Journal of Vascular Surgery (J VASC SURG )

Publisher: Society for Vascular Surgery (U.S.); International Society for Cardiovascular Surgery. North American Chapter, Elsevier


Journal of Vascular Surgery provides cardiothoracic, vascular, and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, prostheses and vascular substitutes, microvascular surgical techniques, angiography, and endovascular management. Special issues publish papers presented at the annual joint meeting of the Journal's sponsoring societies, the Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery. Journal of Vascular Surgery ranks in the top 9.7% of the 4,625 scientific journals most frequently cited (Science Citation Index). The Journal is also recommended for purchase in the Brandon-Hill study, Selected List of Books and Journals for the Small Medical Library (1997/98 Edition).

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    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Outcomes of reinterventions for failing mesenteric open reconstructions (ORs) have not been described. Mesenteric reoperative ORs (R-ORs) are challenging because of excessive scar and more advanced mesenteric disease. The purpose of this study was to evaluate outcomes of R-ORs and endovascular revascularization (ER) in patients with stenosis or occlusion of mesenteric grafts. Methods We reviewed 701 patients treated for chronic mesenteric ischemia (CMI) in two academic centers from 1991 to 2013. Clinical data and outcomes of patients treated for failing ORs with R-ORs or ERs were included in the analysis. A 1:2 case-control matching was used to analyze outcomes of R-ORs compared with patients who underwent their first-time ORs for CMI. End points were early and late mortality, morbidity, patency rates, and freedom from symptom recurrence and reintervention. Results There were 47 patients (five men, 42 women; mean age, 58 ± 13 years) with failing ORs who were treated by R-ORs. Clinical presentation was CMI in 38 patients (81%) or acute mesenteric ischemia (AMI) in nine (19%). Reinterventions included R-ORs in 28 patients (19 CMI and nine AMI) and ERs in 19, all for CMI. Early mortality was 22% in patients treated by R-ORs for AMI. There were no early deaths among patients treated for CMI with R-OR or ER. Early morbidity was 78% for R-ORs in patients treated for AMI. Morbidity was significantly higher for R-ORs than for ERs in patients with CMI (63% vs 16%; P < .05). Mean follow-up was 50 ± 60 months. Patient survival at 5 years was 60% ± 8% for the entire cohort. Primary and secondary patency at 1 year were 61% ± 10% and 92% ± 8% for R-ORs (P = .34) and 77% ± 10% and 100% for ERs (P = .41). Freedom from symptom recurrence and reinterventions at 1 year was 88% ± 6% and 87% ± 7% for R-ORs and 83% ± 8% and 71% ± 10% for ERs. Case case-control (1:2) matching showed R-OR was associated with similar early mortality and morbidity and also similar freedom from recurrence and reintervention but with lower primary patency rates at 1 year compared with first time ORs (66% ± 11% and 94% ± 5%; P < .05). Conclusions R-OR or ER interventions for failing mesenteric ORs carry similar mortality, recurrence, and reintervention rates. Early morbidity is lower with ER compared with R-OR. R-ORs are associated with similar morbidity and mortality and lower primary patency compared with first-time OR for CMI.
