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Ricotta JJ, Upchurch GR, Landis GS, Kenwood CT, Siami FS, Ricotta JJ, White RA. SS25. The Influence of Contralateral Occlusion on Results of Carotid Interventions from the Society for Vascular Surgery (SVS) Vascular Registry™. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pradka SP, Akbari CM, Ricotta JJ, Keshishian JM. Durability of saphenous vein grafts: 44-year follow-up of a saphenous vein interposition graft in a pediatric patient. J Vasc Surg 2012; 56:216-8. [PMID: 22521803 DOI: 10.1016/j.jvs.2011.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/19/2011] [Accepted: 12/22/2011] [Indexed: 11/25/2022]
Abstract
We report the 44-year follow-up of a 9-year-old girl who underwent a saphenous vein interposition graft in 1964 after suffering extensive pelvic trauma with complete disruption of the right common femoral artery. The patient recovered from this injury and experienced no disability or pain until 2008, when she suddenly developed numbness in the right leg. Evaluation at that time showed a new occlusion of the saphenous vein graft, and she underwent uneventful repeat revascularization with autogenous vein. To our knowledge, this 44-year patency is the longest reported for a saphenous vein graft.
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Pradka SP, Trankiem CT, Ricotta JJ. Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness. J Vasc Surg 2012; 55:1769-72. [PMID: 22520365 DOI: 10.1016/j.jvs.2011.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 01/31/2023]
Abstract
We report on a young man who developed complicated pylephlebitis after foodborne illness. Despite antibiotics and resection of the focus of infectious colitis, he developed extensive small bowel infarction. He was treated with anticoagulation, local thrombolytic infusion, and resection of irreversibly ischemic small bowel. Thrombophilia workup demonstrated heterozygosity for factor V Leiden and the prothrombin G20210A mutation. The complications of pylephlebitis can be minimized by using systemic anticoagulation, thrombectomy, and/or local thrombolytic infusion along with antibiotics and surgical management of the infection. Evaluation for thrombophilic states should be considered, particularly if a patient does not respond to initial therapy.
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Abstract
AVFs differ in their characteristics, natural history, and response to interventions. These differences need to be considered when planning treatment. Endovascular treatments have emerged as a mainstay of treatment of all types of AVMs. They can be used as definitive therapy for acquired arteriovenous malformation, in remote or high-risk locations, and in elderly or otherwise debilitated patients. Endovascular control is often helpful in open repair of acquired AVF. Endovascular techniques are essential in the management of congenital AVF and are the first line of interventional therapy. In these cases, repeated interventions are the rule, and careful imaging and planning is the key to success.
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Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease: executive summary. J Vasc Surg 2011; 54:832-6. [PMID: 21889705 DOI: 10.1016/j.jvs.2011.07.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In 2008, the Society for Vascular Surgery published guidelines for the treatment of carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treatment of extracranial carotid disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as first line therapy. In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
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Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 2011; 54:e1-31. [PMID: 21889701 DOI: 10.1016/j.jvs.2011.07.031] [Citation(s) in RCA: 434] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 06/21/2011] [Accepted: 07/12/2011] [Indexed: 11/30/2022]
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Eidt JF, Mills J, Rhodes RS, Biester T, Gahtan V, Jordan WD, Hodgson KJ, Kent KC, Ricotta JJ, Sidawy AN, Valentine J. Comparison of surgical operative experience of trainees and practicing vascular surgeons: A report from the Vascular Surgery Board of the American Board of Surgery. J Vasc Surg 2011; 53:1130-9; discussion 1139-40. [DOI: 10.1016/j.jvs.2010.09.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 12/01/2022]
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Ricotta JJ, Rhodes RS. Evolution of vascular surgery and vascular surgery training: lessons learned. CIR CIR 2011; 79:53-59. [PMID: 21477519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Over the last decade, surgery as a discipline, and vascular surgery in particular, has been faced with a rapid growth in the scope of knowledge and array of techniques to be mastered by the graduating resident and the constraints of work hour limitations. In response, the U.S. vascular surgery community significantly altered its surgical training curriculum. This article will discuss the factors that prompted these changes, the challenges that continue to face vascular surgery education and the expectations for the future. We will also comment on the relevance of this experience to other surgical specialties.
