Background. Up to 30% of patients presenting with ascending aortic disease are deemed inoperable. Ascending aortic endovascular repair provides an alternative option for these patients.Methods. From 2018 to 2019, 13 patients who were considered to have prohibitive risk for open ascending aortic repair underwent endovascular repair. Aortic disease included type A dissection (n [ 8), pseudoaneurysm (n [ 3), penetrating ulcer (n [ 3), and chronic aortic aneurysm (n [ 1). Ascending aortic stent placement with thoracic endovascular aortic repair was performed in 9 patients, endovascular cuff extension was inserted in 3, and in 1 patient endovascular coil embolization was undertaken. Preoperative and follow-up electrocardiogram-gated computed tomographic analysis was performed to compare the remodeling effect of the stent on the aorta. The median follow-up time was 13 months.Results. The stent graft was successfully implanted in all patients (100%). Operative mortality and stroke rate were 15% (2 of 13) and 8% (1 of 13), respectively. One patient required transcatheter aortic valve replacement for severe aortic insufficiency 5 months after ascending thoracic endovascular aortic repair. The location of the aortic pathologic process was in zone 0A in 2 patients, zone 0B in 7 patients, and zone 0C in 3 patients. No endoleak was observed after the ascending endovascular repair in 9 patients (70%). Follow-up computed tomographic scan analysis revealed a tendency of favorable aortic remodeling in the mid-ascending and descending aorta.Conclusions. Ascending aortic stent placement for ascending aortic disease is feasible and is associated with favorable aortic remodeling. Despite persistent perfusion to the false lumen in a subset of patients, there is minimal aortic dilation at short-term follow-up with excellent survival.

Objectives: To evaluate the clinical outcomes and perioperative complications associated with complete percutaneous decannulation of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) with the MANTA closure device.Methods: This is a retrospective analysis of a single surgeon consecutive series of 14 patients at a single center who underwent decannulation from VA-ECMO, 10 of whom underwent a percutaneous method of femoral cannula removal.Results: After a mean duration of VA-ECMO support of 7.4 AE 3.8 days, all 10 patients, with arterial cannulas ranging in size from 17 to 21 Fr, underwent percutaneous decannulation with the MANTA closure device, with immediate hemostasis. One patient had acute lower limb ischemia that was recognized intraoperatively and successfully treated with suction embolectomy. Two patients had a pseudoaneurysm at the distal perfusion catheter site recognized on perioperative imaging studies, one resolving with observation and the other necessitating thrombin injection. One patient had a hematoma that resolved with observation.Conclusions: Percutaneous decannulation from VA-ECMO using the MANTA largebore vascular closure device is feasible and results in immediate hemostasis with excellent angiographic results. (JTCVS Techniques 2021;6:75-81) MANTA closure device deployed for percutaneous closure of a femoral arterial cannulation site.

Developments in diagnosis and treatment have transformed the management of blunt thoracic aortic injuries (BTAIs). For patients in stable condition, treatment practice has shifted from early open repair to nonoperative management for low-grade lesions and routine delayed endovascular repair for more significant injuries. However, effective therapy depends on accurate staging of injury grade and stability to select patients for appropriate management. Recent developments in BTAI risk stratification enable lesion-specific management tailored to the patient and aortic lesion. This review summarizes advances in lesion assessment and treatment and proposes an integrated scheme for the modern management of BTAI.

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<p><strong>Objective: </strong>To evaluate racial differences in the burden of aortic dissection. </p><p><strong>Design: </strong>Retrospective analysis of a comprehensive state-wide inpatient database. <strong></strong></p><p><strong>Setting: </strong>Acute care hospitals in the state of Maryland, 2009 – 2014. </p><p><strong>Participants: </strong>All hospitalized adults with aortic dissection (AD), stratified by race. </p><p><strong>Main Outcome Measures: </strong>Statewide and county-level population adjusted hospitalization rates, access to specialty aortic care, and mortality. <strong></strong></p><p><strong>Results: </strong>Of 3,719,412 admissions to Maryland hospitals during the study period, 3,190 had AD (.09%; 1665 White, 1525 non- White). Non-White race was more common in patients with AD than without (48% vs. 41%, P&lt;.0001). Adjusted for statewide demographics, admission for AD was 1.4 times more common among non-Whites (11 vs. 8 per 100,000, P&lt;.0001). Non-White race was an independent risk factor for AD admission (OR 1.5, 95% CI 1.4 – 1.7). Among patients with AD, non-Whites were younger and more often female, but had similar or lower rates of cardiovascular comorbidities. Non-White race was not associated with decreased access to care or increased mortality. <strong></strong></p><p><strong>Conclusion: </strong>Hospitalization for AD is more common among non-Whites, who develop AD at younger ages despite fewer comorbidities. While clinical correlates are limited from this dataset, this may reflect more severe pathophysiology related to clinical or socioeconomic factors among non-Whites. Further study is warranted to better define this disparity and identify high-risk subgroups who may benefit from aggressive primary prevention. <em>Ethn Dis. </em>2016;26(3):363-368; doi:10.18865/ed.26.3.363 </p>

Background: As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the utilization of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. Study Design: To effectively reduce our average length of stay we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to post-operative care, and expanded outpatient management of post-operative patients. 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between 7/1/2013 and 6/30/2016 were included in the study. Results: Improving communication with critical staff and utilizing procedural space outside of the main operating rooms led to a 2.8-day reduction in length of stay (10.8 vs 8.0, P < 0.001). There was a trend toward a reduction in 30-day readmission rate (12% vs. 10%, respectively; P = 0.01) and no significant difference in case-mix index as a measure of illness severity (2.5 vs. 2.4, respectively; P = 0.15). Length of stay reductions were heterogeneous among the types of vascular disease studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for non-ruptured abdominal aortic aneurysm. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy/stenting and lower extremity bypasses. Conclusions: Restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care that may impact hospital profitability.

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