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 and seek to identify specific patient populations who will benefit from this technique.

The TRA is a practical option with functional patency rates that are comparable to traditional approaches when intervening on a malfunctioning dialysis access in the appropriately selected patient. No hand ischemia was noted. This approach may be particularly attractive for treatment of juxta-anastomotic stenoses in a variety of AV accesses and offers unique practical advantages for the maintenance of AV accesses.

Hospital reimbursement for CAS is significantly higher than that for CEA. While both procedures created net positive income for the hospital, CEA was associated with a 29% higher net revenue due to the 40% cost premium of CAS when looking at all carotid procedures. However, proper DRG coding of CAS cases would have likely resulted in similar net revenue. Asymptomatic patients had the lowest cost and highest net revenue of all the subgroups. Per capita, significantly more healthcare resources were expended with CAS when compared to CEA. Given the lack of improved clinical outcome in most cases, CAS cannot be considered cost-effective for most patients.

rent critical limb ischemia, loss of secondary patency, and major amputation in those with primary occlusion were 55%, 79%, and 22%, respectively, compared with 18%, 10%, and 10% for the remaining cohort (P Ͻ .001). On univariate analysis (hazard ratio [HR] [95% confidence interval]), African American race (1.4 [1.01-1.9]), use of anticoagulants (1.54 [1.2-2]), use of alternative/spliced vein conduit (1.44 [1.1-1.97]) and graft diameter Ͻ3 mm (1.97 [1.2-3.3]) were associated with increased risk of primary occlusion. On multivariate analysis (HR [95% confidence interval]) graft diameter Ͻ3 mm (1.8 [1.1-3]) and use of anticoagulants (1.4 [1.04-1.89]) were independent predictors. In 110 individuals, DUS had revealed no critical threshold abnormalities prior to the thrombosis. On multivariate analysis, graft diameter Ͻ3 mm (2.3 [1.2-4.7]) was the sole independent predictor of these unheralded occlusions.Conclusions: Approximately one-third of primary vein graft events are occlusions even in the setting of DUS surveillance. Smaller diameter grafts are at increased risk. These findings suggest that prevention of vein graft thrombosis requires further improvements in risk stratification, surveillance, and antithrombotic therapies.

No abstract