Publications by authors named "Jeniann A Yi"

15 Publications

  • Page 1 of 1

The Changing Demographics of Surgical Trainees in General and Vascular Surgery: National Trends over the Past Decade.

J Surg Educ 2021 Jun 4. Epub 2021 Jun 4.

Division of Vascular and Endovascular Surgery, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.

Objective: Recent initiatives have targeted the issue of gender and ethnic/racial disparities in general surgery and vascular surgery. However, the prevalence of these disparities in general and vascular surgical training programs is unknown.

Design: A retrospective analysis was conducted using data from three separate sources, including the US Graduate Medical Education annual report, Electronic Residency Application Service database, and National Resident Matching Program annual report. Demographic information regarding gender distribution and ethnic/racial identity was collected from 328 general surgery residency programs, 59 vascular surgery residency programs, and 100 vascular surgery fellowship programs across the US. The primary outcomes of this study were to evaluate national trends in gender and ethnic diversity in general surgery and vascular surgery training programs, including both traditional fellowship and integrated residency paradigms.

Results: From 2011-2020, general surgery residency programs showed a positive trend towards both female applicants (from 31.9%-41.5%) and trainees (from 36.2%-43.1%) (p < 0.0001 each). The proportion of minority trainees decreased, primarily among Black (from 7.2%-5.4%) and Asian trainees (from 21.5%-19.2%) (p < 0.0001 each). Concurrently, the number of vascular integrated residency programs grew from 27 to 59, resulting in a fivefold increase in trainees (from 64-335). Despite this growth, there was no change in the proportion of women applicants or trainees for both vascular integrated residency (24.9% applicants; 36.2% trainees) and fellowship programs (27.4% applicants; 25.9% trainees) over the study period (p = 0.11, 0.89, 0.43, and 0.13 respectively). Moreover, there was no significant change in proportion of minority trainees in both vascular integrated residency and fellowship programs.

Conclusion: While general surgery programs have expanded in proportion of both female applicants and trainees, racial diversity has decreased. Gender and racial diversity in vascular training has not changed. Future initiatives in general and vascular surgery should focus on recruitment and promotion of proficient women and minority trainees.
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http://dx.doi.org/10.1016/j.jsurg.2021.05.002DOI Listing
June 2021

Epidemiology of end-stage kidney disease.

Semin Vasc Surg 2021 Mar 4;34(1):71-78. Epub 2021 Feb 4.

Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Anschutz School of Medicine, Aurora, CO.

End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.
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http://dx.doi.org/10.1053/j.semvascsurg.2021.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177747PMC
March 2021

Intercostal artery embolization to induce false lumen thrombosis in type B aortic dissection.

J Vasc Surg Cases Innov Tech 2020 Sep 25;6(3):433-437. Epub 2020 Jun 25.

Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Persistent false lumen flow is common after thoracic endovascular aortic repair of type B aortic dissection and may contribute to continued aortic aneurysmal degeneration. We report an innovative technique of intercostal artery embolization within the false lumen for a patient who had incomplete false lumen thrombosis and progressive aortic enlargement after thoracic endovascular aortic repair of chronic type B aortic dissection. Technical success was facilitated by use of on-table cone beam computed tomography angiography, virtual vessel marking, and modern endovascular tools. The patient had no complications from the procedure. Postoperative imaging demonstrated complete thoracic false lumen thrombosis and favorable aortic remodeling with reduction in maximal aortic diameter.
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http://dx.doi.org/10.1016/j.jvscit.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396825PMC
September 2020

Atypical May-Thurner syndrome caused by endovascular aortic aneurysm repair.

J Vasc Surg Cases Innov Tech 2020 Sep 25;6(3):397-400. Epub 2020 Jun 25.

Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

May-Thurner syndrome is characterized by unilateral lower extremity venous hypertension and stasis due to compression of an iliac vein between an iliac artery and the lumbar spine. In almost all cases, the left common iliac vein is compressed by the right common iliac artery; however, other patterns have been described. Rarely, May-Thurner syndrome may be created iatrogenically as a result of iliac artery stenting. We present an unusual case of new left common iliac vein thrombosis caused by ipsilateral left iliac artery compression after aortobi-iliac endovascular aneurysm repair.
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http://dx.doi.org/10.1016/j.jvscit.2020.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369519PMC
September 2020

Plantar Flexion-Induced Entrapment of the Dorsalis Pedis Artery in a Teenaged Cross-Country Runner.

Ann Vasc Surg 2021 Jan 22;70:213-218. Epub 2020 Apr 22.

Department of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address:

Background: Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a nonatherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old girl presenting with foot pain upon plantar flexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon.

Methods: The patient was a 17-year-old girl who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position. The potential site of compression was identified on MRI where the DP artery ran deep to the EHB tendon near the first and second tarsometatarsal joints. On diagnostic arteriogram, there was notching of the dorsalis pedis over the talus bone. The dorsalis pedis Doppler signal was obliterated upon plantar flexion. A longitudinal incision was made over the artery in the area of compression. The flexor retinaculum was incised. Abnormal fibrous bands were identified, which were lysed anterior to the artery. The EHB tendon was released and transferred distally to the extensor hallucis longus tendon.

Results: A completion angiogram showed a persistently patent dorsalis pedis artery with plantar flexion. She was discharged one day postoperatively without issues. On follow-up, the patient was ambulatory with complete resolution of her pain. Arterial duplex demonstrated normal velocities through the dorsalis pedis in all positions.

Conclusions: Symptomatic peripheral artery disease is a rare presentation in young adults and is usually due to nonatherosclerotic pathophysiology. We present a rare case of dorsalis pedis artery entrapment syndrome. Given the mechanical nature of obstruction, surgical correction was an effective treatment.
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http://dx.doi.org/10.1016/j.avsg.2020.03.045DOI Listing
January 2021

Fenestrated aortic endograft branching with Gore VBX poses failure risk from delayed-onset branch kinking.

J Vasc Surg Cases Innov Tech 2019 Mar 31;5(1):18-21. Epub 2018 Dec 31.

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, Colo.

The Gore VBX stent graft (Gore Medical, Flagstaff, Ariz) provides a new option for branching of fenestrated aortic endografts. However, its modular stent structure has raised concerns about potential kinking at the interspace between stent rings if lateralizing force exists between the fenestration and target vessel orifice. We present a case of near-occlusion of a VBX celiac branch due to narrowing of this interspace identified at postoperative month 3. Although the Gore VBX offers several potential advantages as a branch endoprosthesis, its design poses the risk of unpredictable, delayed-onset kinking and raises concern for its use as a fenestrated endograft branch.
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http://dx.doi.org/10.1016/j.jvscit.2018.08.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313828PMC
March 2019

Fourth Time Redo Common Femoral Vein Reconstruction with a Novel Hybrid Technique.

Ann Vasc Surg 2019 May 23;57:49.e7-49.e11. Epub 2018 Nov 23.

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of USC, Los Angeles, CA. Electronic address:

Background: Iliofemoral vein thrombosis can lead to debilitating edema and venous claudication that significantly worsens quality of life, especially in young active individuals. Venous reconstruction becomes increasingly complex and has worsening patency with subsequent revisions so preoperative planning is critical to success.

Methods: We report a case of a 54-year-old man in active military service with profoundly symptomatic leg swelling after failure of 3 previous common femoral vein (CFV) reconstructions. The CFV and distal external iliac vein were thrombosed up to a few centimeters above the inguinal ligament. Direct proximal control would have required a retroperitoneal or transabdominal incision. However, a hybrid approach utilizing through-wire access, remote balloon control of the external iliac vein, cryopreserved vein graft, stent graft, and arteriovenous fistula was able to address the factors (graft size, external compression, adequate flow) contributing to his previous graft failures with a novel, less invasive approach.

Results: At 1-year follow-up, he was asymptomatic and the graft remained patent with normal vascular duplex studies. His leg swelling subsided and he was able to return to his previous physical activity level.

