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O'Banion LA, Aparicio C, Borshan C, Siada S, Matheny H, Woo K. Improved long-term functional outcomes and mortality of patients with vascular-related amputations utilizing the lower extremity amputation pathway. J Vasc Surg 2024; 79:856-862.e1. [PMID: 38141741 DOI: 10.1016/j.jvs.2023.11.037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Enhanced recovery after surgery pathways lead to improve perioperative outcomes for patients with vascular-related amputations; however, long-term data and functional outcomes are lacking. This study evaluated patients treated by the lower extremity amputation pathway (LEAP) and identified predictors of ambulation. METHODS A retrospective review of LEAP patients who underwent major amputation from 2016 to 2022 for Wound, Ischemia, and foot Infection stage V disease was performed. LEAP patients were matched 1:1 with retrospective controls (NOLEAP) by hospital, need for guillotine amputation, and final amputation type (above knee vs below knee). The primary end point was the Medicare Functional Classification Level (K level) (functional classification of patients with amputations) at the last follow-up. RESULTS We included 126 patients with vascular-related amputations (63 LEAP and 63 NOLEAP). Seventy-one percent of the patients were male and 49% were Hispanic with a mean state Area Deprivation Index of 9/10. There were no differences in baseline demographics or comorbidities. All patients had a K level of >0 (ambulatory) before amputation and an average Modified Frailty Index of 4. The median follow-up was 270 days (interquartile range, 84-1234 days) in the NOLEAP group and 369 days (interquartile range, 145-481 days) in the LEAP group. Compared with NOLEAP patients, LEAP patients were more likely to receive a prosthesis (86% vs 44%;P > .001). LEAP patients were more likely to have a K level of >0 (60% vs 25%; P = .003). On multivariable logistic regression, participation in LEAP increased the odds of a K level of >0 at follow-up by 5.8-fold (odds ratio, 5.8; 95% confidence interval, 2.5-13.6). Patients with a K level of >0 had significantly higher survival at 4 years (93% vs 59%; P = .001). In a Cox proportional hazards model, adjusted for demographics, comorbidities and amputation level, a K level of >0 at follow-up was associated with an 88% decrease in the risk of mortality compared with a K level of 0. CONCLUSIONS LEAP leads to improved ambulation with a prosthesis in a socioeconomically disadvantaged and frail patient population. Patients with a K level of >0 (ambulatory) have significantly improved mortality.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA. leighann.o'
| | - Carolina Aparicio
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Christian Borshan
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Sammy Siada
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Heather Matheny
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Lucero L, Dhawan DS, O'Banion LA. Surgical management of carotid stump syndrome. J Vasc Surg Cases Innov Tech 2023; 9:101342. [PMID: 38023323 PMCID: PMC10654014 DOI: 10.1016/j.jvscit.2023.101342] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Leah Lucero
- Department of Surgery, University of California, San Francisco, Fresno, CA
| | | | - Leigh Ann O'Banion
- Department of Surgery, University of California, San Francisco, Fresno, CA
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O'Banion LA. Improving outcomes through standardization of care for penetrating aortic ulcers and intramural hematomas. J Vasc Surg 2023; 78:1188-1189. [PMID: 37865425 DOI: 10.1016/j.jvs.2023.07.010] [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] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
