Visual surveys provide baseline data on small vessel traffic and waterbirds in a coastal protected area.

The coastal waters of southern British Columbia, Canada, encompass habitat of international conservation significance to coastal and marine birds, including sizeable areas designated in the early 1900s as Migratory Bird Sanctuaries (MBS) to protect overwintering waterfowl from hunting near urban centres. Two of these, Shoal Harbour (SHMBS) and Victoria Harbour (VHMBS), have seen significant marine infrastructure development in recent decades and experience considerable vessel traffic. Vessel-related stressors are known to affect waterbirds, but traffic characteristics in coastal urban areas are poorly understood for the smaller vessels not tracked by Automatic Identification Systems (AIS). We conducted a pilot study using shore-based observers to develop small-vessel baselines for the winter months, when regional waterbird numbers are highest. During our surveys we recorded considerable inter-site variability in vessel traffic characteristics, with one site (SHMBS) a source of nearly twice as many vessel transits as the other (VHMBS). Most recorded vessels were small watercraft (mean length 26 ± 17', mode 18'), and vessels at the high-traffic site were both shorter and faster on average. One in six vessels were classified as 'noisy', of interest given that noise is an important component of vessel disturbance of waterbirds and other marine animals. Few vessels (7% of all recorded) were of the type required to carry AIS transponders, which highlights the monitoring gap created by using AIS-based approaches alone in nearshore waters, and allows for correction of AIS-derived vessel counts. Waterbird community composition also varied by locality, with one site dominated by gulls (Laridae), cormorants (Phalacrocoracidae), and seaducks (Tribe Mergini), and the other by gulls, cormorants, and alcids (Alcidae). Our results demonstrate that fine-scale local variability must be taken into account when managing for vessel traffic disturbance of waterbirds, particularly at sites of high human population density and increasing coastal development.

Automated identification system for ships data as a proxy for marine vessel related stressors.

An increasing number of marine conservation initiatives rely on data from Automatic Identification System (AIS) to inform marine vessel traffic associated impact assessments and mitigation policy. However, a considerable proportion of vessel traffic is not captured by AIS in many regions of the world. Here we introduce two complementary techniques for collecting traffic data in the Canadian Salish Sea that rely on optical imagery. Vessel data pulled from imagery captured using a shore-based autonomous camera system ("Photobot") were used for temporal analyses, and data from imagery collected by the National Aerial Surveillance Program (NASP) were used for spatial analyses. The photobot imagery captured vessel passages through Boundary Pass every minute (Jan-Dec 2017), and NASP data collection occurred opportunistically across most of the Canadian Salish Sea (2017-2018). Based on photobot imagery data, we found that up to 72 % of total vessel passages through Boundary Pass were not broadcasting AIS, and in some vessel categories this proportion was much higher (i.e., 96 %). We fit negative binomial General Linearized Models to our photobot data and found a strong seasonal variation in non-AIS, and a weekend/weekday component that also varied by season (interaction term p < 0.0001). Non-AIS traffic was much higher during the summer (Apr-Sep) and during the weekend (Sat-Sun), reflecting patterns in recreational vessel traffic not obligated to broadcast AIS. Negative binomial General Additive Models based on the NASP data revealed strong spatial associations with distance from shore (up to 10 km) and non-AIS vessel traffic for both summer and winter seasons. There were also associations between non-AIS vessels and marina and anchorage densities, particularly during the winter, which again reflect seasonal recreational vessel traffic patterns. Overall, our GAMs explained 20-37 % of all vessel traffic during the summer and winter, and highlighted subregions where vessel traffic is under represented by AIS.

Hydrobiogechemical interactions in the hyporheic zone of a sulfate-impacted, freshwater stream and riparian wetland ecosystem.

