Introduction The coronavirus disease 2019 (COVID-19) pandemic has led to widespread postponement and cancelation of elective surgeries in the United States. We designed and administered a global survey to examine the impact of COVID-19 on vascular surgeons. We describe the impact of the pandemic on the practices of Vascular Surgeons in the United States. Methods The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons is an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force disseminated April 14-24, 2020. This analysis focuses on pattern changes in vascular surgery practices in the United States including the inpatient setting, ambulatory, and vascular laboratory setting. Specific questions regarding occupational exposure to COVID-19, adequacy of personal protective equipment (PPE), elective surgical practice, changes in call schedule, and redeployment to non-vascular surgery duties were also included in the survey. Regional variation was assessed. The survey data were collected using REDCap and analyzed using descriptive statistics. Results A total of 535 vascular surgeons responded to the survey from 45 states. Most of the respondents were male (73.1%), White (70.7%), practiced in urban settings (81.7%), and in teaching hospitals (66.8%). Almost half were in hospitals with greater than 400 beds (46.4%). There was no regional variation in the presence of pre-operative COVID-19 testing, COVID-19 OR protocols, adherence to national surgical standards, and the presence of PPE. The overwhelming majority of respondents (91.7%) noted elective surgery cancellation, with the Northeast and Southeast regions having the most case cancellations 94.2% and 95.8% respectively %). The Northeast region reported the highest percentage of operations/procedures on patients with COVID-19, which was either identified at the time of the surgery or later in the hospital course (82.7%). Ambulatory visits were performed via telehealth (81.3%), with 71.1% having restricted hours. Over half of OBLs were closed, although there was regional variation with over 80% in the Midwest being closed. Cases performed in OBLs focused on critical limb ischemia (42.9%) and dialysis access maintenance (39.9%). Call schedules modifications were common, although the number of call days remained the same (45.8%). Conclusions Vascular surgeons in the United States report substantial impact on their practices during the COVID-19 pandemic, and regional variations are demonstrated - particularly in OBL utilization, ICU bed availability, and COVID-19 exposure at work.

In patients with claudication, open surgery, endovascular therapy, and exercise therapy were superior to medical management in terms of walking distance and claudication. Choice of therapy should rely on patients' values and preferences, clinical context, and availability of operative expertise.

The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

Duodenal perforation caused by IVC filters is a rare complication that frequently requires extensive workup. Excellent outcomes with low complication rate have been reported in cases where an open procedure was performed with either extraction of the filter or removal of the offending struts.

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Introduction The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges for health care systems globally. We designed and administered a global survey to examine the impact of COVID-19 on vascular surgeons and explore the COVID-19 related stressors faced, coping strategies employed, and support structures available Methods The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons is an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Committee. The survey analysis evaluates the impact of COVID-19 related stressors on vascular surgeons as measured by the Generalized Anxiety Disorder 7-item (GAD-7) scale. The 28-item Brief Coping Orientation to Problems Experienced (Brief-COPE) inventory was used to assess the active and avoidant coping strategies. Survey data were collected using REDCap between 4/14/2020 and 4/24/2020 inclusive. Additional qualitative data were collected using open-ended questions. Univariable and multivariable analysis of factors associated with anxiety levels and qualitative analysis were performed. Results A total of 1,609 survey responses (70.5% male, 82.5% Vascular Surgeons in Practice) from 58 countries (43.4% United States, 43.4% Brazil) were eligible for analysis. Some degree of anxiety was reported by 54.5% of the respondents and 23.3% reported moderate or severe anxiety. Most respondents (∼60%) used active coping strategies and the avoidant coping strategy “self-distraction and 20% used other avoidant coping strategies. Multivariable analysis identified the following factors as significantly associated with increased self-reported anxiety levels: staying in a separate room at home or staying at the hospital/hotel after work (OR 1.39 (95%CI 1.08-1.79), donning/doffing personal protective equipment (OR 1.81, 95%CI 1.41-2.33), worry about potential adverse patient outcomes due to care delay (OR 1.47, 95%CI 1.16-1.87), and financial Concerns (OR 1.90, 95%CI 1.49-2.42). Factors significantly associated with decreased self-reported anxiety levels were hospital support (OR 0.83, 95%CI 0.76-0.91) and use of positive reframing as an active coping strategy (OR 0.88, 95%CI 0.81-0.95). Conclusions Vascular surgeons globally are experiencing multiple COVID-19 related stressors during this devastating crisis. These findings highlight the continued need for hospital systems to support their vascular surgeons and the importance of national societies to continue to invest in peer support programs as paramount to promoting the well-being of vascular surgeons during and after the COVID-19 pandemic.

The advent of duplex ultrasound (DU) has changed vascular practice over the years. Venous anatomy, valve function and obstruction can be evaluated in real time using DU. It is a low cost, portable, non-invasive, safe and operator-friendly device that can be used for diagnosis, treatment guidance and follow-up. This paper defines the patterns, location and characteristics of venous reflux and also provides insightful information on acute and chronic venous obstruction.