Twin registries provide data on concordance of aneurysmal disease between twin sets, but provide no granular data. Four sets of monozygotic (MZ) twin families with aortic pathology and aortic imaging were identified within a single health care system to create a Dice score for aortic comparison. MZ twin Dice scores in families A through D were 32.3%, 34%, 46.5%, and 42.4% respectively. Nontwin siblings Dice scores were 31% and 33.2% for families B and C, respectively. Our case series illustrates that MZ twin aortas have higher rates of concordance compared with their nontwin siblings.

Background: Traditionally, extracranial carotid artery aneurysms or pseudoaneurysms (ECCAs) have been managed through open surgical repair. Recent literature highlights the increasing success of endovascular techniques in treating ECCAs. Our study explores our center's experience with endovascular management of ECCAs, including the innovative use of transcarotid artery revascularization (TCAR) at a tertiary-care center. Methods: We performed a retrospective analysis of patients with ECCAs who underwent endovascular intervention at a single institution. We examined our database from the period of 2010 to 2024. Our treatment modalities have expanded to include covered stenting, stentassisted coil embolization, braided stents, overlapping closed-cell stents, and most recently TCAR. Results: There were 29 extracranial carotid artery aneurysms in 27 patients treated with various endovascular modalities. The average age was 67.6 years, with 17 (63.0%) males and 10 (37.0%) females. Eight (29.6%) patients had prior ipsilateral carotid intervention. Nine (31.0%) aneurysms were symptomatic. The most common etiology was idiopathic, with 16 (55.2%) aneurysms being spontaneous. Treatment modalities included: 2 (6.9%) treated with covered stents, 2 (6.9%) with stent-assisted embolization, 3 (10.3%) with flow-diverting braided stents, 3 (10.3%) with embolization or ligation alone, 17 (58.6%) with overlapping bare metal stents via femoral or radial access, and 2 (6.9%) with overlapping bare metal stents via TCAR. Technical success was achieved in all patients. The mean follow-up duration was 236 days (range: 2e3,039 days). No perioperative or postoperative complications occurred, including no neurological deficits or embolic events. All patients were discharged on postoperative day 1 or 2. All 29 (100%) stents maintained vessel patency on follow-up imaging, and exclusion of ECCAs was confirmed on postprocedure surveillance imaging. Conclusion: Our study highlights that endovascular therapy is effective in managing ECCAs, with high patency rates and a favorable procedural safety profile.

Objectives: The potential benefit of transcarotid artery revascularization (TCAR) over transfemoral carotid artery stenting (tfCAS) has been studied in the perioperative period with lower rates of stroke and death; however, data on mid-term outcomes are limited. We aimed to evaluate 3-year outcomes after TCAR and tfCAS and determine the primary predictors of 30-day and 1-year mortality following TCAR. Methods: Data from the Vascular Quality Initiative for patients undergoing TCAR or tfCAS from January 2016 to December 2022 were analyzed. 1:1 propensity score matching using the nearest-neighbor method was used to adjust baseline demographics and clinical characteristics. Kaplan-Meier survival analysis and Cox Proportional Hazard Regression were used to evaluate long-term outcomes. Iterative stepwise multiple logistic regression analysis and Cox Proportional Hazard Regression were used to identify predictors of 30-day and 1-year mortality, respectively, based upon preoperative, intraoperative, and postoperative factors. Results: A total of 70 237 patients were included in analysis (TCAR=58.7%, tfCAS=41.3%). Transcarotid artery revascularization patients were older and had higher rates of comorbid conditions and high-risk medical and anatomic features than tfCAS patients. Propensity score matching yielded 22 322 pairs with no major differences between groups except that TCAR patients were older (71.6 years vs 70.8 years). At 3 years, TCAR was associated with a 24% reduction in hazard of death compared with tfCAS (hazard ratio [HR]=0.76, 95% confidence interval [CI]=0.71-0.82, p<0.001), for both symptomatic and asymptomatic patients. This survival advantage was established in the first 6 months (HR=0.59, 95% CI=0.53-0.62, p<0.001), with no difference in mortality risk from 6 months to 36 months (HR=0.95, 95% CI=0.86-1.05, p=0.31). Transcarotid artery revascularization was also associated with decreased hazard for 3-year stroke (HR=0.81, 95% CI=0.66-0.99, p=0.04) and stroke or death (HR=0.81, 95% CI=0.76-0.87, p<0.001) compared with tfCAS. The top predictors for 30-day and 1-year mortality were postoperative complications. The primary independent predictor was the occurrence of postoperative stroke. Conclusions: Transcarotid artery