Coupled abiotic and biotic processes in the hyporheic zone, where surface water and groundwater mix, play a critical role in the biogeochemical cycling of carbon, nutrients, and trace elements in streams and wetlands. Dynamic hydrologic conditions and anthropogenic pollution can impact redox gradients and biogeochemical response, although few studies examine the resulting hydrobiogeochemical interactions generated within the hyporheic zone. This study examines the effect of hyporheic flux dynamics and anthropogenic sulfate loading on the biogeochemistry of a riparian wetland and stream system. The hydrologic gradient as well as sediment, surface water, and porewater geochemistry chemistry was characterized at multiple points throughout the 2017 spring-summer-fall season at a sulfate-impacted stream flanked by wetlands in northern Minnesota. Results show that organic-rich sediments largely buffer the geochemical responses to brief or low magnitude changes in hydrologic gradient, but sustained or higher magnitude fluxes may variably alter the redox regime and, ultimately, the environmental geochemistry. This has implications for a changing climate that is expected to dramatically alter the hydrological cycle. Further, increased sulfate loading and dissolved or adsorbed ferric iron complexes in the hyporheic zone may induce a cryptic sulfur cycle linked to iron and carbon cycling, as indicated by the abundance of intermediate valence sulfur compounds (e.g., polysulfide, elemental sulfur, thiosulfate) throughout the anoxic wetland and stream-channel sediment column. The observed deviation from a classical redox tower coupled with potential changes in hydraulic gradient in these organic-rich wetland and stream hyporheic zones has implications for nutrient, trace element, and greenhouse gas fluxes into surface water and groundwater, ultimately influencing water quality and global climate.

Decadal differences in polycyclic aromatic compound (PAC) concentrations in two seabird species in Arctic Canada.

Seabirds are exposed to a variety of environmental contaminants in the Arctic. While the persistence, bioaccumulation, and toxicity of some groups of contaminants have been well-studied in seabirds since the 1970s, there is less known about polycyclic aromatic compounds (PACs). With increased vessel traffic, and potential oil and gas development in the Arctic region, there is a need to understand existing PAC exposure in biota against which to compare potential effects of anticipated increases of PACs in the marine region. Thick-billed murres (Uria lomvia) and northern fulmars (Fulmarus glacialis) collected in the Baffin Bay - Davis Strait region during the International Polar Year (IPY; 2007-08), and during a recent Strategic Environmental Assessment (2018; SEA) were examined for hepatic PAC concentrations. We found that fulmars generally had higher concentrations of PACs than the murres, but murres and fulmars sampled in 2007/08 had higher concentrations of most groups of PACs compared to birds from 2018. The one exception to this pattern was that the sum of the alkylated congeners of the heterocyclic aromatic compounds containing a sulfur atom (dibenzothiophene; ΣAHET) was significantly higher in murres in the more recent sampling period (2018) as compared to 2007/08. ΣAHETs likely reflect recent exposure to more refined petroleum products associated with small boats, such as diesel, gasoline and motor oil. This work highlights the need for longitudinal studies on PAC concentrations in biota for us to gain a better understanding of how Arctic biota are exposed to this group of contaminants, and the potential deleterious effects associated with PACs.

Targeted CRISPR screening identifies PRMT5 as synthetic lethality combinatorial target with gemcitabine in pancreatic cancer cells.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most challenging cancers to treat. Due to the asymptomatic nature of the disease and lack of curative treatment modalities, the 5-y survival rate of PDAC patients is one of the lowest of any cancer type. The recurrent genetic alterations in PDAC are yet to be targeted. Therefore, identification of effective drug combinations is desperately needed. Here, we performed an in vivo CRISPR screen in an orthotopic patient-derived xenograft (PDX) model to identify gene targets whose inhibition creates synergistic tumor growth inhibition with gemcitabine (Gem), a first- or second-line chemotherapeutic agent for PDAC treatment. The approach revealed protein arginine methyltransferase gene 5 (PRMT5) as an effective druggable candidate whose inhibition creates synergistic vulnerability of PDAC cells to Gem. Genetic depletion and pharmacological inhibition indicate that loss of PRMT5 activity synergistically enhances Gem cytotoxicity due to the accumulation of excessive DNA damage. At the molecular level, we show that inhibition of PRMT5 results in RPA depletion and impaired homology-directed DNA repair (HDR) activity. The combination (Gem + PRMT5 inhibition) creates conditional lethality and synergistic reduction of PDAC tumors in vivo. The findings demonstrate that unbiased genetic screenings combined with a clinically relevant model system is a practical approach in identifying synthetic lethal drug combinations for cancer treatment.

Seasonal variability in vulnerability for Cassin's auklets (Ptychoramphus aleuticus) exposed to microplastic pollution in the Canadian Pacific region.