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O'Leary EA, Sabahi I, Ricotta JJ, Walitt B, Akbari CM. Femoral profunda artery aneurysm as an unusual first presentation of Behcet disease. Vasc Endovascular Surg 2010; 45:98-102. [PMID: 20810402 DOI: 10.1177/1538574410379655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Behcet disease is a multisystem inflammatory disorder, rarely found in African Americans. Arterial involvement occurs in less than 8% of patients. Profunda femoral artery aneurysms (PFAAs) are extremely rare and often occur with synchronous aneurysms. We present a case of an African American man diagnosed with Behcet disease from his presentation with PFAA. He was also found to have a synchronous hypogastric artery aneurysm. The patient was immediately treated with corticosteroids and infliximab to control systemic and vascular inflammation, returning 1 month later for surgery. He had a repair of the left PFAA with a common femoral to profunda femoris artery bypass with reversed saphenous vein graft and aneurysmorrhaphy. When a patient presents with an aneurysm in an unusual location, it is important to evaluate for other aneurysms. A careful history and physical examination is also required to see if the aneurysm may be part of an underlying systemic syndrome.
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Xenos M, Rambhia SH, Alemu Y, Einav S, Labropoulos N, Tassiopoulos A, Ricotta JJ, Bluestein D. Patient-based abdominal aortic aneurysm rupture risk prediction with fluid structure interaction modeling. Ann Biomed Eng 2010; 38:3323-37. [PMID: 20552276 DOI: 10.1007/s10439-010-0094-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 06/01/2010] [Indexed: 11/30/2022]
Abstract
Elective repair of abdominal aortic aneurysm (AAA) is warranted when the risk of rupture exceeds that of surgery, and is mostly based on the AAA size as a crude rupture predictor. A methodology based on biomechanical considerations for a reliable patient-specific prediction of AAA risk of rupture is presented. Fluid-structure interaction (FSI) simulations conducted in models reconstructed from CT scans of patients who had contained ruptured AAA (rAAA) predicted the rupture location based on mapping of the stresses developing within the aneurysmal wall, additionally showing that a smaller rAAA presented a higher rupture risk. By providing refined means to estimate the risk of rupture, the methodology may have a major impact on diagnostics and treatment of AAA patients.
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Ricotta JJ. Commentary on "Trials in progress". PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2010; 22:92. [PMID: 20858610 DOI: 10.1177/1531003510380273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ricotta JJ, Ricotta JJ. Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: endarterectomy or stent? PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2010; 22:69. [PMID: 20858606 DOI: 10.1177/1531003510381138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ricotta JJ, Ricotta JJ. Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: management options and patient selection. PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2010; 22:5-6. [PMID: 20798070 DOI: 10.1177/1531003510381137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ricotta JJ. Commentary on "Carotid interventions in acute stroke". PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2010; 22:58-59. [PMID: 20798080 DOI: 10.1177/1531003510381520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Xenos M, Rambhia S, Alemu Y, Einav S, Ricotta JJ, Labropoulos N, Tassiopoulos A, Bluestein D. Patient based abdominal aortic aneurysm rupture risk prediction combining clinical visualizing modalities with fluid structure interaction numerical simulations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:5173-5176. [PMID: 21095820 DOI: 10.1109/iembs.2010.5626138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Fluid structure interaction (FSI) simulations of patient-specific fusiform non-ruptured and contained ruptured Abdominal Aortic Aneurysm (AAA) geometries were conducted. The goals were: (1) to test the ability of our FSI methodology to predict the location of rupture, by correlating the high wall stress regions with the rupture location, (2) estimate the state of the pathological condition by calculating the ruptured potential index (RPI) of the AAA and (3) predict the disease progression by comparing healthy and pathological aortas.
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Reed AB, Rhodes RS, Biester TW, Ricotta JJ. PP22. Report of the First Vascular Surgery in-Training Examination (VSITE). J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gasparis AP, Kokkosis A, Labropoulos N, Tassiopoulos AK, Ricotta JJ. Venous Outflow Obstruction With Retroperitoneal Kaposi's Sarcoma and Treatment With Inferior Vena Cava Stenting. Vasc Endovascular Surg 2009; 43:295-300. [DOI: 10.1177/1538574408328666] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 26-year-old man presented with acute renal insufficiency, and severe lower extremity swelling. Computed tomographic scan revealed retroperitoneal lymphadenopathy encasing both ureters and the inferior vena cava. He underwent placement of ureteral stents to relieve the obstruction and afterward underwent lymph node biopsy, which revealed Kaposi's sarcoma. He subsequently was diagnosed with acquired immunodeficiency syndrome. Abdominal and lower extremity venous duplex ultrasound did not show any evidence of deep vein thrombosis. The inferior vena cava measured 3.5 mm in diameter and was encased by retroperitoneal lymphadenopathy. Bilateral transfemoral venography and intravascular ultrasound demonstrated significant compression of the inferior vena cava below the renal veins. Endovascular treatment was followed with primary stenting under intravascular ultrasound guidance. His symptoms improved with reduction in swelling. At 1-year follow-up, the patient was ambulatory with mild symptoms, and on venography the iliac vein and inferior vena cava stents were widely patent.
