for AMAB, p<.001) and presented to the hospital nearly two years later (74.42 +/- 8.73 years versus 72.95 +/- 8.53 years for AMAB, p<.001) (Table 1). Similarly, despite comprising only ~20% of the study population, patients AFAB (N=4,616) were 1.919 times more likely to have died while hospitalized relative to patients AMAB (N=16,781) (95% CI 1.607-2.292) (Table 2). These results suggest there are meaningful differences in patients AFAB presenting with AAA and undergoing subsequent AAA repair compared to their AMAB counterparts. This data provides rationale for revision of current AAA guidelines (3) for further consideration of patients AFAB in screening protocols.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Name: Indrani Sen

Address: 1221 Whipple St
eau claire, wi 54701
United States

Will this author present: Yes

Email: sen.indrani@mayo.edu

Cell: 5079933641

Abstract Title: Spectrum of aortic aneurysm wall biomechanical characteristics stratified by gender and aortic size

Abstract Body:

Background: There is limited data on the biomechanical aortic wall characteristics of abdominal aortic aneurysms (AAA) in women as compared to men.
Methods: A multicenter study was conducted between 2021-2023 of all patients with AAA based on identification using ICD 9/10 and CPT codes with chart review to confirm diagnosis. Demographics, aneurysm diameter at diagnosis, and biomechanical wall volume and wall stress were compared between men and women, stratified based on current size cutoff for repair (5cm in women, 5.5 in men) and the presence of intraluminal thrombus. CT angiogram images were processed using a well-established computational flow dynamics to extract the region of interest, perform 3D surface reconstruction, and apply material properties to the aneurysm wall and intraluminal thrombus. The wall stress analysis (Figure 1) was performed by constraining the proximal and distal boundaries of the AAA and pressurizing to an ideal systolic pressure of 120 mmHg. A custom in-house MATLAB (MathWorks Inc., Natick, MA, USA) script was used to extract additional one-, two-, three-, and higher dimensional morphological indices.
Results: There were 390 patients (30% female); compared to men, women had smaller initial aneurysm size (4.1 vs 4.7 cm, p < 0.001), with less intraluminal thrombus, volume and surface area, and lower peak and mean wall stress. However, peak and mean wall stress remained significantly different when results were analyzed based on the current size thresholds for repair.
Conclusions: AAAs in women have different biomechanical and morphological characteristics when compared to men, biomechanical wall characteristics need to be studied as an adjunct to establish optimal repair thresholds.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Name: Sarah Loh

Address: 28 W Side Drive
Hamden, CT 06514
United States

Will this author present: Yes

Email: sarah.loh@yale.edu

Cell: 480-766-1080

Abstract Title: Sex-Based Comparisons for Dialysis Access Steal

Abstract Body:

Introduction: Dialysis steal is a feared complication of vascular access due to associated upper extremity morbidity. There is limited information on the impact of patient sex on dialysis steal and subsequent interventions.
Methods: A retrospective database of hemodialysis patients at a tertiary care center over an 8-year period (6/2015-12/2023) was queried for keyword “steal” and data extracted.
Results: Women who developed steal had similar rates of diabetes mellitus, hypertension, and coronary artery disease compared to men, but were less likely to have congestive heart failure. 79 of 576 patients (13.7%) developed dialysis steal symptoms after an access procedure, including 34/245 women (13.9%) and 45/331 men (13.6%; p=0.74). Patients with incomplete records (n=9) were excluded from further analysis, and 2 patients developed steal after two separate access procedures, resulting in a total of 72 episodes of steal analyzed.
Upper arm accesses accounted for 84.7% (61/72) of dialysis steal cases [Table I]. Clinical presentation was ischemic pain in 77.8%, sensory complaints in 55.6%, motor deficits in 20.8%, tissue loss in 22.2%, and were similar by sex. There was a trend towards earlier presentation in women, but this was not statistically significant (median 75 days for women and 149 days for men, p=0.3)
47 patients underwent 68 surgical procedures for vascular steal [Table I]. Women were equally likely to undergo intervention to treat steal and had on average 1.5 procedures compared to 1.4 for men (p=0.63). 6 men and 0 women required major or minor upper extremity amputations. Only 11 patients (4 women, 7 men) underwent a new upper extremity access. At latest hemodialysis session (median follow-up 726 days), 25 patients (34.7%) were using the same index access that resulted in steal (9/30, 30% women and 16/42, 38.1% men, p=0.48). 45.8% of patients who developed steal were dialysis catheter-dependent at last follow-up [Figure 1].
Conclusions: These data demonstrate a high incidence of dialysis steal with upper extremity access with a similar prevalence in women and men. Female patients on average presented earlier for steal symptoms. Approximately one-third of patients were able to continue using their access after developing dialysis steal.

