Annals of Vascular Surgery

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Bedside Tunneled Hemodialysis Catheter Placement in Patients with COVID-19

COVID-19, the syndrome caused by the novel SARS-CoV2, is associated with high rates of acute kidney injury requiring renal replacement therapy (RRT). It is well known that despite the ease of bedside insertion, the use of non-tunneled dialysis catheters (NTDCs) is associated with increased complications compared to tunneled dialysis catheters (TDCs). Our objective was to develop a strategy for TDC placement at the bedside to provide effective dialysis access, conserve resources and decrease personnel exposure at our medical center in an epicenter of the COVID-19 pandemic.

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Lessons learned from the impact of the COVID-19 pandemic in a Vascular Surgery department and preparation for future outbreaks

In January 2020, an outbreak of a novel respiratory virus, SARS-CoV-2, spread from Wuhan, China. [1] Besides the morbidity and mortality directly related to the virus, health institutions and personnel were forced to reorganize their activities and deal with the pandemic. Vascular Surgery practices were no exception, with a necessity to withhold elective activities and surgeries. [2] On March 18th, non-essential activities were interrupted, and confinement became mandatory, as a state of emergency was declared in Portugal (figure 1A).

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Severe Aortic Thrombosis in the early period after COVID-19: Two cases

A total occlusion of the aorta is a rare condition; however, while rare, it has a very high mortality rate. Coronavirus disease 2019 (COVID-19) poses serious health problems, including vascular problems. Inflammatory changes produced by viral infections can cause serious disturbances in the coagulation system. Although cases showing a marked increase in thrombotic activity in the venous system have been presented, thrombosis in the arterial system, especially in the aorta, has rarely been reported.

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Correspondence,

I read with great interest the paper by Bautista et al (1), where outcomes on a national multicenter description for patients with acute limb ischemia is given.

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Using Payment Incentives to Decrease Atherectomy Overutilization

Atherectomy has overtaken balloon angioplasty and peripheral stent placement as the most common catheter-based peripheral vascular intervention performed in the US.1 Its rapid growth has nullified the promised cost savings of shifting peripheral arterial disease (PAD) treatment to the outpatient setting and has not delivered added benefit to patients relative to more traditional endovascular techniques. Value-based payment reform is needed to curtail the explosion of atherectomy volume nationwide.

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Vascular Surgeons Should be Valued by Contemporarily Derived Productivity Metrics

We read with great interest the manuscript by Fang et al noting that vascular surgeons are not adequately valued by traditional productivity metrics [1]. The authors evaluated Centers for Medicare and Medicaid Services (CMS) 5% sampling de-identified claims data from over 1.3 million fistulagrams, with and without adjunctive balloon angioplasty or stenting, performed by vascular surgeons over a 4-year period, focusing on medical center, office-based lab (OBL) and physician reimbursement. In 2016, the same authors published on a multidisciplinary approach to vascular surgery procedure coding to improve coding accuracy, work relative value unit (wRVU) assignment, and reimbursement that was well received as financial and reimbursement guidance [2].

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Changing venous practice in the COVID-19 era: “Never let a good crisis go to waste”

The COVID-19 pandemic is having an unprecedented impact on vascular surgery practice, services and resources worldwide. Although there are several negative consequences, we would like to share with you one positive experience of our own. The first wave of the pandemic in March 2020 found us in the midst of trying to transform our varicose vein practice from open surgery to an endovenous approach. Traditionally, this unit, based at a large inner city University Hospital, embraced modern endovascular therapies in the field of aortic aneurysm, carotid and peripheral arterial disease.

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Innominate Artery Ligation: A History from Mott to Matas

Innominate artery ligation emerged in the nineteenth century as an early operation for right subclavian aneurysm. Clinical outcomes were often dire, but undeterred surgeons believed that ligation represented an opportunity that outweighed the risks of nonoperative aneurysm management. Valentine Mott of New York performed the procedure in 1818; his patient died 26 days later. Variations on Mott's approach were undertaken thirteen more times from 1822-1861 by surgeons in the US and abroad, all of which proved fatal.

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