Scholars@Duke
Zachary F Williams

Zachary F Williams

Assistant Professor of Surgery
Surgery, Vascular and Endovascular Surgery
zachary.f.williams@duke.edu
7682B HAFS Bldg, Durham, NC 27710
Box 3467 Med Ctr, Durham, NC 27710

Selected Publications

Outcomes After Utilization of Autogenous Arm Vein Grafts for Lower Extremity Bypasses.

Journal Article Ann Vasc Surg · December 2025 BACKGROUND: Lower extremity bypasses performed with autogernous conduit have superior patency and limb salvage. This is often performed with single segment great saphenous vein (GSV), but other options may be required for patients without available GSV. Th ... Full text Link to item Cite

Implementation of an acute care vascular surgery "Surgeon of the Week" model improves efficiency of inpatient care delivery.

Journal Article J Vasc Surg · October 2025 OBJECTIVE: Acute care vascular surgery (ACVS) comprises a significant proportion of modern vascular surgery practice. Given the burden of ACVS at our institution, we have transitioned from a traditional "on call" model to a "Surgeon of the Week" (SOW) mode ... Full text Link to item Cite

Carotid Interventions in the Community are Associated with Higher Rates of Complications.

Journal Article Ann Vasc Surg · August 2025 BACKGROUND: The Maintaining Internal Systems and Strengthening Integrated Outside Networks Act was a landmark legislation that expanded Veterans' ability to seek care in the community (CITC). The purpose of this study is to evaluate perioperative outcomes ... Full text Link to item Cite

Postoperative Bleeding Complications are Common among Patients Undergoing Transcarotid Artery Revascularization.

Journal Article Ann Vasc Surg · January 2025 BACKGROUND: Current practice guidelines recommend dual antiplatelet therapy for at least 30 days postoperatively after transcarotid artery revascularization (TCAR) to promote stent patency. However, many patients are already taking other antithrombotic med ... Full text Link to item Cite

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System.

Journal Article Ann Vasc Surg · January 2025 BACKGROUND: The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity r ... Full text Link to item Cite

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center.

Journal Article Ann Vasc Surg · December 2024 BACKGROUND: Vascular surgeons play a critical role in the functioning of a healthcare system. As a service line, vascular surgery not only performs its own complex operations but also provides support to other surgical specialties by assisting in the manag ... Full text Link to item Cite

Prophylactic Sartorius Flap Reconstruction Is Associated With Reduced Vascular Graft Infection.

Journal Article J Surg Res · December 2024 INTRODUCTION: Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound compl ... Full text Link to item Cite

Endovascular Management of Aortic Stump Blowout by Parallel Grafting and Coil Embolization of Visceral Aorta.

Journal Article Vasc Endovascular Surg · July 2024 Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence and ... Full text Link to item Cite

Surgical outcomes of patients with inferior vena cava leiomyosarcoma.

Journal Article J Vasc Surg Venous Lymphat Disord · July 2024 INTRODUCTION: Primary vascular leiomyosarcomas are incredibly rare and have a poor prognosis. The purpose of this study was to analyze the surgical outcomes of patients with primary inferior vena cava (IVC) leiomyosarcoma. METHODS: We performed a retrospec ... Full text Link to item Cite

Feasibility and Intermediate Results of Transcarotid Revascularization with a Prosthetic Conduit.

Conference Ann Vasc Surg · June 2024 BACKGROUND: Transcarotid artery revascularization (TCAR) is a hybrid technique with excellent initial outcomes. The technical success and safety of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not meet ... Full text Link to item Cite

Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis.

Journal Article Vasc Endovascular Surg · April 2024 BACKGROUND: The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS: Accreditation Council for Graduate Medical ... Full text Link to item Cite

Risk factors and consequences of wound complications following sartorius flap reconstruction.

Journal Article J Vasc Surg · February 2024 OBJECTIVE: Groin wound complications are common following vascular surgery and can lead to significant patient morbidity. Sartorius muscle flap coverage may help to prevent vascular graft infection in the setting of wound dehiscence or infection. However, ... Full text Link to item Cite

Surgical Specialty Impacts Quality of Operative Training in Carotid Endarterectomy.

Journal Article Ann Vasc Surg · February 2024 BACKGROUND: Carotid endarterectomy (CEA) is currently performed by multiple surgical specialties. The impact of surgical specialty and operative volume on post-CEA outcomes has been well described. However, it is unclear whether trainees of different surgi ... Full text Link to item Cite

Failure-to-Salvage After Femoropopliteal Bypass Surgery is Associated With Nonmodifiable Risk Factors.

Journal Article J Surg Res · January 2024 INTRODUCTION: Bypass graft failure and major amputation are among the worst complications after femoropopliteal bypass surgery. In this large multicenter analysis, we examined our incidence and risk factors for failure-to-salvage (FTS) following either byp ... Full text Link to item Cite

Prosthetic Conduit Use Does Not Adversely Impact Outcomes after Open Repair of Popliteal Artery Aneurysms.

