Objective: The Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well -established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals. Methods: We queried the VA Surgical Quality Improvement Program database for elective infrarenal AAA repairs, EVAR and OSR, then merged in follow-up imaging and mortality information. Mortality rate over time was derived using Kaplan -Meier estimation. Generalized estimating equation with a logit link and a sandwich standard error estimate was performed to compare the probability of having annual follow-up imaging over time between procedure types and to identify variables associated with follow-up imaging for EVAR patients. Results: Our analysis included 11,668 patients who underwent EVAR and 4507 patients who underwent OSR at VA hospitals between the years 2000 and 2019. The 30 -day mortality rate for EVAR and OSR was 0.37% and 0.82%, respectively. OSR was associated with lower long-term mortality after adjusting age, sex, American Society of Anesthesiologists classi fi cation and preoperative renal failure with an adjusted hazard ratio of 0.88 (95% con fi dence interval, 0.840.92; P < . 01). Of surviving patients, the follow-up imaging rate was 69.1% by 1 year post-EVAR. The follow-up rate after 5 years was 45.6% post-EVAR compared with 63.6% post-OSR of surviving patients. A history of smoking or drinking, baseline hypertension, and known cardiac disease were independently associated with poor follow-up after EVAR. Conclusions: Patients undergoing elective open AAA repair in the VA hospital system had lower long-term mortality compared with patients who underwent endovascular repair. Compliance with post-EVAR imaging is low. Patient factors associated with poor post-EVAR imaging surveillance were smoking within the last year, excess alcohol consumption, and cardiac risk factors including hypertension, prior myocardial infarction, and congestive heart failure. (J Vasc Surg 2024;80:89-95.)

We present here a case of an uncommon cutaneous manifestation after paclitaxel-coated balloon angioplasty. In this case, the patient underwent drug-coated balloon angioplasty for stenosis of a prior vein bypass graft. The patient subsequently developed extensive cutaneous lesions not confined to a single arterial distribution. This case represents a rare complication related to paclitaxel-eluting balloons and provides a cautionary tale as well as clinical acumen for providers in using such devices in their practice.

Objective This retrospective cohort study is aimed at determining the safety and efficacy between Femoral Open-Cutdown access and Percutaneous access with Endovascular Aneurysm Repair (EVAR) by contrasting perioperative complication rates. We hypothesized that the percutaneous approach is a better alternative for aortic aneurysm patients as it is minimally invasive and has been demonstrated to decrease the length of hospital stay. Methods We retrospectively reviewed data for patients undergoing EVAR between the years of 2005 and 2013. We then compared overall mortality, hematoma or seroma formation, graft infection, arterio-venous injury, distal embolization, limb loss, myocardial infarction or arrhythmia, and renal dysfunction. Results were demonstrated using a retrospective cohort study design to confirm the hematoma rate associated with EVAR open compared to percutaneous access. Results Our series involves 73 patients who underwent percutaneous access for EVAR (n = 49) or traditional open cutdown (n = 24). Percutaneous access resulted in significantly less hematoma formation when compared to the traditional open cutdown (4% vs. 12.5%; p < 0.059). Our analysis suggests decreased mortality rates associated with EVAR as compared to the Open-Cutdown method using Northside Medical Center's Study and the OVER Veterans Affairs Cooperative Study (p = 0.0053). Conclusion Percutaneous access for EVAR is safe and effective when compared to Open-Cutdown access for aortic aneurysm patients. Percutaneous access was associated with decreased rates of in-hospital mortality, hematoma formation, graft infection, and respiratory failure.