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Matheny H, Woo K, Siada S, Qumsiyeh Y, Aparicio C, Borashan C, O'Banion LA. Community-wide feasibility of the Lower Extremity Amputation Protocol amongst vascular amputees. J Vasc Surg 2023; 78:1057-1063. [PMID: 37315909 DOI: 10.1016/j.jvs.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Lower Extremity Amputation Protocol (LEAP) is a multidisciplinary enhanced recovery after surgery pathway for vascular amputees. The objective of this study was to examine feasibility and outcomes of community-wide implementation of LEAP. METHODS LEAP was implemented at three safety net hospitals for patients with peripheral artery disease or diabetes requiring major lower extremity amputation. Patients who underwent LEAP (LEAP) were matched 1:1 with retrospective controls (NOLEAP) on hospital location, need for initial guillotine amputation, and final amputation type (above- vs below-knee). Primary endpoint was postoperative hospital length of stay (PO-LOS). RESULTS A total of 126 amputees (63 LEAP and 63 NOLEAP) were included with no difference between baseline demographics and co-morbidities between the groups. After matching, both groups had the same prevalence of amputation level (76% below-knee vs 24% above-knee). LEAP patients had shorter duration of postamputation bed rest (P = .003) and were more likely to receive limb protectors (100% vs 40%; P ≤ .001), prosthetic counseling (100% vs 14%; P ≤ .001), perioperative nerve blocks (75% vs 25%; P ≤ .001), and postoperative gabapentin (79% vs 50%; P ≤ .001). Compared with NOLEAP, LEAP patients were more likely to be discharged to an acute rehabilitation facility (70% vs 44%; P = .009) and less likely to be discharged to a skilled nursing facility (14% vs 35%; P = .009). The median PO-LOS for the overall cohort was 4 days. LEAP patients had a shorter median PO-LOS (3 [interquartile range, 2-5] vs 5 [interquartile range, 4-9] days; P < .001). On multivariable logistic regression, LEAP decreased the odds of a PO-LOS of ≥4 days by 77% (odds ratio, 0.23; 95% confidence interval, 0.09-0.63). Overall, LEAP patients were significantly less likely to have phantom limb pain (5% vs 21%; P = .02) and were more likely to receive a prosthesis (81% vs 40%; P ≤ .001). In a multivariable Cox proportional hazards model, LEAP was associated with an 84% reduction in time to receipt of prosthesis (hazard ratio, 0.16; 95% confidence interval, 0.085-0.303; P < .001). CONCLUSIONS Community wide implementation of LEAP significantly improved outcomes for vascular amputees demonstrating that utilization of core ERAS principles in vascular patients leads to decreased PO-LOS and improved pain control. LEAP also affords this socioeconomically disadvantaged population a greater opportunity to receive a prosthesis and return to the community as a functional ambulator.
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Affiliation(s)
- Heather Matheny
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Sammy Siada
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Yazen Qumsiyeh
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Carolina Aparicio
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Christian Borashan
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA. leighann.o'
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Kabeil M, Wohlauer MV, D'Oria M, Khetarpaul V, Gillette R, Moore E, Colborn K, Cuff RF, O'Banion LA, Koleilat I, Aziz F, Mouawad NJ. Carotid Artery Operation Delay During the Covid-19 Pandemic: Results of a Multicenter International Study. Ann Vasc Surg 2023; 96:44-56. [PMID: 37355018 DOI: 10.1016/j.avsg.2023.05.041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/09/2023] [Accepted: 05/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND To measure the impact of the COVID-19 pandemic on the management of patients with carotid artery stenosis. METHODS We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of operative delay due to the COVID-19 pandemic. RESULTS A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70-80) and 80% of them were planned for carotid endarterectomy. Most patients were asymptomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource conservation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19. CONCLUSIONS Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.
