WVS Abstracts

Name: Anahita Dua

Address: 55 Fruit Street Wang 440
Apt 2
Boston, MA 02114
United States

Will this author present: Yes, No, No, No, No, No

Email: mmajumdar1@mgh.harvard.edu, hdwaller@partners.org, iemcelroy@partners.org, srihari.lella@mgh.harvard.edu, ajkirshkaln@mgh.harvard.edu, adua1@mgh.harvard.edu

Cell: 7083692585

Abstract Title: Viscoelastic Profiling Provides Novel Insight into Potential Risk Factors for Peripheral Artery Disease in Women

Abstract Body:

Introduction
The prevalence and burden of peripheral artery disease (PAD) is equal, if not higher, in women as compared to men, and clinical outcomes in women after revascularization is worse. However, women are notably under-represented in existing PAD studies, contributing to a gap in clinical knowledge regarding the risk factors and nature history of female-specific disease.
Traditional comorbidities associated with cardiovascular disease and PAD are more prevalent in men than women, suggesting that alternative etiologies may be contributing to atherosclerosis in female patients. Thromboelastography with Platelet Mapping (TEG-PM) measures the viscoelastic properties of a blood clot as a dynamic process and may provide an integral key to the next stage of patient-centered hypercoaguability assessment.
This prospective observational study aimed to characterize the clinical and TEG-PM profiles of female and male patients prior to lower extremity revascularization procedures.
Methods
All patients undergoing named vessel revascularization during December 2020–December 2021 at a large tertiary institution were prospectively included. TEG-PM assays were performed on patients prior to surgery. These data, along with clinical metrics, were compared between men and women.
Results
One hundred and twenty-one patients were enrolled, of which forty (39.6%) were female. Female patients had significantly lower rates of hypertension [62.5% vs. 88.9%, p<0.01] and diabetes [25.0% vs. 54.3%, p<0.01]. There were no differences in age at time of enrollment, BMI, smoking status, or hyperlipidemia between groups (Table I).
TEG-PM data demonstrated significantly higher levels of platelet aggregation [62.8(±36.6) vs. 43.6(±34.9), p=0.03], and lower platelet inhibition [37.2 (±36.6) vs. 56.4 (±34.9), p=0.03] in female patients (Figure I). There was no significant difference in the use of monoantiplatet therapy [62.5% vs. 61.7%, p=1.00], dual antiplatelet therapy [22.5% vs. 38.2%, p=1.00] or anticoagulation [30.0% vs. 46.9%, p=0.08] between groups. (Table I).
Conclusion
In this preoperative cohort traditional PAD risk factors, such as hypertension and diabetes, were significantly more frequent in men compared to women. Viscoelastic data, however, showed significantly greater platelet reactivity in women compared to men. This important insight demonstrates that the prevailing paradigm of risk stratification and disease modification may not fit the female-PAD population, and provides an important basis for further research into gender-specific coagulation profiles.

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The prevalence and burden of PAD is equal, if not higher in women, a fact that is not always recognized by either patients or physicians. Despite this, women are severely underrepresented in PAD research and the etiologies of disease are unstudied. Data has shown that the traditional risk factors associated with PAD in men are less prevalent in women. Thus, it is imperative to address gender-specific risk factors for PAD so that treatment paradigms may be addressed on a demographic-specific basis. This study aims to understand the mechanisms driving PAD in women.

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Yes – Haemonetics supports Dr. Dua’s coagulation lab in terms of equipment / supplies.

Has this material been previously published? No

Name: liang lingli

Address: University of South China
Hengyang, hunan 421001
China

Will this author present: Yes

Email: 1431279509@qq.com

Cell: 15211372183

Abstract Title: MicroRNAs: key regulators of the trophoblast function in pregnancy disorders

Abstract Body:

The placenta is essential for a successful pregnancy and healthy intrauterine development in mammals. During human pregnancy, the growth and development of the placenta are inseparable from the rapid proliferation, invasion, and migration of trophoblast cells. Previous reports have shown that the occurrence of many pregnancy disorders may be closely related to the dysfunction of trophoblasts. However, the function regulation of human trophoblast cells in the placenta is poorly understood. Therefore, studying the factors that regulate the function of trophoblast cells is necessary. MicroRNAs (miRNAs) are small, non-coding, single-stranded RNA molecules. Increasing evidence suggests that miRNAs play a crucial role in regulating trophoblast functions. This review outlines the role of miRNAs in regulating the function of trophoblast cells and several common signaling pathways in pregnancy disorders.

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Name: liang lingli

Address: University of South China
Hengyang, hunan 421001
China

Will this author present: Yes

Email: 1431279509@qq.com

Cell: 15211372183

Abstract Title: MicroRNAs: key regulators of the trophoblast function in pregnancy disorders

Abstract Body:

The placenta is essential for a successful pregnancy and healthy intrauterine development in mammals. During human pregnancy, the growth and development of the placenta are inseparable from the rapid proliferation, invasion, and migration of trophoblast cells. Previous reports have shown that the occurrence of many pregnancy disorders may be closely related to the dysfunction of trophoblasts. However, the function regulation of human trophoblast cells in the placenta is poorly understood. Therefore, studying the factors that regulate the function of trophoblast cells is necessary. MicroRNAs (miRNAs) are small, non-coding, single-stranded RNA molecules. Increasing evidence suggests that miRNAs play a crucial role in regulating trophoblast functions. This review outlines the role of miRNAs in regulating the function of trophoblast cells and several common signaling pathways in pregnancy disorders.

