Social Media Posts About Carpal Tunnel Release: A Cross-Sectional Analysis of Patient and Surgeon Perspectives.

BACKGROUND: Social media provides an increasingly popular, unfiltered source of perspectives on healthcare. The objective of this study is to characterize the landscape of social media posts regarding carpal tunnel release (CTR). METHODS: Content was queried from Instagram between February 2, 2019 to August 12, 2021 using the hashtags #carpaltunnelrelease and #carpaltunnelsurgery. The 1500 most-liked posts were analyzed. Poster demographics including age, gender, region, and symptom qualities and post characteristics including type, number, timing relative to surgery, tone, and satisfaction were collected. Categorical variables were compared utilizing chi-squared test. Univariate and multivariate regression were performed. RESULTS: The most popular post types included single photo (55.2%), multiple photos (18.8%), or single video (18.2%). Of all, 70.6% posts had fewer than 50 "likes." Patients accounted for 51.8% of posts, followed by surgeons (13.3%), other health care providers (11.7%), and physical therapists (8.8%). Women (66.7%) outnumbered men (33.3%). Fifty-five percent of posts were domestic. Posts mostly depicted postoperative care (85.6%). The most frequently mentioned symptoms were pain, burning, numbness, and tingling. Of all posts, 45.1% had a positive tone, 49.1% neutral, and 5.7% negative. Univariate analysis revealed that posters who were patients, underwent open CTR, and were female were more likely to post negative sentiments. CONCLUSIONS: Most posts regarding CTR are from patients, are postoperative, and are positive or neutral. Although rare, negative posts were more likely to originate from posters who are patients, female, or underwent open CTR. With this information, surgeons will be better prepared to address patient concerns, set patient expectations, and enter the social media themselves.

Social Media Posts About Distal Radius Fracture: A Cross-Sectional Analysis of Patient and Provider Perspectives.

BACKGROUND: Social media offers a popular, unfiltered source of patient and provider perspectives on health care. This study investigated the characteristics of social media posts referencing distal radius fracture (DRF). METHODS: Content was queried from Instagram from February 06, 2019, to December 08, 2021, using the hashtags "#distalradiusfracture" and "#wristfracture." The 1500 most-liked posts were analyzed. Poster demographics including age, gender, region, laterality, and treatment type and post characteristics including post type, number, content, timing relative to treatment, tone, and satisfaction were examined. Variables were compared using χ2 tests. Univariate, multivariate, and stepwise regression were performed. RESULTS: The most popular post formats were single photo (44.5%), multiple photos (32.3%), and single video (13.9%). Patients (40.3%) were the most common poster followed by surgeons (33.4%). Men (48.7%) and women (51.3) were evenly represented. Of the total posts, 87.7% depicted the post-treatment phase of care; 54.8% of posts depicted operative management, while 26.6% depicted non-operative management; and 73.7% of posts were positive in tone, 18.7% neutral, and 7.6% negative. Univariate analysis demonstrated that posters who were patients, friends/family of patients, female, and posts with >100 "likes" were more likely to share negative tones. Multivariate and stepwise regression were consistent with the above. CONCLUSION: Most posts regarding DRF originate from patients, are post-treatment, and are positive. Negative tone is associated with posts from patients, family/friends of patients, female posters, and posts with >100 likes. With this information, surgeons will be better prepared to address patient concerns, manage expectations, and actively participate in social media themselves.

Complete zone 0-10 aortic endovascular reconstruction.

