Search

With an aging workforce and high prevalence of vascular disease, the US is expected to face a pronounced shortage of vascular surgeons over the next 2 decades. This has driven initiatives to expand vascular surgery training positions leading to the rise of integrated residency programs (0 + 5) and the expansion of traditional fellowships (VSFs, 5 + 2). Given the increase in dedicated vascular surgery training positions, there has been a growing concern that general surgery residents (GSRs) are experiencing decreased vascular case volumes. We aim to evaluate trends in vascular surgery specialty choice relative to vascular case volumes for US GSRs over the last 20 years.

Background Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor.Methods This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes.Results Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P= .004), increased hospital readmission (OR: 1.657, P= .021), and increased mortality (OR: 2.101, P= .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days (P= .008), mortality at 1 year (P= .001), ambulatory status (P< .001), and prosthesis use (P= .023). In male patients, frail and non-frail patients differed on readmission at 90 days (P= .019), death at 1 year (P= .001), and ambulatory status (P= .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes.Discussion The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.

Introduction Patients with a history of Opioid Use Disorder (OUD) have higher postoperative complication rates and mortality in many settings. Yet, it remains poorly understood how the opioid epidemic has affected patients undergoing major lower extremity amputation (LEA) and whether outcomes differ by OUD status.Methods We conducted a retrospective chart review of all 689 patients who underwent major LEA at a large tertiary referral center from 2015 to 2021. This study assessed patient characteristics and long-term postoperative outcomes for patients with preoperative OUD.Results 133 (19.3%) patients had a lifetime history of preoperative OUD. Preoperative OUD was associated with key characteristics, comorbidities, and outcome measures. OUD was significantly associated with younger age (P< .001), black race (P= .026), single relationship status (P< .001), BMI <30 (P= .024), no primary care provider (P= .004), and Medicaid insurance (P< .001). Comorbidities significantly associated with OUD include current smoking (P< .001), Human Immunodeficiency Virus (HIV; P= .003), and history of osteomyelitis (P< .001). Preoperative OUD independently predicted lower rates of 30-60-day readmission (odds ratio [OR] .54, P= .018) and 1-12-month reamputation (OR .41, P= .006). There was no significant difference in long-term mortality and follow-up.Conclusion This study demonstrates the prevalence of OUD in patients undergoing major LEA and reports associations and long-term outcomes. Our findings highlight the importance of recognizing OUD and raise questions about the mechanisms underlying its relation to rates of postoperative readmission and reamputation.

The utilization of deep vein arterialization (DVA) is a feasible and successful operative strategy for patients with severe chronic limb-threatening ischemia (CLTI) with no open or endovascular surgical options other than major limb amputation. The DVA technique creates a connection, either percutaneously or surgically, between a source of arterial inflow and venous outflow, allowing distal blood flow to heal chronic wounds that otherwise would have required amputation. In this case report, we describe a single patient with CLTI and nonreconstructable arterial disease and a chronic nonhealing wound who underwent a percutaneous DVA procedure with improvement in their ischemic rest pain and complete healing of their wound.