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Ricotta JJ. Commentary on "Office-based vascular interventions": is it a step forward? PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2008; 20:346-347. [PMID: 19033267 DOI: 10.1177/1531003508329114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ricotta JJ, Pagan J, Xenos M, Alemu Y, Einav S, Bluestein D. Cardiovascular disease management: the need for better diagnostics. Med Biol Eng Comput 2008; 46:1059-68. [PMID: 19002517 DOI: 10.1007/s11517-008-0416-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/09/2008] [Indexed: 11/30/2022]
Abstract
Current diagnostic testing for cardiovascular pathology usually rests on either physiological or anatomic measurement. Multiple tests must then be combined to arrive at a conclusion regarding treatment of a specific pathology. Much of the diagnostic decisions currently made are based on rough estimates of outcomes, often derived from gross anatomic observations or extrapolation of physical laws. Thus, intervention for carotid and coronary disease is based on estimates of diameter stenosis, despite data to suggest that plaque character and lesion anatomy are important determinants of outcome. Similarly, abdominal aortic aneurysm (AAA) intervention is based on maximal aneurysm diameter without regard for arterial wall composition or individual aneurysm geometry. In other words, our current diagnostic tests do not reflect the sophistication of our current knowledge of vascular disease. Using a multimodal approach, computer modeling has the potential to predict clinical outcomes based on a variety of factors including arterial wall composition, surface anatomy and hemodynamic forces. We term this more sophisticated approach "patient specific diagnostics", in which the computer models are reconstructed from patient specific clinical visualizing modalities, and material properties are extracted from experimental measurements of specimens and incorporated into the modeling using advanced material models (including nonlinear anisotropic models) and performed as dynamic simulations using the FSI (fluid structure interaction) approach. Such an approach is sorely needed to improve the effectiveness of interventions. This article will review ongoing work in "patient specific diagnostics" in the areas of carotid, coronary and aneurismal disease. We will also suggest how this approach may be applicable to management of aortic dissection. New diagnostic methods should allow better patient selection, targeted intervention and modeling of the results of different therapies.
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Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
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Pagan J, Ricotta JJ. Commentary: Dubinsky RM, Lai SM. Mortality from combined carotid endarterectomy and coronary artery bypass surgery in the US. Neurology. 2007;68:195-197. PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2008; 20:94-95. [PMID: 18388024 DOI: 10.1177/1531003507310831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
available at http://www.neurology.org/cgi/ content/abstract/68/3/195.
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Gasparis AP, Ricotta JJ. Commentary on "Diagnosis and management of pseudoaneurysms". PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2007; 19:65-6. [PMID: 17437983 DOI: 10.1177/1531003507299665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Ricotta JJ. Comparison of results of carotid stenting followed by open heart surgery versus combined carotid endarterectomy and open heart surgery. PERSPECTIVES IN VASCULAR SURGERY AND ENDOVASCULAR THERAPY 2006; 18:193-4. [PMID: 17060246 DOI: 10.1177/1531003506290892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Ricotta JJ, Wall LP, Blackstone E. The influence of concurrent carotid endarterectomy on coronary bypass: A case-controlled study. J Vasc Surg 2005; 41:397-401; discussion 401-2. [PMID: 15838469 DOI: 10.1016/j.jvs.2004.11.035] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are associated with an increased incidence of stroke and death compared to isolated CABG. It is unclear whether this reflects two concurrent operative procedures or the increased risk in patients with more extensive atherosclerosis. METHODS To address this question, a case controlled study was performed using data from the New York State Cardiac Database from 1997 to 1998. Patients who underwent combined CEA-CABG were compared with all isolated CABG patients and a risk-matched cohort of isolated CABG patients. RESULTS The 35,539 isolated CABG patients had fewer postoperative complications than the 744 combined CEA-CABG patients, but also had a lower overall risk profile. The isolated CABG patients had a lower incidence of stroke (2% vs 5.1%), death (2% vs 4.4%), and combined stroke and death (3.7% vs 8.1%) compared with the combined group ( P < .001). After risk-factor matching, no differences in stroke (5% vs 5.1%), death (3.9% vs 4.4%), or combined stroke and death (8.5% vs 8.1%) were observed. CONCLUSIONS Although increased complications are reported after CEA-CABG, these do not differ from those of a risk-matched cohort of isolated CABG patients. Thus, the major morbidity of combined CEA-CABG is due to inherent patient risk and not the addition of CEA to CABG.
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Ricotta JJ. Invited Commentary. J Vasc Surg 2004. [DOI: 10.1016/j.jvs.2004.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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