Marine plastic pollution is an emerging global conservation challenge, potentially impacting organisms at all trophic levels. However, currently it is unclear to what extent plastic pollution is impacting marine organisms at the population, species or multispecies level. In this study, we explore seasonal exposure (i.e., vulnerability) of Cassin's Auklet (Ptychoramphus aleuticus) to plastic pollution with exposure models during boreal summer and winter seasons. Based on these models, we infer exposure at the population level for this species, in the Canadian Pacific region where approximately 75% of the global population of this species breeds. The models quantify plastic exposure by determining seasonal core foraging areas and plastic concentrations found in those same areas. Core foraging areas were determined using a Generalized Additive Model based on at-sea observation data (collected year round: 1990-2010) and 50% Home Range Kernels based on aerial telemetry data (May and June 1999-2001). Plastic concentrations within these core areas were interpolated based on seawater microplastic concentrations from the summer of 2012. We found that during the boreal summer, Cassin's Auklets were exposed to relatively low concentrations of plastics. During the winter, auklet distribution shifted towards the coast where plastic concentrations are considerably higher. Model derived seasonal variability in exposure was consistent with necropsy results from bird carcasses recovered during the winter of 2014, and from a multiyear study on chick provisioning during the summer. Local oceanography likely plays a role in determining seasonal shifts in both marine bird as well microplastic concentrations, and hence exposure. As well, individual sensitivity (i.e., dose-dependent effect) may vary with annual cycles. Currently, research is focusing on determining how sensitive individual birds are to microplastic concentrations, and our models will help translate sensitivity found at the individual level to potential impacts at population or species level.

Are ocean conditions and plastic debris resulting in a 'double whammy' for marine birds?

We report a mortality event of Red Phalaropes (Phalaropus fulicarius) that occurred from October to November 2016 on the north coast of British Columbia, Canada. All individuals were severely underweight and showing signs of physiological stress. The guts of all carcasses contained ingested plastics (100%, n = 9). Distribution modelling from pelagic bird surveys (1990-2010) indicated that Red Phalaropes are not typically found in the study area during fall months. Ocean conditions during fall 2016 were unusually warm, coinciding with reduced upwelling in the study area. eBird records since 1980 indicated Red Phalaropes are observed closer to shore during periods associated with reduced upwelling. These results suggest that distribution shifts of Red Phalaropes closer to shore, where plastic debris occurs in higher concentrations, may lead phalaropes to feed on plastic debris while in a weakened state, resulting in a combination of two adverse circumstances.

Modeling the distribution of illicit oily discharges detected by aerial surveillance in western Canadian marine waters.

Oily discharges from vessel operations have been documented in Canada's Pacific region by the National Aerial Surveillance Program (NASP) since the early 1990s. We explored a number of regression methods to explain the distribution and counts per grid cell of oily discharges detected from 1998 to 2007 using independent predictor variables, while trying to address the large number of zeros present in the data. Best-fit models indicate that discharges are generally concentrated close to shore typically in association with small harbours, and with major commercial and tourist centers. Oily discharges were also concentrated in Barkley Sound and at the entrance of Juan de Fuca Strait. The identification of important factors associated with discharge patterns, and predicting discharge rates in areas with surveillance effort can be used to inform future surveillance. Model output can also be used as inputs for risk models for existing conditions and as baseline for future scenarios.

Fish oil disrupts seabird feather microstructure and waterproofing.

Seabirds and other aquatic avifauna are highly sensitive to exposure to petroleum oils. A small amount of oil is sufficient to break down the feather barrier that is necessary to prevent water penetration and hypothermia. Far less attention has been paid to potential effects on aquatic birds of so called 'edible oils', non-petroleum oils such as vegetable and fish oils. In response to a sardine oil discharge by a vessel off the coast of British Columbia, we conducted an experiment to assess if feather exposure to sheens of sardine oil (ranging from 0.04 to 3 µm in thickness) resulted in measurable oil and water uptake and significant feather microstructure disruption. We designed the experiment based on a previous experiment on effects of petroleum oils on seabird feathers. Feathers exposed to the thinnest fish oil sheens (0.04 µm) resulted in measurable feather weight gain (from oil and water uptake) and significant feather microstructure disruption. Both feather weight gain and microstructure disruption increased with increasing fish oil thickness. Because of the absence of primary research on effects of edible oils on sea birds, we conducted interviews with wildlife rehabilitation professionals with experience rehabilitating sea birds after edible oil exposure. The consensus from interviews and our experiment indicated that physical contact with fish and other 'edible oils' in the marine environment is at least as harmful to seabirds as petroleum oils.

Incidence and cost of hospitalizations associated with Staphylococcus aureus skin and soft tissue infections in the United States from 2001 through 2009.

