News from the SVS

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.

Slide sets of the guidelines, useful as educational tools, also are available online.

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.

Slide sets of the guidelines, useful as educational tools, also are available online.

SVS has partnered with Guidelines Central to create a Pocket Guide version of the new AAA guidelines. Also available are pocket guides on Management of Diabetic Foot, Peripheral Arterial Disease and Venous Leg Ulcers.

SVS members can access the digital versions for free; printed guidelines vary in price. The guidelines also are available as a bundled set.

Slide sets of the guidelines, useful as educational tools, also are available online.

It's nearly here! The 2018 Vascular Annual Meeting takes a big step forward this week with the opening of housing and registration. Prepare to sign up for VAM, June 20 to 23 in Boston.

Following a full day of postgraduate courses, VESS abstracts, workshops and international programming, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.

It's nearly here! The 2018 Vascular Annual Meeting takes a big step forward this week with the opening of housing and registration. Prepare to sign up for VAM, June 20 to 23 in Boston.

Following a full day of postgraduate courses, VESS abstracts, workshops and international programming, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.

It's nearly here! The 2018 Vascular Annual Meeting takes a big step forward this week with the opening of housing and registration. Prepare to sign up for VAM, June 20 to 23 in Boston.

Following a full day of postgraduate courses, VESS abstracts, workshops and international programming, abstract-based scientific sessions will open June 21 and continue to June 23. The Exhibit Hall will be open June 21 to 22.

Catch the highlights of this year's annual meeting here.

A new review of the literature on chronic venous insufficiency in pregnant women reveals considerable guidance for their treatment. CVI occurs in up to 80% of pregnant women, while around 7 of every 1,000 pregnant mothers face venous thromboembolism and pulmonary embolism.

As reported in the March edition of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, clinicians from Johns Hopkins Hospital and the Greater Baltimore Medical Center led by vascular surgeon Dr. Jennifer Heller, analyzed 80 studies related to pregnancy, VTE and CVI.

Pregnancy causes significant hemodynamic changes within the circulatory system.  While these are considered essential for the health of the developing fetus, the changes place considerable stress on the expectant mother’s heart and lower extremity veins. 

Chronic venous insufficiency (CVI), marked by varicose veins, pain, edema, itching, skin discoloration, night cramps and heaviness are all common, particularly during the third trimester.  Venous thromboembolism (VTE) and pulmonary embolism (PE) affects pregnant women nearly five times more than non-pregnant women.  In fact, VTE is the number one cause of maternal death in developing countries.

With regards to the hemodynamic and physiologic changes, the review reveals pregnancy:

• Decreases systemic vascular resistance
• Increases heart rate
• Increases cardiac output
• Decreases deep venous blood flow
• Increases deep vein diameters, and
• Induces a hypercoagulable state

Treatment strategies for primary CVI in pregnancy, which occurs in up to 80% of women, were reviewed and include indications for non-pharmacologic therapies (compression, reflexology, water emersion), and pharmacologic treatments (non-steroidal anti-inflammatory drugs, fondaparinux, and low-molecular-weight heparin).

With an incidence up to 7 per 1,000 pregnancies, acute VTE remains an important issue in pregnancy.  The authors provided a thorough review of VTE prevention during pregnancy, and VTE treatment during pregnancy (including indications for caval filters and management of iliofemoral thrombosis).

“It is important for physicians to comprehend the full extent of the hemodynamic factors that contribute to the increased risk of lower extremity venous disease as well as the most appropriate and effective evidence-based management options,” stated Dr. Heller.  “While prophylaxis and treatment of VTE has been extensively studied in pregnancy, further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and fetus.” 

She also hopes that future randomized trials will evaluate treatment strategies to relieve symptoms associated with chronic venous insufficiency during pregnancy.

Complete understanding of these issues helps physicians prepare their patients for these eventualities during pregnancy and treat venous complications effectively. 

To download the complete article, open access through April 30, click here.  

A new review of the literature on chronic venous insufficiency in pregnant women reveals considerable guidance for their treatment. CVI occurs in up to 80% of pregnant women, while around 7 of every 1,000 pregnant mothers face venous thromboembolism and pulmonary embolism.

As reported in the March edition of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, clinicians from Johns Hopkins Hospital and the Greater Baltimore Medical Center led by vascular surgeon Dr. Jennifer Heller, analyzed 80 studies related to pregnancy, VTE and CVI.

Pregnancy causes significant hemodynamic changes within the circulatory system.  While these are considered essential for the health of the developing fetus, the changes place considerable stress on the expectant mother’s heart and lower extremity veins. 

