Beck, Adam W.

Cronenwett, Jack L.

DeMartino, Randall R.

Eldrup-Jorgensen, Jens

Goodney, Philip P.

Hallett, John W.

Hoel, Andrew W.

Upchurch, Gilbert R.

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SS25 Participation in the Vascular Quality Initiative (VQI) Is Associated With Improved Perioperative Medication Use and Longer Patient Survival 

Fig.
JOURNAL OF VASCULAR SURGERY
34S Abstracts June Supplement 201415 during the second 5 years. When comparing the second
5-year period with the ﬁrst 5-year period, patients were
younger (P ¼ .066), reported a signiﬁcantly shorter length
of preoperative symptoms (35.4 vs 52.1 months, P < .01),
prior narcotic use decreased from 31.5% to 23.8% (P <
.05), and a history of prior surgical intervention on the ipsi-
lateral side (head, neck, shoulder) increased from 30.1% to
51.9% (P < .01). Use of lidocaine blocks as a diagnostic
tool (57% to 35.4%, P ¼ .06) and Botox blocks as a ther-
apeutic tool (29.1% to 12.7%, P < .01) decreased in the
second 5 years with similar positive results. Improved or
fully resolved symptoms after FRRS increased from 89%
in the ﬁrst 5 years to 92.8% in the second 5 years. Average
length of follow-up over the 10-year period was 13.4
months.
Conclusions: (1) Excellent results were seen in this
largest surgical series reported for NTOS. (2) Younger pa-
tients with shorter duration of symptoms with less
narcotic use led to even better FRRS results in the second
5 years of surgical intervention. (3) An established
vascular practice for referrals for NTOS resulted in an
increased number of appropriate patients for surgical
intervention, requiring less lidocaine and/or botox injec-
tions preoperatively.
Author Disclosures: A. Cohen: Nothing to disclose; J.
Freischlag: Nothing to disclose; K. Likes: Nothing to
disclose; Y. W. Lum: Nothing to disclose; S. Mirza:
Nothing to disclose; M. S. Orlando: Nothing to disclose;
T. Reifsnyder: Nothing to disclose; Q. Salditch: Nothing
to disclose.
S6: SVS Plenary Session VI
SS25
Participation in the Vascular Quality Initiative (VQI)
Is Associated With Improved Perioperative
Medication Use and Longer Patient Survival
Randall R. DeMartino1, Jens Eldrup-Jorgensen2, Andrew
W. Hoel3, Adam W. Beck4, John W. Hallett5, Gilbert R.
Upchurch6, Jack L. Cronenwett7, Philip P. Goodney7.
1Division of Vascular and Endovascular Surgery, Mayo
Clinic, Rochester, Minn; 2Maine Medical Center,
Portland, Me; 3Northwestern University Feinberg School
of Medicine, Chicago, Ill; 4University of Florida College of
Medicine, Gainesville, Fla; 5Roper St. Francis Heart &
Vascular Center, Charleston, SC; 6University of Virginia,
Charlottsville, Va; 7Dartmouth-Hitchcock Medical Center,
Lebanon, NH
Objectives: Medical management (MM) with anti-
platelet and statin therapy is recommended for most pa-
tients undergoing vascular surgery. We tested the
association of Vascular Quality Initiative (VQI) participa-
tion and perioperative MM use over time and the effect
of optimal MM on patient survival.
Methods: We studied VQI patients treated with MM
preoperatively and at discharge from 2005 to 2013,
including all elective carotid endarterectomy (CEA)/ca-
rotid artery stenting (CAS; n ¼ 19,428), supra/infraingui-
nal bypass (n ¼ 8,462), peripheral vascular interventions (n
¼ 15,525), and open/endovascular abdominal aortic aneu-
rysm repair (n ¼ 9,530). We examined trends of MM useover time, as well as the effect of duration of VQI partici-
pation on MM use. Multivariable analyses were performed
to identify factors associated with MM use and 2-year
survival.
JOURNAL OF VASCULAR SURGERY
Volume 59, Number 6S Abstracts 35SResults: MM across VQI centers improved from 56%
in 2005 to 69% in 2009, and declined when many new cen-
ters joined VQI in 2010 (Fig). Longer center participation
in VQI was associated with improved MM across all proce-
dure types (Fig, B). After multivariable adjustment, centers
in VQI >2 years were 40% more likely to have patients on
MM (odds ratio, 1.4, 95% conﬁdence interval [CI], 1.4-
1.5; P < .01). Use of MM was associated with improved
2 year survival (92% vs 86%; HR for death, 0.6; 95% CI,
0.5-0.7; P < .01), as was treatment at centers in VQI >2
years (HR, 0.86; 95% CI, 0.8-0.9; P < .01).
Conclusions: These data demonstrate that optimal
MM is associated with improved survival after a number of
vascular procedures. Importantly, VQI participation improves
the use of MM, demonstrating that involvement in an orga-
nized quality effort can greatly impact patient outcomes.
Author Disclosures: A. W. Beck: Nothing to disclose; J.
L. Cronenwett: Nothing to disclose; R. R. DeMartino:
Nothing to disclose; J. Eldrup-Jorgensen: Nothing to
disclose; P. P. Goodney: Nothing to disclose; J. W. Hal-
lett: Nothing to disclose; A. W. Hoel: Nothing to disclose;
G. R. Upchurch: Nothing to disclose.
VS6
Transvenous Embolization of High-Flow Arteriovenous
Malformations With a Dominant Outﬂow Vein
Allan M. Conway, Jennifer Drury, Robert Rosen. Lenox
Hill Hospital, New York, NY