To the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period, five patients with complex thoracoabdominal aortic aneurysms and dissections involving zone 0-10 presented with rupture (n = 1; 20%), were symptomatic (n = 2; 40%), or had an aortic pseudoaneurysm (n = 2; 40%) and underwent complete endovascular zone 0-10 reconstruction using off-the-shelf stent grafts in parallel configurations that included chimneys, periscopes, and endovascular docking stations. The zone 0-5 complete arch chimney thoracic endovascular repair included chimneys that extended from the ascending thoracic aorta to the innominate, left common carotid, and left subclavian arteries and a thoracic stent graft extending from zone 0 to 5. The zone 5-10 aortic reconstructions were staged. Stage 1 included either thoracic stent graft and antegrade four visceral chimney placement or abdominal aortic stent graft and retrograde four visceral chimney placement. Stage II included completion of the remainder of the aortic reconstruction with cerebrospinal fluid drainage. A total of 15 aortic procedures included 34 chimneys (14 aortic arch and 20 visceral). Two patients (40%) underwent zone 0-5 aortic reconstruction first, and three patients (60%) underwent zone 5-10 aortic reconstruction first. The incidence of 30-day mortality, spinal cord ischemia, myocardial infarction, stroke, and visceral ischemia was 0%. At a mean follow-up of 4.5 ± 3.1 years, the aortic reconstruction-related mortality was 0%. All-cause mortality was 20%; one patient had died of pneumonia at 3 years postoperatively. Two endoleaks each occurred in zone 0-5 and zone 5-10 (40% for both groups). All endoleaks were treated with coil embolization. Complete endovascular zone 0-10 aortic reconstruction using parallel stent grafts with a docking station is a feasible and relatively safe technique that offers the ability to customize off-the-shelf devices for the treatment of high-risk patients with limited morbidity and mortality.

Comparative analysis of discharge and sediment flux from two contiguous glacierized basins of Central Himalaya, India.

In the present study, suspended sediment load (SSL), sediment yield and erosion rates in Pindari Glacier basin (PGB) and Kafni Glacier basin (KGB) have been estimated using daily discharge and suspended sediment concentration (SSC) data for three ablation seasons (2017-2019). For this, one meteorological observatory and two gauging sites have been established at Dwali (confluence point), and water samples have been collected twice in a day for high flow period (July to September) and daily for lean period (May, June and October). An area-velocity method and stage-discharge relationship has been established to convert water level into discharge (m3 s-1). For estimating SSC (mg/l), collected water samples have been filtered, dried, analysed and confirmed with an automatic suspended solid indicator. Further, SSL, sediment yield and erosion rates have been computed using SSC data. The results reveal that mean annual discharge in PGB (35.06 m3 s-1) has been found approximately 1.7 times higher than KGB (20.47 m3 s-1). The average SSC and SSL in PGB have been observed about 396.07 mg/l and 1928.34 tonnes, and in KGB, it is about 359.67 mg/l and 1040.26 tonnes, respectively. The SSC and SSL have followed the pattern of discharge. A significant correlation of SSC and SSL has been found with discharge in both the glacierized basins (p < 0.01). Interestingly, average annual sediment yield in PGB (3196.53 t/km2/yr) and KGB (3087.23 t/km2/yr) have been found almost identical. Likewise, the erosion rates in PGB and KGB have been witnessed about 1.18 and 1.14 mm/yr, respectively. Sediment yield and erosion rates in PGB and KGB have been found in correspondence with other basins of Central Himalaya. These findings will be beneficial for engineers and water resource managers in the management of water resources and hydropower projects in high-altitude areas and in the planning and designing of water structures (dams, reservoirs etc.) in downstream areas.

Ascending thoracic endovascular aortic repair with chimney stent graft to free vein coronary bypass for ruptured type A aortic dissection.

The standard treatment for ruptured type A aortic dissection is open surgical repair. We have described the case of a frail patient with home oxygen-dependent chronic obstructive pulmonary disease and prior free vein circumflex coronary artery bypass who had presented with a ruptured type A aortic dissection and was deemed too high risk for open surgery. On July 7, 2017, the patient underwent emergent endovascular ruptured ascending thoracic aortic aneurysm repair with a chimney stent graft to a free vein coronary bypass that originated from the ascending thoracic aorta. The procedure was uneventful, and the patient was discharged home on postoperative day 1.

Outcomes of the V-Healthy education and awareness program that empowers high school students to understand and diagnose vascular disease risk factors.