Chronic venous insufficiency (CVI), marked by varicose veins, pain, edema, itching, skin discoloration, night cramps and heaviness are all common, particularly during the third trimester.  Venous thromboembolism (VTE) and pulmonary embolism (PE) affects pregnant women nearly five times more than non-pregnant women.  In fact, VTE is the number one cause of maternal death in developing countries.

With regards to the hemodynamic and physiologic changes, the review reveals pregnancy:

• Decreases systemic vascular resistance
• Increases heart rate
• Increases cardiac output
• Decreases deep venous blood flow
• Increases deep vein diameters, and
• Induces a hypercoagulable state

Treatment strategies for primary CVI in pregnancy, which occurs in up to 80% of women, were reviewed and include indications for non-pharmacologic therapies (compression, reflexology, water emersion), and pharmacologic treatments (non-steroidal anti-inflammatory drugs, fondaparinux, and low-molecular-weight heparin).

With an incidence up to 7 per 1,000 pregnancies, acute VTE remains an important issue in pregnancy.  The authors provided a thorough review of VTE prevention during pregnancy, and VTE treatment during pregnancy (including indications for caval filters and management of iliofemoral thrombosis).

“It is important for physicians to comprehend the full extent of the hemodynamic factors that contribute to the increased risk of lower extremity venous disease as well as the most appropriate and effective evidence-based management options,” stated Dr. Heller.  “While prophylaxis and treatment of VTE has been extensively studied in pregnancy, further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and fetus.” 

She also hopes that future randomized trials will evaluate treatment strategies to relieve symptoms associated with chronic venous insufficiency during pregnancy.

Complete understanding of these issues helps physicians prepare their patients for these eventualities during pregnancy and treat venous complications effectively. 

To download the complete article, open access through April 30, click here.  

A new review of the literature on chronic venous insufficiency in pregnant women reveals considerable guidance for their treatment. CVI occurs in up to 80% of pregnant women, while around 7 of every 1,000 pregnant mothers face venous thromboembolism and pulmonary embolism.

As reported in the March edition of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, clinicians from Johns Hopkins Hospital and the Greater Baltimore Medical Center led by vascular surgeon Dr. Jennifer Heller, analyzed 80 studies related to pregnancy, VTE and CVI.

Pregnancy causes significant hemodynamic changes within the circulatory system.  While these are considered essential for the health of the developing fetus, the changes place considerable stress on the expectant mother’s heart and lower extremity veins. 

Chronic venous insufficiency (CVI), marked by varicose veins, pain, edema, itching, skin discoloration, night cramps and heaviness are all common, particularly during the third trimester.  Venous thromboembolism (VTE) and pulmonary embolism (PE) affects pregnant women nearly five times more than non-pregnant women.  In fact, VTE is the number one cause of maternal death in developing countries.

With regards to the hemodynamic and physiologic changes, the review reveals pregnancy:

• Decreases systemic vascular resistance
• Increases heart rate
• Increases cardiac output
• Decreases deep venous blood flow
• Increases deep vein diameters, and
• Induces a hypercoagulable state

Treatment strategies for primary CVI in pregnancy, which occurs in up to 80% of women, were reviewed and include indications for non-pharmacologic therapies (compression, reflexology, water emersion), and pharmacologic treatments (non-steroidal anti-inflammatory drugs, fondaparinux, and low-molecular-weight heparin).

With an incidence up to 7 per 1,000 pregnancies, acute VTE remains an important issue in pregnancy.  The authors provided a thorough review of VTE prevention during pregnancy, and VTE treatment during pregnancy (including indications for caval filters and management of iliofemoral thrombosis).

“It is important for physicians to comprehend the full extent of the hemodynamic factors that contribute to the increased risk of lower extremity venous disease as well as the most appropriate and effective evidence-based management options,” stated Dr. Heller.  “While prophylaxis and treatment of VTE has been extensively studied in pregnancy, further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and fetus.” 

She also hopes that future randomized trials will evaluate treatment strategies to relieve symptoms associated with chronic venous insufficiency during pregnancy.

Complete understanding of these issues helps physicians prepare their patients for these eventualities during pregnancy and treat venous complications effectively. 

To download the complete article, open access through April 30, click here.  

Physicians should consider prescribing high-dose angiotensin inhibitors for patients with chronic limb-threatening ischemia (CLTI), a recent study from Harvard University suggests.

The report was published in the March edition of the Journal of Vascular Surgery by researchers from the Division of Vascular and Endovascular Surgery from the Beth Israel Deaconess Medical Center led by vascular surgeon Dr. Marc Schermerhorn.