revascularization had a sustained mid-term survival advantage associated over tfCAS, with the benefit being established primarily within the first 6 months. Notably, our findings highlight the importance of postoperative stroke as the primary independent predictor for 30-day and 1-year mortal. Clinical Impact The ongoing debate over the superiority of TCAR compared to tfCAS and CEA has been limited by a lack of comparative studies examining the impact of pre-operative symptoms on outcomes. Furthermore, data are scarce on mid-term outcomes for TCAR beyond the perioperative period. As a result, it remains uncertain whether the initial benefits of stroke and death reduction observed with TCAR over tfCAS persist beyond one year. Our study addresses these gaps in the literature, offering evidence to enable clinicians to assess the efficacy of TCAR for up to three years. Additionally, our study seeks to identify risk factors for postoperative mortality following TCAR, facilitating optimal patient stratification

Background Pre-clinical students have limited exposure and training in surgical skills. As a result, many students report negative experiences during their surgery clerkship from a lack of confidence in their technical abilities and thus lower participation in cases. Moreover, in fields such as vascular surgery where a shortage of physicians persists, the absence of surgery and field-specific exposure for medical students may limit recruitment. To address these gaps, we designed a surgical skills curriculum for pre-clinical medical students utilizing surgical simulators to develop fundamental surgical skills, introduce students to vascular surgery early, and provide training on vascular surgery-specific procedures. We hypothesize that a surgical skills course can significantly enhance pre-clinical students' surgical abilities before they enter their surgical clerkship and increase interest in pursuing a surgical specialty. Methods 26 students took part in a structured surgical skills curriculum comprising three sections: fundamental surgical skills, application of skills in a clinical context, and a surgical skills competition. Over the course of six workshops, students received formative feedback from proctors using task-specific standardized rubrics and assessments through the Objective Standardized Assessment of Technical Skills (OSATS). Additionally, students' attitudes and perceptions towards surgical training and vascular surgery were evaluated using the modified Vascular Surgery Interest Forum (VSIF). The summative performance of pre-clinical students enrolled in the surgical skills course was compared to their initial performance after a skills workshop as well as that of third-year medical students who had completed surgical rotations. Differences in responses and attitudes were analyzed at the beginning and conclusion of the course using bivariate analysis. Results Of the 26 students, the majority were female (61.5%) and in their second year of medical school (76.9%). 23.1% identified as underrepresented minorities in medicine, 7.7% had physician family member(s), and 19.2% felt decided on a specialty.Following both knot-tying and suturing workshops, students reported a statistically significant increase in their self-rated understanding, comfort, and knowledge of tasks. Third-year medical students outperformed pre-clinical students in knot-tying and instrument-tying tasks. However, there was no difference in performance on these tasks between third-year medical students and the top three pre-clinical students who completed the course. Both groups performed similarly on the anastomosis challenge (29.25 vs. 28.42, P=0.9) and the vascular simulation challenge (27.25 vs. 26.83, P=0.6).At the program’s conclusion, students demonstrated an increased mean interest in vascular surgery (2.3±1.1 to 2.9±1.2, P=0.39), an enhanced interest in surgery due to its hands-on nature (4.5±0.8 to 4.7±0.6, P=0.06), a preference for surgical simulation in teaching fundamental skills (3.7±1.0 to 3.9±0.8, P=0.31), and increased awareness of radiation exposure in surgical practice (2.5±1.0 to 3.0±1.3, P=0.11). Students cited personality fit, exposure during medical school, and identification of a mentor as the most influential factors for pursuing a surgical career. The competitiveness of a residency program and resident workload and lifestyle were least influential. Conclusion A structured surgical skills curriculum for pre-clinical medical students increased students’ technical skills and fostered a greater appreciation for the hands-on and technical nature of surgery. Moreover, early exposure to vascular surgery enhanced interest and knowledge of the field. Notably, students believed that medical school does not adequately prepare them for success on surgical rotations, and emphasized the importance of personality fit, early exposure, and mentorship in considering a surgical career.

