Vascular Surgery

A Pragmatic Multicenter Randomized Controlled Trial to Assess the Clinical and Cost-Effectiveness of Negative Pressure Wound Therapy vs Usual Care for Surgical Wounds Healing by Secondary Intention Catherine Arundel, MS, Ian Chetter, MBChB, FRCS, MD York Trials Unit, University of York, York, UK; University of Hull, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK Introduction: Surgical wounds healing by secondary intention (SWHSI) are common and treatment is often complex and expensive. The SWHSI-2 Trial evaluated the effectiveness of negative pressure wound therapy (NPWT) compared with standard dressings (no NPWT) for improving time to healing of SWHSI. Methods: We conducted a pragmatic, 2-arm, parallel group, unblinded superiority randomized controlled trial (RCT), which planned to randomize 696 UK patients (1:1) with a SWHSI to receive NPWT or standard dressings (no NPWT). The primary outcome was time to wound healing (days since randomization). Secondary outcomes included wound infection, additional treatment, death, wound pain, health-related quality of life (HRQoL) and resource use. Results: A total of 686 participants were randomized and analyzed (NPWT n = 349; standard dressings n = 337). Most SWHSI were foot or leg wounds (n = 620, 90.4%) after vascular surgery (n = 619, 90·2%). There was no clear evidence that NPWT reduced time to wound healing compared with standard dressings (hazard ratio [HR] 1·08, 95% CI 0·88 to 1·32, p = 0.47). Differences between groups in the odds of wound infection, antibiotic use, readmission, reoperation, amputation, or death were not statistically significant, nor were differences in HRQoL or wound pain scores at any time point. Serious adverse events were rare (9 NPWT; 4 standard dressings). Economic analysis suggested that NPWT increased cost by £251.44 (95% CI: £-2,192.63 to £2,695.52), although this was not statistically significant. Longer term modelling found that the probability of NPWT being cost-effective, against UK NICE thresholds, was 28.9% and 29.5%. Conclusion: Use of NPWT in the management of SWHSI in this patient population cannot be supported based on clinical and cost-effectiveness analysis. A Value-Based Approach to Stent-Graft Inventory for Blunt Thoracic Aortic Injury Fiorella Yep Mendizabal, MD, Alexandra MacHugh, MD, Joshua Crapps, MD, Jason Hutzler, MD, Joseph J Dubose, MD, FACS, Pedro G R Teixeira, MD, FACS Dell Medical School at The University of Texas at Austin, Austin, TX Introduction: Thoracic endovascular repair (TEVAR) is the standard treatment for blunt thoracic aortic injury (BTAI). The market for thoracic aortic stent-grafts is vast, creating logistical challenges for hospital inventory. We hypothesized that a lean inventory of stent grafts could adequately treat most BTAIs. Methods: The Aortic Trauma Foundation registry was used to identify BTAI patients from 52 trauma centers (01/2012-01/2024). Patients from the registry who had documented aortic measurement derived from CT scans, stent-graft manufacturer, and stent-graft size used were included. Stent-grafts were rankled by use frequency for each manufacturer. The number of sizes required to treat 90% of patients was identified. Results: Among 371 patients with BTAI who underwent TEVAR, 339 had aortic measurement, graft manufacturer, and size information. Most patients were men (80%) with a mean age of 42 ± 17 years. Overall in-hospital mortality was 7.5%. The most commonly used manufacturer was Gore at 61% [206/339], followed by Medtronic at 21% [72/339], Cook at 12% [39/339], and Terumo at 6% [22/339]). On average, 11 different stent-graft options were used per manufacturer. The top 6 most frequently used stent-grafts were able to treat 91% of the patients with Cook devices, 91% Gore, 95% Medtronic, and 97% Terumo. Most frequently used devices had diameters ranging from 21 to 32 mm. There was no difference in BTAI grade or in-hospital mortality among different manufacturers. Conclusion: A lean inventory of 6 stent-graft sizes from any of the 4 manufacturers can treat at least 91% of BTAI patients, supporting a value-based approach to inventory selection. Aortic Graft Infolding after Thoracic Endovascular Aortic Repair Mouhammad Halabi, MD, Hassan Chamseddine, MD, Alexander D Shepard, MD, FACS, Loay Kabbani, MD, FACS Henry Ford Hospital, Detroit, MI Introduction: Graft infolding (GI), a rare but significant complication of thoracic endovascular aortic repair (TEVAR), occurs when the endograft partially or completely collapses inward (Figure 1), often due to excessive oversizing beyond instructions for use (IFU) recommendations. This study evaluates the incidence, natural history, treatment strategies, and outcomes of aortic GI after TEVAR. Methods: A