The team conducted a retrospective review of 1,161 patients between 2005 and 2014 and evaluated the effect of renin-angiotensin system (RAS) inhibition on mortality in patients undergoing revascularization (both endovascular and surgical bypass) for CLTI.

In this population, RAS inhibition resulted in: 
•    Reduced mortality (67% versus 54% survival at three years)
•    Lower 30-day myocardial infarction (1.6% versus 4.3%)
•    No difference in major adverse limb events, amputation, or reinterventions

“These benefits were restricted to those prescribed high-dose RAS inhibition, and not realized in those on lower doses,” noted first author Dr. Thomas Bodewes.  As such, the authors recommend that, “physicians should strive to maintain patients on high-dose RAS inhibition, provided that such doses are tolerated in terms of blood pressure.”
Patients with CLTI are heavily burdened with atherosclerosis, which affects nearly all important vascular beds, including the cerebral, coronary, peripheral, renal and mesenteric circulatory systems.
 
A growing body of evidence suggests that renin-angiotensin system (RAS) inhibition has multiple cardiovascular benefits including:
•    Blood pressure control
•    Decrease in preload and afterload
•    Stabilization of plaque
•    Inhibition of smooth muscle proliferation
•    Improved vascular endothelial function
•    Reduced ventricular hypertrophy
•    Enhanced fibrinolysis

Despite this evidence, questions remain. The authors note that this was a retrospective single institution review and despite adjustment for multiple variables, the association between RAS inhibitor use and long-term outcomes may be confounded by other factors including some that were unmeasured. 
There are relatively modest number of non-white patients, and actual use of the medications beyond hospital discharge among the study patients is unknown. There are potential side effects to the use of RAS inhibitors that providers must consider in the dosing of these medications. Larger confirmatory studies are needed to confirm these findings and strengthen the evidence.

ClIck here to read the full-article, which is free to non-subscribers until April 30.

Physicians should consider prescribing high-dose angiotensin inhibitors for patients with chronic limb-threatening ischemia (CLTI), a recent study from Harvard University suggests.

The report was published in the March edition of the Journal of Vascular Surgery by researchers from the Division of Vascular and Endovascular Surgery from the Beth Israel Deaconess Medical Center led by vascular surgeon Dr. Marc Schermerhorn.

The team conducted a retrospective review of 1,161 patients between 2005 and 2014 and evaluated the effect of renin-angiotensin system (RAS) inhibition on mortality in patients undergoing revascularization (both endovascular and surgical bypass) for CLTI.

In this population, RAS inhibition resulted in: 
•    Reduced mortality (67% versus 54% survival at three years)
•    Lower 30-day myocardial infarction (1.6% versus 4.3%)
•    No difference in major adverse limb events, amputation, or reinterventions

“These benefits were restricted to those prescribed high-dose RAS inhibition, and not realized in those on lower doses,” noted first author Dr. Thomas Bodewes.  As such, the authors recommend that, “physicians should strive to maintain patients on high-dose RAS inhibition, provided that such doses are tolerated in terms of blood pressure.”
Patients with CLTI are heavily burdened with atherosclerosis, which affects nearly all important vascular beds, including the cerebral, coronary, peripheral, renal and mesenteric circulatory systems.
 
A growing body of evidence suggests that renin-angiotensin system (RAS) inhibition has multiple cardiovascular benefits including:
•    Blood pressure control
•    Decrease in preload and afterload
•    Stabilization of plaque
•    Inhibition of smooth muscle proliferation
•    Improved vascular endothelial function
•    Reduced ventricular hypertrophy
•    Enhanced fibrinolysis

Despite this evidence, questions remain. The authors note that this was a retrospective single institution review and despite adjustment for multiple variables, the association between RAS inhibitor use and long-term outcomes may be confounded by other factors including some that were unmeasured. 
There are relatively modest number of non-white patients, and actual use of the medications beyond hospital discharge among the study patients is unknown. There are potential side effects to the use of RAS inhibitors that providers must consider in the dosing of these medications. Larger confirmatory studies are needed to confirm these findings and strengthen the evidence.

ClIck here to read the full-article, which is free to non-subscribers until April 30.

Physicians should consider prescribing high-dose angiotensin inhibitors for patients with chronic limb-threatening ischemia (CLTI), a recent study from Harvard University suggests.

The report was published in the March edition of the Journal of Vascular Surgery by researchers from the Division of Vascular and Endovascular Surgery from the Beth Israel Deaconess Medical Center led by vascular surgeon Dr. Marc Schermerhorn.