Conclusions: A hybrid approach to complex venous reconstruction can provide a minimally invasive and durable alternative to more invasive procedures and alleviate mechanical causes of early graft failure.
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http://dx.doi.org/10.1016/j.avsg.2018.10.006DOI Listing
May 2019

Inferior Vena Cava Filter Resulting in Perforation and Massive Retroperitoneal Hematoma Presenting as Acute Onset of Lower Extremity Weakness.

Ann Vasc Surg 2019 May 12;57:48.e13-48.e17. Epub 2018 Sep 12.

Vascular Surgery, Mid-Atlantic Permanente Group, Rockville, MD.

Perforation of inferior vena cava (IVC) filter struts is a common incidental finding on postoperative computed tomography (CT) scans that is not associated with bleeding or major complications. However, in rare circumstances, it can be associated with hemorrhage requiring immediate removal. We present a case of a 62-year-old man who developed abdominal pain and right lower extremity weakness 2 weeks after treatment of a pulmonary embolism with IVC filter placement and anticoagulation. A CT scan revealed a large right-sided retroperitoneal hematoma with active extravasation from the IVC filter struts that had perforated the IVC wall. He underwent a hybrid operation with endovascular retrieval of the IVC filter and concomitant IVC primary repair combined with evacuation of the hematoma, causing nerve compression. Postoperatively, he regained normal sensory and motor function. Perforation of IVC filter struts is usually asymptomatic, but in rare circumstances, it can cause hemorrhage requiring immediate removal and IVC repair. Surgical intervention is indicated in the setting of a large hematoma with nerve or vessel compression and may require a combined endovascular and open approach.
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http://dx.doi.org/10.1016/j.avsg.2018.09.002DOI Listing
May 2019

Carotid Artery Entrapment by the Hyoid Bone-A Rare Cause of Recurrent Strokes in a Young Patient.

Ann Vasc Surg 2019 May 12;57:48.e7-48.e11. Epub 2018 Sep 12.

Division of Vascular and Endovascular Therapy, University of Southern California, Los Angeles, CA. Electronic address:

The search for etiology of stroke in a young patient may present a diagnostic challenge. In rare cases, chronic trauma to the carotid artery may be the cause of cerebral thromboembolic events. The hyoid bone lies in close proximity to the carotid artery bifurcation, and anatomic variants have been implicated in carotid compression, stenosis, dissection, and pseudoaneurysm. We report a case of recurrent strokes in a 32-year-old woman due to an elongated hyoid bone causing thrombus formation in her right internal carotid artery (ICA), resulting in recurrent embolic strokes confirmed on diffusion-weighted magnetic resonance imaging. Computed tomography angiography of the neck and head demonstrated the right hyoid bone was located between the ICA and external carotid artery (ECA), just above the carotid bifurcation, with residual nonocclusive thrombus in the right ICA. Carotid duplex ultrasonography confirmed that with the neck in neutral position, the hyoid was located between the ICA and ECA; however, with neck rotation, the hyoid slipped across the ICA and out of the bifurcation. There was no evidence of carotid stenosis. After an initial course of anticoagulation and antiplatelet therapy, resection of the greater cornu of the hyoid bone with release of the right ICA was performed. One year postoperatively, the patient had complete return of neurologic function and had no further neurologic events. Hyoid bone entrapment of the carotid artery is a rare etiology of thromboembolic stroke caused by repetitive local trauma. The diagnosis can be confirmed by carotid duplex with provocative maneuvers. Partial hyoid resection is a safe and effective treatment to relieve recurrent symptoms. Hyoid bone entrapment may be an important and under-recognized cause of stroke in young adults.
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http://dx.doi.org/10.1016/j.avsg.2018.09.001DOI Listing
May 2019

Claims Variability in Charges and Payments for Common Open and Endovascular Procedures.

Ann Vasc Surg 2019 Jan 11;54:40-47.e1. Epub 2018 Sep 11.

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, CO; Department of Vascular Surgery, Mid-Atlantic Permanente Medical Group, Rockville, MD.

