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Rontoyanni VG, Blears E, Nunez Lopez O, Ogunbileje J, Moro T, Bhattarai N, Randolph AC, Fry CS, Fankhauser GT, Cheema ZF, Murton AJ, Volpi E, Rasmussen BB, Porter C. Skeletal Muscle Bioenergetics in Critical Limb Ischemia and Diabetes. J Surg Res 2023; 288:108-117. [PMID: 36963297 PMCID: PMC10192034 DOI: 10.1016/j.jss.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Mitochondrial dysfunction is implicated in the metabolic myopathy accompanying peripheral artery disease (PAD) and critical limb ischemia (CLI). Type-2 diabetes mellitus (T2DM) is a major risk factor for PAD development and progression to CLI and may also independently be related to mitochondrial dysfunction. We set out to determine the effect of T2DM in the relationship between CLI and muscle mitochondrial respiratory capacity and coupling control. METHODS We studied CLI patients undergoing revascularization procedures or amputation, and non-CLI patients with or without T2DM of similar age. Mitochondrial respiratory capacity and function were determined in lower limb permeabilized myofibers by high-resolution respirometry. RESULTS Fourteen CLI patients (65 ± 10y) were stratified into CLI patients with (n = 8) or without (n = 6) T2DM and were compared to non-CLI patients with (n = 18; 69 ± 5y) or without (n = 19; 71 ± 6y) T2DM. Presence of CLI but not T2DM had a marked impact on all mitochondrial respiratory states in skeletal muscle, adjusted for the effects of sex. Leak respiration (State 2, P < 0.025 and State 4o, P < 0.01), phosphorylating respiration (P < 0.001), and maximal respiration in the uncoupled state (P < 0.001), were all suppressed in CLI patients, independent of T2DM. T2DM had no significant effect on mitochondrial respiratory capacity and function in adults without CLI. CONCLUSIONS Skeletal muscle mitochondrial respiratory capacity was blunted by ∼35% in patients with CLI. T2DM was not associated with muscle oxidative capacity and did not moderate the relationship between muscle mitochondrial respiratory capacity and CLI.
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Affiliation(s)
| | - Elizabeth Blears
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - John Ogunbileje
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Tatiana Moro
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas
| | - Nisha Bhattarai
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Amanda C Randolph
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas
| | - Christopher S Fry
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Grant T Fankhauser
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Zulfiqar F Cheema
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Andrew J Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Elena Volpi
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Blake B Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Craig Porter
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Department of Pediatrics, University of Arkansas for Medical Sciences & Arkansas Children's Research Institute, Little Rock, Arkansas.
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Abstract
Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Eighteen patients presented to the emergency department with acute complications of jejunal diverticulosis. Ages ranged from 47 to 86 years (mean, 72 years). Seven patients presented with evidence of free bowel perforation. Six had either diverticulitis or a contained perforation. The remaining five were found to have gastrointestinal bleeding. Fourteen of the patients underwent surgical management. Four patients were successfully managed nonoperatively. As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon. Although nonoperative management can be successful, most patients should undergo surgical intervention. Traditional management dictates laparotomy and segmental jejunal resection. Diverticulectomy is not recommended as a result of the risk of staple line breakdown. The entire involved portion of jejunum should be resected when bowel length permits.
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Affiliation(s)
- Kevin N. Johnson
- Departments of General Surgery, Mayo Clinic, Arizona, Phoenix, Arizona
| | | | | | - Marianne V. Merritt
- Departments of Cardiothoracic Surgery, Mayo Clinic, Arizona, Phoenix, Arizona
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Affiliation(s)
- Grant T Fankhauser
- Division of Vascular Surgery, University of Texas Medical Branch, Galveston, Tex.