    Journal of Vascular Surgery 10/2014;
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    ABSTRACT: Objective Data on the influence of contralateral carotid occlusion (CCO) on carotid endarterectomy (CEA) are conflicting and are absent for carotid artery stenting (CAS). This study evaluated the influence of CCO on CEA and CAS. Methods We evaluated patients with and without CCO in the Society for Vascular Surgery Vascular Registry. Primary outcome was a composite of periprocedural death, stroke, or myocardial infarction (MI) (major adverse cardiovascular events [MACE]) and its individual components. Further analysis was done to identify the influence, if any, of symptom status on outcomes. Results There were 1128 CAS and 666 CEA patients with CCO. CAS patients were more often symptomatic with a greater incidence of coronary artery disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and New York Heart Association class >III. Absolute risk of periprocedural MACE (2.7% for CAS vs 4.2% for CEA), death (1.1% for CAS vs 0.7% for CEA), stroke (2.1% for CAS vs 3.1% for CEA), and MI (0.3% for CAS vs 0.6% for CEA) was statistically equivalent for both. This equivalence was maintained when patients with CCO were segregated according to symptom status and after adjusting for periprocedural risk. There were 16,646 patients without contralateral occlusion (5698 CAS; 10,948 CEA). Patients without contralateral occlusion with CEA have better outcomes in periprocedural MACE (1.8% for patients without contralateral occlusion vs 4.2% for patients with CCO), and stroke (1.1% for patients without contralateral occlusion vs 3.1% for patients with CCO) (P < .0001 for both). In CAS patients, CCO did not significantly affect periprocedural MACE (3.2% for patients without contralateral occlusion vs 2.7% for patients with CCO), death (0.8% for patients without contralateral occlusion vs 1.0% for patients with CCO), stroke (2.3% for patients without contralateral occlusion vs 2.1% for patients with CCO), or MI (0.6% for patients without contralateral occlusion vs 0.3% for patients with CCO). In CEA patients, CCO increased MACE, primarily by increasing stroke rates in asymptomatic (0.7% vs 2.0%; P = .0095) and symptomatic (1.7% vs 4.9%; P = .0012) patients. Conclusions Although CEA is preferred in patients without contralateral occlusion, regardless of symptom status, based on lower rates of periprocedural MACE, death, and stroke, the benefit of CEA is lost in patients with CCO because of increased stroke rates in CCO patients after CEA but not after CAS regardless of symptom status. The results of CAS and CEA in patients with CCO are equivalent and within acceptable American Heart Association guidelines.
    Journal of Vascular Surgery 10/2014; 60(4):958–965.e2.
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    ABSTRACT: Background Iodinated contrast during endovascular aneurysm repair (EVAR) is used with caution in patients with chronic kidney disease. Contrast-enhanced ultrasound (CEUS) imaging using nonnephrotoxic sulphur hexafluoride microbubble contrast is a novel imaging modality that accurately identifies and characterizes endoleaks during EVAR follow-up. We report our initial experience of using three-dimensional (3D) CEUS imaging intraoperatively as completion imaging after endograft deployment. Our aim was to compare intraoperative 3D CEUS against uniplanar angiography in the detection of endoleak, stent deformity, and renal artery perfusion during EVAR. Methods The study enrolled 20 patients undergoing elective conventional infrarenal EVAR, after which a completion angiogram was performed and the presence of endoleak, renal artery perfusion, or device deformity were recorded. With the patient still under anesthetic, a vascular scientist blinded to angiographic findings performed 3D CEUS and reported on the same parameters. Results Three endoleaks, one type I and two type II, were detected on uniplanar angiography and 13 endoleaks, 11 type II and two type I, were found using 3D CEUS imaging. Of note, one of these type I endoleaks was not seen on angiography, and this patient underwent balloon moulding of the neck with resolution of the endoleak on repeat imaging. Of the 11 type II endoleaks seen with 3D CEUS imaging, the inflow vessel was identified in nine cases. No graft deformity or limb kinking was seen in any patient. Both renal arteries could be visualized in 10 patients, whereas the target renal artery was seen in 11 patients. In the remaining patients, the renal arteries could not be visualized, mainly due to intra-abdominal gas or patient body habitus. Conclusions 3D CEUS imaging detected endoleaks not seen on uniplanar digital subtraction angiography, including a clinically important type I endoleak, and was also more sensitive than 2D CEUS imaging for the detection of the source of endoleak. This technology has the potential to supplement or replace digital subtraction angiography for completion imaging to reduce the use of x-ray contrast. Intraoperative 3D CEUS has been applied to allow safe EVAR with ultralow or no iodinated contrast usage in selected cases, without compromising completion imaging.