Background: Cost-effectiveness in healthcare is being increasingly scrutinized. Data regarding claims variability for vascular operations are lacking. Herein, we aim to describe variability in charges and payments for aortoiliac (AI) and infrainguinal (II) revascularizations.

Methods: We analyzed 2012-2014 claims data from a statewide claims database for procedures grouped by Current Procedural Terminology codes into II-open (II-O), II-endovascular (II-E), AI-open (AI-O), and AI-endovascular interventions (AI-E). We compared charges and payments in urban (≥50,000 people, UAs) versus rural areas (<50,000 people, RAs). Amounts are reported in $US as median with interquartile range. Cost-to-charge ratios (CCRs) as a measure of reimbursement were calculated as the percentage of the charges covered by the payments. Wilcoxon rank-sum tests were performed to determine significant differences.

Results: A total of 5,239 persons had complete claims data. There were 7,239 UA and 6,891 RA claims, and 1,057 AI claims (AI-E = 879, AI-O = 178) and 4,182 II claims (II-E = 3,012, II-0 = 1,170). Median charges were $5,357 for AI [$1,846-$27,107] and $2,955 for II [$1,484-$9,338.5] (P < 0.0001). Median plan payment was $454 for AI [$0-$1,380] and $454 for II [$54-$1,060] (P = 0.67). For AI and II, charges were significantly higher for UA than RA (AI: UA $9,875 [$2,489-$34,427], RA $3,732 [$1,450-$20,595], P < 0.0001; II: UA $3,596 [$1,700-$21,664], RA $2,534 [$1,298-$6,169], P < 0.0001). AI-E charges were higher than AI-O (AI-E $7,960 [$1,699-$32,507], AI-O $4,774 [$2,636-$7,147], P < 0.0001), but AI-O payments were higher (AI-E $424 [$0-$1,270], AI-O $869 [$164-$1,435], P = 0.0067). II-E charges were higher (II-E $2,994 [$1,552-$22,164], II-O $2,873 [$1,108-$5,345], P < 0.0001), but II-O payments were higher (II-E $427 [$50-$907], II-O $596 [$73-$1,299], P < 0.0001). CCRs were highest for II operations and UAs.

Conclusions: Wide variability in claim charges and payments exists for vascular operations. AI procedures had higher charges than II, without any difference in payments. UA charged more than RA for both AI and II operations, but RA had higher payments and CCRs. Endovascular procedures had higher charges, while open procedures had higher payments. Charge differences may be related to endovascular device costs, and further research is necessary to determine the reasons behind consistent claims variability between UA and RA.
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http://dx.doi.org/10.1016/j.avsg.2018.08.071DOI Listing
January 2019

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass.

J Vasc Surg Cases Innov Tech 2018 Mar 27;4(1):58-62. Epub 2018 Feb 27.

Department of Surgery, University of Colorado Denver, Aurora, Colo.

Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved. At 12 months postoperatively, the graft remained patent with normal results of vascular laboratory studies. This report demonstrates that in cases of refractory vasospasm after peripheral bypass, continuous vasodilator infusion can be an effective treatment to prevent early graft failure.
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http://dx.doi.org/10.1016/j.jvscit.2017.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928283PMC
March 2018

A Fourteen-Year Experience with Vascular Anomalies Encountered during Transaxillary Rib Resection for Thoracic Outlet Syndrome.

Ann Vasc Surg 2017 Apr 12;40:105-111. Epub 2016 Dec 12.

Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, CO; Department of Radiology, Presbyterian/St. Luke's Medical Center, Denver, CO. Electronic address:

Background: Transaxillary approach to first rib resection and scalenectomy (TAFRRS) is a well-established technique for treatment of thoracic outlet syndrome (TOS). Although anatomic features encountered during TAFRRS are in general constant, vascular anomalies may be encountered but have not been described to date. Herein we describe vascular abnormalities encountered during TAFRRS.

Methods: We performed a retrospective review of a prospective practice database of 224 operations for TOS performed in 172 patients from March 2000 to March 2014. We excluded 10 patients with missing operative reports, 3 reoperations on the same patient, and 8 non-transaxillary resections. We recorded vascular anomalies identified in operative reports and reviewed computed tomography imaging to delineate the nature of these abnormalities.

