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Background US black and Hispanic populations are growing at a steady pace. In contrast, the medical profession lacks the same minority growth and representation. Women are also under-represented in many surgical disciplines. The purpose of this study was to assess trends in the proportion of women, blacks and Hispanics admitted to vascular surgery (VS) and related specialties, and to compare them to each other and to a surgical specialty, orthopedic surgery (OS), with a formal diversity initiative. Methods Data on the fellowship pool of VS, interventional radiology (IR), and interventional cardiology (IC), as well as the resident pools of general surgery (GS) and orthopedic surgery (OS) were obtained from US graduate medical education reports for 1999 through 2005. Cochrane-Armitage trend tests were used to assess trends in the proportion of females, blacks and Hispanics in relation to the total physician workforce for each subspecialty. Results No significant trends in the proportion of females, blacks or Hispanics accepted into VS and IC fellowship programs occurred during the study period. In contrast, IR, GS, and OS programs revealed significant trends for increasing proportions of at least one of the underrepresented study groups. In particular, OS, which has implemented a diversity awareness program, showed a positive trend in female and Hispanic trainees (P < .04 and P <.02, respectively). Blacks showed a significant increasing trend only in IR (P =.05). Conversely, a positive trend toward continued growth in the Hispanic group was seen in GS (P <.001), IR and OS (P =.04 and P =0.02, respectively). Conclusions The racial/ethnic and gender composition of the physician trainee pool in vascular specialties, particularly VS, has not matched the increasing growth of underrepresented groups in the US population of patients with vascular disease. Formal programs to recruit qualified women and minorities appear successful in increasing workforce diversity.

Peripheral arterial disease (PAD) is a highly prevalent public health problem associated with major detrimental effects on quality of life and functional status, and it is also the main cause of limb amputation. More importantly, PAD has been classified as a coronary artery disease equivalent, meaning that patients with a diagnosis of PAD carry a risk for major coronary events equal to that of established coronary artery disease. PAD is also a potent predictor of stroke and death. Despite its frequent occurrence (8 to 10 million Americans are affected), little is known about the natural history of PAD in racial/ethnic minorities, particularly in Hispanics, who represent 12.5% of the United States population. Furthermore, the disease is commonly underdiagnosed and undertreated in this minority group, and outcomes are poorer in Hispanics as compared with whites. Limited access to health care, difficulties for recruitment in population-based studies, and limitations of the noninvasive screening tests are well-established barriers to determine the prevalence and natural history of PAD in Hispanics. Although the most widely used test for assessment of patients at risk for PAD is the ankle-brachial index (ABI), the test has substantial limitations in individuals with diabetes and arterial calcification, which are highly prevalent in Hispanics. The ABI should, therefore, be supplemented by the use of other noninvasive tests, such as the pulse volume recordings (PVR) and toe-brachial index. Besides the use of a combination of diagnostic techniques, the implementation of a research methodology that improves recruitment of Hispanics in population-based studies is necessary to obtain better knowledge of the epidemiology of the disease in this group. Community-based participatory research may be the most appropriate approach to study this ethnic minority because it overcomes barriers for limited access to health care and increases the possibility of overcoming distrust of research on the part of communities. Understanding the epidemiology of PAD to improve its detection and treatment among Hispanics is relevant to reduce disparities in the health status of this group, the most rapidly growing ethnic minority in the United States.

antegrade approach. Routine anticoagulation and dual-antiplatelet therapy was used peri-procedurally. Antegrade access was used to treat any lesion that required a stent placement, after the retrograde wire was snared and brought through the antegrade guide catheter. Patient indications and comorbidities were recorded; outcomes analyzed were limb salvage rate, peri-procedural complications and mortality. Mean and standard deviations were calculated; Kaplan-Meier was used to calculate limb salvage rates. Results: A review all lower extremity interventional angiograms from July 2010 thru August 2013 (n ¼ 764) identified 13 cases in which a retrograde pedal access was performed (mean age was 71.4 6 12.4 years, 9 men). There was high prevalence of diabetes (77%; 10/13), chronic renal insufficiency (stages III-V; 69%, 9/13), and previous contralateral major amputation (38%; 5/13). Indications for a retrograde pedal revascularization were Rutherford chronic limb ischemia class IV (15%; 2/13) and class V (85%; 11/13). Technical success rate was 69% (9/13); a variety of popliteal (2/13) and tibial (13/13) vessels were intervened with angioplasty alone (10/13) via a retrograde approach and with angioplasty/stent placement (3/13). The technical failures were due to inability to cross the occlusion(s). Periprocedurally, there was one myocardial infarction, no local complications, worsening renal insufficiency or deaths. At a mean follow-up of 13.4 6 10.3 months, the limb salvage rate was 77% (10/13) (Fig). There was a high mortality rate on follow-up in this cohort (23%; 3/13) occurring at median 6 6 4 months. Conclusions: Retrograde pedal access for limb salvage in high-risk patients is feasible and safe with acceptable limb salvage rates at intermediate follow-up. Appropriate candidates are those who have failed an antegrade intervention and are poor candidates for a tibial bypass. Future studies should test whether this mode of revascularization has favorable limb salvage rates in larger patient populations.

The congenital absence of the inferior vena cava (AIVC) is a rare condition affecting any portion of the infrahepatic IVC. Most confirmed patients are male, with unilateral or bilateral deep vein thrombosis (DVT) involving the iliac and femoral veins. AIVC is typically diagnosed by computed tomography (CT) or magnetic resonance imaging after an abnormal lower extremity venous ultrasound study. The following case report involves a 30-year-old man who developed a unilateral iliofemoral DVT without known risk factors. CT scan confirmed the presence of DVT but failed to identify AIVC. Repeat ultrasound imaging identified the absence of the IVC and common iliac veins, which was confirmed by venogram.

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Aneurysms involving the third portion of the axillary artery and its branches have been reported in baseball pitchers and in other overhead-throwing athletes. The abnormality can vary from intermittent compression to axillary artery thrombosis and formation of an aneurysm. Patients presenting with symptoms secondary to an axillary artery injury, like upper extremity weakness, require rapid and precise diagnosis. Moreover, accurate identification of the arterial pathology helps guide necessary surgical therapy. Previous reports have made the diagnosis from physical examination, noninvasive studies, and additional, invasive studies, such as arteriography. In this case, a young healthy major league baseball pitcher was referred for hand numbness and a suspected axillary artery aneurysm. We were able to confirm the physical examination abnormalities with arterial duplex only and make an operative plan on the basis of the ultrasound findings.