    Journal of Vascular Surgery 10/2014;
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    ABSTRACT: Objective This study determined for the first time the clinical applicability of a global positioning system (GPS)-monitored community-based walking ability assessment in a large cohort of patients with peripheral artery disease (PAD). Methods A multicenter study was conducted among PAD patients who complained of intermittent claudication. Patients equipped with a GPS device performed a community-based outdoor walk. We determined the number of technically satisfactory GPS recordings (attempt No. 1). Patients with unsatisfactory GPS recordings were asked to perform a second attempt (attempt No. 2). From the satisfactory recordings obtained after attempts No. 1 and No. 2, we analyzed several GPS parameters to provide clinical information on the patients' walking ability. Results are reported as median (interquartile range). Results A total of 218 patients performed an outdoor walk. GPS recordings were technically satisfactory in 185 patients (85%) and in 203 (93%) after attempts No. 1 and No. 2, respectively. The highest measured distance between two stops during community walking was 678 m (IQR, 381-1333 m), whereas self-reported maximal walking distance was 250 m (IQR, 150-400 m; P < .001). Walking speed was 3.6 km/h (IQR, 3.1-3.9 km/h), with few variations during the walk. Among the patients who had to stop during the walk, the stop durations were <10 minutes in all but one individual. Conclusions GPS is applicable for the nonsupervised multicenter recording of walking ability in the community. In the future, it may facilitate objective community-based assessment of walking ability, allow for the adequate monitoring of home-based walking programs, and for the study of new dimensions of walking in PAD patients with intermittent claudication.
    Journal of Vascular Surgery 10/2014;
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    ABSTRACT: We report our staged multimodal treatment of a female infant with a very large complex venolymphatic malformation of the axilla and chest wall. We successfully managed the patient's severely restricted arm mobility and consumptive coagulopathy with surgical debulking followed by medical therapy with the mammalian target of rapamycin inhibitor sirolimus. The diseased burden reduced in size throughout therapy, and hematologic parameters reached and maintained normal levels. Normal health and limb functionality were restored with no observed adverse side effects of medical therapy. This case presents a previously unreported and potentially promising method to treat severe vascular malformations.
    Journal of Vascular Surgery 10/2014;
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    ABSTRACT: Objective To report the outcomes of endovascular interventions on deep veins in patients with venous ulcers (C6). Methods This was a retrospective review of a case series. All patients with active venous ulceration who underwent endovascular interventions to the deep venous system from February 2011 to June 2013 were included. Patients with C6 disease who failed a trial of adequate compression therapy or superficial vein interventions were considered for evaluation of the deep veins. Patients with deep vein reflux or without significant venous reflux or with a previous history of deep vein thrombosis underwent computed tomographic venogram or ascending venogram. In the absence of intravenous ultrasound trial ballooning to look for a “waist” to identify subtle lesions was used. Lesions were stented with long Nitinol stents. Results Thirty-eight patients underwent deep vein stenting of 44 limbs with venous ulcers. The lesions were considered to be post-thrombotic in 31 limbs and non-thrombotic iliac vein lesions in 13 limbs. A mean of 1.8 stents were used per patient. There were no significant complications associated with the interventions. At a median follow-up of 15 months, the primary and assisted primary patency rates were 94% and 97%, respectively. Sustained ulcer healing was achieved in 60% of limbs. A further 20% of ulcers had reduced in size. Recurrent ulcers developed in 13% of limbs, and half of these healed with interventions for newly developed incompetence in superficial veins. Conclusion Endovascular interventions to the deep veins appear to be an effective adjunct in achieving the healing of recalcitrant ulcers.
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: We previously showed that duplex ultrasound (DU) imaging is beneficial in the diagnosis of failing vein and prosthetic grafts performed for arterial occlusive disease. The purpose of this study was to evaluate whether DU imaging can reliably diagnose failing stent grafts (ie, covered stents) placed for arterial occlusive disease.
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: Our aim was to evaluate the effect of gender on early and late procedural and functional outcomes of lower extremity bypass (LEB).
