30-Second Takeaway
- F/BEVAR outcomes show clear surgeon and hospital volume thresholds tied to 30-day mortality.
- Active smoking before suprainguinal bypass worsens respiratory complications and medium-term survival, especially in CLTI.
- A 5-minute delay in dialysis needle removal markedly reduces early AVF access complications without extra resources.
Week ending April 4, 2026
Volume, risk factors, and devices: sharpening decision-making across aortic, carotid, access, and venous practice
Clear hospital and surgeon volume thresholds for safer F/BEVAR in Medicare patients
In 8,015 Medicare F/BEVAR cases, 30-day mortality was 4.4% and strongly associated with hospital and surgeon annual volume. LOESS analysis identified inflection thresholds at >9 F/BEVARs per year for hospitals and >7 per year for surgeons. Low-volume hospitals (≤9/year) had higher adjusted odds of 30-day mortality (aOR 1.43; 95% CI 1.02–1.99). Low-volume surgeons (≤7/year) similarly showed increased 30-day mortality (aOR 1.51; 95% CI 1.04–2.18) after risk adjustment. These data support concentrating F/BEVAR in centers and operators consistently exceeding these thresholds as devices disseminate.
Active smoking before suprainguinal bypass increases respiratory complications and mortality
This VQI study propensity-matched 4,831 pairs of active versus former smokers undergoing elective suprainguinal bypass for aortoiliac occlusive disease. Active smoking (vs ≥1 month cessation) increased 30-day respiratory complications (OR 1.34; 95% CI 1.11–1.62) without affecting early mortality or MALE. At 1 year, active smokers had higher adjusted mortality (aHR 1.76; 95% CI 1.10–2.81), persisting at 3 years (aHR 1.68; 95% CI 1.26–2.28). Respiratory risk was elevated in both claudication and CLTI presentations, underscoring pulmonary vulnerability across indications. These findings reinforce aggressive preoperative smoking cessation as a core component of open inflow reconstruction planning.
Five-minute post-dialysis needle delay cuts early AV fistula complications and pain
In 109 patients with new AV fistulas, delaying needle removal by 5 minutes after pump cessation was compared with immediate removal. Delayed removal shortened haemostasis time by 32% (16.4 vs 24.1 minutes) and reduced hematomas by 76% (3.3% vs 13.1%). Three-month reinterventions fell by 66% (9.0% vs 26.2%) with delayed removal, with substantially less reported pain and higher satisfaction. This simple protocol change required no additional nursing resources yet meaningfully improved early fistula safety and patient experience.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.