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Name: Javairiah Fatima

Address: 110 Irving St suite 3600
109
Washington, DC 20010
United States

Will this author present: Yes, No, No, No, No, No, No, No

Email: turna.j.mukherjee@medstar.net, cheng.zhang@medstar.net, misaki.m.kiguchi@medstar.net, Krystal.m.maloni@medstar.net, danielle.salazar@medstar.net, kyle.b.reynolds@medstar.net, joshua.a.dearing@medstar.net, javairiah.fatima@medstar.net

Cell: 2404985554

Abstract Title: Sex Based Differences in Outcomes of Complex Endovascular Aortic Aneurysm Repair

Abstract Body:

Prior studies have demonstrated worse outcomes in women undergoing thoracic and abdominal endovascular repair. The difference in outcomes among men and women undergoing complex endovascular aneurysm repair (cEVAR) is not well defined. We review perioperative and short-term outcomes in cEVAR using the Vascular Quality Initiative (VQI) database.
Patients undergoing cEVAR from 2010 to 2021 in VQI with device implantation with proximal extent of device from zone 0 to 8 and distal extent of device in zone 9 to 11 were identified, including parallel stent grafts, commercial fenestrated, branched or physician modified devices. Patients undergoing an open surgical repair and those lost to follow-up were excluded. The primary outcome was sex-based differences in mortality after cEVAR. Secondary outcomes included postoperative outcomes, re-interventions and perioperative complications. Binary variables are tested using chi squared test. Marginal survival function gender group is estimated via Kaplan-Meier estimator, and log-rank test is used for testing the equality of the two survival functions. A multivariate cox regression was used to adjust demographics and comorbidities
During the study period 2640 cEVAR were performed (771 females, 1869 males). Of these, 94% were elective and 6% were for ruptures. 3.6% women had ruptures compared to 2.5% men, p < .097. Males presented with larger preoperative aneurysm size at 58.89 +/- 14.42mm, compared to females with 55.27 +/- 14.11mm, p <0.001. Mortality rate was significantly higher in women (3.18% at 2 year) compared to men (1.94% at two year) with a log-rank p value of .0180. After adjustment, the hazard ratio of women over men is estimated at 1.81 (95% confidence interval [1.04, 3.13], p value= 0.03). Women were also more likely to have prolonged intubation, higher postoperative lower extremity complications, longer ICU stay, higher need for transfusion and reintervention (Table 1). There was no significant difference in post-operative MI, need for hemodialysis, intestinal ischemia, endoleak or spinal cord ischemia.
Females undergoing cEVAR experience increased mortality, higher perioperative complications, longer ICU stay, postoperative transfusion requirement, delay in extubation, and all cause need for re-intervention. These findings call for careful risk stratification and consideration in women when planning a complex EVAR.

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Teaching points, lessons learned …..

Women have worse outcomes compared to men after complex EVAR

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No

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Name: liang lingli

Address: University of South China
Hengyang, hunan 421001
China

Will this author present: No

Email: 1431279509@qq.com

Cell: 15211372183

Abstract Title: TMAO induces trophoblast cells pyroptosis through TET2-CYTB-ROS pathway

Abstract Body:

Abstract:
Objective: Pyroptosis is a kind of programmed cell death characterized by pro-inflammatory, which is an important factor in the formation of preeclampsia. Trimethylamine N-oxide (TMAO) is a gut microbiota metabolite closely related to pyroptosis. This study aimed to investigate the role of TMAO in trophoblast pyroptosis and to explore possible mechanism.
Methods: To compare the expression of pyroptosis-related molecules, the ten-eleven translocation 2(TET2)and cytochrome b(CYTB) in placental tissue of patients with preeclampsia and normal placental tissue. The expression of pyroptosis-related molecules, TET2, CYTB and mitochondria-related proteins was detected by Western blot after TMAO was applied to HTR8/SVneo cells. Mitochondrial function was detected by JC-1 method and high performance liquid chromatography, and mitochondrial reactive oxygen species (ROS) level was detected by fluorescent probe DCFH-DA. Whether CYTB is regulated by TET2 was detected by Bisufite sequencing PCR (BSP). Furthermore, TET2 mimic, small interfering RNA TET2(siTET2) and CYTB mimic were transfected into HTR8/SVneo cells, respectively, and the pyroptosis, mitochondrial function, ROS generation and CYTB expression were detected. Finally, N-acetyl-L-cysteine (NAC) was used to reduce intracellular ROS to observe the promoting effect of TMAO on intracellular ROS.
Results: Results in this study showed that the expression levels of pyroptosis-related molecules in the placental tissue of PE patients were significantly increased, while the expressions of TET2 and CYTB were significantly decreased. TMAO induces trophoblast cells pyroptosis and mitochondria dysfunction. Furthermore, we found that CYTB reversed TMAO-mediated trophoblast pyroptosis, mitochondrial dysfunction, and abnormal ROS production. Notably, TET2 was involved in the regulation of CYTB expression and trophoblast cells pyroptosis. Finally, NAC can inhibit the effect of increased ROS generation in trophoblast cells in TMAO group.
Conclusion: Taken together, these findings suggest that TMAO induces trophoblast cells pyroptosis through the TET2–CYTB–ROS pathway, which may provide new directions for the treatment of preeclampsia.
Keywords: HTR8-S/Vneo, Trimethylamine N-oxide, Pyroptosis, cytochrome b