Relevant History and Physical Exam:

Presenting symptoms of dialysis access steal include ischemic rest pain, numbness or tingling, hand weakness, and gangrene.

Relevant Test Results:

Patients presenting with dialysis access steal symptoms often undergo ultrasound evaluation, wrist-brachial indices, finger pressures, and upper extremity angiograms to further evaluate for ischemia.

Teaching points, lessons learned …..

Upper extremity access contributed to majority of dialysis access steal cases with similar prevalence in women and men.

Do you have Grant Support? Please explain:  

N/a

Has this material been previously published? No

If Yes, Where?

Name: Shima Rahgozar

Address: 4067 Miramar st
Box 4714
La Jolla, Ca 92092
United States

Will this author present: Yes

Email: srahgozar@ucsd.edu

Cell: 4089914901

Abstract Title: Predictors of Myocardial Infarction Among Patients with no Prior History of Coronary Artery Diseases Following Carotid Artery Revascularization

Abstract Body:

Background:
Postoperative myocardial infarction (MI) contributes to the overall mortality associated with carotid revascularization. Current guidelines regarding preoperative cardiac evaluation are limited to patients with a coronary artery disease (CAD) history. This study aimed to identify postoperative MI predictors in patients without a prior history of CAD undergoing carotid revascularization.
Methods:
We performed a retrospective analysis of all patients undergoing carotid artery revascularization without a prior history of CAD in the VQI database from 2016-2023. Multivariable logistic regression was used to identify variables associated with postoperative MI following carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), and transfemoral carotid artery stenting (TFCAS). Hosmer-Lemeshow goodness-of-fit (GOF) and Area under the ROC curve (AUC) were used to assess model fit and accuracy.

Results:
The cohorts included 63,802 (0.40% with MI) CEA, 11,301(0.35% with MI) TFCAS, and 17,941(0.24% with MI) TCAR cases. In the CEA group, those with postoperative MI were more likely to be non-white, have diabetes, HTN, CKD, prior contralateral CEA/CAS, ipsilateral stenosis ≥ 80%, prior stroke, on dialysis, and former smokers compared to patients without MI. In the TFCAS group, patients with postoperative MI were more likely to be Hispanic/Latino, with history of stroke, CHF, ipsilateral stenosis≥ 80%, undergoing urgent/emergent surgery, and under general anesthesia. In the TCAR group, those with postoperative MI were more likely to have CKD and be on dialysis (Table I). In the CEA group, age (OR:1.05, 95%CI;1.04-1.07, P<.001), female sex (OR:1.40, 95%CI;1.09-1.79, P=.01), diabetes (OR:1.53, 95%CI;1.19-1.96, P<.001), ipsilateral stenosis ≥80% (OR:1.65, 95%CI;1.24-2.19, P<0.001), and prior contralateral CEA/CAS (OR:1.83, 95%CI;1.34-2.50, P<.001) were associated with a higher risk of postoperative MI. Conversely, preoperative anticoagulants (OR:0.53, 95%CI;0.33-0.84, P=0.01), and elective surgery (OR:0.40, 95%CI;0.30-0.54, P<.001) correlated with a lower risk of MI. In the TFCAS group, age (OR:1.03, 95%CI;1.00-1.05, P=.07), and general anesthesia (OR:2.16, 95%CI;1.13-4.12, P=.02) were associated with a higher risk of MI, whereas elective surgeries (OR:0.42, 95%CI;0.21-0.82, P=.01) were linked to a lower risk. In the TCAR group, the risk of MI was increased in patients with a history of CKD (OR:1.96, 95%CI;1.06-3.64, P=0.03) (Fig 1).