retrospective review of all TEVAR procedures performed at our quaternary care institution between 2014 and 2024 identified cases of aortic GI. Data collected included patient demographics, device parameters, procedural details, and clinical outcomes. Size mismatch was defined as the difference between the largest proximal and smallest distal stent graft diameters. Results: Four patients with GI were identified—2 with aortic dissection and 2 with aneurysm. All cases exhibited oversizing deviations from IFU guidelines, exceeding 15%, with 3 cases >20%. Larger mismatches correlated with earlier or symptomatic presentations. One patient (21% mismatch) had GI detected at 1 month, complicated by an intrastent thrombus, successfully treated with anticoagulation. Another (17% mismatch) was diagnosed at 3 months and managed with balloon angioplasty. In aneurysm cases, mismatches of 38% and 26% were observed; 1 patient remained asymptomatic, while the other developed renal artery occlusion requiring intervention, Figure 1. Conclusion: Aortic GI is a rare but clinically significant TEVAR complication. Strict adherence to IFU guidelines and optimal graft sizing are crucial for prevention. Postoperative surveillance is essential for early detection and management to minimize adverse outcomes.Figure 1Artificial Intelligence-Enabled Analysis of Visual Attention and Hand-Tool Interactions in the Operating Room Benjamin C Liu, BS, MS, Leia Chen, Philip Chen, Nicholas Rennie, MD, Ryan Dumas, MD, FACS, Isabele Van Herzeele, MD, Anita Rau, BS, PhD, Jeffrey K Jopling, MD, Serena Yeung-Levy, BS, PhD Stanford University, Stanford, CA; University of British Columbia, Vancouver, BC, Canada; University of California, San Diego, San Diego, CA; University of Ghent, Gent, Belgium; University of Texas Southwestern, Dallas, TX; Johns Hopkins University, Baltimore, MD Introduction: Artificial intelligence (AI) has the potential to standardize the analysis of attention and focus across operating room (OR) videos to identify opportunities for quality improvement. We aim to develop a computer vision-based approach for automatically detecting individual and group attention events in concert with hand-tool interactions from OR videos. Methods: We conducted a retrospective review of 92 endovascular surgery procedures at a tertiary referral center and labeled OR videos with key as and We a detection with a to from all We group and hand-tool events by to the interactions across of Results: events and hand-tool interactions were at a of and attention events and group at a of and and In the of and focus individual attention and hand-tool interactions at the of and Figure 1. Conclusion: We a for automatically attention and hand-tool across across focus on this analysis to OR and a for MD, MD, MD, MD, FACS University School of Introduction: The vascular a in management and are of natural and clinical review at use to the of 3 common on clinical and to vascular Methods: Patients with were identified standard and We for review to for vascular were to to a of and were a and were as for was compared against were for (Figure Results: the all 4 All performed on compared with the not Conclusion: as a for from is of and are required can be for and for clinical or the and Artificial MD, MD, MD, FACS, MD, FACS, MD, FACS University Introduction: Artificial intelligence (AI) has in are often to by The of our study was to between and for to vascular surgery and can Methods: were collected from who to vascular or from each were used to to Four vascular surgery were to review and each of of and the was by a was Results: Four participants and 4 were Four to an and quality of each were and were to receive an The quality of was of were able to that a was of the 1. Conclusion: In this found vascular were to between and to not in the study and be of 1. vs p of ± ± ± ± ± ± Overall ± ± and the of A MD, MD, MD, MD, PhD, FACS, MD, PhD, MD, PhD, MD, PhD, MD, PhD San Introduction: for of to to at the evidence that be an and This study to the between artery and to identify potential in a Methods: A retrospective analysis of CT was performed on patients from a and of Patients were based on the Trial and groups were conducted to differences (Figure Results: and artery not a significant with as the most artery on the and on the with patients exhibited diameters and which and Conclusion: is not a significant of but differences a is to and to early in and of an to to Injury MD, C MS, BS, BS, PhD, PhD, PhD, R MD, FACS, University of University of University, Introduction: for treatment of secondary to from has developed that to that of and We to develop to a on vascular and in We that an to Methods: 1 that was labeled with were and and secondary were evaluated and artery balloon