The team conducted a retrospective review of 1,161 patients between 2005 and 2014 and evaluated the effect of renin-angiotensin system (RAS) inhibition on mortality in patients undergoing revascularization (both endovascular and surgical bypass) for CLTI.

In this population, RAS inhibition resulted in: 
•    Reduced mortality (67% versus 54% survival at three years)
•    Lower 30-day myocardial infarction (1.6% versus 4.3%)
•    No difference in major adverse limb events, amputation, or reinterventions

“These benefits were restricted to those prescribed high-dose RAS inhibition, and not realized in those on lower doses,” noted first author Dr. Thomas Bodewes.  As such, the authors recommend that, “physicians should strive to maintain patients on high-dose RAS inhibition, provided that such doses are tolerated in terms of blood pressure.”
Patients with CLTI are heavily burdened with atherosclerosis, which affects nearly all important vascular beds, including the cerebral, coronary, peripheral, renal and mesenteric circulatory systems.
 
A growing body of evidence suggests that renin-angiotensin system (RAS) inhibition has multiple cardiovascular benefits including:
•    Blood pressure control
•    Decrease in preload and afterload
•    Stabilization of plaque
•    Inhibition of smooth muscle proliferation
•    Improved vascular endothelial function
•    Reduced ventricular hypertrophy
•    Enhanced fibrinolysis

Despite this evidence, questions remain. The authors note that this was a retrospective single institution review and despite adjustment for multiple variables, the association between RAS inhibitor use and long-term outcomes may be confounded by other factors including some that were unmeasured. 
There are relatively modest number of non-white patients, and actual use of the medications beyond hospital discharge among the study patients is unknown. There are potential side effects to the use of RAS inhibitors that providers must consider in the dosing of these medications. Larger confirmatory studies are needed to confirm these findings and strengthen the evidence.

ClIck here to read the full-article, which is free to non-subscribers until April 30.

Through the Leadership Development and Diversity Committee, the SVS continues its strong commitment to leadership development in women. The Women's Leadership Training Grant seeks to identify female surgeons who want to sharpen their leadership skills. A $5,000 award will defray costs for travel, hotel accommodations and registration expenses to attend relevant courses and/or other leadership training opportunities and activities. Application deadline is March 14.

Through the Leadership Development and Diversity Committee, the SVS continues its strong commitment to leadership development in women. The Women's Leadership Training Grant seeks to identify female surgeons who want to sharpen their leadership skills. A $5,000 award will defray costs for travel, hotel accommodations and registration expenses to attend relevant courses and/or other leadership training opportunities and activities. Application deadline is March 14.

Through the Leadership Development and Diversity Committee, the SVS continues its strong commitment to leadership development in women. The Women's Leadership Training Grant seeks to identify female surgeons who want to sharpen their leadership skills. A $5,000 award will defray costs for travel, hotel accommodations and registration expenses to attend relevant courses and/or other leadership training opportunities and activities. Application deadline is March 14.

The SVS and American Venous Forum seek to update their joint clinical practice guidelines on the care of patients with varicose veins and associated chronic venous diseases (pdf of full text here). This update will address new research and advances in care since the original guidelines were published in 2011.

The SVS Document Oversight Committee seeks current SVS members with significant relevant practice and research experience to participate. All interested members must complete a conflict of interest disclosure for 2018-2019 to be considered. The SVS requires each volunteer to disclose all relevant financial relationships with commercial interests within the past 12 months. Please indicate your interest here by March 1.

The SVS and American Venous Forum seek to update their joint clinical practice guidelines on the care of patients with varicose veins and associated chronic venous diseases (pdf of full text here). This update will address new research and advances in care since the original guidelines were published in 2011.

The SVS Document Oversight Committee seeks current SVS members with significant relevant practice and research experience to participate. All interested members must complete a conflict of interest disclosure for 2018-2019 to be considered. The SVS requires each volunteer to disclose all relevant financial relationships with commercial interests within the past 12 months. Please indicate your interest here by March 1.

The SVS and American Venous Forum seek to update their joint clinical practice guidelines on the care of patients with varicose veins and associated chronic venous diseases (pdf of full text here). This update will address new research and advances in care since the original guidelines were published in 2011.

The SVS Document Oversight Committee seeks current SVS members with significant relevant practice and research experience to participate. All interested members must complete a conflict of interest disclosure for 2018-2019 to be considered. The SVS requires each volunteer to disclose all relevant financial relationships with commercial interests within the past 12 months. Please indicate your interest here by March 1.

The SVS Patient Safety Organization and the SVS Quality and Performance Measures Committee (QPMC) will hold a webinar at 8 p.m. Eastern Standard Time, Thursday, Feb. 15. It will help unravel the new Quality Payment Program (QPP) under Medicare, including what surgeons still can do for 2017 to avoid reimbursement penalties. Learn more here and register here.