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Name: Katharine McGinigle

Address: 4001 Burnett-Womack Building
CB #7050
Chapel Hill, North Carolina 27599-7050
United States

Will this author present: Yes, No, No, No, No, No, No, No

Email: kathleen.marulanda@unchealth.unc.edu, emiliedd@live.unc.edu, sapna_patel@med.unc.edu, sydney_browder@med.unc.edu, daniel.kindell@unchealth.unc.edu, dmcaruso@email.unc.edu, erv2vm@hscmail.mcc.virginia.edu, katharine_mcginigle@med.unc.edu

Cell:

Abstract Title: Increased long-term bleeding complications in females undergoing endovascular revascularization for peripheral arterial disease

Abstract Body:

Objective: Females with peripheral arterial disease treated with endovascular interventions have increased limb-based procedural complications compared to males. Little is known regarding long-term bleeding risk in these patients who often require long-term antiplatelet or anticoagulation therapy. We hypothesize that females have a higher incidence of bleeding events compared to males in the year following endovascular intervention for peripheral arterial disease.
Methods: We identified adults (≥65 years) who underwent endovascular revascularization for peripheral arterial disease between 2008-2015 in Medicare claims data. Patients were allocated by prescribed post-procedural antithrombotic therapy including 1) antiplatelet therapy, 2) anticoagulation therapy, 3) dual antiplatelet and anticoagulation therapy, and 4) no antithrombotic therapy. Bleeding events were classified as gastrointestinal, intracranial, hematoma, airway, or other. Crude and covariate-standardized 30-, 90- and 365 days cumulative incidence of bleeding events, overall and by gender, were estimated using Aalen-Johansen estimators accounting for death as a competing risk. Gender differences were identified using Gray’s test.
Results: Of the 31,593 eligible patients, 54% were females. Females were older (77.9 vs 75.5 years) and tended to use antiplatelet therapy more often at 30-, 90- and 365 days post-intervention. Clopidogrel was the most prescribed antiplatelet, and 32% of patients continued its use at 365 days. Anticoagulants were prescribed to 26% of patients at the time of the procedure, and only 8.8% continued anticoagulation at 365 days. Thirty-one percent of patients were diagnosed with a bleeding event within 1-year after intervention. Cumulative incidence of any bleeding event during the post-intervention period was higher in females compared to males with a risk difference of 3% between gender cohorts (p<0.01). Specifically, females had a higher incidence of GI bleed and hematoma (p<0.01), but a lower incidence of airway-related bleeding at each time point compared to males (p<0.01).
Conclusion: Gender disparities in bleeding complications following endovascular intervention for peripheral arterial disease persist long-term. Females are more likely to be readmitted with a bleeding complication up to one-year post-procedure. Antithrombotic therapy disproportionately increases the risk of bleeding in females. Further research is necessary to understand the mechanisms responsible for abnormal coagulopathy in females post endovascular therapy.

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Sex-based risk differences in post-interventional bleeding persists up to 1 year after infrainguinal endovascular treatment of peripheral arterial disease and is further exacerbated by anticoagulation agents.

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Name: Anil Hingorani

Address: 960 50th Street
apartment 617
Brooklyn, NY 11219
United States

Will this author present: Yes, No, No, No, No, No, No

Email: msanta01@nyit.edu, nikitasingh0014@gmail.com, epoltiye@nyit.edu, nataliemarksmd@gmail.com, easchermd@gmail.com, ahingorani67@gmail.com

Cell: 3362874583, 3362874683, 3362874683

Abstract Title: Seasonal Variation in Swelling of Lower Extremity Edema in Patients with Chronic Venous Insufficiency

Abstract Body:

Objective:
We noted some patients with chronic venous insufficiency (CVI) whose lower extremity edema worsened during warmer weather. Patients with CVI were surveyed to determine whether there’s significant seasonal variation of edema in the lower extremities and what factors may be associated with it.

Methods:
Patients with lower extremity edema were asked whether it worsened in warmer weather. There were 1683 patients with ages from 16 to 102 (mean= 62, SD=14.3). Data was collected on presenting symptoms, degree of GSV venous reflux, and season at the time of questioning. For statistical analysis, chi-square goodness of fit tests and one-way ANOVA tests were used.