were (n = or (n = after were evaluated Results: that in a ratio with artery balloon found that to (Figure no of the was in the and the not to or of the was Conclusion: We developed a to and of this to the of of this in an and of the of BS, BS, MD, PhD, R MD, FACS The University of University of School of and The University Medical Introduction: and are is to outcomes in by and Methods: We conducted a retrospective study of all patients endovascular or for at The University We compared and across and and Results: the had had were and to renal patients were in = In patients, were to to amputation, and death p with a in as patients outcomes to patients, with no significant differences in amputation, or death p groups patients = p p identified as a of (hazard ratio [HR] p = as p = and as mortality p Conclusion: In patients, is with outcomes. outcomes to patients, and groups and patient and in among MD, FACS, Jeffrey J MD, FACS, PhD, PhD Medical Medical Introduction: We to the in use and outcomes of or repair Methods: The most were to patients We evaluated the of patients who were as of of and in-hospital mortality among Results: to has a significant in the of vascular surgery patients who were a of were that for or p a of the was with an significant in ratio of or but no significant in the ratio among patients vs p = all of increased the study this for all procedures Use of endovascular aneurysm repair increased among (Figure Conclusion: All but with use of outcomes among patients, other a in outcomes and of be an in improving outcomes among patients vascular for in from a Multicenter MD, FACS, MD, MD, MD, MD, MD, FACS University Hospital, Introduction: is a rare and by and with a of potential and that often to The of endovascular has to repair for This study to and outcomes of endovascular in Methods: We performed a study of all patients with across centers from to Results: of patients underwent and underwent a In of patients, additional endovascular procedures were Among treated with 2 patients required a for and in the early patients care grade were in The hospital was Overall mortality was with and 3 between and was in patients, with a mortality of All 4 patients with in the Conclusion: a treatment for the mortality due to the of the and with and MD, MD, BS, MD, FACS, MD, FACS, MD, University of Medical Introduction: with artery with in adverse outcomes. We that a reduced of for symptomatic when compared with Methods: We included vascular surgery for among in a included treatment and pain and adverse events which were compared across with and odds and with 95% Results: the patients with ± 11 were A total of patients underwent was with an of vs = p = Figure Among managed was with an increased of pain vs p = = of treatment was and not by = p = Conclusion: with symptomatic were to in to men and to be treated with after There is an to differences in the and management of to vascular care for all of in A BS, BS, BS, MD University of School of Baltimore, of University of Baltimore, Baltimore, MD Introduction: often the of frequency on outcomes This study to the number of procedures the of and outcomes in Methods: A retrospective review of patients who underwent at a tertiary care between the 2014 and 2024 was readmission, and mortality were included and with at p Results: The mean age of the was (n = men and (n = The was (n = 38% (n = and (n = included (n = (n = and (n = Among the patients, underwent at least 1 The that increased the of = were not with readmission, or mortality Figure 1. Conclusion: patients increased odds of the of the and of the for that while adverse outcomes in this to A for at a MD, MD, MD, FACS University of California, San of Introduction: artery Patients at frequently with to a due to We that early and for patients at can adverse Methods: In a vascular surgery on from to vascular by We care in endovascular in and a in A patient registry was developed to patients as for or outcomes and Results: registry identified and Among patients, procedures increased by 6% in to in while from in to in the primary care to identify patients and with for cases, Figure 1. Conclusion: The of a vascular surgery has and outcomes for to early resource and with other to outcomes.Figure of on the of MD, Fiorella Yep Mendizabal, MD, MD, J BS, BS, Pedro G R Teixeira, MD, FACS, Joseph J Dubose, MD, FACS, MD University of Texas at Austin, Austin, TX Introduction: the of but is the for This study evaluates patients with by of to Methods: A retrospective study of patients who underwent was demographics, and were from clinical and was were of controlled and controlled were Analysis included and Results: A total of patients underwent age was and were All patients were to from to and compared with patients of but