INTRODUCTION: V-Healthy (Center for Vascular Awareness Inc, Latham NY) is a grassroots vascular health education and awareness campaign that educates high school students about the importance of the vascular disease risks they face today and its impact decades later, and empowers health care professionals and schoolteachers to lead vascular health education in their communities. This study evaluates the impact of the V-Healthy initiative in empowering and educating adolescents about the implications of vascular disease risk factors and in creating a blueprint for a community outreach program that focuses on vascular health and disease education and awareness. METHODS: The V-Healthy program is an initiative that connects community vascular health care professionals and educators with high school students, for a day of vascular health education. The V-Healthy program curriculum is provided in two distinct stages. Stage I consists of didactic vascular health education and takes place in the classroom for the duration of one class period (40-50 minutes). The class period is divided into four sessions including a PowerPoint presentation to teach the impact of vascular disease risk factors (hypertension, diabetes, hyperlipidemia, smoking/vaping, and genetics) on the development of peripheral arterial disease, venous disease, aortic disease, and stroke, and three hands-on sessions that introduce students to vascular innovation and technology, vascular patients, and the diagnosis of a vascular disease risk factor such as hypertension. Stage I concludes with a student questionnaire aimed to gauge students' retention of the material and attitude toward the program. Stage II offers students (with parental consent) the opportunity to participate in the "Diagnosing Hypertension" study. Students were provided automated blood pressure monitors and taught to measure blood pressure in their parents daily for 1 week. Findings are recorded in designated blood pressure logs, which are then categorized using the 2018 American Heart Association blood pressure categorization system: normal (<120/<80), elevated (120-129/<80), stage I (130-139/80-89), or stage II (≥140/≥90). No identifiable student or guardian information is collected. RESULTS: Over 3 years, more than 12,000 students participated in the V-Healthy program and 5120 students completed student surveys, which indicated that 97% improved their understanding of vascular health, >93% could identify vascular disease risk factors, 84% wanted to educate their families, and 76% wanted more vascular health education. A total of 1064 students participated in the "Diagnosing Hypertension" study and diagnosed hypertension in 73% of their parents: 34% for stage I hypertension and 39% for stage II hypertension. Over a 3-year period of this study, the number of schools participating increased 20-fold (from 1 to 20), the number of volunteer vascular health professionals and schoolteachers increased 13-fold (from 16 to 210), and our ability to connect with and impact high school students grew 15-fold (from 800 to over 12,000). CONCLUSIONS: V-Healthy is the first program to connect over 12,000 students to vascular health professionals in their communities to empower them to diagnose and understand vascular disease risk factors and their implications on the development of vascular disease. Furthermore, the V-Healthy program has displayed substantial growth over a 3-year period in impacting high school students and vascular health care professionals, and has the potential to be used as a blueprint for community-based vascular health education and awareness initiatives.

Impact of an Electronic Health Record Pain Medication Prescribing Tool on Opioid Prescriptions for Postoperative Pain in Hand, Orthopedic, Plastic, and Spine Surgery Across a Health Care System.

PURPOSE: We hypothesized that a pain management prescribing tool embedded in the electronic health record system of a multihospital health care system would decrease prescription opioids for postoperative pain by hand, orthopedic, plastic, and spine surgeons. METHODS: A prescribing tool for postoperative pain was designed for hand, orthopedic, plastic, and spine surgeons and implemented into electronic discharge order sets in a 10-hospital health care system. Stakeholders were educated on tool use in person and/or by email on 2 occasions. A dashboard was created to monitor opioid pill quantities and morphine milligram equivalents (MMEs) prescribed. Overall compliance with the suggested opioid amounts was assessed for 20 months after tool implementation. A subgroup of 6 hand surgeons, one of whom was instrumental in designing the tool, were evaluated for MMEs prescribed, opioid refills, patient emergency room visits, and patient readmissions within 30 days after discharge. Comparisons in this subgroup were made from 12 months before to 15 months after tool implementation. RESULTS: The mean system-wide compliance with the suggested opioid pill quantities and MMEs prescribed in all 4 specialties improved by less than 5%. In the subgroup of hand surgeons, 5 of whom championed tool use, prescribed MMEs decreased by 10% during each of the 4 quarters before launching the tool and contracted an additional 26% in the first quarter after tool implementation. Opioid refills held steady at 5%, and there were no emergency room visits or readmissions within 30 days after discharge in this patient subgroup. CONCLUSIONS: The prescribing tool had a negligible impact on system-wide compliance with suggested prescription opioid pill quantities and MMEs. In a small group of surgeons who championed the use of the tool, there was a significant and sustained decline in MMEs prescribed without adversely impacting patient refills, emergency room visits, or readmissions. CLINICAL RELEVANCE: An electronic prescribing tool to assist surgeons in lowering opioid prescription pill quantities and MMEs may have a negligible impact on prescribing behavior in a multihospital health care system.