BACKGROUND: The emergence of community-associated methicillin-resistant Staphylococcus aureus (SA) and its role in skin and soft tissue infections (SSTIs) accentuated the role of SA-SSTIs in hospitalizations. METHODS: We used the Nationwide Inpatient Sample and Census Bureau data to quantify population-based incidence and associated cost for SA-SSTI hospitalizations. RESULTS: SA-SSTI associated hospitalizations increased 123% from 160,811 to 358,212 between 2001 and 2009, and they represented an increasing share of SA- hospitalizations (39% to 51%). SA-SSTI incidence (per 100,000 people) doubled from 57 in 2001 to 117 in 2009 (p<0.01). A significant increase was observed in all age groups. Adults aged 75+ years and children 0-17 years experienced the lowest (27%) and highest (305%) incidence increase, respectively. However, the oldest age group still had the highest SA-SSTI hospitalization incidence across all study years. Total annual cost of SA-SSTI hospitalizations also increased and peaked in 2008 at $4.84 billion, a 44% increase from 2001. In 2009, the average associated cost of a SA-SSTI hospitalization was $11,622 (SE=$200). CONCLUSION: There has been an increase in the incidence and associated cost of SA-SSTI hospitalizations in U.S.A. between 2001 and 2009, with the highest incidence increase seen in children 0-17 years. However, the greatest burden was still seen in the population over 75 years. By 2009, SSTI diagnoses were present in about half of all SA-hospitalizations.

Northern fulmars as biological monitors of trends of plastic pollution in the eastern North Pacific.

Marine plastic debris is a global issue, which highlights the need for internationally standardized methods of monitoring plastic pollution. The stomach contents of beached northern fulmar (Fulmarus glacialis) have proven a cost-effective biomonitor in Europe. However, recent information on northern fulmar plastic ingestion is lacking in the North Pacific. We quantified the stomach contents of 67 fulmars from beaches in the eastern North Pacific in 2009-2010 and found that 92.5% of fulmars had ingested an average of 36.8 pieces, or 0.385 g of plastic. Plastic ingestion in these fulmars is among the highest recorded globally. Compared to earlier studies in the North Pacific, our findings indicate an increase in plastic ingestion over the past 40 years. This study substantiates the use of northern fulmar as biomonitors of plastic pollution in the North Pacific and suggests that the high levels of plastic pollution in this region warrant further monitoring.

Marine mammals and debris in coastal waters of British Columbia, Canada.

Entanglement in and ingestion of synthetic marine debris is increasingly recognized worldwide as an important stressor for marine wildlife, including marine mammals. Studying its impact on wildlife populations is complicated by the inherently cryptic nature of the problem. The coastal waters of British Columbia (BC), Canada provide important habitat for marine mammal species, many of which have unfavorable conservation status in the US and Canada. As a priority-setting exercise, we used data from systematic line-transect surveys and spatial modeling methods to map at-sea distribution of debris and 11 marine mammal species in BC waters, and to identify areas of overlap. We estimated abundance of 36,000 (CIs: 23,000-56,600) pieces of marine debris in the region. Areas of overlap were often far removed from urban centers, suggesting that the extent of marine mammal-debris interactions would be underestimated from opportunistic sightings and stranding records, and that high-overlap areas should be prioritized by stranding response networks.

Increasing role of Staphylococcus aureus and community-acquired methicillin-resistant Staphylococcus aureus infections in the United States: a 10-year trend of replacement and expansion.

BACKGROUND: There is the need to properly characterize the temporal trend of U.S. Staphylococcus aureus infections, including methicillin-resistant S. aureus (MRSA) and community-acquired (CA) MRSA in inpatient and outpatient settings. METHODS: The study used the Surveillance Network(®) surveillance database (Eurofins Medinet) and the National Hospitalization Discharge Survey for the period 1998-2007. CA-MRSA phenotype was defined by a resistance profile that includes susceptibility to gentamicin and cotrimoxazole, and coresistance to ciprofloxacin/clindamycin. Adjusted rates, rate ratios, and 95% confidence intervals (CIs) were computed using multivariate logistic regression. RESULTS: The study consisted of 1,761,991 S. aureus isolates. Annual MRSA prevalence continuously increased over the 10-year period from 32.7% in 1998 to 53.8% in 2007 (odds ratio 2.4, 95% CI 2.3-2.5). CA-MRSA replaced competing strains by increasing its share of MRSA from 22.3% in 1998 to 66.1% in 2007 (odds ratio 6.7, 95% CI 6.5-6.9). MRSA-related hospitalization rate per 1,000 discharges doubled from 3.5 ± 0.9 in 1998 to 7.6 ± 1.5 in 2007 (RR 2.2, 95% CI 1.8-3.1), whereas CA-MRSA increased from 0.4 ± 0.14 hospitalizations per 1,000 discharges in 1998 to 3.1 ± 0.5 in 2007 (RR 8.1, 95% CI 5.2-14.1), By 2007, 81.5% of all MRSA isolates were categorized as CA-MRSA among children, whereas CA-MRSA represented 48.9% of MRSA isolates from the elderly. CONCLUSION: MRSA not only replaced methicillin susceptible S. aureus (MSSA) isolates as a percentage of all S. aureus isolates, but its hospitalization rates increased over and above the replacement process. This trend also applies to CA-MRSA over hospital-acquired (HA) MRSA.