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: Open repair is the gold standard management for juxtarenal aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) is indicated for high-risk patients. The long-term outcomes of FEVAR are largely unknown, and there is no Level I comparative evidence. This systematic review and meta-analysis of case series compares elective juxtarenal aneurysm surgery by open repair and FEVAR.
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs.
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: Primary aortic mural thrombus (PAMT) is an uncommon condition but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. We report our experience of thromboembolic disease from PAMT and review its contemporary management.
    Journal of Vascular Surgery 09/2014;
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    ABSTRACT: Vascular surgeons are well acquainted with chronic critical limb ischemia (CLI), the most severe manifestation of peripheral arterial disease, with patients presenting with ischemic rest pain or ulcerations, or both. Epidemiologic data predict a burgeoning epidemic of CLI within the United States, commensurate with the increasing incidence and prevalence of atherosclerotic risk factors, especially age and diabetes. Untreated, the risk of major amputation (above the ankle) or death, or both, ranges between 20% and 40% at 1 year. Current open and endovascular therapies have imperfect results, diverse treatment options, and recommendations that are often conflicting and confuse physicians, industry, and patients alike. The best treatment options are ideally evaluated by prospective, randomized controlled trials. However, these have proven impractical in CLI because the rapid evolution of devices and techniques has outstripped the ability to measure outcomes and compare treatment options. Alternatively, risk-stratifying models have been proposed to allow physicians, patients, and industry to objectively evaluate new therapeutics and devices as they evolve. These models are developed from prospective cohorts to identify and quantify variables that can subsequently predict outcome in individual patients. The risk stratification models can also compare CLI outcomes between physicians and institutions, supporting quality assessments, and compensation decisions within Accountable Care Organizations under the Affordable Health Care Act (ACA). Widespread adoption of risk-stratification schemes has yet to occur, despite the critical need for such a tool in CLI, because present models lack optimal predictive ability and generalizability. The passage of the ACA amplifies the importance of developing an improved risk-stratification tool to ensure equitable quality assessments and compensation. This review presents current risk-stratification models for CLI with a summary of the respective strengths and limitations of each. Future research is needed to simplify and improve the accuracy and generalizability of risk stratification in CLI.
    Journal of Vascular Surgery 09/2014;
  • Journal of Vascular Surgery 09/2014; 60(3):785.
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    ABSTRACT: Objectives Arterial stiffness (AS) is increasingly recognized as an independent risk factor in different high-risk populations. Whether changes in AS can predict prognosis in patients with symptomatic peripheral arterial disease (PAD) has never been investigated. The aim of the present study was to test the hypothesis that AS is an independent predictor of all-cause and cardiovascular disease (CVD) mortality in patients with symptomatic PAD. Methods A cohort of 117 symptomatic PAD patients (aged 62.3 ± 7.7 years) were prospectively recruited from the Department of Vascular Surgery, Tartu University Hospital, between 2002 and 2010. The AS was measured using pulse wave analysis and assessment of pulse wave velocity (PWV). Results During the follow-up period (mean 4.1 ± 2.2 years) there were 32 fatal events. Kaplan–Meier analysis showed that the probability of all-cause and CVD mortality decreased with increasing small artery elasticity (SAE), as estimated by the log-rank test (p = .004; p = .005, respectively). By contrast, large artery elasticity, augmentation index, and aortic and brachial PWV were not significantly related to mortality. In a Cox proportional hazard model, SAE above the median was associated with decreased all-cause and CVD mortality after adjustment for confounding factors: relative risk (RR), 0.37; 95% confidence interval (CI), 0.17–0.81; p = .01; RR, 0.11; 95% CI, 0.01–0.86; p = .04, respectively). Conclusions This study provides the first evidence, obtained from an observational study, that decreased small artery elasticity is an independent predictor of all-cause and CVD mortality in patients with symptomatic PAD.
    Journal of Vascular Surgery 09/2014;