Outcomes and Durability of Endovascular Aneurysm Repair in Octogenarians.

BACKGROUND: Endovascular aneurysm repair (EVAR) accounts for the majority of all abdominal aortic aneurysm (AAA) repairs in the United States. EVAR utilization in the aging population is increasing due to the minimally invasive nature of the procedure, the low associated perioperative morbidity, and early survival benefit over open repair. The objective of this study is to compare the outcomes of octogenarians after elective EVAR to their younger counterparts, a question that can be answered by a long-term, institutional data set. METHODS: This was a retrospective series of 255 patients, who underwent elective EVAR within our institution from 2008 to 2015. A comparative analysis of patients aged 80 years and older and less than 80 years was performed. Outcomes measured included perioperative death and myocardial infarction (MI), length of stay, and readmission within 30 days. Aneurysm reintervention, long-term surveillance imaging, and aneurysm-related deaths were also evaluated. In addition, subset analyses of octogenarians were compared for survival at 24 months. RESULTS: Overall, 255 patients were included in our analysis. Fifty-nine patients were octogenarians, and 196 patients were nonoctogenarians. The mean age difference between the two groups was significant (84.5 years [SD, ±3.44] vs. 69.6 years [SD, ±6.13] in the ≥80 and <80 groups, respectively; P < 0.0001). There was no significant difference in the mean aneurysm size (6.03 cm [SD, ±1.12] vs. 5.535 cm [SD, ±0.9]; P < 0.06) between the ≥80 and < 80 groups. Octogenarians had higher rates of perioperative MI (5% vs. 1%, P < 0.04), thirty-day mortality (7% vs. 0%, P < 0.003), a higher number of perioperative complications (0.64 incidence per patient [SD, ±1.11] vs. 0.31 [SD, ±0.69], P < 0.005), and a longer mean hospital stay (5.34 [SD, ±5.75] days vs. 3.16 [SD, ±3.23] days, P < 0.0003), and they were also less likely to be discharged home after surgery (75% vs. 91%, P < 0.002). In the evaluated long-term outcomes, the two groups were similar with regard to aneurysm reintervention (10% vs. 9%, P < 0.06) and the stability of aneurysm sac size on imaging at last follow-up (71% vs. 80%, P < 0.27). The overall aortic related cause of death was different between the groups (8% vs. 1%, P < 0.003); however, the long-term aortic related mortality was not different between the two groups (2% vs. 1%, P < 0.4). Finally, a subset analysis of the octogenarian group was performed comparing patients based on survival status at 24 months. Higher preoperative creatinine (1.73 mg/dL [SD, ±1.54] vs. 1.15 mg/dL [SD, ±0.46]) and lower preoperative hematocrit (33.9% [SD, ±3.43] vs. 37.2% [SD, ±4.9]) along with number of perioperative complications (1.2 incidence per patient [SD, ±1.74] vs. 0.45 [SD, ±0.73]) were associated with death at 24 months after the index operation. CONCLUSIONS: Elective endovascular repair of AAA in octogenarians carries a higher risk of perioperative mortality but acceptable long-term outcomes. Appropriateness of elective EVAR in octogenarians should be answered based on this potential short-lived survival benefit, taking into account that advanced age should not be the sole basis of exclusion for otherwise suitable candidates for elective EVAR.

A review of the current management and treatment options for superficial venous insufficiency.

The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency.

Improving Radiology Trainees' Perception Using Where's Waldo?

RATIONALE AND OBJECTIVES: Perception is an essential skill leading to expertise in diagnostic radiology. We determined if practicing "Where's Waldo?" images improves accuracy and speed with which first and second year radiology residents detect abnormalities on chest radiographs (CXRs). MATERIALS AND METHODS: Residents at three institutions were pretested using 50 CXRs, identifying locations of potential abnormalities. They were then split into trained (examining 7 "Where's Waldo?" images over three weeks) and control groups (no "Where's Waldo?"). They were then re-tested on the 50 CXRs. At one site, visual search parameters were acquired. Data were analyzed with repeated measures ANOVAs. RESULTS: There was no significant difference in performance for trained vs control (F = 0.622, p = 0.436), with both improving significantly on post-test (F = 4.72, p = 0.037). Session time decreased significantly for both groups from pre to post-test (F = 81.47, p < 0.0001) and the decrease was significantly more (F = 31.59, p < 0.0001) for the trained group than the control group as well as for PGY with PGY3 having a larger average decrease in session time than PGY2. Eye-tracking data also showed significant increases in per image search efficiency with training. CONCLUSION: Practicing "Where's Waldo?" or similar nonradiology search tasks may facilitate the acquisition of radiology image search but not detection skills, impacting reading efficiency more than detection accuracy.

Overview of Noninterpretive Artificial Intelligence Models for Safety, Quality, Workflow, and Education Applications in Radiology Practice.

Artificial intelligence has become a ubiquitous term in radiology over the past several years, and much attention has been given to applications that aid radiologists in the detection of abnormalities and diagnosis of diseases. However, there are many potential applications related to radiologic image quality, safety, and workflow improvements that present equal, if not greater, value propositions to radiology practices, insurance companies, and hospital systems. This review focuses on six major categories for artificial intelligence applications: study selection and protocoling, image acquisition, worklist prioritization, study reporting, business applications, and resident education. All of these categories can substantially affect different aspects of radiology practices and workflows. Each of these categories has different value propositions in terms of whether they could be used to increase efficiency, improve patient safety, increase revenue, or save costs. Each application is covered in depth in the context of both current and future areas of work. Keywords: Use of AI in Education, Application Domain, Supervised Learning, Safety © RSNA, 2022.

The Impact of Fatigue on Complex CT Case Interpretation by Radiology Residents.

RATIONALE AND OBJECTIVES: To examine the effect of fatigue on diagnostic performance and interpretation of complex CT trauma studies by radiology residents. MATERIALS AND METHODS: Ten 2nd, 3rd, and 4th year radiology residents were given 1 hour to review as many complex CT cases as they could, once when they were fresh and once when they were fatigued (after a full day or night of diagnostic reading activity). Number of cases completed, interpretation accuracy and time per case were analyzed. RESULTS: On average readers completed 7.5 cases when fresh and 7.3 when fatigued, with 4th and 3rd year residents spending more time per case when fresh than fatigued and 2nd year residents spending more time when fatigued. The total number of true positives for major (fresh mean = 29.4 vs fatigued mean = 24.1) and minor (fresh mean = 23.30 vs fatigued mean = 18.90) findings decreased for fresh vs fatigued; and there was a significant difference as a function of year of residency (F = 4.72, p = 0.027). The 4th year residents had the most TPS in both conditions, followed by 3rd then 2nd year residents. There were more false positives when fatigued than fresh. CONCLUSION: Fatigue significantly impacts radiologic diagnostic efficiency and efficacy, and differs as a function of year of residency.

Preoperative optimization of the vascular surgery patient.

It is well known that patients who suffer from peripheral (noncardiac) vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of non-cardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery.