Issam Koleilat

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This multi-center study tested whether a set of appropriateness guidelines actually predicts outcomes for patients treated for leg artery disease causing walking pain. Patients who received treatment deemed inappropriate by the guidelines had significantly worse outcomes — more reinterventions, less symptom relief, more amputations — and were more likely to be Black or Hispanic and to have had less conservative therapy beforehand. The findings validate these guidelines as a real predictor of outcomes, not just a bureaucratic benchmark, and highlight racial disparities in who receives guideline-aligned care.

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This case report describes an 86-year-old dialysis patient who developed a painful false aneurysm at her dialysis access site, successfully treated with an ultrasound-guided injection of thrombin. The pseudoaneurysm resolved completely and her symptoms cleared at follow-up. The case reinforces that thrombin injection is a safe and effective option for pseudoaneurysms at arteriovenous fistula sites, even though it is not formally FDA-approved for this use.

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This study used a national vascular procedure registry to evaluate how well surgeons were following the 2015 Society for Vascular Surgery guidelines for treating leg artery disease causing walking pain, before and after the guidelines were published. Medication prescribing improved after guideline release, but decisions about stents and which vessels to treat did not change meaningfully — and care for patients in socioeconomically deprived areas remained worse. The findings reveal a gap between guideline adoption for drugs versus procedures, and point to social disadvantage as a driver of unequal care.

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This study examined whether each additional unit of blood transfused during open aortic aneurysm repair increased the risk of complications, using a national surgical registry of over 4,600 patients. Every additional unit of blood given during surgery increased the odds of in-hospital death by 24%, and also raised the risk of heart attack, respiratory failure, kidney failure, and wound problems. The results argue against liberal transfusion practices in this setting and support more restrictive blood use even when bleeding occurs.

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This study tracked outcomes for 150 patients whose elective vein procedures were delayed by the COVID-19 pandemic across 12 U.S. hospitals, with delays averaging about three months. None of the patients required emergency intervention for their venous disease during the delay, and no major adverse events occurred after the procedures were eventually completed. Elective venous interventions can be safely postponed during a healthcare crisis, though the impact on quality of life during the delay warrants attention.

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This study compared outcomes of carotid artery stenting performed under local/regional versus general anesthesia using a large national surgical database. General anesthesia was associated with more deaths and more pneumonia after the procedure, but fewer heart attacks, though the death finding appeared partly explained by patients' underlying lung conditions. No clear winner emerged for the combined outcome of stroke, heart attack, and death, leaving the anesthesia choice dependent on individual patient factors.

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This study asked whether experienced surgical residency reviewers could tell the difference between personal statements written by real applicants and those generated by AI. Human reviewers were poor at the task — their accuracy was only 55% and they barely agreed with each other — while AI was biased against perceived AI-authored statements when deciding who to interview. As AI-written text becomes indistinguishable from human writing, the residency application process may need to rethink how it evaluates candidates.

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This study asked whether using a larger-diameter stent graft for complex aortic aneurysm repair involving the kidney vessels affected outcomes, using national registry data on nearly 700 patients. Unlike in standard infrarenal repairs where larger grafts carry higher risk, large-diameter grafts for this more complex procedure showed no difference in leak rates, reintervention rates, or survival compared to smaller grafts. Graft size alone does not appear to drive outcomes in this setting, suggesting other factors matter more.

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This study analyzed speaker and moderator data from five major vascular surgery conferences to assess gender gaps not just in who presents, but in what topics they present on. Women made up only 18% of presenters and 16% of moderators, 68% of panels were all-male, and women were most likely to present on dialysis access and least likely on venous disease. Significant disparities persist in both representation and topic distribution, with some incremental improvement over time but clear room for structural change.

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This systematic review of 53 studies examined how hemodialysis access outcomes differ between women and men. Women have lower rates of fistula maturation, worse patency across all definitions, require more procedures to achieve and maintain a working fistula, and are more likely to end up using a catheter or graft instead. These findings highlight a significant and poorly understood disparity that should be discussed with patients and addressed through dedicated research.

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This paper describes a prototype implantable device that continuously measures pressure inside the skull and transmits the data wirelessly to a smartphone app via Bluetooth. The device met accuracy targets at normal and slightly elevated pressure ranges, and could simulate several types of brain shunt failure. It represents a potential path to noninvasive, continuous monitoring for patients with hydrocephalus or other conditions requiring ongoing intracranial pressure tracking.

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This international study from 25 centers tracked 96 patients with significant carotid artery narrowing whose surgery was delayed by COVID-19 pandemic restrictions, with a median wait of 71 days. None of the patients deteriorated or required emergency surgery during the delay, though five died of COVID-19 while waiting. Carotid surgery can generally be safely postponed for weeks to months, but pandemic-era hospital policies led to wide variation in how long patients waited across regions.

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This study analyzed 144 malpractice cases involving varicose veins, thoracic outlet syndrome, and lymphatic disease drawn from a legal database spanning over three decades. Post-procedure complications were the most common cause of litigation, with vascular surgeons and general surgeons the most frequently named defendants, and defendant verdicts in 71% of cases. The most litigated interventions — stab phlebectomy, foam sclerotherapy, and rib resection — point to specific areas where improved technique and informed consent could reduce legal exposure.

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This study used national registry data on nearly 20,000 patients to compare complication rates between atherectomy (plaque removal) plus angioplasty versus angioplasty alone for blocked leg arteries. In the thigh and knee region, adding atherectomy significantly increased rates of vessel tearing, clot breaking off downstream, and need for emergency stenting; in the lower leg, atherectomy was associated with fewer dissections but still more emergency stent use. These findings raise questions about the routine use of atherectomy, particularly in femoropopliteal disease.

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This study examined whether the day a patient underwent endovascular repair for a symptomatic aortic aneurysm — from admission day through day 8 or later — affected 30-day mortality, using a national surgical database of 804 patients. Same-day surgery had the lowest mortality, and waiting 8 or more days was associated with dramatically higher death rates, but delays of up to 4 days did not significantly worsen outcomes. The findings suggest a window for brief medical optimization without increasing risk, but prolonged delays are harmful.

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This study looked at whether performing a fistulogram — an imaging procedure using iodine-based contrast dye — in patients with advanced kidney disease who weren't yet on dialysis accelerated their progression to needing dialysis. In patients with the most severe kidney disease, larger contrast volumes and use of a specific contrast agent were linked to starting dialysis within a month of the procedure. The results support caution with contrast volume in pre-dialysis patients with severe kidney impairment, and suggest exploring alternatives like carbon dioxide contrast.

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This study used a national registry of nearly 39,000 patients to identify factors associated with acute kidney injury after endovascular aortic aneurysm repair. Aneurysm rupture before repair was by far the strongest predictor of kidney injury, while contrast volume had the weakest association — each 25 mL increase in contrast raised risk by only 4%. The findings suggest that preventing rupture and optimizing pre-existing kidney function matter far more than minimizing contrast for most EVAR patients.

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This study compared outcomes of two techniques for emergency endovascular repair of complex aortic aneurysms near the kidney vessels: physician-modified grafts versus chimney/snorkel grafts, using national registry data. Neither technique was superior for survival, endoleak rates, or reintervention at one year, though post-operative complications — especially heart attack and bowel ischemia — strongly predicted death regardless of technique. The results suggest both approaches are viable, and that preventing post-operative complications matters more than choosing between them.

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This study analyzed 377 malpractice cases involving vascular surgeons as expert witnesses, drawing on court records from 1999 to 2014. Vascular surgeons who testified four or more times were more likely to serve as plaintiff witnesses, and plaintiff experts were more likely to work outside academics and had lower research output than defense experts. The findings highlight how experience and academic standing differ between plaintiff and defense witnesses, and argue for national minimum credentialing standards for vascular surgery expert witnesses.

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This study used national registry data on over 4,000 tibial bypass operations to compare how different conduit choices — the type of vessel or synthetic material used to reroute blood around a blockage — affected limb survival and bypass patency at one to two years. Single-segment vein from the leg remained the best choice overall, but the performance gap between conduit types was smaller than commonly assumed, and synthetic grafts performed similarly to arm vein. When the preferred conduit isn't available, the data suggest more flexibility in material choice than traditional teaching implies.

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This study compared three surgical approaches for treating radiation-damaged carotid arteries in nearly 2,000 patients from a national registry: traditional open surgery, transfemoral stenting, and transcervical stenting with flow reversal. Patients treated with the transcervical approach had the lowest combined rate of stroke, death, and heart attack, as well as the lowest rates of nerve injury, though these advantages were not individually statistically significant. The results support transcervical stenting as a preferred approach for radiation-induced carotid disease, pending longer-term follow-up.

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This study reviewed 346 malpractice cases involving aortic aneurysms and dissections from over 30 years of court records, finding that 83% were wrongful death suits. The most common claim was failure to diagnose, not post-operative complications, and emergency medicine and cardiology physicians were the most frequently sued — not surgeons. Improving awareness and diagnostic accuracy among first-contact clinicians across all specialties may be the most effective lever for reducing litigation in aortic disease.

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This study tracked trends in the racial, ethnic, and gender makeup of U.S. psychiatry residency applicants from 2008 to 2019 and compared them to all other residency applicants. Representation of women, Black, Hispanic, and other historically underrepresented groups increased in both psychiatry and non-psychiatry applicant pools over the study period. Psychiatry had a higher share of Black applicants than other specialties throughout, but continued effort is needed to recruit and retain diverse trainees into the psychiatric workforce.