The SVS Patient Safety Organization and the SVS Quality and Performance Measures Committee (QPMC) will hold a webinar at 8 p.m. Eastern Standard Time, Thursday, Feb. 15. It will help unravel the new Quality Payment Program (QPP) under Medicare, including what surgeons still can do for 2017 to avoid reimbursement penalties. Learn more here and register here.

The SVS Patient Safety Organization and the SVS Quality and Performance Measures Committee (QPMC) will hold a webinar at 8 p.m. Eastern Standard Time, Thursday, Feb. 15. It will help unravel the new Quality Payment Program (QPP) under Medicare, including what surgeons still can do for 2017 to avoid reimbursement penalties. Learn more here and register here.

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

“BLACK PATIENTS PRESENT WITH MORE SEVERE VASCULAR DISEASE AND A GREATER BURDEN OF RISK FACTORS THAN WHITE PATIENTS AT TIME OF MAJOR VASCULAR INTERVENTION.” Journal of Vascular Surgery, February 2018.

African Americans come into the vascular operating room with significant co-morbidities that may explain their more severe level of disease and higher risk factors, report researchers who reviewed 76,000 vascular cases for their report in the February edition of the Journal of Vascular Surgery.

This study drills deeper into the severity of vascular disease in African Americans, adding more fuel to the discussion of health disparities between racial and ethnic groups explored by the American Medical Association, which found that minorities are less likely to receive routine medical care and face higher rates of morbidity and mortality than non-minorities.

Invited commentator Dr. William R. Flinn found the study so profound he stated, “It should be read by every vascular surgeon, in fact, by every physician.”

Researchers have observed similar outcomes in vascular surgical procedures, but determining the cause of these disparities is difficult, since databases do not provide detail on disease severity.

For this report, a multi-institutional team of vascular surgeons led by vascular surgeon Dr. Marc Schermerhorn from Beth Israel Deaconess Medical Center took direct aim at this problem. Using de-identified data from the Vascular Quality Initiative gathered between 2009 and 2014, they found that compared to white patients, black patients were:

• Younger
• More likely to smoke
• More often diagnosed with insulin-dependent diabetes, hypertension, congestive heart failure and end-stage renal disease
• Less often medicated with statins
• Less often insured

Black patients also were sicker at the time of surgery. Compared with whites, black patients had more severe:

• Carotid disease (36% versus 31% symptomatic lesions)
• AAA (27% versus 16% symptoms/rupture, and more iliac aneurysm)
• PAD (73% versus 62% critical limb ischemia)

Furthermore, black patients were less likely to be discharged on aspirin and statin therapy after treatment for AAA and PAD than whites.

The authors note that their study is limited by factors common to all database studies including missing data, variability in definitions, and no way to adjust for socio-economic factors, compliance, family support, hospital type and timing of referral.

“Even in hospitals invested in quality improvement – as evidenced by participation in the VQI – black patients present with more advanced disease and more comorbidities compared with whites, despite presenting at a younger age,” states first author Dr. Peter Soden.  “And these disparities were uniform across the spectrum of vascular disease, including carotids, AAA and PAD.” 

The increase in presenting risk factors, along with disparity in medical management, offers clues as to the well-reported worse outcomes for black patients after major vascular procedures.

“The majority of the disparities highlighted in this manuscript are not from biologic differences, but instead from social, economic and health care delivery factors,” noted Dr. Flinn. “What this most clearly suggests is that there are untold numbers of black [patients] throughout the country with undiagnosed and untreated carotid disease, abdominal aortic aneurysm and PAD (and hypertension, and diabetes, and chronic kidney disease) because they do not have equitable access to health care in the United States in the 21^st century.

“The vascular community has a unique opportunity to contribute to the health care debate in this country,” he added. “I hope we have both the scientific rigor and the political courage to pursue it aggressively.”

To download the complete article (freely available Jan.  22 - March 31), click: vsweb.org/JVS-Severe.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

Applications are due March 2 for the Wylie Scholar Award, co-sponsored by the SVS Foundation and Vascular Cures. The three-year, $150,000 grant is awarded to a promising vascular surgeon-scientist in North America and is designed to support outstanding surgeon-scientists conducting innovative academic research in the early stages of their careers.

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!

SVS members, please remind any vascular PAs with whom you work to consider submitting an abstract for the inaugural PA programming or be a speaker during our 2018 Vascular Annual Meeting. More information is here -- please forward to your PAs!