Conclusion:
This study identified postoperative MI predictors following carotid revascularization in patients with no prior history of CAD. The highlighted predictors provide a basis for risk assessment tailored to specific procedures and helps identifying high-risk patients for additional cardiac screening before the procedure. Additionally, interventions focusing on modifiable factors such as diabetes, medications, and anesthesia type aid in reducing postoperative MI risk in these patients.

Relevant History and Physical Exam:

N/A

Relevant Test Results:

N/A

Teaching points, lessons learned …..

The MI predictors in this study provide a basis for risk assessment tailored to specific procedures and helps identifying high-risk patients for additional cardiac screening before the procedure. Additionally, interventions focusing on modifiable factors such as diabetes, medications, and anesthesia type aid in reducing postoperative MI risk in these patients.

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Name: Olga Bakayev

Address: 147 Maujer Street
Brooklyn, NY 11206
United States

Will this author present: Yes

Email: dr.olga.bakaev@gmail.com

Cell: 215-554-1118

Abstract Title: The Impact of Multiparity on Venous Insufficiency.

Abstract Body:

The purpose: Our study aims to clarify the relationship between multiparity and venous insufficiency in women, addressing gaps¹ and controversies² in the existing literature.
Methods: We called female patients older than 18, who underwent venous mapping duplex for any reason from 01.19.2020 to 01.19.2023. The patients were asked to participate in our survey from February 2023 to December 2023. Survey content pertained to demographics, obstetric history, and vascular disease risk factors. The most recent duplex results were collected. Multivariate analysis was conducted using IBM SPSS software. Patients were categorized into groups according to maternal age at first delivery (<17 years; 18–28 years; 29–39 years; < 40 years)³ and number of parities (no parities; <5 parities; ≥5 parities, but less than 10; ≥10 parities)⁴. Controls for smoking, diabetes, hypertension, and complications related to pregnancy were incorporated within the model. The retrospective, non-randomized, observational study was approved by the Institutional Review Board.
Results: Using computer-assisted telephone interviews, 379 participants were contacted and a total of 102 patients (26.9%) consented. Patient’s mean age was 63 years (24-92 years) and most women reported being retired or living on social assistance (42%). Gravida ranged widely from no previous pregnancies to twelve (mean n=1.9). 67% of participants reported a risk factor for vascular disease (diabetes, obesity, hypertension) with clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction of 3 (55%). Duplex scans revealed obliteration in the great saphenous vein (57%) and small saphenous veins (31%) in most cases. The multivariate analysis concluded that increasing multiparity predicted the presence of venous insufficiency on venous mapping (OR 1.25 95% CI 1.05–1.83, p < 0.05). The association between multiparity and venous insufficiency was not affected by BMI and age.
Conclusions. Our study showed a correlation between venous insufficiency on venous mapping with higher multiparity. This data may target the care of women at higher risk for severe venous insufficiency.

Relevant History and Physical Exam:

clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction and Venous Clinical Severity Score.

Relevant Test Results:

venous mapping duplex

Teaching points, lessons learned …..

The study highlights the need for personalized management and prevention strategies for multiparous women.