Results:
56.6% of patients experienced worsening of their lower extremity edema during warmer weather. 62.7% of female and 37.3% of male patients reported worsening. Female patients had significant worsening of their lower extremity edema (p=7.06e-18). Female age is associated with whether they experienced worsening (p=0.02), with younger patients reporting more worsening. Age isn’t associated with whether men reported worsening (p=0.97). .
There was no significant mean difference in the degree of venous reflux between the right great saphenous vein (GSV) (p=0.61) or left (p= 0.89) in those that reported worsening and those who didn’t.
The season in which patients were surveyed is associated with whether worsening was reported. Patients that were questioned in winter and summer months reported more worsening of their edema in warmer months (p=0.008, p=0.0002), respectively. Patients that were questioned in spring and fall months didn’t significantly report worsening in warmer months (p=0.167, p=0.119), respectively.

Conclusion:
56.6% of all patients surveyed reported worsened edema in warmer months. Women reported significant worsening while men didn’t. The degree of GSV reflux and presenting symptom degree doesn’t seem to be associated with whether worsening was reported. The season in which patients were questioned does seem to be associated with whether they reported worsening. Patients questioned in coldest and warmest months reported more worsening. Patients that were questioned in milder months didn’t report more worsening. These findings suggest that there’s a sex and age bias in the seasonal variation of lower extremity edema in populations with chronic venous insufficiency.

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no

Has this material been previously published? Yes

Name: Yana Etkin

Address: 1999 Marcus Ave, Suite 106B
Lake Success, NY 11042
United States

Will this author present: Yes, No, No, No, No

Email: etkinyana@gmail.com, jsilpe@northwell.edu, ddelijani@northwell.edu, glandis@northwell.edu, etkinyana@gmail.com

Cell: 5162333701

Abstract Title: Gender Disparities in Arteriovenous Fistula Maturation Outcomes

Abstract Body:

Objective:
The End-Stage Kidney Disease (ESKD) Life-Plan aims to individualize hemodialysis (HD) access selection in patients requiring renal replacement therapy. The goal of this study was to identify risk factors associated with poor AVF maturation outcomes in women that will help guide individualized HD access selection.

Methods: 
A retrospective review of 1,077 patients that had AVF creation between 2014 and 2021 at an academic medical center was performed. Maturation outcomes were compared between 596 men and 481 women. Multivariate logistic regression models were created for the male and female cohorts to identify factors associated with unassisted maturation. AVF was considered matured if it was successfully used for HD on three consecutive sessions without need for interventions. Unassisted fistula was defined as AVF that maturated without any interventions.

Results: 
Men were more likely to receive distal AVF: 378(63%) men vs. 244(51%) women had radiocephalic AVF, 160(27%) men vs. 179(37%) women had brachiocephalc AVF, and 58(10%) men vs. 58(12%) had brachiobasilic AVF, p<0.001. Maturation outcomes were worse in women; 387(80%) AVFs matured in women vs. 519(87%) in men, p<0.001. Similarly, unassisted rate of maturation was 26%(125) in women vs. 39%(233) in men, p<0.001. Mean pre-operative vein diameters were similar in both groups 2.8±1.1mm in men vs. 2.7±0.97mm in women, (p=0.17). Irrespective of gender, vein diameters were significantly larger in patients that had unassisted maturation, 3.1±1.1mm vs. 2.7±0.98mm in patients that had assisted maturation or AVF failure, p<0.001.
Multivariate logistic regression analysis of the female cohort revealed that Black race (OR:0.6, 95%CI:0.4-0.9, p=0.045), radiocephalic AVF (OR: 0.6, 95%CI:0.4-0.9, p=0.045), and pre-operative vein diameter (OR: 1.4, 95%CI:10.33-0.901.1-1.7, p=0.014) were independent predictors of unassisted maturation. In the male cohort, preoperative vein diameter (OR: 1.4, 95%CI:1.2-1.7, p<0.001) and need for HD prior to AVF creation (OR: 0.6, 95%CI:0.3-0.9, p=0.018) were independent predictors of unassisted maturation.

Conclusions: 
Black women with marginal forearm veins may have worse maturation outcomes and upper arm fistula creation should be considered when advising patients on their ESKD Life-Plan.

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Name: Ageliki Vouyouka

Address: 1468 Madison Ave
New York, New York 10029
United States

Will this author present: Yes, No, No, No, No, No, No, No

Email: elyssa.dionne@mountsinai.org, peter.cooke@icahn.mssm.edu, logan.cho@icahn.mssm.edu, vikram.vasan@icahn.mssm.edu, halbert.bai@icahn.mssm.edu, christopher.gonzalez@icahn.mssm.edu, windsor.ting@mountsinai.org, ageliki.vouyouka@mountsinai.org

Cell: 9738868236

Abstract Title: differences in presentation and recovery between sexes in iliofemoral vein stenting for chronic venous insufficiency

Abstract Body:

Introduction: Gender significantly impacts the clinical presentation and procedural outcome of vascular conditions. Little is known about sex’s effect on chronic venous insufficiency (CVI) and outcomes after iliac vein stenting (IVS). This large prospective and retrospective database of IVS for CIV illuminates this effect.
Methods: 866 patients who underwent vein stenting for CVI at one institution from August 2011 to June 2021 were analyzed via retrospective chart review. Patients were followed up to six years after initial stent placement. Presenting symptoms were quantified using venous clinical severity score (VCSS) and CEAP class. Reoperations after initial iliac vein stenting were recorded. Major reoperations were defined as iliac interventions. Minor reoperations included endovenous thermal ablation. Multivariate logistic regression models were used determine odds of any reintervention and major reintervention.