Characterizing Leadership Trends in Hand Surgery Fellowship Programs.

Purpose: The purpose of this study was to characterize academic and demographic factors most associated with fellowship director (FD) roles in hand surgery programs. A secondary aim was to characterize educational and employment trends. The final aim was to compare these findings with those in other orthopedic subspecialties. Methods: Domestic programs were identified using the American Society for Surgery of the Hand fellowship directory. Data were collected via internet searches of publicly available information and direct contact with programs. Variables included demographic characteristics (age, sex, and race/ethnicity), education and employment history, Hirsch index (H-index) research productivity, and membership of select hand surgery societies. Results: Information about 86 FDs was collected from a total of 88 identified hand surgery fellowships. Seventy-six (88.4%) FDs were men, whereas 10 (11.6%) were women. The mean age was 53.3 years. Most FDs (n = 68, 79.1%) completed their residency in orthopedic surgery. The average Scopus H-index was 16.3. Most FDs were White (n = 64, 74%) followed by Asian (n = 14, 16%). The mean duration from fellowship completion to FD appointment was 12.6 years, whereas the mean duration of employment at an institution before FD appointment was 17.9 years. The mean duration of tenure as an FD was 9.8 years. Twenty-eight (32.94%) individuals served as an FD at their residency institution and 20 (23.5%) led at their fellowship institution. The most frequently attended residency institution by FDs was University of Pennsylvania, whereas Mayo Clinic was the most frequently attended fellowship program. Six FDs have served as the presidents of a hand surgery society. Conclusions: Fellowship directors are largely White and men. They are distinguished by their research productivity. A few select programs contribute an outsized proportion of individuals to FD positions. This may be due to a pipeline effect or because applicants with ambition to become FDs pursue specific programs for training. Clinical relevance: This study characterizes the academic/demographic factors of hand surgery FDs.

Temporal Bone Trauma Management: A Study of 100 Cases.

To address the management of complications after temporal bone fractures and the outcomes. A prospective clinical study of 100 patients from the Department of Trauma (Surgery + E.N.T.), P.D.U. Medical College, Rajkot between the time period of 2017-2019. Among 100 patients, 79 were males and 21 were females. The most affected age group was 16-45 years (72). The longitudinal fracture (90) is the most common type of fracture, in which non-petrous type is the most prevalent (88) as low impact injuries are more common. The most common presentations of temporal bone fracture are ear bleed (59) and decreased hearing (59), mostly over the side of trauma. The most common clinical finding is hearing impairment (59), followed by haemotympanum (20) and facial palsy (15), more common over the side of trauma. Facial palsy had been easily managed conservatively by steroids and physiotherapy in most of the cases. 12 out of 15 patients had good recovery i.e. upto grade I and II by conservative management, 3 had undergone facial nerve decompression, following which 1 had recovered completely, i.e. grade 1; 1 upto grade II while 1 did not show any improvement. Other complications included giddiness (18), trigeminal neuralgia (1) and abducens nerve palsy (1). The temporal bone is more prone to injury and complications following trauma like hearing impairment, cerebrospinal fluid leak and facial palsy resolve either spontaneously or with conservative management. Surgeries must be undertaken only if adequate conservative treatment fails and after proper investigations.

Calcaneal Reconstruction With Femoral Head Allograft Vascularized by an Osteocutaneous Medial Femoral Condyle Flap: A Case Report.

CASE: A 25-year-old man presented with a closed calcaneal fracture after a 6-storey fall, complicated by osteomyelitis from fixation attempts necessitating near-complete debridement of his calcaneal tuberosity. He underwent a successful single-stage calcaneal and soft-tissue reconstruction using a femoral head structural allograft vascularized with an osteocutaneous medial femoral condyle flap. At the 18-month follow-up, his limb is largely pain-free and functional, allowing ambulation and his combined allograft-vascularized bone reconstruction shows radiographic evidence of incorporation. CONCLUSION: Calcaneal tuberosity reconstruction with a femoral head structural allograft and vascularized bone flap is a viable option for calcaneal tuberosity bone loss because of injury/infection.

Body Packer Syndrome.