Do you have Grant Support? Please explain:  

None

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Hana Shafique

Address: 2616 Erwin Rd
Apt 1433
Durham, NC 27705
United States

Will this author present: Yes

Email: hss23@duke.edu

Cell: 3178471817

Abstract Title: The role of Spp1+ macrophages in chronic limb-threatening ischemia

Abstract Body:

PAD is the leading cause of limb loss in the US. Despite significant improvements in medical and surgical therapies, the rate of limb loss continues to rise. Recently, the importance of skeletal muscle recovery to clinical outcomes in PAD has emerged as a new area of investigation and a potential therapeutic strategy. To further this line of investigation, our group generated a single-cell transcriptional atlas in human PAD patients and preclinical PAD model. This worked identified a pro-inflammatory macrophage signature as a hallmark of end-stage PAD, also known as chronic limb threatening ischemia (CLTI). Macrophages are key determinants of muscle regeneration and this preliminary work highlights the importance immune-mediated mechanisms in PAD. Our hypothesis is that pro-inflammatory macrophages inhibit muscle regeneration in PAD by inhibiting muscle stem cell and macrophage reparative programs.

First, we sought to determine if pro-inflammatory macrophages impaired muscle regeneration. We FACS isolated macrophages from the ischemic limb of BALB/c mice (pro-inflammatory CLTI model) and C57BL/6 (regenerative model) and generated strain-specific conditioned media. Next, we cultured muscle stem cells (MuSCs) in strain-specific media. This demonstrated impaired regeneration in myoblast cultured pro-inflammatory macrophage media (Fig 1A). To elucidate the macrophage-MuSC signaling pathways responsible for impaired MuSC regeneration, we profiled the transcriptomes of macrophages in our murine PAD model and human PAD patients and identified Spp1 signaling as major signaling pathway between macrophages and MuSCs in the ischemic limb (Fig 1B). Next, we demonstrated in in-vitro assays that Spp1 inhibits MusC regeneration and impairs macrophage polarization to a reparative phenotype (Fig 1C,D).

This work identifies Spp1+ macrophages as a candidate pathologic macrophage population in PAD. Future studies are needed to determine the sufficiency and necessity of macrophage-derived Spp1 in skeletal muscle regeneration in PAD.

Relevant History and Physical Exam:

n/a

Relevant Test Results:

n/a

Teaching points, lessons learned …..

n/a

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Name: Vaishnavi Siripurapu

Address: 537 Spring Forest Rd
G
Greenville, NC 27834
United States

Will this author present: Yes

Email: siripurapuv22@students.ecu.edu

Cell: 9195275545

Abstract Title: Characterizing Modifiable Lifestyle Risk Factors in Complete Vascular Desert Counties in North Carolina

Abstract Body:

Intro: Peripheral limb disease (PAD) and chronic limb-threatening ischemia (CTLI) impact over 2 million people annually. Patients often present with modifiable factors like smoking and obesity, contributing to poor CTLI outcomes with a 20% amputation rate and up to 40% long-term mortality[1]. To date, there has been no research defining vascular deserts in North Carolina. The current study will define vascular desert counties and their characteristics.

Methods: Board-certified vascular surgeons in North Carolina were characterized and addresses were geocoded utilizing ArcGIS. Counties with absolutely no vascular care centers were identified. Modifiable lifestyle factors such as smoking, obesity, and physical inactivity rate were overlaid with the vascular desert counties identified. Local community health needs assessments (CHNAs) were utilized to compare vascular desert counties with the North Carolina average.

Results: Only two of the 13 assessed counties indicated every margin of lifestyle modifiable factors below the state average. The remaining 84% of counties exhibited at least one factor above the NC average. Jones and Swain counties have significantly higher smoking rates (23% and 25%. NC Average: 17%), obesity rates (41% and 36%. NC Average: 34%), and physical inactivity rates (25% and 28%. NC Average: 22%) than the NC averages. Over half (53%) of the indicated vascular desert counties exhibit premature death rates above the NC Average.

Conclusions: Overall, counties with no vascular care have higher rates of modifiable lifestyle risk factors than the NC Average. Furthermore, over half of the counties indicated premature death rates above the NC average. This indicates both an increased need for vascular care, and a need for lifestyle modification education in these areas in order to mitigate future vascular disease.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

None

Has this material been previously published? No

If Yes, Where?