Results from inspections of farmer-installed rollover protective structures.

This study sought to assess the feasibility of self-installing rollover protective structures (ROPS) and to identify any patterns of self-installation deficiencies in a sample of New York ROPS Retrofit Rebate Program participants. Inspection engineers looked for/at damage, rust, holes, deteriorated welding, location of attachment, axle housing, the presence of original plates/bolts, and adequate seatbelt installation. Results indicated that only 31% of farmers received correct parts and also installed these parts properly. Ten percent of self-installed tractors had installation problems so severe they were referred to a dealer for correction. Issues with seatbelts, torque, and unmarked or defective bolts in ROPS kits were also detected.

Ingested plastic in a diving seabird, the thick-billed murre (Uria lomvia), in the eastern Canadian Arctic.

Plastic debris has become ubiquitous in the marine environment and seabirds may ingest debris which can have deleterious effects on their health. In the North Atlantic Ocean, surface feeding seabirds typically ingest high levels of plastic, while the diving auks which feed in the water column typically have much lower levels. We examined 186 thick-billed murres from five colonies in the eastern Canadian Arctic for ingested plastic debris. Approximately 11% of the birds had at least one piece of plastic debris in their gastrointestinal tracts, with debris dominated by user plastics. This is the first report of ingested plastics in an auk species in Canada's Arctic, and the highest incidence of plastic ingestion to date for thick-billed murres (Uria lomvia).

Surgical repair of carotid artery aneurysms: a 10-year, single-center experience.

BACKGROUND: The aim of this study was to evaluate the surgical management of carotid artery aneurysms (CAAs) presenting to a tertiary care center over a 10-year period of time. METHODS: The medical records of patients undergoing repair of CAA between 1998 and 2008 were reviewed. Demographics, clinical presentation, and operative interventions were recorded. Postoperative outcomes were assessed, and patency and survival rates were calculated using life-table analysis. RESULTS: Two patients (11%) had a history of neck dissection, one (5%) neck irradiation, and three (16%) a combination of neck dissection and irradiation for cancer. Five (26%) had previous carotid endarterectomy, while three (16%) had prior carotid artery stenting for occlusive disease. Eight (42%) patients presented with neurologic symptoms, all transient in nature. Aneurysms were isolated to the internal carotid artery in eight (42%) cases, the common carotid artery in one (5%) case, and both regions in the remaining 53%. The etiologies of the aneurysms were divided among atherosclerotic aneurysms (36.8%), mycotic pseudoaneurysms (36.8%), and patch aneurysms (26.3%).Twelve (63%) underwent resection and interposition grafting, six underwent aneurysm resection and patch repair, and one (5%) had end-to-end reconstruction. Postoperative complications included one transient ischemic attach (5%), two strokes (10%), and one cranial nerve deficit (5%). Primary patency at 30 months was 90% (standard error [SE] = 0.10), and survival at 48 months was 92% (SE = 0.10). Assisted primary patency was maintained at 90% at 30 months (SE = 0.10). CONCLUSION: CAA surgery, while rare, can be performed safely and with durable patency. Future studies will be necessary to assess the efficacy of endovascular therapy for this disease.

Effects of sheens associated with offshore oil and gas development on the feather microstructure of pelagic seabirds.