Most preclinical medical education does not provide significant exposure or training in surgical skills prior to surgical clerkships. Many students report having negative experiences during their surgical clerkships, often due to their inability to participate or contribute, such as not performing skin closures due to lack of confidence in their basic surgical abilities. The objective of this study was to determine whether an elective course on learning surgical skills could tangibly improve preclinical first and year students' surgical skills prior to entering their surgical clerkship. Fifteen preclinical medical students at a single institution volunteered to take a 7-week elective course on learning basic surgical skills. Students were assessed at baseline after 1 hour of instruction and 30 minutes of practice on a skill and assessed again at the conclusion of the course. Knot-tying ability was quantified by the number of knots tied in 30 seconds. Suturing ability was quantified by judgment of performance by a trained instructor based on a predetermined rubric. During the final assessment, students were also assessed on their knot-tying and suturing competency by vascular surgeons and the surgical clerkship director on a 5-point Likert scale, with 5 indicating competency expected of a competent medical student after completing their surgical clerkship. Paired t-tests were performed to determine students' improvement from initial to final assessment. Table I displays the comparison of performance between baseline and final assessment. Students demonstrated improvement in all forms of knot-tying, simple interrupted suturing, and simple continuous suturing. When assessed by the surgical clerkship director, students showed significant improvement in knot-tying competency (1.0 vs 3.8; P < .01) and suturing competency (1.0 vs 3.8; P < .01). When assessed by vascular surgeons, students again showed significant improvement in knot-tying competency (1.0 vs 3.7; P < .01) and suturing competency (1.0 vs 3.8; P < .01). An elective surgical skills course may be effective in improving preclinical students' surgical ability. After approximately 14 hours of formal instruction, the average student achieved a score of 3.7 of 5 on a 5-point Likert scale for surgical competency relative to a competent clerkship student when assessed by both vascular surgeons and the surgical clerkship director. The class is easily replicable and implementable for most medical school programs and could serve to provide preclinical students with tangible skills prior to their surgical clerkships, allowing students to have a more positive experience during their clerkships. TableScore comparison of surgical skillsCharacteristicBeforeAfterP-valueNumber of one-handed surface knots3.7 ± 2.56.0 ± 2.4.02Number of one-handed deep cavity knots2.9 ± 2.25.6 ± 1.8.001Number of two-handed surface knots2.5 ± 2.15.4 ± 1.7.0003Number of two-handed deep cavity knots2.1 ± 1.95.1 ± 1.6<.01Number of instrument tie knots3.0 ± 2.05.8 ± 2.1.001Simple interrupted score17.0 ± 1.622.8 ± 2.0<.01Simple continuous score17.2 ± 5.723 ± 4.0.003Knot-tying competency (surgical clerkship director)1.0 ± 03.8 ± 0.7<.01Suturing competency (surgical clerkship director)1.0 ± 03.8 ± 0.7<.01Knot-tying competency (vascular attendings)1.0 ± 03.7 ± 0.5<.01Suturing competency (vascular attendings)1.0 ± 03.8 ± 0.6<.01 Open table in a new tab

The superiority of transcarotid artery revascularization (TCAR) over transfemoral carotid artery stenting (TFCAS) has been established in the perioperative period with a lower risk of stroke and death. However, it remains unclear whether TCAR will sustain its advantage in the longer term. We evaluated the 3-year outcomes for death, transient ischemic attack (TIA), stroke, and myocardial infarction (MI) after TCAR and TFCAS. Data from the Vascular Quality Initiative carotid artery stenting database for patients who had undergone TCAR or TFCAS from 2017 to 2020 were analyzed. We used 1:1 propensity score matching to adjust for 36 baseline characteristics. The Student t test and χ2 test were used to compare the differences in patient characteristics and perioperative outcomes. Kaplan-Meier survival estimates and Cox