Name: Ruojia Debbie Li

Address: 2160 S 1ST AVE
MAYWOOD, IL 60153
United States

Will this author present: Yes

Email: ruojia.li@lumc.edu

Cell: 6514921380

Abstract Title: Social Determinants of Health and Hospital Volume Do Not Impact Outcomes in Fenestrated Visceral Segment Endovascular Aortic Repair

Abstract Body:

Objective
Endovascular repair of aortic aneurysm involving the visceral segments carries high procedural complexity and adverse event compared to standard infrarenal endovascular aneurysm repair (EVAR). The objectives of our study were to (1) determine impact of social determinants of health on access to high volume centers; (2) evaluate clinical outcomes in fenestrated abdominal aortic endograft; and (3) assess the effect of center volume and outcomes.

Methods

We used the Vascular Quality Initiative (VQI) TEVAR and Complex EVAR module from Aug 2014 to Feb 2023. Social determinants of health exposure variables were categorizedinto rural status, non-metropolitan living area, highest and lowest decile and quintile area deprivation index (ADI), insurance status, and non-home living status. Center volume were divided into top 25% case volume, bottom 25% case volume and centers with <10 total cases. Univairable analyses were performed with Chi-squared testing for categorical variable and t-test for continuous variables. Multivariable logistic regression was performed to identify risk factors for composite adverse perioperative event.

Results

There was no statistically significant different with composite adverse perioperative event, 30-day mortality, or 12-month mortality for the social determinants of health or center volume categories. Patients who live in rural area and with military/VA insurance were significant more likely to be lost to follow up at their index VQI center at 1 year. 3 or 4 visceral vessels had statistically significantly more 30-day mortality, composite adverse perioperative event, and 12-month mortality compared to 2 vessels fenestrated. When accounting for all standard co-morbidities and center volume, 3 or 4 visceral vessels stented were more likely to have composite perioperative event compared to 2 visceral vessels stented, and baseline renal insufficiency also had increased odds for composite adverse perioperative event. There were no difference in outcomes based on center volume.

Conclusion
Social determinants of health and center volume did not impact outcomes in fenestrated visceral segment aortic endograft procedures in centers participating in the Vascular Quality Initiative. There is progressive morbidity and mortality in moving from 2 to 3 to 4 visceral stents and fenestrations, however lower volume centers within VQI achieve equivalent outcomes to high volume centers in performing 3 and 4 vessel visceral fenestrated stent cases.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: AREEBA SALIM

Address: R-458,Haroon Banglows, Phase I,Sector 38-A, Scheme 33, Gulzar-e-Hijri,
Karachi., Sindh 75270
Pakistan

Will this author present: Yes

Email: areebasalim@gmail.com

Cell: 923332208468

Abstract Title: Patterns and outcomes of vascular complications post orthopaedic interventions: An Experience of high-volume trauma institute of Pakistan

Abstract Body:

Objectives: To assess patterns of presentation, offered interventions and outcomes of arterial injuries post orthopaedic interventions.

Methodology: A retrospective observational study conducted at Department of Vascular and Endovascular Surgery Shaheed Mohtarma Benazir Bhutto Institute of Trauma. Patients who underwent limb orthopaedic intervention and referred with postoperative vascular complications during January 2019 to March 2023 were included. After institutional ERC approval data collected by reviewing patient files, charts, follow up notes and analysed using SPSS version 29. Continuous variables were given as mean ± S.D.Categorical variables presented as frequencies and percentages. P value of <0.05 was considered as significant.

