Alik Farber

Alik Farber
Boston Medical Center · Department of Surgery

About

382
Publications
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3,883
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Publications

Publications (382)
Article
Objectives There is limited contemporary data regarding health-related quality of life (HRQOL) measures in patients with chronic limb-threatening ischemia (CLI). Methods The Best Endovascular versus Best Surgical Therapy in Patients with CLI (BEST-CLI) trial is an ongoing, NIH-sponsored, multicenter, randomized controlled trial comparing revascula...
Article
Objective Vascular closure devices (VCD) and manual compression (MC) are used to achieve hemostasis following peripheral vascular interventions (PVI). We sought to compare perioperative outcomes between MC and four VCDs following PVI in a multicenter setting. Methods The Vascular Quality Initiative was queried for all lower extremity (LE) PVIs wit...
Article
Objective Chronic limb-threatening ischemia (CLTI) has been increasing in prevalence and remains a significant cause of limb loss and disability and a strong predictor of cardiovascular mortality. Previous studies have demonstrated that endovascular and open repair are similarly effective. These findings led to a significant increase in the adoptio...
Article
Objective In 2014, in addition to male smokers aged 65-75, the U.S. Preventive Services Task Force (USPSTF) recommended abdominal aortic aneurysm (AAA) screening for male never-smokers aged 65-75 with cardiovascular risk factors (Grade C). The USPSTF evolved from a negative to neutral position on screening for female smokers aged 65-75 (Grade I). W...
Article
Objective Percutaneous radial artery access is increasingly being used for peripheral vascular interventions (PVI). Our goal was to characterize practice patterns and perioperative outcomes among patients treated using PVI performed via radial artery access. Methods The Vascular Quality Initiative was queried from 2016-2020 for PVI performed via u...
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Objective While endovascular therapy is often first-line treatment for medically refractory intermittent claudication (IC) caused by aorto-femoral disease, suprainguinal bypass is commonly performed. Although this is often aorto-femoral bypass (AoFB), axillo-femoral bypass (AxFB) is still sometimes performed despite limited data evaluating its util...
Article
Full-text available
Chronic kidney disease (CKD) imposes a strong and independent risk for peripheral artery disease (PAD). While solutes retained in CKD patients (uremic solutes) inflict vascular damage, their role in PAD remain elusive. Here, we show that the dietary tryptophan-derived uremic solute including indoxyl sulfate (IS) and Kynurenine (Kyn), at concentrati...
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Objectives Multiple studies have shown improved outcomes and higher utilization of care with the increase of insurance coverage. This study aims to assess whether Medicaid expansion (ME) has changed the utilization and outcomes of abdominal aortic aneurysm (AAA) repair in the United States. Design Retrospective observational study. Materials Data...
Article
Objective : Patients who are obese or underweight are traditionally at higher risk for perioperative morbidity and mortality. The effect of body mass index (BMI) on outcomes after carotid endarterectomy (CEA) is unclear. Our goal was to analyze the association of BMI with perioperative and long-term outcomes after elective CEA. Design : Retrospect...
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Objective: The National Health Service demonstrated that regions of the United Kingdom with the highest number of patients enrolled in research studies had the lowest risk-adjusted mortality when patients were admitted to the hospital. Our goal was to investigate if this correlation was evident for patients with chronic limb threatening ischemia (...
Article
Full-text available
Introduction: In cancer, there are survival-based staging systems and tailored, stage-based treatments. There is little personalized treatment in vascular disease. The 2019 Global Vascular Guidelines on the Management of CLTI proposed successful treatment hinges upon Patient risk, Limb severity, and ANatomic complexity (PLAN). We sought to confirm...
Article
Introduction Penetrating injuries to the inferior vena cava (IVC) and/or iliac veins are a source of hemorrhage but may also predispose patients to venous thromboembolism (VTE). We sought to determine the relationship between iliocaval injury, VTE and mortality. Methods The National Trauma Data Bank was queried for penetrating abdominal trauma fro...
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The Society for Vascular Surgery (SVS) Clinical Practice Guidelines on Popliteal Artery Aneurysms (PAAs) leverage the work of a panel of experts chosen by the SVS to review the current world literature as it applies to PAAs to extract the most salient, evidence-based recommendations to the management of these patients. These guidelines focus on PAA...
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Objective To summarize the best available evidence comparing open vs. endovascular popliteal artery aneurysm repair. We also summarized the natural history of popliteal artery aneurysms to support of the Society for Vascular Surgery guidelines. Methods We searched MEDLINE, EMBASE, Cochrane databases, and Scopus for studies of patients with poplite...