Results: Compared to males, females preoperatively presented with a lower mean CEAP class (3.3 vs. 3.6; P<0.001), lower VCSS composite (9.9 vs. 11.3; P<0.001), lower smoking history (10.0% vs. 35.5%; P<0.001), and higher levels of pain preoperatively, and higher rates of previous vein surgery (49.3% vs 40.8% P=0.020). The two groups were similar in age (P=0.125), BMI (P=0.898), previous deep vein thrombosis (DVT) (P=0.085), diabetes (P=0.386), hypertension (P=1.0), and CAD (P=0.499). Multivariate analyses revealed no association between gender and any reintervention (OR, 1.02; 95%CI, 0.71-1.46; P=0.935) or between gender and major reintervention (OR, 1.39; 95%CI, 0.86-2.23 P=0.177). There were no differences in number of stents placed (P=0.736) or symptomatic improvement at 1-month (P=0.951), 3-months (P=0.233), 6-months (P=0.068), and greater than 1-year (P=0.287). However, at the 1-year follow-up, the male cohort had higher CAS values than females (P=0.034). Males had larger reduction in composite VCSS than women at 1-year (5.1 vs. 3.8; P=0.003) and 3-years (5.3 vs. 3.7; P=0.031) of follow-up and similar levels of improvement in post op (4.0 vs. 3.5; P=0.059)), 2-years (4.3 vs. 3.8; P=0.295), 4-years (5.1 vs. 4.6; P=0.529), 5-years (5.6 vs. 4.2; P=0.174), and 6-years (5.93 vs. 3.3 P=0.089) (Table 1).
Conclusions: Compared to males, females presented with less severe CVI preoperatively, demonstrated differences in VCSS changes at certain follow-ups, but no differences in likelihood of reintervention.

Relevant History and Physical Exam:

Patients were examined prior to surgery, post-operatively, and in up to six years of follow up

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no

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Name: Patrick Metzger

Address: 25 Pádua Ave
Salvador, Bahia 41830480
Brazil

Will this author present: No, Yes, No, No, No

Email: sarah.fernandez@outlook.com.br, mgfernandez2510@gmail.com, wlamirribeiro18.1@bahiana.edu.br, joaosouza19.2@bahiana.edu.br, patrickvascular@gmail.com

Cell: +5571993358927, +5575999289775, +5571981062476, +5571999779483, +5571999776356

Abstract Title: PELVIC VEINS EMBOLIZATION FOR LESSENING DYSPAREUNIA ASSESSED BY VISUAL ANALOG SCALE: A SYSTEMATIC REVIEW

Abstract Body:

Purpose: Pelvic Venous Insufficiency (PVI) was recently identified as a meaningful etiology of chronic pelvic pain, a symptom responsible for 10-40% of gynecology referrals. Approximately 60% of women suffering from PVI develop Pelvic Congestion Syndrome (PCS), progressing into a broad clinical spectrum, which delays diagnosis and appropriate treatment. However, the symptom of dyspareunia, conventionally assessed by the Visual Analog Scale (VAS), indicates PCS with greater specificity, in which transcatheter embolization represents its principal therapy. This study aims to systematically review the efficacy of embolization for lessening dyspareunia attributable to PCS.

Methods: A sensitive and systematic search was performed in six bibliographic databases employing several terms for pelvic congestion, dyspareunia, and embolization. Case reports, review articles, and studies that failed to report VAS scores for dyspareunia previous and post embolization were excluded. Data were extracted by four independent investigators and organized in chronological order. A flow diagram describing the selection process for articles is presented in Figure 1.

Results: Four observational studies, three retrospectives and one prospective, were included. 204 patients, all female, undergone pelvic vein embolization, in which two studies approached bilateral ovarian veins and two performed embolization on internal iliac and ovarian veins concurrently. Concerning embolization agents, one-half of the studies used metallic coils or sclerosants in isolation and the others associated coils with vascular plugs or sclerosants. Assuming sample sizes as weights (range, 15-127), studies included patients with weighted averages of 3.7 for dyspareunia VAS scores previous embolization and 1.45 for scores at the last follow-up period. When evaluated separately, mean age and mean VAS scores before and after therapy ranged between 34-41.5, 3.3-8.875, and 0.3-2, respectively. One study reported recurrence of dyspareunia, in which mean VAS scores rose from 0.3 to 1.2, at the end of follow-up. Three episodes of coil migration were registered (1.47%), without any clinical significance. Mean VAS scores for dyspareunia during follow-up periods are presented in Graphic 1.

Conclusions: Pelvic vein embolization demonstrates efficacy and safety since it significantly lowers dyspareunia VAS scores with a low rate of complications. Further studies are essential to determine the recurrence of symptoms in longer follow-up periods.

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We do not have any grant support.