Results: The overall incidence of vascular anomalies was 11% (22 of 203 TAFRRS). Most patients with anomalies had venous TOS (vTOS) (9 patients, 41%), followed by 7 (32%) with neurogenic TOS (nTOS). The remainder of the patients had arterial TOS (aTOS) (6 patients, 27%). Seven patients (32%) had an abnormal subclavian artery (SCA) with 5 (23%) having an abnormal arterial course in the anterior scalene muscle (ASM); 6 patients (27%) had an abnormal internal mammary artery (IMA) originating from distal SCA; 4 (18%) had abnormalities in the supreme thoracic artery (bifurcation or duplication); 2 (9%) had an abnormal branch from the SCA with anomalous location in the operative field; and 3 (14%) had an abnormal large venous branch penetrating the ASM. In the 19 patients with arterial anomalies, 8 (42%) were recognized as arterial branches penetrating the ASM, and 11 (58%) were noticed as they had anomalous arterial locations within the operative field. Most arterial anomalies were seen in vTOS (9, 45%), followed by nTOS (7, 35%). No intraoperative vascular complications occurred. Perioperative complications included 1 occurrence of postoperative transfusion for bleeding following axillary drain discontinuation and 2 Horner's syndromes. One aberrant IMA was electively ligated to allow complete thoracic outlet decompression.

Conclusions: Arterial anomalies during TAFRRS are encountered in 11% of operations, and may present with vessel locations in unusual areas within the operative field, or as abnormal vessels penetrating the ASM, thus making scalenectomy precarious. Careful attention must be paid to possible abnormal locations of vessels in the thoracic outlet to avoid bleeding complications.
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http://dx.doi.org/10.1016/j.avsg.2016.08.037DOI Listing
April 2017

Surgical Energy-Based Device Injuries and Fatalities Reported to the Food and Drug Administration.

J Am Coll Surg 2015 Jul 27;221(1):197-205.e1. Epub 2015 Mar 27.

Department of Surgery, University of Colorado School of Medicine, Aurora, CO. Electronic address:

Background: Energy-based devices are used in virtually every operation. Our purposes were to describe causes of energy-based device complications leading to injury or death, and to determine if common mechanisms leading to injury or death can be identified.

Study Design: The FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for surgical energy-based device injuries and deaths reported over 20 years (January 1994 to December 2013). Device-related complications were recorded and analyzed.

Results: We analyzed 178 deaths and 3,553 injuries. Common patterns of complications were: thermal burns, 63% (n = 2,353); hemorrhage, 17% (n = 642); mechanical failure of device, 12% (n = 442); and fire, 8% (n = 294). Events were identified intraoperatively in 82% (3,056), inpatient postoperatively in 9% (n = 351), and after discharge in 9% (n = 324). Of the deaths, 12% (n = 22) occurred after discharge home. Common mechanisms for thermal burn injuries were: direct application, 30% (n = 694); dispersive electrode burn, 29% (n = 657); and insulation failure, 14% (n = 324). Thermal injury was the most common reason for death (39%, n = 70). The mechanism for these thermal injuries was most frequently direct application (84%, n = 59, p < 0.001 vs all other mechanisms). Fires were most common with monopolar "Bovie" instruments (88%, n = 258, p < 0.001 vs all other devices) when they were used in head and neck operations (66%, n = 193, p < 0.001 vs all other locations).

Conclusions: Complications due to energy-based devices occur from 4 main causes: thermal burn, hemorrhage, mechanical failure, and fire. Thermal direct application injuries are the most common reason for both injury and death.
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http://dx.doi.org/10.1016/j.jamcollsurg.2015.03.031DOI Listing
July 2015

Image of the month-quiz case. Diagnosis: primary colorectal carcinoma with ovarian metastasis.

Arch Surg 2012 Sep;147(9):885-6

Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO, USA.

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http://dx.doi.org/10.1001/archsurg.2011.1283bDOI Listing
September 2012
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