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Rontoyanni VG, Nunez Lopez O, Fankhauser GT, Cheema ZF, Rasmussen BB, Porter C. Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease. Front Physiol 2017; 8:141. [PMID: 28348531 PMCID: PMC5346567 DOI: 10.3389/fphys.2017.00141] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/23/2017] [Indexed: 11/14/2022] Open
Abstract
Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD. Following a short discussion of the available in vivo and in vitro methodologies to quantitate indices of muscle mitochondrial function, we review the current evidence implicating skeletal muscle mitochondrial dysfunction in the pathophysiology of PAD myopathy, while attempting to highlight questions that remain unanswered. Given the rising prevalence of PAD, the detriment in quality of life for patients, and the associated significant healthcare resource utilization, new alternate therapies that ameliorate lower limb symptoms and the functional impairment associated with PAD are needed. A clear understanding of the role of mitochondria in the pathophysiology of PAD may contribute to the development of novel therapeutic interventions.
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Affiliation(s)
- Victoria G Rontoyanni
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA; Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Omar Nunez Lopez
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA; Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Grant T Fankhauser
- Department of Surgery, University of Texas Medical Branch Galveston, TX, USA
| | - Zulfiqar F Cheema
- Department of Surgery, University of Texas Medical Branch Galveston, TX, USA
| | - Blake B Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical Branch Galveston, TX, USA
| | - Craig Porter
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA; Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
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Roughneen PT, Fankhauser GT, DeAnda A. Acute retrograde aortic dissection: "To be [treated] or not to be, that is the question". J Thorac Cardiovasc Surg 2016; 153:66-67. [PMID: 27986259 DOI: 10.1016/j.jtcvs.2016.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Patrick T Roughneen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
| | - Grant T Fankhauser
- Division of Vascular Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex.
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Perone JA, Fankhauser GT, Adhikari D, Mehta HB, Woods MB, Tyler DS, Brown KM. It depends on your perspective: Resident satisfaction with operative experience. Am J Surg 2016; 213:253-259. [PMID: 27776758 DOI: 10.1016/j.amjsurg.2016.09.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/08/2016] [Accepted: 09/24/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors. METHODS Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test. RESULTS Residents and faculty were very satisfied in 56/87 (64%) and 36/87 (41%) of cases respectively. Resident satisfaction was associated with their perceived role as surgeon (p < 0.04), performing >50% of the case (p < 0.01), autonomy (p < 0.03), and PGY year 4-5(p < 0.02). Faculty taking over the case was associated with both resident and faculty dissatisfaction. Faculty satisfaction was associated with resident preparation (p < 0.01), faculty perception of resident autonomy (p < 0.01), and faculty familiarity with resident's skills (p < 0.01). CONCLUSIONS Resident and faculty satisfaction are associated with the resident's competent performance of the case, suggesting interventions to optimize resident preparation for a case or faculty's ability to facilitate resident autonomy will improve satisfaction with OR experience.
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Affiliation(s)
- Jennifer A Perone
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Grant T Fankhauser
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Deepak Adhikari
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Majka B Woods
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Kimberly M Brown
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
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Fankhauser GT, DeAnda A, Roughneen PT. Setting the bar in thoracoabdominal aortic aneurysm repair: Bridge over troubled aorta. J Thorac Cardiovasc Surg 2016; 153:S20-S21. [PMID: 27527247 DOI: 10.1016/j.jtcvs.2016.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Grant T Fankhauser
- Division of Vascular Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex.
| | - Patrick T Roughneen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
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Fankhauser GT, Fowl RJ, Stone WM, Money SR. Elimination of pneumothorax and hemothorax during placement of implantable venous access ports using ultrasound and fluoroscopic guidance. Vascular 2016; 21:345–8. [PMID: 23493277 DOI: 10.1177/1708538112472279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Implantable venous access ports are essential for patients requiring chronic venous access. Ultrasound guided catheter placement has been recognized as a valuable adjunct for reducing complications during placement of access ports in the radiology and critical care medicine literature. We reviewed the medical records of patients undergoing insertion of implantable venous access ports from June 2006 through June 2009. All procedures were performed using ultrasound guidance with the internal jugular vein as the access site. There were 500 implantable venous access ports placed and included for review. There were no post-procedure pneumothoraces or hemothoraces. Carotid puncture was documented in 4 (0.8%)cases. Routine use of ultrasound guidance during placement of implantable venous access ports has eliminated the complications of pneumothorax and hemothorax during placement of internal jugular venous access ports on our vascular surgery service. Elimination of these complications and decreased use of chest x-rays should also provide increased cost savings for this procedure.