Journal Article Ann Vasc Surg · January 2024 BACKGROUND: Single segment, greater saphenous vein (GSV) conduit is considered the optimal bypass conduit among patients undergoing bypass surgery for peripheral artery disease (PAD). While this data has been extrapolated to patients undergoing bypass for ... Full text Link to item Cite

A national analysis of vascular surgery resident operative experience in peripheral artery disease.

Journal Article J Vasc Surg · December 2023 BACKGROUND: Endovascular and hybrid interventions have played an increasingly prominent role in the treatment of peripheral arterial disease (PAD) in the past decade. This shift has prompted concerns about the adequacy of open surgical training for current ... Full text Link to item Cite

Sex-based differences in outcomes after lower extremity bypass for chronic limb-threatening ischemia.

Journal Article Atherosclerosis · November 2023 BACKGROUND AND AIMS: Lower extremity bypass surgery is an effective treatment option for patients with chronic limb-threatening ischemia (CLTI). Recent studies have suggested that sex-based differences may impact patient outcomes following lower extremity ... Full text Link to item Cite

Mechanical thrombectomy of inferior vena cava filter-associated caval thrombosis using FlowTriever and ClotTriever systems.

Journal Article J Vasc Surg Venous Lymphat Disord · November 2023 OBJECTIVE: Chronically indwelling inferior vena cava filters (IVCFs) can have multiple adverse sequelae, including IVCF-associated thrombosis. The Inari ClotTriever and FlowTriever mechanical and aspiration thrombectomy systems (Inari Medical) can be used ... Full text Link to item Cite

Outcomes Following in Situ Reconstruction for Aortic Infection with the Neo-Aortoiliac System and Aortic Homograft.

Journal Article Ann Vasc Surg · March 2023 BACKGROUND: In situ reconstruction is one of the primary surgical options for primary aortic and graft and endograft infections. One institution's outcomes following aortic reconstruction with femoro-popliteal vein (i.e., the neo-aortoiliac system) and cry ... Full text Link to item Cite

Restoring Venous Patency with the ClotTriever Following Deep Vein Thrombosis.

Journal Article Ann Vasc Surg · January 2023 BACKGROUND: Although randomized data remain inconclusive, invasive endovenous therapy is increasingly favored in patients with extensive iliocaval or iliofemoral deep vein thrombosis (DVT) to reduce the rates of postthrombotic syndrome. Previously, pharmac ... Full text Link to item Cite

Partial Inferior Vena Cava Reconstruction with Cryopreserved Aortic Homograft Following Resection for Malignancy.

Journal Article Vasc Endovascular Surg · January 2023 Malignant invasion of the inferior vena cava (IVC) often necessitates complete tumor thrombectomy and IVC reconstruction. Bovine pericardial xenografts and prosthetic grafts are frequently used for partial or entire IVC reconstruction with adequate subsequ ... Full text Link to item Cite

Vertebral artery transection with pseudoaneurysm and arteriovenous fistula requiring antegrade and retrograde embolization.

Conference J Vasc Surg Cases Innov Tech · June 2022 Traumatic vertebral artery injury is a rare, life-threatening injury that has been increasingly managed with endovascular intervention. However, an antegrade endovascular approach alone can fail to occlude traumatic pseudoaneurysms (PSAs) and arteriovenous ... Full text Link to item Cite

Retrograde Transamputation Revascularization: A Case Report.

Journal Article Ann Vasc Surg · July 2021 Below-knee amputation remains the most common level of amputation in patients with lower extremity gangrene and critical limb ischemia. Failure to heal, requiring additional operative debridement or conversion to an above-knee amputation remains a signific ... Full text Link to item Cite

Cerebral monitoring during transcarotid artery revascularization with flow reversal via transcranial doppler ultrasound examination.

Journal Article J Vasc Surg · January 2021 OBJECTIVE: Transcarotid artery revascularization (TCAR) is a hybrid technique for carotid artery revascularization that relies on proximal carotid occlusion with flow reversal for distal embolic protection. The hemodynamic response of the intracranial circ ... Full text Link to item Cite

Basic Angiography: Radiation Safety, Power Injector Use, and Image Intensifier Positioning

Chapter · January 1, 2021 Radiation safety is critically important for both patients and healthcare staff during diagnostic and therapeutic angiography. As technology advances, improvements in fluoroscopy equipment have reduced radiation exposure, but procedures have become more co ... Full text Cite

Safety and Feasibility of Simultaneous Transcarotid Revascularization With Flow Reversal and Coronary Artery Bypass Grafting for Concomitant Carotid Artery Stenosis and Coronary Artery Disease.

Journal Article Vasc Endovascular Surg · July 2020 OBJECTIVE: The management of patients with combined severe carotid artery and coronary artery disease (CAD) is controversial. Transcarotid stenting with flow reversal (TCAR) is a novel hybrid technique for carotid revascularization. We sought to investigat ... Full text Link to item Cite

A systematic review of venous stents for iliac and venacaval occlusive disease.