Operational discharges of hydrocarbons from maritime activities can have major cumulative impacts on marine ecosystems. Small quantities of oil (i.e., 10 ml) results in often lethally reduced thermoregulation in seabirds. Thin sheens of oil and drilling fluids form around offshore petroleum production structures from currently permissible operational discharges of hydrocarbons. Methodology was developed to measure feather microstructure impacts (amalgamation index or AI) associated with sheen exposure. We collected feather samples from two common North Atlantic species of seabirds; Common Murres (Uria aalge) and Dovekies (Alle alle). Impacts were compared after feather exposure to crude oil and synthetic lubricant sheens of varying thicknesses. Feather weight and microstructure changed significantly for both species after exposure to thin sheens of crude oil and synthetic drilling fluids. Thus, seabirds may be impacted by thin sheens forming around offshore petroleum production facilities from discharged produced water containing currently admissible concentrations of hydrocarbons.

The role of genomic data in the discovery, annotation and evolutionary interpretation of the interferon-lambda family.

BACKGROUND: Type-I interferons, type-II interferons, and the IL-10 family are helical cytokines with similar three-dimensional folds. However, their homologous relationship is difficult to detect on the basis of sequence alone. We have previously described the discovery of the human type-III interferons (IFN lambda-1, -2, -3 or IL-29, IL-28A, IL-28B), which required a combination of manual and computational techniques applied to predicted protein sequences. PRINCIPAL FINDINGS: Here we describe how the use of gene structure analysis and comparative genomics enabled a more extensive understanding of these genes early in the discovery process. More recently, additional mammalian genome sequences have shown that there are between one and potentially nine copies of interferon lambda genes in each genome, and that several species have single exon versions of the interferon lambda gene. SIGNIFICANCE: The variable number of single exon type-I interferons in mammals, along with recently identified genes in zebrafish homologous to interferons allows a story of interferon evolution to be proposed. This model suggests that the gene duplications and single exon retrotransposons of mammalian type-III interferons are positively selected for within a genome. These characteristics are also shared with the fish interferons and could be responsible for the generation of the IL10 family and also the single exon type-I interferons.

The management of severe aortoiliac occlusive disease: endovascular therapy rivals open reconstruction.

OBJECTIVE: Aortobifemoral bypass (ABF) grafting has been the traditional treatment for extensive aortoiliac occlusive disease (AIOD). This retrospective study compared the outcomes and durability of recanalization, percutaneous transluminal angioplasty, and stenting (R/PTAS) vs ABF for severe AIOD. METHODS: Between 1998 and 2004, 86 patients (161 limbs) underwent ABF (n = 75) or iliofemoral bypass (n = 11), and 83 patients (127 limbs) underwent R/PTAS. All patients had severe symptomatic AIOD (claudication, 53%; rest pain, 28%; tissue loss, 12%; acute limb ischemia, 7%). The analyses excluded patients treated for aneurysms, extra-anatomic procedures, and endovascular treatment of iliac stenoses. Original angiographic imaging, medical records, and noninvasive testing were reviewed. Kaplan-Meier estimates for patency and survival were calculated and univariate analyses performed. Mortality was verified by the Social Security database. RESULTS: The ABF patients were younger than the R/PTAS patients (60 vs 65 years; P = .003) and had higher rates of hyperlipidemia (P = .009) and smoking (P < .001). All other clinical variables, including cardiac status, diabetes, symptoms at presentation, TransAtlantic Inter-Society Consensus stratification, and presence of poor outflow were similar between the two groups. Patients underwent ABF with general anesthesia (96%), often with concomitant treatment of femoral or infrainguinal disease (61% endarterectomy, profundaplasty, or distal bypass). Technical success was universal, with marked improvement in ankle-brachial indices (0.48 to 0.84, P < .001). Patients underwent R/PTAS with local anesthesia/sedation (78%), with a 96% technical success rate and similar hemodynamic improvement (0.36 to 0.82, P < .001). At the time of R/PTAS, 21% of patients underwent femoral endarterectomy/profundaplasty or bypass (n = 5) for concomitant infrainguinal disease. Limb-based primary patency at 3 years was significantly higher for ABF than for R/PTAS (93% vs 74%, P = .002). Secondary patency rates (97% vs 95%), limb salvage (98% vs. 98%), and long-term survival (80% vs 80%) were similar. Diabetes mellitus and the requirement of distal bypass were associated with decreased patency (P < .001). Critical limb ischemia at presentation (tissue loss, hazard ratio [HR], 8.1; P < .001), poor outflow (HR, 2; P = .023), and renal failure (HR, 2.5; P = .02) were associated with decreased survival. CONCLUSION: R/PTAS is a suitable, less invasive alternative to ABF for the treatment of severe AIOD. Repair of the concomitant femoral occlusive disease is often needed regardless of open or endovascular treatment. Infrainguinal disease negatively affects the durability of the procedure and patient survival.