Long-term impact of the Vascular Study Group of New England carotid patch quality initiative

Edenfield, Leia; Blazick, Elizabeth; Healey, Christopher; Hawkins, Robert E.; Błoch, P; Eldrup-Jørgensen, Jens; Nolan, Brian

doi:10.1016/j.jvs.2018.07.078

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…Since the initiative, they documented increased patch utilization in the New England regions from 71 to 91% between 2003 and 2014 with a significantly lower rate of 1-year stroke/TIA and restenosis. 9 In our study, we assessed the regional and temporal variation of patch use within the VQI. Our statistical analysis includes the eversion technique within our patch cohort.…”

Section: Discussionmentioning

confidence: 99%

“…VSGNE studies recognized both the value of protamine and patch angioplasty which led to societal initiatives that proved advantageous in improving utilization of patch placement and protamine. 8,9 These studies of 4579 and 14,636 patients respectively noted improvement in protamine administration from 43% to 62% between 2003 and 2010 and increased patch placement from 71% to 91% between 2003 and 2014. An additional VSNGE project quantified the benefit of antiplatelet and statin medications in patients undergoing atherosclerotic based vascular surgery.…”

Section: Introductionmentioning

confidence: 97%

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Temporal Trends and Contemporary Regional Variation in Management of Patients Undergoing Carotid Endarterectomy

Penton

Kelly

et al. 2023

Vasc Endovascular Surg

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Introduction The purpose of this study is to investigate regional variation and temporal trends in seven quality metrics amongst CEA patients: discharge on antiplatelet after CEA; discharge on statin after CEA; protamine administration during CEA; patch placement at conventional CEA site; continued statin usage at the time of most recent follow-up; continued antiplatelet usage at the time of most recent follow-up; and smoking cessation at the time of long term follow up. Methods There are 19 de-identified regions within the VQI database in the United States. Patients were placed into one of three temporal eras based on the time of their CEA: 2003-2008; 2009-2015; and 2016-2022. We first investigated temporal trends across the seven quality metrics for all regions combined on a national basis. The percentage of patients in each time era with the presence/absence of each metric was identified. Chi-squared testing was performed to confirm statistical significance of the differences across eras. Next, analysis was performed within each region and within each time metric. We separated out the 2016-2022 patients within each region to serve as the status of each metric application in the most modern era. We then compared the frequency of metric non-adherence in each region utilizing Chi-squared testing. Results There was statistically significant improvement in achievement of all seven metrics between the initial 2003-2008 era and the modern 2016-2022 era. The most marked change in practice pattern was noted for lack of protamine usage at surgery (decreased from 48.7% to 25.9%), discharge home postoperatively without statin (decreased from 50.6% to 15.3%), and lack of statin usage confirmed at time of most recent long term follow up (decreased from 24% to 8.9%). Significant regional variation exists across all metrics ( P < .01 for all). Lack of patch placement at the time of conventional endarterectomy ranges from 1.9% to 17.8% across regions in the modern era. Lack of protamine utilization ranges from 10.8% to 49.7%. Lack of antiplatelet and statin at the time of discharge varies from 5.5% to 8.2% and 4.8% to 14.4% respectively. Adherence to the various measures at the time of most recent follow up are more tightly aligned across regions with ranges of: 5.3% to 7.5% for lack of antiplatelet usage; 6.6% to 11.7% lack of statin utilization; and 13.3 to 15.4% for persistent smoking. Conclusions Prior studies and societal initiatives on CEA documenting the beneficial effects of patch angioplasty, protamine use at surgery, smoking cessation, antiplatelet utilization and statin compliance have positively impacted adherence to these measures over time. In the modern 2016-2022 era the widest regional variation is noted in patch placement, protamine utilization and discharge medications allowing individual geographic areas to identify areas for potential improvement via internal VQI administrative feedback.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Temporal Trends and Contemporary Regional Variation in Management of Patients Undergoing Carotid Endarterectomy

Penton

Kelly

et al. 2023

Vasc Endovascular Surg

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“…Restenosis risk was also significantly higher at 2 years in patients with no patching (10.7% vs 3.1% with patching) (Table IV). Recently, Edenfield et al 291 reported on the long-term impact of the Vascular Study Group of New England carotid patch quality initiative (14,636 CEA), showing that patch use increased from 71% to 91% (P < .001) between 2003 and 2014. The rate of return to the operating room for bleeding (P < .001), 1-year restenosis or occlusion (P < .001), and 1-year stroke or TIA (P < .003) were statistically lower with patch closure.…”

Section: Carotid Closure: Primary Versus Patchingmentioning

confidence: 99%

The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease

AbuRahma

Avgerinos

Chang

et al. 2022

Journal of Vascular Surgery

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“…A veia safena magna pode ser usada como material de remendo (patch) no fechamento de arteriotomias em vários territórios, entre elas a endarterectomia de carótida 1,2 , endarterectomia de femoral 3 , no trauma 4 e outras. O uso de remendos em endarterectomia de carótida já foi extensamente estudado e é frequentemente relacionado a melhores resultados tanto precoces como tardios 5,6 , apesar de alguns relatos favorecerem o fechamento primário 7,8 .…”

Section: Introductionunclassified

Estudo experimental comparativo da resistência tensional da safena magna no tornozelo e na região inguinal

2021

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Resumo Contexto A veia safena magna é usada como material de remendo em vários tipos de reconstrução arterial, incluindo no trauma e endarterectomias de carótida e femoral. Houve relatos de ruptura do remendo de safena, particularmente de veias colhidas na região do tornozelo. Há uma necessidade de medição objetiva da resistência tecidual da safena magna. Objetivos Mensurar a força tensional suportada pela veia safena magna e analisar a correlação entre resistência e diâmetro da veia. Métodos As veias foram coletadas durante operações de safenectomia por varizes dos membros inferiores. Foram analisados apenas segmentos sem refluxo. Foram analisados 10 membros de oito pacientes, com um total de 20 espécimes. Os espécimes foram submetidos a ensaio de tração em equipamento eletrônico, obtendo-se os valores de tensão máxima do material em quilogramas-força por centímetro quadrado (kgf/cm2; força máxima dividida pela área de secção transversa do segmento submetido à tração). Resultados A tensão máxima suportada pela veia safena do tornozelo variou de 74,02 a 190,10 kgf/cm2, e a tensão máxima da veia safena da crossa variou de 13,53 a 69,45 kgf/cm2 (p < 0,0001). O coeficiente de correlação de Pearson entre o diâmetro da veia distendida e a tensão máxima suportada foram iguais a -0,852 (correlação inversa moderada a forte). Conclusões A resistência tecidual da veia safena magna do tornozelo é maior do que a da crossa em mulheres submetidas a operação de varizes; há correlação negativa entre o diâmetro da veia e sua resistência tecidual nessa mesma população.

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Long-term impact of the Vascular Study Group of New England carotid patch quality initiative

Cited by 16 publications

References 15 publications

Temporal Trends and Contemporary Regional Variation in Management of Patients Undergoing Carotid Endarterectomy

Temporal Trends and Contemporary Regional Variation in Management of Patients Undergoing Carotid Endarterectomy

The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease

Estudo experimental comparativo da resistência tensional da safena magna no tornozelo e na região inguinal

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