"Body packers" are persons who voluntarily or through coercion, swallow or insert drug-filled packets into body cavity, generally in an attempt to smuggle them across secure borders. The drugs most often involved in body packing are heroin and cocaine. Body packers can present in the emergency department as a result of ruptured drug packets, bowel obstruction, or for medicolegal purposes. Suspected cases are diagnosed with X-ray and computed tomography scan of the abdomen. Symptomatic patients require urgent removal of packets. We present a case of foreign national male in whom a drug packet got ruptured and 49 other packets were retrieved with help of laxatives and manual evacuation.

Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis.

BACKGROUND: Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). METHODS: Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling. RESULTS: The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = -9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = -6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF (ß = 0.20, P = .07) and PI (ß = -0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively (ß = -0.74, P < .01; ß = -0.61, P < .01). CONCLUSION: Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Safety and effectiveness of the TREO stent graft for the endovascular treatment of abdominal aortic aneurysms.

OBJECTIVE: The short- and mid-term outcomes of endovascular aortic aneurysm repair have made it a standard treatment of abdominal aortic aneurysms. However, newer generation devices have yet to demonstrate improved long-term rates for complications, reinterventions, and survival. The TREO stent graft is a latest generation device and was evaluated for approval in the United States. METHODS: In a multicenter, nonrandomized, investigational device exemption clinical trial, we assessed the safety and effectiveness of the TREO device, with core laboratory assessment of the imaging studies and an independent adjudication of safety. The primary effectiveness endpoint was successful aneurysm treatment at 1 year. The primary safety endpoint was the incidence of major adverse events (MAE) at 30 days. RESULTS: A total of 150 patients (132 men; 88.0%) with infrarenal abdominal aortic (87.3%) or aortoiliac (12.7%) aneurysms were enrolled. The data were normally distributed. The mean age was 71.7 ± 7.4 years. The MAE incidence at 30 days was 0.7%. One subject experienced two MAE: myocardial infarction and procedural blood loss of 1000 mL. The proportion of successful aneurysm treatment at 1 year was 93.1%. Longer term follow-up continues, with no aneurysm-related mortality at the latest follow-up. At 3 years, the cumulative all-cause mortality and incidence of type I and type III endoleaks was 10.7% (n = 16), 2.7% (n = 4), and 0% (n = 0), respectively. In addition, aneurysm sac shrinkage >5 mm at 3 years had occurred in 54.3% of patients, and 9.3% had required a secondary intervention (n = 14). CONCLUSIONS: The safety and effectiveness of endovascular repair of abdominal aneurysms with TREO were demonstrated, with 93.1% successful aneurysm treatment at 1 year and aneurysm sac shrinkage >5 mm at 3 years in 54.3% of patients. Long-term follow-up continues to determine whether these favorable outcomes will be sustained.

An unusual case of Staphylococcus pasteuri osteomyelitis.

Staphylococcus pasteuri is a gram-positive organism found in food products as well as naturally occurring in air and on surfaces. We present the first known case of Staphylococcus pasteuri osteomyelitis caused by machine injection injury. The patient was treated with emergent surgical debridement as well as doxycycline for a soft tissue infection. Despite targeted therapy, the infection progressed to osteomyelitis and was treated successfully with additional surgical debridement and trimethoprim-sulfamethoxazole. There is sparse information on both infections and treatment of Staphylococcus pasteuri. We present our case report as well as a review of the literature on the epidemiology, susceptibility and treatment recommendations for Staphylococcus pasteuri infections.

Long-term outcomes of the Ovation Stent Graft System investigational device exemption trial for endovascular abdominal aortic aneurysm repair.