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Name: Janice Nam

Address: 2160 S. 1st Avenue
EMS Building 110, Room 3213
Maywood, IL 60153
United States

Will this author present: Yes, No, No, No, No

Email: lindsey.korepta@lumc.edu, carlos.bechara@lumc.edu, mschneck@lumc.edu, bnguyen7@luc.edu, jnam@luc.edu

Cell:

Abstract Title: Symptomatic and Asymptomatic Carotid Interventions by Division and Effect on Surgical Trainee Volume

Abstract Body:

Objectives:
A detailed analysis of carotid interventions at a single tertiary-care referral center. With the growth of endovascular interventions for acute stroke, there appears to be a concomitant shift in the consultation specialty patterns for symptomatic carotid artery stenosis.

Methods:
Data was collected retrospectively on case volume by division including vascular surgery (VS), neurosurgery (NS), cardiothoracic surgery (CT), and cardiology from the years 2018-2021. Carotid Interventions included carotid endarterectomy (CEA), transfemoral carotid artery stenting (CAS), and TCAR. Emergent/morbid patients were excluded. Outcomes of interest included the major perioperative complications of myocardial infarction (MI), stroke, death, return to OR, and one year carotid reintervention. These were evaluated by division and by symptomatic status. VS fellow trainee carotid intervention numbers were also collected over the same time period.

Results:
During the study interval, 115 CEA, 26 CAS, and 28 TCARs were performed. VS performed 51 CEA (15 symptomatic, 36 asymptomatic), 2 CAS (both symptomatic), and 28 TCARs (19 symptomatic, 9 asymptomatic). NS performed 42 CEA (36 symptomatic, 6 asymptomatic) and 16 CAS (14 symptomatic and 2 asymptomatic). CT surgery performed 22 CEA (12 symptomatic, 10 asymptomatic). Cardiology performed 8 CAS (4 symptomatic, 4 asymptomatic).

For asymptomatic patients, all divisions performed similarly with a nearly 0% major complication rate. The overall complication rates for different types of carotid interventions and within the different divisions in symptomatic patients was more varied from 0-7.14%. Overall major complication rates for symptomatic CEA was 4.7-8.3%. Overall major complication rates for symptomatic CAS was 0-7.14%. Symptomatic TCAR was an outlier, with increased overall major complication rates. The VS fellows’ corresponding primary surgeon operative numbers were 34 (2018-2020), 34 (2019-2021), and 11 (2020-2021 with on-going collection).

Conclusions:
Discrepant surgical outcomes between intervention type and performing specialty types for symptomatic patients exists. VS fellows at our institution continue to meet the primary carotid procedure operative case volumes but with a decline in the percentage of symptomatic carotid artery cases. This has significant implication for trainees in how to approach the preoperative and perioperative management of symptomatic carotid artery disease. In order to improve VS fellow training in all facets of carotid artery disease management, a robust multi-disciplinary approach to carotid disease is necessary.

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No

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Name: Michael Stoner

Address: 140 Canal View Blvd
Rochester, NY 14623
United States

Will this author present: Yes, No, No

Email: karina_newhall@urmc.rochester.edu, grayson_pitcher@urmc.rochester.edu, michael_stoner@urmc.rochester

Cell: 17175990109

Abstract Title: No sunshine for women: industry payment disparities in vascular surgery

Abstract Body:

Objectives
Industry relationships provide opportunities for professional growth and technical innovation. This study characterized gender disparities in financial relationships between industry and vascular surgeons.

Methods
Retrospective study was performed using Centers for Medicare and Medicaid (CMS) Open Payments Database. Data was extracted for all payments made to vascular surgeons from 2014-2020 and gender determined for all vascular surgeons receiving payments. Physician profile or publicly available website was used to determine gender. Payment form and amount was collected. Average payment per category, by gender, was calculated.

Results
A total of 438,367 payments were made to 5380 vascular surgeons (87 % male, 13% female) from 2014-2020. Average for a male surgeon was significantly higher than a female surgeon: $247 +/- 3693 versus $150 +/- 817, P< 0.001. When examining payment categories, female surgeons received 13% of industry payments in education and 26% of industry grant payments. However, they received 0% of licensing or royalty payments, 0% of ownership, and only 3% of Honoraria payments. Among the largest 15 companies, which represented over 70% of payments to surgeons, men earned on average 2.5x more per payment than women, with a range from 30-1000% more per-person (Figure 1) . Over the study period, the average male vascular surgeon received about nearly three times more in industry payments than the average female surgeon ($21,720 vs $8276). The average annual amount paid to surgeons by industry per year decreased by 30%, from $4703 to $3279. Despite this overall decline, the relationship between payments to male and female surgeons remained constant at 2.6-2.8x throughout the study period (Figure 2).

Conclusions
Analysis of the Open Payments Database reveals that female vascular surgeons earn less than half as much as men from industry, with little improvement in payment disparities over time.