Journal Article J Vasc Surg Venous Lymphat Disord · January 2020 OBJECTIVE: Endovascular stenting of the deep venous system is increasingly used to treat stenotic and occluded veins. This article reviews the efficacy and safety of venous stenting for lower extremity occlusive disease. METHODS: The Ovid portal was used t ... Full text Link to item Cite

Simultaneous transcarotid artery revascularization with flow reversal and coronary artery bypass grafting: A novel hybrid technique.

Conference J Vasc Surg Cases Innov Tech · December 2019 Optimal management of concomitant coronary artery disease and carotid artery stenosis remains unknown. Current treatment strategies for patients with significant dual disease burden include simultaneous carotid endarterectomy and coronary artery bypass gra ... Full text Link to item Cite

The Clinical Utility and Assessment of Renal Biomarkers in Acute Kidney Injury After Abdominal Endovascular Aneurysm Repair. A Systematic Review.

Journal Article Curr Pharm Des · 2019 The widespread adoption of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is due to the obvious advantages of the procedure compared to the traditional open repair. However, these advantages have to be weighed against the increase ... Full text Link to item Cite

Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort.

Journal Article Hernia · October 2018 PURPOSE: Given the difficulty of durable repairs, there is continued interest in hernia prevention. One emerging prevention technique for parastomal hernias is prophylactic mesh placement, whereby mesh is inserted during the index procedure as hernia proph ... Full text Link to item Cite

Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair.

Journal Article Am Surg · September 1, 2018 We describe a method to measure abdominal wall tension during hernia surgery and evaluate a possible correlation between hernia defect width and abdominal wall tension. After Institutional Review Board approval and informed consent, a prospective trial to ... Link to item Cite

An evaluation of abdominal wall closure in general surgical and gynecological residents.

Journal Article Hernia · December 2017 PURPOSE: To evaluate abdominal wall closure knowledge base and technical skills in surgical and OB/GYN residents. METHODS: Residents consented to participate in a skills laboratory and quiz. The skills portion involved closure of a 10-cm incision on a simu ... Full text Link to item Cite

Suture to wound length ratio in abdominal wall closure: how well are we doing?

Journal Article Hernia · December 2017 PURPOSE: Research has established that a ≥4:1 suture to wound (S:W) length ratio decreases incisional hernias. We evaluated our ability to obtain a 4:1 S:W length ratio in a surgery residency program. METHODS: Consecutive abdominal wall closures from 12/1/ ... Full text Link to item Cite

Emerging Technology: Robotic Inguinal Hernia Repair

Chapter · January 1, 2017 Inguinal hernia repair is one of the most common operations performed by general surgeons worldwide. Several techniques for open and laparoscopic repair of inguinal hernias have been well described and are common in general surgical practice. These techniq ... Full text Cite

Updates in abdominal wall management.

Journal Article Minerva Chir · October 2015 The field of abdominal wall hernia surgery continues to evolve at a rapid pace. Surgeons dealing with abdominal wall hernias must constantly stay abreast as new biomaterials and surgical techniques evolve. Increasing knowledge related to hernia formation a ... Link to item Cite

Early versus delayed amputation in the setting of severe lower extremity trauma.

Journal Article Am Surg · June 2015 Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital depositi ... Link to item Cite

The effect of watchful waiting on the management and treatment of inguinal hernias in a community setting.

Journal Article Am Surg · March 2015 A landmark study by Fitzgibbons et al. reported the safety of watchful waiting in men with minimally symptomatic inguinal hernias. The extent to which this study has changed practice patterns is unknown. The purpose of our study was to survey physicians ca ... Link to item Cite

Laparoscopic ventral hernia repair: Techniques and complications

Chapter · January 1, 2014 Laparoscopy has revolutionized the field of surgery allowing for faster recovery times and smaller incisions. Laparoscopic incisional hernia repair has become wellaccepted due to a low probability of conversion to an open procedure, shorter hospital stays, ... Cite

Quantification of Vibrio vulnificus in an Estuarine Environment: A Multi-Year Analysis Using QPCR

Journal Article Estuaries and Coasts · January 1, 2014 Using a refined quantitative polymerase chain reaction assay, we compared surface and bottom water concentrations of Vibrio vulnificus with total Vibrio spp. concentrations, fecal indicator bacteria (Escherichia coli and Enterococcus sp.), and environmenta ... Full text Cite

Trends in total Vibrio spp. and Vibrio vulnificus concentrations in the eutrophic Neuse River Estuary, North Carolina, during storm events

Conference Aquatic Microbial Ecology · September 1, 2008 Vibrio spp. are ubiquitous members of aquatic microbial food webs that can be pathogenic to humans and a range of other organisms. Previously published predictive models for Vibrio spp. concentrations in estuarine and coastal waters, based only on salinity ... Full text Cite