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Ascertainment bias is a well-recognized source of bias in research, but few studies have systematically analyzed sources of ascertainment bias in randomized trials in which blinding is not possible and endpoint assessment is not protocolized. In the current study, we sought to evaluate differences in the clinical practice patterns of trial investig...
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Background Intensive care unit (ICU) admission after endovascular aortic aneurysm repair (EVAR) varies across medical centers. We evaluated the association of postoperative ICU utilization with perioperative and long-term outcomes after EVAR. Study Design The Vascular Quality Initiative (2003-2019) was queried for index elective EVARs. Included ce...
Article
Objectives Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving intervention. However, recent reports of associations with limb loss and mortality have called its safety into question. We aimed to evaluate patient and hospital characteristics associated with major amputation and in-hospital mortality among...
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Objectives The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law established in 1986 to ensure that patients who present to an emergency department (ED) receive medical care regardless of means. Violations are reported to the Centers for Medicare and Medicaid Services (CMS) and can result in significant financial penalties. Our ob...
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Objectives Despite published guidelines and data for Medicare patients, it is uncertain how younger patients with intermittent claudication (IC) are treated. Additionally, the degree to which treatment patterns have changed over time with the expansion of endovascular interventions and outpatient centers is unclear. Our goal was to characterize IC...
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Objective It is recommended that patients with ≥50% carotid artery stenosis undergo surveillance imaging and atherosclerotic risk reduction medical therapies, regardless of whether revascularization is performed. The objective of this study was to determine rates of adherence to these recommended measures and to identify risk factors for non-adhere...
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Objective In the United States, many low-income patients initiating hemodialysis are uninsured before qualifying for Medicare. Inadequate access to pre-dialysis care may delay their arteriovenous (AV) access creation and increase tunneled dialysis catheter (TDC) use. The 2014 Affordable Care Act expanded eligibility for Medicaid among low-income ad...
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Objectives Although intervention is generally the standard of care for severe (80-99%) asymptomatic carotid stenosis, conservative management may be appropriate for a subset of patients. Our goal was to assess reasons for and outcomes of non-operative/delayed operative management of asymptomatic severe carotid stenosis. Methods Institutional vascu...
Article
Objective The day of the week (DOW) for performing procedures and operations has been shown to affect clinical and resource utilization outcomes. Limited published data is available on vascular surgery operations. Our primary objective was to assess outcomes by DOW for infrainguinal lower extremity bypass (LEB) performed for claudication or rest pa...
Article
Objective: Active smoking among patients undergoing interventions for intermittent claudication (IC) is associated with poor outcomes. Notwithstanding, current levels of active smoking in these patients are high. State-level tobacco control policies have been shown to reduce smoking in the general U.S. Population: We evaluated whether state ciga...
Article
Objective Arteriovenous (AV) access is the preferred hemodialysis modality to avoid the complications associated with tunneled dialysis catheters (TDCs). Despite efforts to create timely AV access, many patients still initiate hemodialysis through TDCs. Our goal was to determine the patient factors associated with having a TDC present at initial AV...
Article
Objectives: The choice of intervention for treating suprainguinal arterial disease, bypass versus endovascular, is often tempered by patient age and comorbidities. In this study, we compared the association of patient's age with 1-year major adverse limb event (MALE)-free survival and reintervention-free survival (RFS) rates among patients undergo...
Article
Objectives: Length of stay (LOS) after carotid endarterectomy (CEA) and stenting (CAS) for asymptomatic disease is utilized as a quality measure and affects hospital operating margins. Patient-level Medicaid status has traditionally been associated with longer hospital LOS. Our goal was to assess the association between hospital-level Medicaid pre...
Article
Background Thoracic endovascular aortic repair (TEVAR) has significantly improved the ability to treat traumatic aortic injuries (tTEVAR). We sought to determine whether center volume correlated with better outcomes. Study Design Vascular Quality Initiative (VQI) TEVAR data (2011-2017) for trauma was used in this analysis. Based on the distributio...
Article
Background The present study compares the senior level operative experience of graduates from the traditional vascular surgery fellowship (5+2) and integrated vascular surgery training programs (0+5) using contemporary operative case log data. Methods The Accreditation Council for Graduate Medical Education (ACGME) integrated vascular surgery, vas...
