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The current national criteria for carotid artery stenting overestimate its efficacy in patients who are symptomatic and at high risk
In this study, we stratified patients who underwent CAS or CEA by CMS high-risk criteria and symptom status and examined their 30-day outcomes.Methods: A nonrandomized, retrospective cohort study was performed by chart review of all patients undergoing CEA or CAS from January 1, 2005, to December 31, 2010, at our institution. Demographic data and data pertaining to the presence or absence of high-risk factors were collected. Patients were stratified using symptom status and high-risk status as variables, and 30-day adverse events (stroke, death, myocardial infarction [MI]) were compared.Results: A total of 271 patients und...
Source: Journal of Vascular Surgery - April 8, 2013 Category: Surgery Authors: Shunsuke Yoshida, Rodney P. Bensley, Julia D. Glaser, Christoph S. Nabzdyk, Allen D. Hamdan, Mark C. Wyers, Elliot L. Chaikof, Marc L. Schermerhorn Tags: Clinical research studies Source Type: research

The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry
Objective: The Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.Methods: We analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death,...
Source: Journal of Vascular Surgery - February 13, 2013 Category: Surgery Authors: Marc L. Schermerhorn, Margriet Fokkema, Philip Goodney, Ellen D. Dillavou, Jeffrey Jim, Christopher T. Kenwood, Flora S. Siami, Rodney A. White, SVS Outcomes Committee Tags: Clinical research studies Source Type: research

Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting
Conclusions: Administrative data are unreliable for determining symptom status, high-risk status, and perioperative stroke and should not be used to analyze CEA and CAS. NSQIP data do not adequately identify high-risk patients, but do accurately identify perioperative strokes and to a lesser degree, symptom status.
Source: Journal of Vascular Surgery - March 13, 2013 Category: Surgery Authors: Rodney P. Bensley, Shunsuke Yoshida, Ruby C. Lo, Margriet Fokkema, Allen D. Hamdan, Mark C. Wyers, Elliot L. Chaikof, Marc L. Schermerhorn Tags: Clinical research studies Source Type: research

Routine revascularization is unnecessary in the majority of patients requiring zone II coverage during thoracic endovascular aortic repair: A longitudinal outcomes study using United States Medicare population data.
ConclusionsTEVAR + SUB were associated with lower rates of mortality and complications. Only a small percentage of TEVAR + SUB required a bypass at one year after procedure. Our data suggest that routine LSA bypass during TEVAR is unnecessary and associated with increase morbidity and mortality. PMID: 24003009 [PubMed - as supplied by publisher]
Source: Vascular - September 3, 2013 Category: Surgery Authors: Wilson JE, Galiñanes EL, Hu P, Dombrovskiy VY, Vogel TR Tags: Vascular Source Type: research

Insurance Type and Major Complications After Hysterectomy
Objectives: The aim of this study was to investigate the relationship between primary insurance type and major complications after hysterectomy. Methods: A retrospective analysis was performed on women with Medicaid, Medicare, and private insurance who underwent hysterectomy from January 1, 2012, to July 1, 2014, and were included in the Michigan Surgical Quality Collaborative. Major complications within 30 days of surgery included the following: deep/organ space surgical site infection, deep venous and pulmonary thromboembolism, myocardial infarction or stroke, pneumonia or sepsis, blood transfusion, readmission, and dea...
Source: Journal of Pelvic Medicine and Surgery - December 20, 2016 Category: Surgery Tags: Original Articles Source Type: research

IP131. Transfemoral Carotid Angioplasty and Stenting With Embolic Protection: A 7-year Retrospective Analysis of a Single-Center Experience
Carotid angioplasty and stenting (CAS) is an excellent, often superior, alternative to carotid endarterectomy (CEA). When performed by experienced operators, both are equivalent in periprocedural risk and stroke prevention. Widespread adoption of CAS in the United States has been impeded by reimbursement regulations mandated by the Centers for Medicare and Medicaid Services (CMS) that favor CEA over CAS for patients with asymptomatic carotid disease. This policy has led to decreased CAS volumes and an increase in percentages of patients receiving CAS for symptomatic vs asymptomatic disease.
Source: Journal of Vascular Surgery - May 17, 2017 Category: Surgery Authors: Michael B. Silva, Garold Motes, Zulfiqar Faisal. Cheema, Grant Fankhauser, Nikita Tihonov, Jennifer Worsham, Kaled Diab, Charlie Cheng Tags: IP: Interactive Poster Session Source Type: research

VESS05. In-Hospital Outcomes of Transcarotid Artery Revascularization and Carotid Endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative
This study compares initial in-hospital outcomes of CEA and TCAR using the Society for Vascular Surgery (SVS) Vascular Quality Initiative TCAR Surveillance Project done in collaboration with the Centers for Medicare and Medicaid Services to create more information for future coverage decisions.
Source: Journal of Vascular Surgery - May 22, 2018 Category: Surgery Authors: Marc L. Schermerhorn, Hanaa Dakour Aridi, Vikram S. Kashyap, Grace J. Wang, Brian Nolan, Jack Cronenwett, Jens Eldrup-Jorgensen, Mahmoud B. Malas Source Type: research

Expansion of Transcarotid Artery Revascularization to Standard Risk Patients for Treatment of Carotid Artery Stenosis
Transcarotid artery revascularization (TCAR) is currently reimbursed by the Centers for Medicare and Medicaid Services for treatment of medically and anatomically high-risk patients. TCAR has been found to be associated with equivalent stroke/death outcomes compared with carotid endarterectomy (CEA) for high-risk patients. However, the safety profile of TCAR in standard-risk patients is currently not well-defined and has limited its expansion of use in this patient population.
Source: Journal of Vascular Surgery - August 24, 2021 Category: Surgery Authors: Patric Liang, Jack Cronenwett, Eric Secemsky, Jens Eldrup-Jorgensen, Mahmoud Malas, Grace J. Wang, Brian Nolan, Vikram S. Kashyap, Raghu L. Motaganahalli, Marc L. Schermerhorn Tags: S2: Plenary Session 2 Source Type: research

Rules of engagement: The delicate dance between vascular surgeons, industrial partners, and patient outcomes
In 1953, Michael E. DeBakey performed the first carotid endarterectomy successfully. It would be almost 60  years until a new technique disrupted the carotid world with as much furor. In 2012, transcarotid artery revascularization (TCAR) burst onto the scene. With its minimally invasive, hybrid appeal and equivalency to carotid endarterectomy stroke risk, TCAR quickly won the hearts of many vascular sur geons. The update of TCAR technology was rapid, increasing dramatically at 15% annually, with a real jolt coming in 2016 when the Centers for Medicare& Medicaid Services allowed coverage for TCAR under the existing nationa...
Source: Journal of Vascular Surgery - November 19, 2021 Category: Surgery Authors: Anahita Dua Tags: Invited commentary Source Type: research