Preoperative sarcopenia does not appear to affect length of stay but does portend worse long-term survival. This simple preoperative measurement may help vascular surgeons tailor repair thresholds and avoid nonbeneficial procedures.

Of these patients, 21 (88%) had repair because of size criteria, and 15 (63%) had an aneurysm related complication that warranted surgery. Sixtythree aneurysms (72%) did not require an intervention during our study window. The mean initial diameter at diagnosis was 16.9 mm (15.8, 18.1). Forty-eight (55%) aneurysms developed thrombus within the PAA. The mean ankle-brachial index of the evaluated extremity at diagnosis was 1.0 (0.941, 1.053). Univariate analysis identified initial diameter (14.7 vs 19.2 mm; P ¼ .02), atrial fibrillation (16.0% vs 53.8%, P ¼ .042), and the presence of thrombus (33.3% vs 66.7%, P # .001) as predictors of diameter expansion greater than the mean. Using multivariate analysis of the univariate factors determined that only initial diameter (OR, 5.53; P ¼ .007) and the presence or development of thrombus (OR, 4.00; P ¼ .08,) maintained significance.Conclusions: Although the majority of patient comorbidities and risk factors provided no predictive value concerning the expansion rate of PAAs, several identified a significant difference. Patients presenting with an aneurysm at or greater than 20 mm, significant thrombus, or atrial fibrillation may need to be observed using more frequent scanning intervals than those without these risk factors. Further studies are required to validate these predictive PAA growth factors.

Objective: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. Methods: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twentythree of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.

Asymptomatic patients with isolated mesenteric artery dissection may be observed and followed up with intermittent imaging. Symptomatic patients tend to have longer dissections than asymptomatic patients. Symptomatic isolated mesenteric artery dissection without evidence of ischemia does not require anticoagulation and may be treated with antiplatelet therapy or observation alone.