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Affiliation(s)
- Grant T Fankhauser
- Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
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Johnson KN, Fankhauser GT, Chapital AB, Merritt MV, Johnson DJ. Emergency management of complicated jejunal diverticulosis. Am Surg 2014; 80:600-603. [PMID: 24887799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Eighteen patients presented to the emergency department with acute complications of jejunal diverticulosis. Ages ranged from 47 to 86 years (mean, 72 years). Seven patients presented with evidence of free bowel perforation. Six had either diverticulitis or a contained perforation. The remaining five were found to have gastrointestinal bleeding. Fourteen of the patients underwent surgical management. Four patients were successfully managed nonoperatively. As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon. Although nonoperative management can be successful, most patients should undergo surgical intervention. Traditional management dictates laparotomy and segmental jejunal resection. Diverticulectomy is not recommended as a result of the risk of staple line breakdown. The entire involved portion of jejunum should be resected when bowel length permits.
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Affiliation(s)
- Kevin N Johnson
- Department of General Surgery, Mayo Clinic, Arizona, Phoenix, Arizona, USA
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O'Donnell, MMedSc ME, Cheney SM, Castle EP, Fankhauser GT, Fowl RJ, Stone WM, Money SR. Robotic Removal of a Symptomatic Inferior Vena Cava Filter. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2013.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Donnell, MMedSc ME, Fankhauser GT, Stone WM, Fowl RJ, Pence-Smith C, Money SR. United States National Survey of Vascular Surgery Consent. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2013.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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O'Donnell ME, Jaroszewski DE, Coan K, Fankhauser GT, Fowl RJ, Stone WM, Kazmier FJ, Money SR. Brachiocephalic Vein Bypass with Sternal Reconstruction for Symptomatic Occlusion. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fankhauser GT, Oderich G, Minion DJ, O'Donnell M, Stone WM, Kalra M, Money SR. A Multi-Institution Series of Hypogastric Preservation During Endovascular Repair of Aneurysms Involving the Common Iliac Artery. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fankhauser GT, Stone WM, Fu R, Money SR. Spiral Vein Graft for Internal Jugular Bypass in a Patient With Multiple Sclerosis and Suspected Chronic Cerebrospinal Venous Insufficiency. Ann Vasc Surg 2013; 27:673.e5-8. [DOI: 10.1016/j.avsg.2012.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/28/2012] [Accepted: 05/31/2012] [Indexed: 10/26/2022]
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Coan KE, O’Donnell ME, Fankhauser GT, Bodnar Z, Chandrasekaran K, Stone WM. Bilateral Pulmonary Emboli Secondary to Indwelling Hemodialysis Reliable Outflow Catheter. Vasc Endovascular Surg 2013; 47:317-9. [DOI: 10.1177/1538574413484973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a 33-year-old dialysis-dependent female who presented with new onset split second heart sound. Following a failed left upper extremity dialysis fistula, a right upper extremity hemodialysis reliable outflow (HeRO) graft was performed in 2011. Her subsequent cadaveric renal transplant had delayed function necessitating concurrent use of hemodialysis. However, as renal function improved, hemodialysis was discontinued. Two weeks following transplantation, the HeRO graft occluded. Subsequent clinical and radiological assessment confirmed widespread pulmonary emboli. Following cessation of hemodialysis and subsequent HeRO graft occlusion, removal was deemed appropriate to reduce further thromboembolic phenomenon. Right atrial thrombi are complications associated with central venous catheters. However, their actual incidence varies significantly. Right heart thromboemboli are associated with a 4% to 6% pulmonary embolism rate. Katzman et al assessed 38 patients who underwent HeRO graft and reported 1 (2.6%) patient with right atrial emboli and likely pulmonary embolism. Although thrombotic complications remain rare, consideration of graft removal should always be evaluated particularly in the absence of an alternative thrombotic source.