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This bibliometric study identified the 100 most-cited research articles on peripheral artery disease by searching a major academic database, then analyzed patterns in where, when, and by whom the work was done. The top papers span 1959 to 2017 and cover surgical techniques, therapeutic angiogenesis, and epidemiology, with most originating from the U.S. The analysis maps how scientific thinking on this disease has evolved and identifies the journals and researchers with the greatest influence on the field.

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This study systematically searched Google and YouTube for 25 common vascular surgery topics and evaluated how well the results informed the public and acknowledged vascular surgeons as the relevant specialists. Vascular surgeons were mentioned as the appropriate referral physician in only about half of results, and comprehensive disease information was rare across both platforms. The findings reveal a gap in vascular surgery's online presence that could affect patient awareness and specialty recognition.

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This study compared vascular surgery training case volumes at three large New York City hospitals during the peak of the COVID-19 pandemic (spring 2020) versus the same period in 2019. Case volume dropped 74% during the peak pandemic month, with emergency procedures like amputations replacing the usual mix of elective endovascular cases. One in five trainee survey respondents worried about meeting certification requirements, pointing to lasting educational consequences from pandemic-era surgical shutdowns.

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This study examined opioid prescribing patterns for patients recovering from dialysis access surgery at a single institution, comparing ambulatory versus inpatient settings and different anesthesia types. Inpatients received far more opioids than outpatients despite similar reported pain levels, and alternative pain medications like acetaminophen were rarely used. Dialysis access surgery represents a concrete opportunity to reduce opioid prescribing by expanding regional anesthesia and non-opioid pain management.

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This early case-control study from the start of the COVID-19 pandemic found that hospitalized COVID-19 patients had a 3.4-fold higher odds of arterial blood clots compared to non-COVID patients. COVID-positive patients with arterial clots were younger, had higher obesity rates, lacked typical cardiovascular risk factors, showed elevated clotting markers, and had a 40% in-hospital mortality rate. The findings provided an early signal that COVID-19 drives arterial thrombosis through inflammation rather than conventional vascular risk, with aortoiliac vessels disproportionately affected.

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This study characterized deep vein thrombosis in COVID-19 patients admitted to a single large hospital early in the pandemic, finding a modest but elevated DVT rate of 13% among those tested. Elevated d-dimer levels strongly distinguished COVID patients who developed DVT from those who did not, and clots formed even in patients receiving standard blood thinners. The results suggested that COVID-19 creates a hypercoagulable state that standard prophylaxis does not fully prevent, and identified d-dimer trends as a potential early warning sign.

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This study used national registry data from over 5,000 patients to compare outcomes of treating varicose veins in one leg at a time versus both legs simultaneously or in staged procedures. Bilateral same-session treatment was not associated with higher complication rates, and improvement in symptom severity scores was similar across groups. Treating both legs at once appears safe and achieves outcomes equivalent to staged procedures, which may reduce the burden on patients of multiple visits.

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This cross-sectional study surveyed 60 hospitals across 13 countries about how they organized central line placement during the COVID-19 pandemic. Dedicated vascular access teams — mostly led by vascular and general surgeons — placed over 2,600 lines with a complication rate of 0.4%, far below historical averages. Having a pre-planned, skills-matched line team in place during a health crisis significantly improves safety and relieves pressure on overloaded ICU and emergency teams.

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This study evaluated the social media presence of accredited vascular surgery training programs in the U.S. across Twitter, Facebook, Instagram, and YouTube, comparing them to their parent hospitals and general surgery programs. Only 31% of vascular training programs had any social media presence, compared to 96% of their affiliated institutions. Programs with a social media presence matched more applicants in the national residency match, suggesting that an underdeveloped online presence may be costing vascular surgery programs in resident recruitment.

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This study used national residency application data to analyze trends in the sex and racial and ethnic makeup of applicants to surgical residency and fellowship programs in the United States. The abstract does not provide specific findings beyond the study design, but it tracks changes in the diversity of the surgical applicant pool over time. Understanding these trends is a prerequisite for designing effective interventions to improve representation in surgery.

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This single-center study examined whether giving protamine — a drug to reverse the blood thinner heparin — after tibial bypass surgery increased the risk of clots or reduced the risk of bleeding. No significant differences were found in clotting events, bleeding, early bypass failure, or 30-day limb survival between patients who did and did not receive protamine. Protamine appears safe to use in this setting, offering reassurance to surgeons concerned about triggering thrombosis by reversing anticoagulation.

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This study applied two sets of screening criteria — the more restrictive U.S. Preventive Services Task Force and the broader Society for Vascular Surgery guidelines — to a national registry of over 55,000 patients who had already been treated for aortic aneurysm. The standard guidelines would have identified only about a third of these patients for screening; the expanded SVS criteria would have captured far more but still missed over a quarter. Patients who fell outside all screening criteria were twice as likely to present with a ruptured aneurysm, making the case for broader screening thresholds.