hazard regression were used to evaluate the longer term outcomes. A total of 19,174 cases (TCAR, 7075; TFCAS, 12,099) were included. Before matching, the TCAR patients were older, had had higher rates of comorbid conditions, and had had higher risk medical and/or anatomic features compared with the TFCAS patients. The TFCAS patients were more likely to be symptomatic. Propensity matching yielded 5760 pairs with no major differences between the two groups. In the matched populations, during the perioperative period, TCAR was associated with a reduced incidence of in-hospital TIA (P = .015), stroke (P < .001), death (P < .001), reperfusion injury (P < .001), and postoperative complications (P < .001) compared with TFCAS. At 1 year after treatment, TCAR was associated with significant reductions in the rate of death (TCAR, 4.3%; vs TFCAS, 8.1%; P < .001) and the composite outcome of TIA/stroke/death/MI (TCAR, 5.9%; vs TFCAS, 9.6%; P < .001). TCAR sustained its advantage over TFCAS through year 3 (Fig 1). The cumulative 3-year risk of death was reduced by 48% (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.53-0.73; P < .001), and the risk of TIA/stroke/death/MI was reduced by 46% (HR, 0.64; 95% CI, 0.55-0.74; P < .001). However, no difference was found in the risk of TIA/stroke between TCAR and TFCAS in the longer term (HR, 1.08; 95% CI, 0.69-1.73; P = .72; Fig 2). The survival advantage of TCAR compared with TFCAS was sustained at 3 years. This advantage is likely established in the short term by the reduced rates of in-hospital stroke. However, no difference in the rates of mid- to long-term stroke were demonstrated between TCAR and TFCAS, suggesting that the intraoperative neuroprotection associated with TCAR is beneficial only in the perioperative period.Fig 2Kaplan-Meier survival estimate for matched populations for freedom from transient ischemic attack (TIA)/stroke. TCAR, Transcarotid artery revascularization; TFCAS, transfemoral carotid artery stenting.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Carotid artery revascularization is performed less frequently among Black and minority populations despite a higher incidence of stroke and greater cardiovascular and stroke risk profile. Limited data exists on what impact race has on outcomes following carotid interventions. We assessed racial differences in perioperative outcomes following carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), and transcarotid artery revascularization (TCAR) using the Vascular Quality Initiative database. We identified patients who underwent CEA, tfCAS, or TCAR in the Vascular Quality Initiative database from January 2016 to December 2022. Patients were stratified by procedure type. Multivariable logistic regression was used to adjust for significant differences in baseline demographics and clinically relevant variables. Variables in regression modeling included age, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, dialysis, hypertension, smoking status, prior coronary artery bypass grafting, prior percutaneous coronary intervention, prior transient ischemic attack/stroke, and insurer. We included individuals who self-identified as White, Black, Asian, or others, which comprised of those who identified as either mixed race, Native American, or Native Alaskan. Primary outcomes included 30-day in-hospital stroke, myocardial infarction, death, and a composite end point of 30-day stroke/myocardial infarction (MI)/death. Overall, 124,386 CEA patients, 28,989 tfCAS patients, and 41,204 TCAR patients were included in the study. Age, race, and comorbidities were comparable between treatment groups. In the CEA group, Black patients had a higher relative risk of perioperative stroke (odds ratio [OR], 1.49; 95% CI, 1.26-1.76) and composite stroke/death/MI (OR, 1.34; 95% CI, 1.15-1.55). Asians had a higher relative risk of death (OR, 2.67; 95% CI, 1.48-4.81) and composite stroke/death/MI (OR, 1.50; 95% CI, 1.14-1.99). In the tfCAS group, patients in the others race had a higher risk of death (OR, 2.03; 95% CI, 1.27-3.15) and composite stroke/death/MI (OR, 1.45; 95% CI, 1.07-1.97). In the TCAR group, Asians had a higher risk of stroke (OR, 2.50; 95% CI, 1.45-4.33) and composite