Results: Out of 13 patients, majority 10(76.9%) were males with mean age 38 years (STD 17.786). The most common inciting orthopaedic intervention was open reduction and internal fixation in 7(53.8%) patients, followed by External fixator(30.8%) and IM nailing(15.4%). About half (53.8%) of injuries occurred during emergency orthopaedic procedures. Most common presentation was bleeding(n=8,61.5%) followed by swelling(n=5, 38.5). Profunda femoris artery was the most commonly injured vessel(n=5,38.5%) followed by superficial femoral artery(n=3,23.1%) and tibial vessels(n=3,23.1%). Majority of patients (n=8,61.5%) underwent open surgery, while 3(23.1%) endovascular and 2 (15.4%) hybrid procedures. Pseudoaneurysm excision and ligation 4(30.8%)was the most commonly performed open procedure and angioembolization was the only performed endovascular modality.11(84.6%) limbs were successfully salvaged with 2(15.3%) having wound complications. No mortality was recorded.

Conclusion: Prompt recognition, timely referral and intervention translates into better outcomes in terms of limb salvage in patients undergoing orthopaedic interventions

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

planning and organization of the resources along with training of surgical or orthopaedic and trauma responders is of utmost importance to cope with the need of time leading to better patient outcomes

Do you have Grant Support? Please explain:  

No

Has this material been previously published? No

If Yes, Where?

Supporting Documents:

Name: Marissa Jarosinski

Address: 200 Lothrop Street
Pittsburgh, Pennsylvania 15213
United States

Will this author present: Yes

Email: jarosinskimc@upmc.edu

Cell: 9084005771

Abstract Title: Racial Disparities Exist in Primary Amputation Rates for Acute limb ischemia

Abstract Body:

Introduction: Acute limb ischemia (ALI) is a surgical emergency that often results in limb and life loss. Similar to racial disparities reported for many chronic vascular conditions, we hypothesize that ALI treatments and outcomes are also impacted by race.
Methods: We analyzed survey-weighted National Inpatient Sample (NIS) data (2010-2020) for emergent admissions of adults (18+ years) with primary diagnosis of lower extremity ALI, excluding trauma/dissection secondary diagnoses. Patients were categorized based on existing NIS categories into White, Black, and Other Race/ethnicity (including Hispanic, Native American, Asian, and other) due to small sample size within certain categories. Our primary outcome was primary amputation defined as major amputation within 4 days of admission, excluding patients who died within 4 days without undergoing either major amputation or revascularization. Adjusted odds ratios (aORs) were generated by multivariable logistic regression, controlling for race, comorbidities, and demographics.
Results: We included 152,945 ALI hospitalizations, 3,294 (2.1%) of which underwent primary major amputation, 26,194 (20%) were observed, and 100,000 (78%) revascularized. Baseline characteristics differed by race for age, insurance, income, and comorbidities (Table 1). On univariable analysis, Black (2.62% 95%CI [2.15-3.18]) and Other (3.01% 95%CI [2.5-2.6]) race patients were more likely to undergo primary amputation compared to White race patients (1.9% 95%CI [1.70-2.07], p<0.0001), and this association remained significant on multivariable analysis (Black: aOR 1.38 95%CI [1.08-1.75], p=0.009; Other: aOR 1.54 95%CI [1.25-1.89], p0.05). For patients who underwent primary revascularization, race was not significantly associated with in-hospital amputation (Black: aOR=0.95 95%CI[0.82-1.09],p=0.44; Other: aOR=0.99 95%CI[0.88-1.11],p=0.81) or death (Black: aOR=0.95 95%CI[0.76-1.20], p=0.68; Other: aOR=1.10 95%CI[0.93-1.30], p=0.25).
Conclusions: Black race was associated with an increased adjusted risk of primary amputation for ALI. Although not a monolithic group, this was true for the Other race group as well. If acutely revascularized, these racial disparities for non-White groups were no longer observed. It appears that racial disparities reported in chronic limb ischemia extend to ALI. How race, access to care, socioeconomic status, and comorbidities influence treatment decision-making and care equity for ALI needs further evaluation.

Relevant History and Physical Exam:

Relevant Test Results:

Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

NIH T32HL098036 (Jarosinski)

Has this material been previously published? No

If Yes, Where?