no difference was for with compared with the Conclusion: This study that patients are to from to and procedures compared with analysis that with outcomes with to as the of to in this 1. among Patients and p to 4 42 to 17 to 4 of on and in Patients with and Alexander BS, BS, MD, MD, MD, FACS School of University of California, Introduction: and reduced in patients with in artery This study the of therapy and outcomes in symptomatic and Methods: A retrospective study the identified with and 2 who or therapy with at least 1 of was as and symptomatic pain, or included amputation, and a of amputation, and (1:1) and with 95% were Results: included symptomatic and patients in and use was with of and of 95% CI 95% CI mortality 95% CI 95% CI and outcomes at 95% CI 95% CI Conclusion: In patients with 2 therapy was with reduced and events are to and in this vascular of the on and Aortic Repair in the BS, Alexander BS, MD, MS, A MD, FACS, MD, MD, FACS School of University of California, Introduction: The to procedures and aortic aneurysm This study evaluated the of the on the of and repair in the Methods: We conducted a analysis of patients with diagnosed in the from to Endovascular and repair was identified in repair were analyzed to with 95% CI were to Results: Among were for and were for The of the study p for from to p increased from to p and from to 2024 p (Figure patients were patients to repair for 95% CI with no significant difference for repair 95% CI Figure 1. Conclusion: The was with a significant in in care increased the of of MD, MD, MD, MD, FACS, MD, PhD, G MD, FACS University Introduction: vascular from the is to in not The of this study was to of procedures performed by vascular based on Methods: The study included all procedures performed by vascular in between and was as vs early or The of cases performed by was with negative Results: A total of were included. There were as and as early performed procedures vs and performed endovascular procedures vs cases a of an early vs most vascular in is a of in vs vascular were to p p surgery p and surgery procedures p = Conclusion: There are significant differences in between and vascular to aortic and are to in 1. All p Surgical in Blunt from the for the of Trauma Injury Trial Fiorella Yep Mendizabal, MD, Joshua Crapps, MD, MD, MD, MD, FACS, MD, Pedro G R Teixeira, MD, FACS, MD, D MD, Joseph J MD, FACS Dell Medical School at The University of Texas at Austin, Austin, TX Introduction: therapy has to the in-hospital of after blunt injury but against Methods: The for the of Trauma Injury registry was used to identify patients who to an in-hospital or requiring for The of this was used to identify the of therapy on Results: to patients were identified. of in in and in was the most commonly at was for from to months included patients with artery injury and patients with artery injury in 1 patient with a artery occlusion at injury on who had a documented at 1 Conclusion: to be for across all of in the The use of or not to any additional a MD, MD, MD, MD, PhD, MD, MD, MD, G MD, FACS University Introduction: is with outcomes. The of this study was to individual and of vascular Methods: were conducted in vascular surgery and to the were was as Results: were with The were men and were of and were with p Patients with = while patients with had = had a = to a vascular in the scores = Patients with = or = were to a with complication = and wound to = had Conclusion: of and significant with vascular The of the to a vascular had a significant the which can to outcomes. of and Aortic by MD University of Medical MI Introduction: The of aortic aneurysm is the of death in the by the and the of has in aortic was identified as an that can the and We the of a on and Methods: was conducted on and We used and with to was aortic be to aortic In and are performed on aortic and for and The be analyzed an Results: of to with of and and of In of in a significant in and in the aortic Figure 1. Conclusion: The of the that can the and the aortic and for in A MD, MS, MD, MD, MS, FACS Medical in Introduction: Graft or stent is a of in artery patients crucial in but is on as has that can in the of in This study to can and with Methods: patients were at a tertiary center and followed from to a for and a for were performed at and patients were compared with analysis operating and Results: the patients age ± developed group vs p = and vs p = the = 95% CI: p = with an optimal Negative between and R = p = R = p = and R = p = Figure 1. Conclusion: in The of with that as a to for for of Aortic an R MD, BS, J MD, R MD, MD, PhD, R MD, FACS, PhD, A MD, PhD University of Introduction: Aortic is the standard to of and treatment for aortic aneurysm. are to We to aortic an We that an intelligence (AI) can