stroke/death/MI (OR, 2.25; 95% CI, 1.39-3.66) (Table). In our study, we found that race significantly impacted perioperative outcomes following carotid interventions. Particularly, Black and Asian patients fared worse following CEA and Asians patients fared worse after TCAR. This study suggests that Black and Asian race may be an important predictor of worse outcomes following carotid intervention, which warrants further investigations.TablePerioperative outcomesWhite OR (95% CI)Black OR (95% CI)Asian OR (95% CI)Others OR (95% CI)CEA StrokeReference1.49 (1.26-1.76)1.27 (0.88-1.82)1.18 (0.98-1.42) MIReference0.75 (0.52-1.09)1.65 (0.99-2.72)1.34 (1.01-1.78) DeathReference1.21 (0.81-1.80)2.67 (1.48-4.81)1.09 (0.71-1.69) Stroke/death/MIReference1.34 (1.15-1.55)1.50 (1.14-1.99)1.20 (1.03-1.41)tfCAS StrokeReference1.31 (0.95-1.81)0.96 (0.42-2.19)1.36 (0.91-2.0) MIReference0.79 (0.36-1.71)1.30 (0.32-5.37)1.85 (0.95-3.59) DeathReference1.06 (0.66-1.72)1.58 (0.64-3.92)2.03 (1.27-3.15) Stroke/death/MIReference1.26 (0.97-1.63)1.22 (0.68-2.21)1.45 (1.07-1.97)TCAR StrokeReference1.29 (0.93-1.81)2.50 (1.45-4.33)1.28 (0.87-1.89) MIReference1.25 (0.69-2.26)1.78 (0.56-5.67)1.30 (0.66-2.57) DeathReference1.50 (0.82-2.55)1.15 (0.28-4.73)1.67 (0.89-3.13) Stroke/death/MIReference1.26 (0.95-1.67)2.25 (1.39-3.66)1.300.94-1.80CEA, Carotid endarterectomy; MI, myocardial infarction; TCAR, transcarotid artery revascularization; tfCAS, transfemoral carotid artery stenting.Boldface entries indicate statistical significance. Open table in a new tab

Objective: It is unclear whether patients with prior neck radiation therapy (RT) are at high risk for carotid artery stenting (CAS). We aimed to delineate 30-day perioperative and 3-year long-term outcomes in patients treated for radiation-induced stenotic lesions by the transfemoral carotid artery stenting (TFCAS) or transcarotid artery revascularization (TCAR) approach to determine comparative risk and to ascertain the optimal intervention in this cohort. Methods: Data were extracted from the Vascular Quality Initiative CAS registry for patients with prior neck radiation who had undergone either TCAR or TFCAS. The Student t-test and the chi(2) test were used to compare baseline patient characteristics. Multivariable logistic regression and Cox Hazard Proportional analysis were used to compare perioperative and long-term differences between patients with and without prior neck radiation following TCAR and TFCAS. Kaplan-Meier estimator was used to determine the incidence of 3-year adverse events. Results: A total of 72,656 patients (TCAR, 40,879; TFCAS, 31,777) were included in the analysis. Of these, 4151 patients had a history of neck radiation. Patients with a history of neck radiation were more likely to be younger, white, and have fewer comorbidities than patients with no neck radiation history. After adjustment for confounding factors, there was no difference in relative risk of 30-day perioperative stroke (P = .11), death (P = .36), or myocardial infarction (MI) (P = .61) between TCAR patients with or without a history of neck radiation. The odds of stroke/death (P = .10) and stroke/death/MI (P = .07) were also not statistically significant. In patients with prior neck radiation, TCAR had lower odds for in-hospital stroke/death/MI (odds ratio, 0.59; 95% confidence interval [CI], 0.35-0.99; P = .05) and access site complications than TFCAS. At year 3, patients with prior neck radiation had an increased hazard for mortality after TCAR (hazard ratio [HR], 1.24; 95% CI, 1.02-1.51; P = .04) and TFCAS (HR, 1.33; 95% CI, 1.12-1.58; P = .001). Patients with prior neck radiation also experienced an increased hazard for reintervention after TCAR (HR, 2.16; 95% CI, 1.45-3.20; P < .001) and TFCAS (HR, 1.67; 95% CI, 1.02-2.73; P<.001). Conclusions: Patients with prior neck radiation had a similar relative risk of 30-day perioperative adverse events as patients with no neck radiation after adjustment for baseline demographics and disease characteristics. In these patients, TCAR was associated with reduced odds of perioperative stroke/death/MI as compared with TFCAS. However, patients with prior neck radiation were at increased risk for 3-year mortality and reintervention.

