Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours.

Objective Although cilostazol is commonly used as an adjunct after peripheral vascular interventions, its efficacy remains uncertain. We assessed the effect of cilostazol on outcomes after peripheral vascular interventions using meta-analytic techniques. Methods We searched MEDLINE (1946–2012), Cochrane CENTRAL (1996–2012), and trial registries for studies comparing cilostazol in combination with antiplatelet therapy to antiplatelet therapy alone after peripheral vascular interventions. Treatment effects were reported as pooled risk/hazard ratio (HR) with random-effects models. Results Two randomized trials and four retrospective cohorts involving 1522 patients met inclusion criteria. Across studies, mean age ranged from 65 to 76 years, and the majority of patients were male (64%–83%); mean follow-up ranged from 18 to 37 months. Most interventions were in the femoropopliteal segment, and overall, 68% of patients had stents placed. Fooled estimates demonstrated that the addition of cilostazol was associated with decreased restenosis (relative risk [RR], 0.71; 95% confidence interval [CI], 0.60–0.84; P < .001), improved amputation-free survival (HR, 0.63; 95% CI, 0.47–0.85; P = .002), improved limb salvage (HR, 0.42; 95% CI, 0.27–0.66; P < .001), and improved freedom from target lesion revascularization (RR, 1.36; 95% CI, 1.14–1.61; P < .001). There was no significant reduction in mortality among those receiving cilostazol (RR, 0.73; 95% CI, 0.45–1.19; P = .21). Conclusions The addition of cilostazol to antiplatelet therapy after peripheral vascular interventions is associated with a reduced risk of restenosis, amputation, and target lesion revascularization in our meta-analysis of six studies. Consideration of cilostazol as a medical adjunct after peripheral vascular interventions is warranted, presuming these findings are broadly generalizable.

Percutaneous axillary artery access is a viable strategy to facilitate complex endovascular interventions. This technique avoids the need for brachial or axillary artery exposure and allows larger sheath sizes because of the caliber of the axillary artery. There were no major neurologic or ischemic complications. This technique is a relatively safe and practical alternative to approaches involving exclusively femoral and brachial access.

participants. Resident-specific spatio-temporal pollution concentration models, incorporating community specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM [2][3][4][5] and NO x between 1999 and 2012. The primary aim was to examine the association between progression of coronary artery calcium and mean carotid artery intima-media thickness in long term exposure to ambient air pollutant concentrations (PM [2][3][4][5] , NO x , and black carbon) between examinations and within the 6 metropolitan areas adjusting for baseline age, sex, ethnicity, socio-economic characteristics, cardiovascular risk factors, site, and CT scanner technology. 4).Comment: PM 2-5 air pollutant particles are particles less than 2.5 mm in diameter, commonly referred to as fine particles and believed to pose the greatest health risk from air pollution because their small size allows them to be inhaled deeply. Primary sources are motor vehicles, power plants, wood burning, and some industrial processes. In this study the authors adjusted for outdoor concentrations of PM 2-5 particles according to time spent indoors and infiltration of particles into the home. However, full characterization of time-location patterns in indoor exposures is difficult and a potential weakness of the study. Nevertheless, the data suggests an accrued relationship between acceleration of atherosclerosis and ambient air pollution, particularly air pollution particles generated by human activity. Pregnancy and the Risk of Aortic Dissection or Conclusion:There is an elevated risk of aortic rupture or dissection during pregnancy and in the postpartum period.Summary: There is an increased risk of vascular events during pregnancy and several months into the postpartum period; particularly venous thromboembolism, myocardial infarction and stroke (Kamel H et al, N Engl J Med 2014;370:1307-15). There have also been case reports that suggest pregnancy may trigger aortic dissection or rupture (Kinney TD et al, Am J Med Sci 1945; 210:725-32). Aortic complications in pregnancy have been described with Marfan syndrome, Loeys-Dietz syndrome, type 4 Ehlers-Danlos syndrome, Turner syndrome and bicuspid aortic valves. Other than case series, however, there are few population based data to support an association between pregnancy and aortic complications. The authors decided to better assess the relationship between pregnancy and aortic complications by performing a cohortcrossover analysis in a large population-based sample of patients. They utilized data from all emergency department visits and acute care hospitalizations in non-Federal healthcare facilities in California, Florida and New York. Included patients included women $12 years of age with labor and delivery or an aborted pregnancy outcome between 2005 and 2013. Primary outcome of this study was a composite of aortic dissection or rupture. Based on the timing of the reported aortic complications during pregnancy the authors defined a period of risk as 6 months befor...

Regionalization of r-AAA repair to centers equipped for both r-EVAR and r-OSR decreased mortality by approximately 20%. Transfer did not impact the mortality of r-EVAR at the tertiary center. Care of r-AAA in the US should be centralized to centers equipped with available technology and vascular surgeons.