OBJECTIVE: The objective of this study was to report the 5-year outcomes of the Food and Drug Administration investigational device exemption clinical trial of endovascular aneurysm repair (EVAR) with the Ovation stent graft (Endologix, Irvine, Calif) for elective treatment of abdominal aortic aneurysm (AAA). METHODS: The study comprised 161 patients who underwent EVAR as part of the prospective, international, multicenter pivotal Ovation stent graft trial. The main inclusion criteria were AAA diameter ≥5 cm, proximal neck length ≥7 mm, neck angulation ≤60 degrees, and bilateral iliac fixation length ≥10 mm. The primary end point was a composite outcome of primary clinical success at 5 years. Primary clinical success was defined in accordance with the Society for Vascular Surgery guidelines as successful aneurysm exclusion without aneurysm-related death, type I or type III endoleak, graft infection or thrombosis, aneurysm expansion, aneurysm rupture, graft migration, or conversion to open repair. Secondary end points included freedom from reintervention, all-cause mortality, and aneurysm-related mortality. RESULTS: Patients were predominantly male (87.6%) and elderly with a mean age of 73 ± 7.7 years; 66 patients (41%) had challenging anatomy and would be considered outside the instructions for use with other stent grafts, 26 (16.2%) had a proximal neck length <10 mm, and 53 (33%) had a minimum access vessel diameter <6 mm. Technical success was 100%. Of 126 surviving patients, 84 (66.7%) completed 5-year follow-up. The 5-year primary clinical success rate was 78%, aneurysm-related mortality was 1% (one patient), and all-cause mortality was 25%. The AAA-related death resulted from AAA post-EVAR rupture at 49 months in a patient who refused treatment for a type IB endoleak. Freedom from type I or type III endoleak was 95.1%. Freedom from secondary interventions was 80.2%. Most of the reinterventions were performed for type II endoleak (24 [63.1%]) or for limb thrombosis or stenosis (7 [18.4%]). There was no graft migration. None of the patients required open conversion. CONCLUSIONS: Five-year results from the Ovation pivotal and continued access investigational device exemption trials demonstrate excellent long-term durability of this endograft despite that 41% of patients had anatomy unfit for other stent grafts. There were no migrations or conversions to open repair and 99% freedom from aneurysm-related mortality. These results suggest a less invasive on-label endovascular option for patients with challenging anatomy who may otherwise require hybrid or open repair.

Immediate Versus Delayed Hip Arthroscopy for Femoroacetabular Impingement: An Expected Value Decision Analysis.

INTRODUCTION: Hip arthroscopy is an increasingly used surgical procedure for both intra- and extra-articular hip pathologies, including femoroacetabular impingement (FAI). Although the arthroscopic approach is known to be preferable to open, the optimal timing of such intervention is unclear. The purpose of this study was to carry out an expected value decision analysis of immediate versus delayed hip arthroscopy for FAI. Its hypothesis is immediate hip arthroscopy is the preferable treatment option. METHODS: An expected value decision analysis was implemented to systematize the decision-making process between immediate and delayed hip arthroscopies. A decision tree was created with options for immediate and delayed surgeries with utilities characterizing each state obtained from surveying 70 patients. Fold-back analysis was then carried out, calculating expected values by multiplying the utility of each health outcome by the probability of that outcome. Corresponding expected values were then summed to "fold back" the decision tree one layer at a time. This was repeated until overall expected values (0 to 100) for immediate and delayed hip arthroscopies resulted with the higher value indicating the preferable option. RESULTS: Fold-back analysis demonstrated that immediate hip arthroscopy is the preferred treatment for FAI over delayed with expected values of 78.27 and 72.63, respectively. Restoration of good function after hip arthroscopy was the most notable contributor to this difference. Immediate hip arthroscopy remained superior even as vast adjustments to preoperative physical function were made in one-way sensitivity analysis. Complications of hip arthroscopy leading to total hip arthroplasty were the least notable contributors to overall expected values. DISCUSSION: This study confirms that immediate surgery is the preferred option when using decision-making analysis combining patient-reported utilities of health outcomes and the probabilities of those outcomes from the literature. This is consistent across a range of estimates of poor function in both the delayed and immediate surgery arms.

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm.