Objectives: To assess outcomes of retrograde emboli-
zation of arteriovenous malformations (AVM) with a
dominant outﬂow vein (DOV).
Methods: We retrospectively reviewed patients with
high ﬂow AVMs who were noted to have a DOV and sub-
sequently underwent transvenous embolization. Three
cases have been selected for video demonstration.
Results: FromNov 2010 to Sep 2013 11 patients (three
male [27%]) underwent transvenous embolization of high
ﬂow AVMs with a DOV. Mean age was 42.2 years (range,
16.4-65.8 years). The AVM was located on an extremity in
six patients (55%) and in the pelvis in ﬁve (45%). The indica-
tion for the procedure was pain in 10 patients (91%) and
swelling in two (18%). Transvenous embolization was per-
formed with coils in eight patients (73%) and with coils and
the Amplatzer Vascular Plug (St. Jude Medical, St. Paul,
Minn) in three (27%). Concurrent use of direct stick emboli-
zation of the AVMnidus was used in four patients (36%), and
transcatheter arterial embolization in seven (63%). Angio-
graphic success was seen in all patients. Five patients (45%)
required further procedures for residual symptoms.
Conclusions: AVMs with a DOV can be successfully
treated by a transvenous approach. The use of direct stick
embolization of the nidus and transcatheter arterial embo-
lization may assist in reducing ﬂow.
Technical description: Patient 1: We demonstrate the
use of retrograde transvenous embolization of an upper
extremity AVM, fed by branches from the proximal ulnar,
radial and common interosseous arteries. Coil embolization
of the vein was performed, followed by direct stick embo-
lization of the AVM nidus using nBCA adhesive. Patient 2:
An AVM involving shunting from the profunda artery to adysplastic draining vein was treated with coil embolization
of the vein, and transcatheter embolization of the profunda
branches using nBCA adhesive. Patient 3: A pelvic AVM
was treated using an Amplatzer Vascular Plug, coil embo-
lization of the outﬂow vein, and transcatheter arterial
embolization of the arterial branches.
Author Disclosures: A. M. Conway: Nothing to disclose;
J. Drury: Nothing to disclose; R. Rosen: Nothing to
disclose.
SS26
Civilian/Military Collaboration in the Management of
Military Vascular Trauma: A 10-year Report of the
SVS Volunteer Program
David L. Gillespie1, Kenneth J. Cherry2, Thomas Evans4,
Raul Corpus3, Todd Rasmussen5. 1Cardiovascular Care
Center, Southcoast Health System, Fall River, Mass;
2University of Virginia, Charlottesville, Va; 3U.S. Army
Institute of Surgical Research, San Antonio, Tex;
4Wilford Hall Medical Center, San Antonio, Tex;
5Uniformed Services University, Bethesda, Md
Objectives: A longstanding spirit of camaraderie has
existed between civilian and military surgeons in the US.
Volunteers from the Society for Vascular Surgery (SVS)
assisted active duty military surgeons in ﬁlling a critical
need for vascular surgery support in the evacuation of
injured U.S. soldiers. The objective of this study is to pro-
vide an assessment of this program, including character-
ization of workload and perspectives of participating
surgeons.
Methods: An online survey instrument (SurveyMon-
key), consisting of 34 questions, was developed and admin-
istered to participants (2003-2012) in the program. The
survey consisted of multiple choice and open-ended
questions.
Results: The response rate was 59% (68 of 115), with
84% indicating they had no prior military experience. The
majority of respondents (76%) served one tour, whereas
24% served multiple tours. The majority (65%) indicated
satisfaction in their operative workload, performing two
to ﬁve operations per week, whereas 17% performed six
to 10. Seventeen participated in clinical research during
the rotation, 70% of which resulted in scientiﬁc presenta-
tion or publication, or both. Over half participated in draft-
ing new Clinical Practice Guidelines for care of patients
with vascular injuries. Of respondents, 90% (n ¼ 61)
were satisﬁed or very satisﬁed with the experience and indi-
cated interest in continuing a civilian-military collabora-
tion. Most volunteers found great value in participating
ﬁrst hand with cutting-edge telemedicine and integration
of combat casualty care over a broad evacuation system
involving three continents.
Conclusions: Over a 10-year period of time civilian
vascular surgeons have provided critical open and endovascu-
lar care to injured U.S. soldiers. SVS volunteers were clinically
and academically active and found value in collaborating with
their military colleagues to provide an extremely high level of
combat casualty care. This unique collaboration carries on
historical traditions of our surgical heritage and is an
extremely valuable care model for future use.


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SS25 Participation in the Vascular Quality Initiative (VQI) Is Associated With Improved Perioperative Medication Use and Longer Patient Survival

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