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Affiliation(s)
- Kathryn E. Coan
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Mark E. O’Donnell
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Grant T. Fankhauser
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Zachary Bodnar
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - William M. Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
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Fankhauser GT, Stone WM, Fowl RJ, O'Donnell ME, Bower TC, Meyer FB, Money SR. Surgical and Medical Management of Extracranial Carotid Artery Aneurysms. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2012.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The medical management of patients with an abdominal aortic aneurysm (AAA) includes modification of risk factors, smoking cessation, cardiovascular risk treatment, and hypertensive therapy. No specific therapy has been shown to alter disease outcome. Many AAA and thoracic aortic aneurysms are amenable to endovascular treatment. Endovascular repair offers the benefit of shorter hospital stays and lower perioperative morbidity and mortality. Most patients with peripheral arterial disease (PAD) are asymptomatic or have atypical symptoms; only a few present with classic intermittent claudication or critical limb ischemia. Smoking and diabetes mellitus are the most important risk factors for developing PAD.
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Affiliation(s)
- Fadi Elias Shamoun
- Department of Carviovascular Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Stone WM, Fankhauser GT, Bower TC, Oderich GS, Oldenburg WA, Kalra M, Naidu S, Money SR. Comparison of open and endovascular repair of inflammatory aortic aneurysms. J Vasc Surg 2012; 56:951-5; discussion 955-6. [DOI: 10.1016/j.jvs.2012.03.253] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/14/2012] [Accepted: 03/16/2012] [Indexed: 11/16/2022]
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Fankhauser GT, Stone WM, Fowl RJ, Kalra M, Gloviczki P, Oldenburg WA, Money SR. Surgical Treatment of Lower Extremity Venous Aneurysms. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fankhauser GT, Stone WM, Naidu SG, Oderich GS, Ricotta JJ, Bjarnason H, Money SR. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2011; 53:966-70. [PMID: 21216559 DOI: 10.1016/j.jvs.2010.10.071] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Minimally invasive methods (MIMs) are now available for the management of visceral artery aneurysms and pseudoaneurysms (visceral artery aneurysms [VAA]). The purpose of this study was to review our 10-year experience with the MIM of treating VAA. METHODS All patients evaluated from June 1999 to June 2009 with VAAs were reviewed. Demographics, therapy, and results were analyzed. RESULTS MIM was attempted in 185 aneurysms in 176 patients. Initial intervention was successful in 98% ofaneurysms. Sixty-three (34%) aneurysms were located in the splenic artery, 56 (30%) in the hepatic, 28 (15%) in the gastroduodenal, 16 (8.6%) in the pancreaticoduodenal, six (3.2%) in the superior mesenteric, four (2.1%) in the gastric, four (2.1%) in the celiac, four (2.1%) in the gastroepiploic, two (1%) in the inferior mesenteric, and one (0.5%) in the middle colic artery. Pseudoaneurysms were more common than true aneurysms (64% vs 36%). Bleeding was the indication for intervention in 86 aneurysms (46%). Initial treatment was successful in 177 aneurysms (98%). Reintervention was required in five (3%) aneurysms within 30 days. Coiling was used alone in 139 aneurysms (75%) and in combination with at least one other technique in 20 (11%) cases. Thirty-day aneurysm-related mortality was 3.4% (six deaths). Five additional deaths occurred during 30-day follow-up, although none was related to complications of the aneurysms (2.8%). CONCLUSIONS MIM for visceral artery aneurysms can be used alone or in combination to effectively treat VAAs in elective or emergent conditions.
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Affiliation(s)
- Grant T Fankhauser
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
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Fankhauser GT, Stone WM, Naidu SG, Oderich GS, Ricotta JJ, Bjarnason H. The Minimally Invasive Management of Visceral Artery Aneurysms and Pseudoaneurysms. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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