as as Methods: We analyzed CT from patients with aortic diameters for each were performed in aortic the and aortic diameters We developed a to the aortic in each (Figure were between and with being the as were performed from Results: were included. The difference between and was ± (95% CI and ± (95% CI between and and to aortic when compared with The in in between ± ± and ± Conclusion: We that an can aortic This has the potential to treatment and with for of C MD, BS, PhD, PhD, PhD, R MD, FACS, University of University, Introduction: developed a that for treatment of a and We to with that in Methods: and were and of were with and secondary were evaluated and a for of or 4 was in aortic Results: of a the and of was with of all of and secondary was with to 1 of was reduced by 6% in treated with the (n = vs (n = p = Conclusion: A was and our and a was after a of the of an treatment in Aortic on Clinical Mouhammad Halabi, MD, Hassan Chamseddine, MD, Alexander D Shepard, MD, FACS, J MD, FACS, R MD, FACS, MD, FACS, MD, FACS, MD, FACS, Loay Kabbani, MD, FACS Henry Ford Hospital, Detroit, MI Introduction: is frequently in aortic dissection and or complication. This study evaluates the for in and on and outcomes. Methods: A retrospective review of patients treated at a quaternary center was Patients were based on the of on were details, and outcomes were analyzed and Results: A total of patients were included = no = Patients with were ± 17 vs ± p = pain was the most common vs (no p = of was in patients with (9 vs 6 p = at were not different vs p = mortality vs p = (Figure and vs p = were in patients with a but not Conclusion: is a common in and is with hospital and a increased not statistically significant, be a of are to in Patients A MD, MS, MD, MD, FACS Hospital, Introduction: is a in with and in in artery this study to and of can in Methods: Patients with between and were evaluated and for 1 to identify events were defined as clinically significant that required or Patients were based on the of and each differences in while operating analysis the optimal for increased Results: A total of patients were of a The exhibited vs p and vs p reduced and analysis the and as for Figure 1. Conclusion: and as of in patients, the potential of in and of a to Surgical in J MD, MD, FACS University of Introduction: Surgical in vascular surgery is common and with graft infection, and increased of antibiotic and negative pressure dressings as as in We a for dissection a from the to a and a vascular Methods: A was used to dissection and graft from a 3 at the from the in Results: dissection and was in all with the was able to be to the of the with and of the common and (Figure from dissection to of from to with a between the and of the vascular with from to Conclusion: dissection and vascular is from a can an with in operating time between This has the potential to and outcomes.Figure Thoracic and but MD, MD, J MD, MD, MD, FACS, MD, FACS, MD, FACS, MD, FACS, D MD, FACS University of University of Introduction: aortic and thoracic aneurysm is an but with mortality ranging from to A of outcomes in this complex patient We aim to the and outcomes of and Methods: We performed a retrospective review of patients who underwent for and from to with primary vascular included and complication. A was performed on Results: patients who with or underwent endovascular and underwent repair mortality was and mortality was was among endovascular and repair vs p = were in of patients, with 1 to operating room in and renal in 6% of In the were and at a ± vs ± p = Conclusion: and a mortality of that at term mortality can be as at and as as to occurs at a age and in for 1. after Repair in Thoracic and Aortic All p at ± ± ± Repair 4 ± 2 ± 2 ± 4 1 2 2 1 1 6 3 3 11 3 of C MS, R PhD, PhD, R MD, FACS, University of University, Introduction: are to be as We which and vascular in and to in We that a a for Methods: were and and of were by in and by and to and were to in after Results: and a were a population with a mean of ± (Figure was at 2 and from (Figure vs p was with 1 (Figure = increased with and for 2 and 4 Figure p Conclusion: of of this in a of of the The of on in MD, MD, PhD, MD, FACS, J MBChB, PhD, FRCS, FACS University, MD Introduction: is a by in treatment mortality after to the of management often patient This study evaluates the of patient on outcomes in Methods: We conducted a retrospective analysis the patients with as the primary Patients were and and mortality were compared between Results: patients diagnosed with underwent age was in patients at compared with in patients was between 4 for groups = was from and ratio p patients had odds of requiring or endovascular procedures p p

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