OBJECTIVE: Endovascular repair of abdominal aortic aneurysm (AAA) remains a challenging clinical scenario when there is a short or nonexistent segment of healthy infrarenal aorta. This study sought to determine the safety and effectiveness of endosuture aneurysm repair (ESAR) using the Endurant II/IIs endograft (Medtronic Vascular, Santa Rosa, Calif) in conjunction with Heli-FX EndoAnchors (Medtronic Vascular) in the treatment of short-neck AAA. METHODS: In this subgroup analysis, 70 patients were identified from the Aneurysm Treatment Using the Heli-FX EndoAnchor System Global Registry (ANCHOR) who had an infrarenal neck length <10 mm down to 4 mm based on core laboratory measurements. Primary outcomes included technical success of the index procedure, rate of type IA endoleak at 1 month and 12 months, and rate of secondary procedures at 12 months. RESULTS: In this short-neck cohort (n = 70), the average neck length and diameter were 6.9 ± 1.6 mm and 25.7 ± 4.0 mm, respectively. Investigators reported an overall procedural success rate of 97.1% and a technical success rate of 88.6%. The duration of the implant procedure, EndoAnchor implantation, and total fluoroscopy time was 148.0 ± 80.0 minutes, 17.1 ± 11.5 minutes, and 35.3 ± 22.0 minutes, respectively, and an average of 5.5 ± 2.1 EndoAnchors were implanted per patient. Through the 30-day follow-up, type IA endoleaks were reported in four patients, of which three resolved spontaneously by the 12-month follow-up. There was an additional type IA endoleak through the 12-month follow-up that has not resulted in AAA enlargement or required a secondary procedure. The Kaplan-Meier estimate for freedom from secondary endovascular procedures and all-cause mortality is 95.4% and 92.7% through 365 days, respectively. No patient in the short-neck cohort experienced main body stent migration, increase in maximum aneurysm diameter, or aneurysm rupture or required conversion to open surgical repair through 12 months. CONCLUSIONS: In this analysis of the short-neck cohort from ANCHOR, the Endurant II/IIs endograft in conjunction with Heli-FX EndoAnchor implants (ESAR) appears to be a safe and effective treatment option with a high technical success rate and low incidence of type IA endoleaks and secondary interventions. Despite the complex and hostile anatomies, the ESAR method required short procedure and fluoroscopy times. These short-term outcomes suggest that ESAR could be complementary to therapies currently available for treatment of hostile AAA anatomy and a viable off-the-shelf endovascular treatment option for patients with short-neck AAAs, although long-term follow-up is critically important.

Analysis of the ROADSTER pivotal and extended-access cohorts shows excellent 1-year durability of transcarotid stenting with dynamic flow reversal.

OBJECTIVE: We report the 1-year outcomes of the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial. This trial introduced a novel transcarotid neuroprotection system (NPS), the ENROUTE transcarotid NPS (Silk Road Medical Inc, Sunnyvale, Calif). Postoperative results demonstrated that the use of the ENROUTE transcarotid NPS is safe and effective. The aim of this study was to evaluate the safety of transcarotid artery revascularization (TCAR) and to present the 1-year outcomes. METHODS: This study is a prospective, single-arm clinical trial. Current enrollment occurs in 14 centers. Primary end points were incidence rates of ipsilateral stroke at 1 year after TCAR. Occurrence of stroke was ascertained by an independent Clinical Events Committee. Patients with anatomic or medical high-risk factors for carotid endarterectomy (CEA) were eligible to be enrolled in the ROADSTER trial. RESULTS: Overall, 165 patients were included in the long-term follow-up (112 of 141 patients from the pivotal phase and 53 of 78 patients from the extended access). Mean age was 73.9 years (range, 42.1-91.3 years). Patients aged 75 years and older were 43.3% of the cohort. The majority of patients were white (92.7%) and male (75.2%). Most patients were asymptomatic (79.9%). Anatomic risk factors were distributed as follows: contralateral carotid artery occlusion (11.0%), tandem stenosis of >70% (1.8%), high cervical carotid artery stenosis (25.0%), restenosis after CEA (25.6%), bilateral stenosis requiring treatment (4.3%), and hostile neck (14.6%). Medical high-risk criteria included two-vessel coronary artery disease (14.0%) and severe left ventricular dysfunction with ejection fraction <30% (1.8%). In general, 43.3% of patients had at least one anatomic high-risk factor, whereas 29.9% of patients had medical high-risk factors. Both subsets of factors were present simultaneously in 26.8% of the cohort. At 1-year follow-up, ipsilateral stroke incidence rate was 0.6%, and seven patients (4.2%) died. None of the deaths were neurologic in origin. CONCLUSIONS: TCAR with dynamic flow reversal had previously shown favorable 30-day perioperative outcomes. This excellent performance seems to extend to 1 year after TCAR as illustrated in this analysis. The promising results from the ROADSTER trial likely stem from the novel cerebral protection provided through the ENROUTE transcarotid NPS in comparison to distal embolic protection devices as well as the transcarotid approach's circumventing diseased aortic arch manipulation and minimizing embolization. TCAR offers a safe and durable revascularization option for patients who are deemed to be at high risk for CEA.