SSI after LEB is associated with an increase in rate of amputation and reoperation. Several patient, operative, and hospital-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve vascular patient outcomes.

A vascular surgery practice can benefit from office-based procedures. Procedures can be done safely. It results in an increase in the number of percutaneous procedures and revenue with a significant savings to the health care system. Surgeons can control their schedule. Every vascular surgeon should consider doing these procedures in office.

When appropriately screened, almost all peripheral interventions can be performed in the office with minimal complications. For dialysis patients, outpatient intervention has a very low complication rate and is the mainstay of treatment to keep the dialysis access patent. Venous insufficiency, when managed in the office setting, also has a low complication rate. Office-based procedural settings should be seriously considered for percutaneous interventions for arterial, venous, and dialysis-related procedures.

Objectives: Outcomes of patients undergoing reintervention for restenosis after prior ipsilateral carotid endarterectomy (CEA) in the era of carotid stenting (CAS) are unclear. We assessed perioperative results and durability of CAS and CEA in symptomatic (SX) and asymptomatic (ASX) patients undergoing reintervention.Methods: Patients undergoing CAS and CEA were identified in the Vascular Study Group of New England (VSGNE) between January 2003 and November 2011. Demographics, preoperative risk factors, 30-day outcome (stroke/death), cranial nerve injury, and restenosis Ն50% at follow-up were compared across primary procedures and reinterventions (CAS vs CEA). Fisher exact test or 2 test were used to analyze significance differences (P Ͻ .05) between the different groups.Results: Of a total of 9357 CEA procedures (33% SX), 212 patients (2.3%) underwent redo CEA (36% SX). Of 663 CAS procedures (34% SX), 220 patients (33%) underwent CAS after prior ipsilateral CEA (31% SX). Demographics of patients undergoing CAS after prior CEA were comparable to patients undergoing redo CEA. Forty percent of CAS patients had at least one medical high-risk factor for CEA. Asymptomatic patients undergoing redo CEA had a significantly higher stroke/death risk (3.0%) than primary CEA (0.9%), but equivalent to CAS after prior CEA (2.0%; Table ). No difference in perioperative cranial nerve injury was identified between redo CEA and primary CEA (5.2% vs 4.7%). Follow-up was available for 56.7% of CAS (median, 254 days) and 68% of CEA patients (median, 370 days). Redo CEA had higher rates of Ն50% restenosis than primary CEA (14.8% vs 9.8%, P ϭ .06); there was no significant difference between CAS after prior CEA (17.2%) compared with redo CEA (14.8%, P ϭ .62) and primary CAS (18.6%, P ϭ .73).Conclusions: In the VSGNE, CEA and CAS showed equivalent outcome (30-day stroke/death risk and restenosis) in ASX and SX patients treated for restenosis after prior ipsilateral CEA. However, regardless of procedure, the risk of reintervention was increased compared with patients undergoing primary CEA.

Preoperative cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.