Secured virtual visits can be conducted using commercially available hardware and software solutions. Synchronous telemedicine with point-of-care ultrasound is effective in evaluating common vascular conditions. Virtual care may be used for management of patients with chronic vascular disease.

Introduction The use of telemedicine services may be effective in the perioperative management of patients with varicose veins. Methods Over a seven-month period, patients with varicose veins were evaluated in the virtual clinic via two-way secure videoconferencing or the traditional clinic by the same physician provider. Data sources included institutional Vascular Quality Initiative registry and patient satisfaction surveys. Results Among a total of 121 patients with varicose veins who underwent endovenous catheter ablation of the saphenous vein, 20 patients (16.5%) chose the telemedicine clinic (Group A) and 101 patients (83.5%) chose the traditional clinic (Group B) for their perioperative management. Comparing Group A and Group B, the mean age was 59.2 ± 12.1 versus 59.6 ± 13.0, respectively ( p = 0.944); women were 75% versus 73.3%, respectively ( p = 0.872); African Americans comprised 5% versus 22.8%, while Caucasians comprised 95% versus 63%, respectively ( p = 0.049). Half of the telemedicine patients had multiple virtual visits for a total of 31 virtual encounters. Among telemedicine patients using SurveyMonkey®, 29 telemedicine encounters (93.5%) reported that their virtual visit is "Yes, definitely" or "Yes, somewhat" more convenient over traditional methods. All patients answered that they were able to communicate clearly with the provider, able to have their questions answered, and able to clearly hear and see the provider via telemedicine methods. Discussion Telemedicine services enable another means to deliver high-quality care for patients with venous disease in a safe and coordinated manner. Patients with varicose veins are highly satisfied with the use of telehealth services over the traditional healthcare delivery model.

Objective: There are limited data evaluating the impact of postoperative hyperglycemia in patients undergoing vascular procedures. This study evaluated the relationship of postoperative hyperglycemia to outcomes after lower extremity (LE) vascular procedures for peripheral artery disease. Methods: Patients with peripheral artery disease admitted for elective LE procedures between September 2008 and March 2014 were selected from the Cerner Health Facts database using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. We examined the relationship between characteristics of the index admission, postoperative hyperglycemia (>180 mg/dL), complications, infections, and 30-day readmission with c 2 analysis. A multivariable logistic model was used to examine the association of patient characteristics, procedure type, and postoperative hyperglycemia with infection. Results: Of 4067 patients, 3217 (79%) had optimal glucose control and 850 (21%) had hyperglycemia. On average, patients with postoperative hyperglycemia experienced longer hospital stays (5.7 vs 4.7 days; P < .0001), higher rates of postprocedure infection (21% vs 13%; P < .0001), and more acute complications (ie, fluid and electrolyte disorders, acute renal failure, postoperative respiratory complications, and posthemorrhagic anemia) than patients with optimal glucose control (Table). Overall 30-day readmission was 10.7% and was similar between groups (10.6% optimal vs 11.2% suboptimal; P ¼ .61). Subgroup analysis revealed similar findings for patients with and without diabetes. Multivariable logistic regression (adjusting for age, gender, race, procedure type, and diabetes) found that patients with hyperglycemia were 1.4 times as likely to have an infectious complication (odds ratio, 1.41; 95% confidence interval, 1.14-1.74) and were 1.9 times as likely to have an increased length of stay (odds ratio, 1.94; 95% confidence interval, 1.57-2.40). Conclusions: One in five patients had postoperative hyperglycemia after LE procedures. Postoperative hyperglycemia was associated with adverse events after LE vascular procedures in patients with and without diabetes, including infection and increased hospital utilization but not increased readmissions. Postoperative glucose management may represent an important quality marker for improving outcomes after vascular procedures.