Angioplasty, stenting, and atherectomy for tibial occlusive disease are commonly performed among critical limb ischemia patients, but restenosis and occlusion significantly hinder long-term durability. For patients requiring reintervention for recurrent tibial occlusive disease, the impact on clinical benefit and patency equivalence is unclear. We compared 1-year outcomes following repeat tibial endovascular intervention(s) to the first (primary) tibial endovascular intervention. Procedural and long-term data from the Vascular Quality Initiative database were queried for patients with critical limb ischemia (Rutherford Class 4-6) undergoing endovascular intervention for isolated tibial occlusive disease (2010-2020). Outcomes included 1-year change from baseline in ambulatory status, functional status (Eastern Cooperative Oncology Group), disposition, minor amputation, and major adverse outcomes (death, below-knee amputation, above-knee amputation). Statistically significant and clinically relevant variables were included in multivariate logistic regression. We included 1871 patients underwent primary isolated tibial endovascular intervention for critical limb ischemia. Of those, 433 (23.1%) patients underwent tibial endovascular reintervention for recurrent disease (tissue loss 35.0%). 81.6% and 14.5% of patients underwent angioplasty and atherectomy, respectively, for primary intervention. Patients requiring repeat intervention(s) had significantly decreased clinical improvement after primary intervention (67.4% vs 77.9%; P < .001) and repeat intervention (67.8% vs 77.9%; P < .001) compared to patients with no reintervention (Table). Among the three groups, a minority of patients achieved improvement in functional status (22.2% vs 20.7% vs 21.9%; P = .84) and ambulatory status at 1-year (20.0% vs 18.6% vs 17.1%; P = .54). Approximately 50% of patients were fully ambulatory at 1 year (Table). After multivariate adjustment, patients with reintervention were 50% less likely to have a patent target vessel at 1-year after primary endovascular treatment vs patients having no reintervention (odds ratio [OR], 0.50; 95% CI, 0.31-0.79; P = .03). Patients with reintervention were also found to have increased risk for minor amputation compared to patients without reintervention (OR, 1.64; 95% CI, 1.20-2.23; P = .002). Repeat interventions significantly increased risk of minor amputation at 1-year compared to primary intervention (OR, 2.41; 95% CI, 1.53-3.80; P < .001). There was no significant difference in death or major amputation (below or above knee) (Table). Atherectomy was associated with significant reduction in high-grade stenosis at 1 year (>50%) after primary treatment compared to angioplasty (OR, 0.097; 95% CI, 0.018-0.52; P = .006). Major adverse outcomes after repeat endovascular tibial intervention for recurrent tibial occlusive disease were similar to those after primary tibial endovascular intervention. However, patients with recurrent tibial occlusive disease requiring reintervention had decreased symptom improvement after primary and repeat treatment, decreased target lesion patency, and increased risk of minor amputation.TableOne-year outcomes following tibial endovascular intervention for critical limb ischemiaPrimary endovascular intervention (no future intervention), n = 1438Primary endovascular intervention (future reintervention), n = 433Repeat endovascular intervention (2+ interventions), n = 143P valueDeath335 (23.3)86 (19.9)39 (27.3).14Symptom improvementn = 1094n = 380n = 115 Regression72 (6.6)35 (9.2)13 (11.3)<.001 No change170 (15.5)89 (23.4)24 (20.9) Improvement852 (77.9)256 (67.4)78 (67.8)Patency (patent)755/827 (91.3)259/298 (86.9)77/89 (86.5).05>50% Stenosis27/160 (16.9)14/75 (18.7)2/20 (10.0).66Functional status changen = 517n = 198n = 64.87 Regression173 (33.5)72 (36.4)25 (39.1) No change229 (44.3)85 (42.9)25 (39.1) Improvement115 (22.2)41 (20.7)14 (21.9)Ambulation status (ambulatory)565/1075 (52.6)200/377 (53.1)60/112 (53.6).69Ambulatory status changen = 1072n = 377n = 111.54 Regression303 (28.3)113 (30.0)26 (23.4) No change555 (51.8)194 (51.5)66 (59.5) Improvement214 (20.0)70 (18.6)19 (17.1)Disposition changen = 358n = 137n = 40.28 Needs advanced care206 (57.5)68 (49.6)23 (57.5) No change152 (42.5)69 (50.4)17 (42.5)Postoperative ABI1.15 ± 0.501.12 ± 0.541.09 ± 0.62.63Amputationn = 1168n = 396n = 118 All cause370 (31.7)152 (38.4)56 (47.5)<.001 Below knee173 (14.8)58 (14.6)15 (12.7).83 Above knee44 (3.8)16 (4.0)8 (6.8).29 Minor amputation (toe/ray/transmetatarsal)153 (16.1)78 (24.2)33 (34.7)<.001Values are number (%) or mean ± standard deviation. Open table in a new tab

Introduction: With increased social isolation due to COVID-19, social media has been increasingly adopted for communication, education, and entertainment. We sought to understand the frequency and characteristics of social media usage among general surgery trainees. Materials and methods: General surgery trainees in 15 American training programs were invited to participate in an anonymous electronic survey. The survey included questions about demographics, frequency of social media usage, and perceptions of risks and benefits of social media. Univariate analysis was performed to identify differences between high users of social media (4-7 h per week on at least one platform) and low users (0-3 h or less on all platforms). Results: One hundred fifty-seven of 591 (26.6%) trainees completed the survey. Most respondents were PGY3 or lower (75%) and high users of social media (74.5%). Among high users, the most popular platforms were Instagram (85.7%), YouTube (85.1%), and Facebook (83.6%). YouTube and Twitter were popular for surgical education (77.3% and 68.2%, respectively). The most reported benefits of social media were improving patient education and professional networking (85.0%), where high users agreed more strongly about these benefits (P = 0.002). The most reported risks were seeing other residents (42%) or attendings (17%) with unprofessional behavior. High users disagreed more strongly about risks, including observing attendings with unprofessional behavior (P = 0.028). Conclusions: Most respondents were high users of social media, particularly Instagram, YouTube, and Facebook. High users incorporated social media into their surgical education while perceiving more benefits and fewer risks of social media. (C) 2022 Elsevier Inc. All rights reserved.