Article
Objective There is limited data on access type when treating ruptured abdominal aortic aneurysms (AAA) with EVAR. Our study’s objective was to evaluate if the type of access in ruptured abdominal aortic aneurysm affected outcomes. Methods The Vascular Quality Initiative was queried from 2009 to 2018 for all ruptured AAA treated with an index EVAR....
Article
Objective Treatment of asymptomatic internal carotid artery (ICA) stenosis, particularly for moderate to severe (70%–80%) disease, is controversial. The goal was to assess the clinical course of patients with moderate to severe carotid stenosis. Methods A single institution retrospective analysis of patients with asymptomatic ICA stenosis identifi...
Article
Objective Given that intermittent claudication (IC) rarely progresses to chronic limb-threatening ischemia and limb loss, safety and durability of elective interventions for IC are essential. Whether patients with IC benefit from tibial intervention is controversial and data supporting its utility are limited. Despite endovascular therapy expansion...
Article
Objectives Tunneled dialysis catheters (TDC) are generally used as temporary means to provide hemodialysis until permanent arteriovenous (AV) access is established. However, some patients may end up having long-term catheter-based hemodialysis due to the lack of alternatives for other dialysis access. Our objective was to evaluate patient character...
Article
Objectives Brachiocephalic arteriovenous fistulas (BCF) are commonly placed in outpatient settings. The impact of general (GA), regional (RA), or local (LA) anesthesia on perioperative recovery and fistula maturation/patency after outpatient BCF creations is unknown. We evaluated whether outcomes of outpatient BCF creations vary based on anesthesia...
Article
Objectives In octogenarians with carotid stenosis, data supporting the decision to intervene and choice of intervention with either carotid endarterectomy (CEA) or stenting (CAS), has been conflicting. The purpose of this study was to compare the perioperative outcomes of CEA and CAS in octogenarians, and to identify patients at high risk for unfav...
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Objective Financial relationships between vascular surgeons (VS) and industry are essential to the development and adoption of innovative technology. However, these relationships may establish competing interests. Our objective was to describe publicly available financial transactions between industry and academic VS. Methods Academic VS were iden...
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Introduction and Objectives: Routine arteriovenous (AV) access creation in octogenarians is controversial. Our goal was to assess perioperative and long-term outcomes in octogenarians after undergoing upper extremity AV access to determine whether advanced age should influence AV access decision making. Methods All AV access creations performed at...
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Full-text available
The Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia trial (BEST-CLI) is an international, prospective, multicentre, multidisciplinary and pragmatic, open-label, superiority-based, comparative-effectiveness randomised controlled trial designed to address the knowledge gap in choosing the appropriate therapy for...
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Objective Management of anti-thrombotic therapy with warfarin in patients undergoing fistulograms and possible interventions is controversial and difficult due to lack of adequate outpatient bridging options. Our goal was to assess peri-procedural outcomes in patients managed using different anticoagulation strategies. Methods A retrospective, sin...
Article
Objective Overtreatment and overutilization of resources are leading causes of rising healthcare costs. Identification and elimination of low value services is important in reducing such costs. At many institutions it is routine to send excised plaque after carotid endarterectomy (CEA) for pathology evaluation. With over 140,000 CEAs performed annu...
Article
Objectives A patient’s body mass index (BMI) can affect both peri- and postoperative outcomes across all surgical specialties. Given that obesity and end-stage renal disease (ESRD) are growing in prevalence, we aimed to evaluate the association between BMI and outcomes of upper extremity arteriovenous (AV) access creation. Methods A retrospective...
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Objectives Rising intravenous drug use (IVDU) paralleled with an increasing dialysis dependent end-stage renal disease population may pose a challenge for creating and maintaining arteriovenous (AV) access for hemodialysis. We aimed to elucidate baseline characteristics and outcomes of AV access creation in the IVDU population. Methods The Vascula...
Article
Background Anemia has been identified as a risk factor for postoperative morbidity and mortality after major vascular procedures. Carotid revascularization carries less cardiac morbidity and physiologic stress compared with other vascular interventions. This study evaluated the association between preoperative anemia and major adverse events after...
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Objectives Despite improvements in treating human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), the risk of end-stage renal disease (ESRD) and need for long-term arteriovenous (AV) access for hemodialysis remain high in HIV-infected patients. Associations of HIV/AIDS with AV access creation complications have been conf...
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Objectives Maintenance of functional arteriovenous dialysis grafts (AVG) is difficult secondary to low primary patency, need for re-interventions, and limited alternative dialysis access options. We assessed our experience with percutaneous thrombectomy for treating occluded AVGs. Methods We performed a retrospective analysis of all percutaneous t...