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No

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Name: Trisha Roy

Address: 6550 Fannin st, ste 1401
Houston, Texas 77030
United States

Will this author present: Yes, No, No, No

Email: ksinha@houstonmethodist.org, ckarmonik@houstonmethodist.org, ablumsden@houstonmethodist.org, troy@houstonmethodist.org

Cell: 8325965194, 7134416511

Abstract Title: Gender differences in the presentation & management of DVTs

Abstract Body:

Background: The incidence, risk factors, clinical presentation, and prognosis of cardiovascular diseases differ among men and women. Recognizing and managing these differences is important in an era of individualized and precision medicine. There has been a growing interest in the understanding of the presentation of DVTs in men and women(1). The clinical impact of distal DVTs is of interest as it has been less studied than proximal DVTs (2). In a registry of 4976 ambulatory patients with clinically suspect DVT, men were shown to have a presentation of non-specific leg symptoms while men presented with symptoms such as whole leg swelling, which led to differences in diagnosis workups (3). Optimal patient selection for the endovascular treatment of iliofemoral DVTs remains a significant clinical challenge though it is still recommended for patients that present within 14 days(4). Symptom onset is used as a gross surrogate for determining the composition of the clot to determine if a lesion is amenable to endovascular treatment. As the thrombus ages, collagen deposition increases and the bulk of fibrin within the thrombus becomes crosslinked and resistant to lysis(5). We have previously demonstrated that MRI using T2-weighted (T2W) and ultrashort echo time (UTE) sequences can accurately characterize collagen and thrombus with histologic validation(6). The goal of this study is to relate MRI characteristics to clot composition to the presentation of the patients and understand how gender plays a role in the presentation and management of these patients.
Methods: Patients with popliteal deep venous thrombus that presented within a week of symptom onset underwent Inari thrombectomy. Patient 1 was imaged in the 7T MRI and patient 2 was imaged with 3T Both patients had T2-weighted (T2W) and UTE sequences. Gross characteristics of collected thrombus were measured.
Results: 3 males and 5 females were scanned. All the females presented later than the males and had more chronic presentations than the males. 2 of the males and 3 of the females had Inari thrombectomy, of which one of the cases had to be aborted. Figure 1 depicts the clot retrieved from 2 of the patients, patient 1 being the male patient that had more acute clot and patient 2 was a female who presented acutely, but actually had chronic clot. Figure 2 depicts imaging differences in patients with acute and chronic clots. Patient 2 had thrombus with high collagen content indicated by low signal intensity on T2W imaging and high signal intensity on UTE MRI. The extracted clot had gross chronic characteristics and was challenging to extract with Inari thrombectomy despite multiple passes. Patient 1 had thrombus with low collagen content indicated by low signal intensity on T2W imaging and isointense on ultrashort echo time imaging. The clot had acute gross characteristics and was easy to extract with Inari thrombectomy.
Conclusion: Symptom onset is not always reflective of the acuity or composition of deep venous thrombus. Females presented later and may have poorer results with thrombectomy. MRI characterization of thrombus can aid patient selection for endovascular treatment by differentiating patients who present acutely v. chronically.

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None

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Name: Philip Goodney

Address: One Medical Center Drive
Lebanon, NH 03765
United States

Will this author present: Yes, No, No, No, No, No, No, No

Email: sadia.ilyas@hitchcock.org, jab@hitchcock.org, Kunal.S.Mehta@hitchcock.org, Barbara.Gladders@hitchcock.org, kayla.moore@hitchcock.org, Niveditta.Ramkumar.med@dartmouth.edu, Stanislav.Henkin@hitchcock.org, philip.p.goodney@hitchcock.org

Cell: 708-668-3705

Abstract Title: Sex-based mortality outcomes in Medicare beneficiaries with peripheral arterial disease

Abstract Body:

PURPOSE:
Patients with peripheral arterial disease (PAD) are at high risk for complications including increased morbidity and mortality. Prior work has suggested that there may be sex-based differences in outcomes in patients with PAD. This study examines the mortality in a large cohort of Medicare patients diagnosed with PAD in recent years.
METHODS:
We studied all Medicare claims, Part A and B, from January 2006 until December 2017. We used previously validated diagnosis codes specific for PAD. Claims data were used to identify mortality at the patient level. We examined differences in mortality by sex in each year in the cohort.
RESULTS:
Over the study period, 4,012,445 Medicare beneficiaries with a diagnosis of PAD were identified. Mean age at inception in the cohort was 76 years, although this declined during the study period from 78 years in 2006 to 75 years of age in 2017. Females were older at the time of diagnosis (80 years old for females in 2006, 76 years old for females in 2017; 77 years for males in 2006, 74 for males in 2017, p<0.001) Crude one year survival was similar by sex (88% among females, 87% among males, 95 %CI, p=NS). Results were similar at five years (60% versus 60%) and ten years (35% versus 35%) after initial diagnosis. (Figure 1). The median survival time for 6.82 years (95% CI 6.80-8.83) females was and 6.88 years (95% CI 6.87-6.9) for males. Kaplan Meier modeling of survival following diagnosis of PAD with diabetes when stratified by sex demonstrated a difference in survival by sex, when adjusting for age, race, comorbidities, and medication adherence with a higher risk for age-adjusted death among males (HR associated with male gender = 1.28 (95% CI 1.27-1.29, p<0.001).
CONCLUSION:
Both males and females with diagnosis of PAD carry a significant mortality risk. In this large claim-based evaluation, when stratified by sex, women were diagnosed at an older age, but died at a slower rate than men, resulting in adjusted survival which was better in females when compared to males. This suggests an opportunity to further improve survival among females with PAD if they are diagnosed earlier in their disease process, as well as the need to improve treatments for men once their PAD diagnosis has been made.