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This study evaluated the websites and social media accounts of all accredited vascular surgery training programs in the U.S. and Canada across 31 quality metrics. Most U.S. programs had searchable websites but lacked key information important to applicants — such as salary, research opportunities, or teaching responsibilities — and only 13% had a social media presence, versus 70% of Canadian programs. The digital underrepresentation of U.S. vascular training programs may put them at a disadvantage in recruiting the next generation of trainees.

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This study queried academic vascular surgery faculty at all U.S. training institutions and compared publication output, citations, grant funding, leadership positions, and industry payments between women and men. Women made up less than 19% of faculty, held fewer leadership and senior professor roles, published less, and received less industry funding — yet when adjusted for years in practice, women had a higher annual research output rate and were more likely to hold NIH grants. Systemic barriers rather than individual productivity appear to drive most of the gender disparity in academic vascular surgery.

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This study developed a method using tissue clearing and light-sheet microscopy to create three-dimensional images of diseased blood vessels in mice, capturing full plaque structure and new vessel growth that standard imaging misses. The technique revealed detailed differences in plaque geometry, volume, and composition between animals, as well as the formation and maturation of new blood vessels around injured arteries. This imaging approach gives researchers a more complete picture of how atherosclerosis and vascular injury evolve, which could aid in testing new treatments.

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This study reviewed 66 malpractice cases involving hemodialysis access from a legal database over a decade, finding that death — usually from bleeding — was the injury in 79% of cases. Vascular surgeons were the most frequently named defendants, and the most common claims were unsafe surgical technique and failure to diagnose and treat. The findings highlight that hemorrhage, not steal syndrome as commonly assumed, drives the most serious litigation in dialysis access care.

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This study analyzed 277 malpractice cases involving pulmonary embolism and deep vein thrombosis filed over 30 years, finding that failure to diagnose was the most common allegation in 62% of cases. Internists and emergency physicians were sued most often, and failure to give blood thinners — both in the hospital and at discharge — appeared repeatedly across cases. The most preventable litigation appears to involve system-level failures in anticoagulation protocols rather than rare technical errors.

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This study compared the annual case volume for peripheral artery procedures between traditional 5+2 vascular surgery fellows and newer 0+5 integrated residents during the phase of training with the most operative autonomy. Fellows performed roughly 1.7 times more total peripheral cases and 1.8 times more endovascular cases than integrated residents at comparable training stages. The results challenge the assumption that the two training pathways produce equivalent operative experience, at least in peripheral vascular procedures.

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This study reviewed 15 years of vascular surgery malpractice cases in the U.S., finding that peripheral revascularization, carotid interventions, and aortic repairs were the most litigated procedures — not thoracic outlet syndrome as widely believed. Failure to diagnose and treat was the most common allegation, and defendants won in about 65% of cases. Understanding where litigation actually clusters — and why — gives surgeons a practical roadmap for reducing legal exposure through better diagnosis and communication.

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This case report describes a former truck driver who developed acute hand ischemia from a blood clot in his ulnar artery, linked to repetitive trauma to the palm — a condition called hypothenar hammer syndrome. Catheter-directed injection of a clot-dissolving drug over 24 hours restored blood flow and resolved his symptoms without complications, and the patient did not have the aneurysm typically associated with the syndrome. The case illustrates that clot-dissolving therapy can be effective even without an underlying anatomic defect to repair surgically.

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This study reviewed over 800 patients who underwent major leg amputation at a single institution, finding that nearly 29% were readmitted within 30 days, most often for wound infections and stump complications. Below-knee amputation patients were more likely than above-knee patients to have stump complications requiring surgery, and over a third of those complications resulted in conversion to a higher-level amputation. Identifying high-risk patients — particularly those with end-stage kidney disease and coronary artery disease — before surgery offers a target for reducing costly and painful readmissions.

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This case series described the use of idarucizumab, a reversal agent for the blood thinner dabigatran, in six patients at a large academic medical center over one year. Bleeding stopped in 86% of cases by clinical assessment, with no adverse reactions to the drug, though two patients died from their underlying conditions. The report supports idarucizumab's effectiveness in real-world practice and calls for institution-specific protocols to standardize its use, including clearer guidance on when baseline coagulation tests indicate treatment.

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This case report describes a 78-year-old man who developed recurrent bleeding into his knee joint after knee replacement surgery, traced to an abnormal connection between an artery and vein accidentally created during the procedure. The connection was sealed using a liquid embolic agent injected through a catheter, resolving his symptoms for at least 10 months. This appears to be the first reported use of this particular embolic material for treating this specific complication of knee replacement surgery.