Despite advancements in surgical and postoperative management, spinal cord injury has been a persistent complication of both open and endovascular repair of thoracoabdominal and descending thoracic aortic aneurysm. Spinal cord injury can be explained with an ischemia-infarction model which results in local edema of the spinal cord, damaging its structure and leading to reversible or irreversible loss of its function. Perfusion of the spinal cord during aortic procedures can be enhanced by several adjuncts which have been described with a broad variety of evidence in their support. These adjuncts include systemic hypothermia, cerebrospinal fluid drainage, extracorporeal circulation and distal aortic perfusion, segmental arteries reimplantation, left subclavian artery revascularization, and staged aortic repair. The Authors here reviewed and discussed the role of such adjuncts in preventing spinal cord injury from occurring, pinpointing current evidence and outlining future perspectives.

Background: Anatomic details affecting the adverse outcomes following carotid artery stenting have not been well characterized. We compared in-hospital outcomes following transcarotid ar-tery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) among symp-tomatic and asymptomatic patients stratified by degree of lesion calcification and aortic arch type.Methods: Data from patients in the Society for Vascular Surgery's Vascular Quality Initiative database undergoing TCAR (January 2017 to April 2020) or TFCAS (May 2005 to April 2020) and had non-missing grading on carotid artery calcification or aortic arch type was analyzed. De-gree of calcification was stratified into 3 groups: none, < 50% calcification, and >50% calcifica-tion. Arch type was stratified as Type I, Type II, and Type III.Results: A total of 9,868 patients (TCAR: 4,224; TFCAS: 5,644) were included in the calcifica-tion analysis. TCAR patients were generally older, white, smokers, and had more comorbidities than TFCAS patients. Among the symptomatic patients, there was no difference in rates of stroke, stroke/transient ischemic attack (TIA), and myocardial infarction (MI) by calcification severity between TCAR and TFCAS. However, there was a trend towards increased risk in all 3 events with higher calci-fication only after TFCAS. Symptomatic patients with severe (>50%) calcification had lower rates of death (TCAR: 0.9% vs. TFCAS: 2.8%, P = 0.013), stroke/death (TCAR: 2.7% vs. TFCAS: 5.8%, P = 0.006), stroke/death/MI (TCAR: 3.3% vs. TFCAS: 6.5%, P = 0.007), and postop complications (TCAR: 6.0% vs. TFCAS: 12.4%, P < 0.001) after TCAR compared to TFCAS. Furthermore, TCAR had lower risk of mortality at all degrees of calcification compared to TFCAS. Similar findings were noted among asymptomatic TCAR patients with >50% calcifi-cation, in which the rates of death (TCAR: 0.4% vs. TFCAS: 1.1%, P = 0.080) and stroke/death (TCAR: 1.5% vs. TFCAS: 3.1%, P = 0.029) were reduced. A comparison of TCAR to TFCAS by arch type showed that rates of stroke/death after TCAR were similar regardless of arch complexity (Type I: 2.6% vs. Type II: 2.8%), but increased after TFCAS with complex, high risk anatomy (Type I: 4.2% vs. Type II: 5.2%).Conclusions: While increased calcification increased rates of adverse events after TFCAS, this trend was not observed after TCAR, which also had lower rates of death and stroke/death among patients with severe calcification. Furthermore, TCAR had lower risk of mortality than TFCAS across all degrees of calcification. TFCAS was associated with increased risk of stroke/death with complex aortic arch anatomy, however, rates of stroke/death after TCAR were similar regardless of arch complexity. Our results suggests that TCAR should be preferen-tially considered in revascularization of patients with anatomy considered high-risk for TFCAS.