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Do you have Grant Support? Please explain:  

Goodney – AHA funding

Has this material been previously published? No

Name: Zachary Williams

Address: 2301 Erwin Road
Durham, NC 27705
United States

Will this author present: Yes, No

Email: av201@duke.edu, zachary.f.williams@duke.edu

Cell: 4108427242

Abstract Title: Gender differences in treatment of acute mesenteric ischemia

Abstract Body:

Introduction:
Acute mesenteric ischemia (AMI) remains an entity with a high rate of in-hospital mortality and associated morbidity, however whether gender differences exist in outcomes of AMI is uncertain.

Methods:
Patients at a single tertiary care center who received an intervention for acute mesenteric ischemia or acute-on-chronic mesenteric ischemia were identified from 01/2016 to 12/31/2021. Retrospective review and analysis of demographics, operative data, and postoperative outcomes was performed.

Results:
39 patients underwent mesenteric revascularization for acute or acute-on-chronic mesenteric ischemia from 01/2016 to 12/31/2021 at a single tertiary care center. 69% of the cohort was female (n = 27); 31% was male (n = 12). In the cohort 16 patients underwent retrograde SMA stent placement (41.0%); 13 patients underwent open SMA embolectomy (33.3%); 3 patients underwent open mesenteric bypass (7.6%); 3 patients underwent catheter directed aspiration thrombectomy (7.6%); and 2 patients underwent antegrade stent placement with laparotomy/laparoscopy (5.1%). The average 30-day mortality for all was 32.4%. If stratified by gender, the 30-day mortality for men was 18% (2/11) and 35% (10/28) for women, which was not statistically significant (p = 0.18). Average length of stay was 14.8 days for men and 18 days for women, again not statistically significant. However, the women in the cohort were more likely to undergo a bowel resection at time of their initial laparotomy – 85% of women (17/20) v. 53% of men (10/19) (p = 0.03).

Conclusion:
Women are more likely to undergo bowel resection at the time of laparotomy for AMI, however their 30-day mortality rate and length of stay remains similar to that of men. Multiple factors may contribute to the increased rate of bowel resection for women, including any delays in presentation for medical care, hypercoagulability status, or presence of various comorbidities.

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N/A

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N/A

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N/A

Has this material been previously published? No

Name: Philip Goodney

Address: One Medical Center Drive
Lebanon, NH 03765
United States

Will this author present: Yes, No, No, No, No, No, No, No

Email: s.ilyas14@gmail.com, Jonathan.Aaron.Barnes@hitchcock.org, Kunal.S.Mehta@hitchcock.org, Barbara.Gladders@hitchcock.org, Kayla.Moore@hitchcock.org, niveditta.ramkumar.med@dartmouth.edu, stanislav.henkin@hitchcock.org, philip.p.goodney@hitchcock.org

Cell: 7086683705

Abstract Title: Sex-based mortality outcomes in Medicare beneficiaries with peripheral arterial disease

Abstract Body:

PURPOSE:
Patients with peripheral arterial disease (PAD) are at high risk for complications including increased morbidity and mortality. Prior work has suggested that there may be sex-based differences in outcomes in patients with PAD. This study examines the mortality in a large cohort of Medicare patients diagnosed with PAD in recent years.
METHODS:
We studied all Medicare claims, Part A and B, from January 2006 until December 2017. We used previously validated diagnosis codes specific for PAD. Claims data were used to identify mortality at the patient level. We examined differences in mortality by sex in each year in the cohort.
RESULTS:
Over the study period, 4,012,445 Medicare beneficiaries with a diagnosis of PAD were identified. Mean age at inception in the cohort was 76 years, although this declined during the study period from 78 years in 2006 to 75 years of age in 2017. Females were older at the time of diagnosis (80 years old for females in 2006, 76 years old for females in 2017; 77 years for males in 2006, 74 for males in 2017, p<0.001) Crude one year survival was similar by sex (88% among females, 87% among males, 95 %CI, p=NS). Results were similar at five years (60% versus 60%) and ten years (35% versus 35%) after initial diagnosis. The median survival time was 6.82 years (95% CI 6.80-8.83) for females and 6.88 years (95% CI 6.87-6.9) for males. Kaplan Meier modeling of survival following diagnosis of PAD with diabetes when stratified by sex demonstrated a difference in survival by gender, when adjusting for age, race, comorbidities, and medication adherence with a higher risk for age-adjusted death among males (HR associated with male gender = 1.28 (95% CI 1.27-1.29, p<0.001)).
CONCLUSION:
Both males and females with diagnosis of PAD carry a significant mortality risk. In this large claims-based evaluation, when stratified by sex, women were diagnosed at an older age, but died at a slower rate than men, resulting in adjusted survival which was better in females when compared to males. This suggests an opportunity to further improve survival among females with PAD if they are diagnosed earlier in their disease process, as well as the need to improve treatments for men once their PAD diagnosis has been made.

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Teaching points, lessons learned …..

Do you have Grant Support? Please explain:  

Goodney – AHA Funding

Has this material been previously published? No