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Affiliation(s)
- Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Vipul Khetarpaul
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Riley Gillette
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ethan Moore
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco (UCSF) Fresno, Fresno, CA
| | - Issam Koleilat
- Department of Surgery, RWJBH Community Medical Center, Toms River, NJ
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Surgery, Penn State University, State College, PA
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Kiguchi MM, Drudi LM, Jazaeri O, Smeds MR, Aulivola B, MacCallum K, Cutler B, D'Ambrosio N, O'Banion LA. Exploring the perception of venous disease within vascular surgery. J Vasc Surg Venous Lymphat Disord 2023; 11:1063-1069.e1. [PMID: 37353156 DOI: 10.1016/j.jvsv.2023.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Biases and gender disparities influence career pathways within medicine, and vascular surgery is no exception. Venous disease comprises an estimated 1% to 3% of total health care expenditures. However, its value among vascular surgeons is poorly understood. This study aims to investigate the factors that influence vascular surgeons' current perceptions of superficial and deep venous disease treatments. METHODS An anonymous survey was distributed electronically to practicing vascular surgeons in December 2021. The respondents were stratified by gender and practice breakdown. A venous-heavy practice was defined as a practice with venous work comprising ≥25% of the total volume. Changes in practice patterns over the respondent's career were also explored. Descriptive, univariate, and multivariate analyses were performed using STATA (StataCorp). RESULTS A total of 315 practicing vascular surgeons responded, with 81.5% from the United States. Their mean age was 46.6 ± 9.6 years, and most identified as men (63.3%). The race and ethnicity breakdown was as follows: White (non-Hispanic), 63.0%; Asian or Asian Indian, 17.1%; Hispanic, Latinx, or Spanish, 8.4%; Black, 1.6%; and unknown, 9.9%. The practice settings were academic for 47.0%, private practice for 26.5%, hospital employed for 23.3%, and other for 3.2%. The female respondents were significantly younger (P < .0001), with fewer years in practice (P < .0001) and were more likely to perceive a gender bias within a career encompassing venous disease compared with the male respondents (P = .02). Of the 315 participants, 143 (45.4%) had a venous-heavy practice. No differences were found in age or gender between the venous-heavy and venous-light practices. Those with a venous-heavy practice had significantly more years in practice statistically (P = .02), had sought more venous training after graduation (P < .0001), were more likely to be in private practice (P < .0001), and were more likely to desire a practice change (P = .001) compared with those with a venous-light practice. Overall, 74.3% of respondents indicated that venous work might be less "valued" than arterial work in the field of vascular surgery. On multivariable regression, the predictors for the perception of venous work being less valued were female gender (odds ratio, 2.01; 95% confidence interval, 1.14-4.03) and completion of a vascular surgery fellowship (odds ratio, 2.0; 95% confidence interval, 1.15-3.57). CONCLUSIONS Vascular surgeons overwhelmingly perceived the management of venous disease to be of less value than that of arterial disease, particularly by women and fellowship-trained vascular surgeons. The prevalence of venous disease, as measured by its proportion of the U.S. healthcare budget, cannot be overstated. Thus, efforts to elevate the importance of chronic venous disease within the scope of vascular surgery practices are essential to ensure patients are provided with appropriate specialty care.
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Affiliation(s)
- Misaki M Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
| | - Laura M Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Omid Jazaeri
- Cardiothoracic and Vascular Surgery Associates, HealthOne Graduate Medical Education, Aurora, CO
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - Bernadette Aulivola
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL
| | - Katherine MacCallum
- Division of Vascular and Endovascular Surgery, Brown Surgical Associates, Providence, RI
| | - Bianca Cutler
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Nicole D'Ambrosio
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
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Kiguchi MM, Fallentine J, Oh JH, Cutler B, Yan Y, Patel HR, Shao MY, Agrawal N, Carmona E, Hager ES, Ali A, Kochubey M, O'Banion LA. Race, sex, and socioeconomic disparities affect the clinical stage of patients presenting for treatment of superficial venous disease. J Vasc Surg Venous Lymphat Disord 2023; 11:897-903. [PMID: 37343787 DOI: 10.1016/j.jvsv.2023.06.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Superficial venous disease has a U.S. prevalence of nearly 30%, with advanced disease contributing to a significant healthcare burden. Although the risk factors for venous disease are well known, the correlation between race, sex, socioeconomic status, and disease severity on presentation is not well established. The area deprivation index (ADI) is a validated metric with respect to regional geography, social determinants of health, and degree of socioeconomic disadvantage. In the present study, we aimed to identify the disparities and the effect that the ADI, in addition to race and sex, has among patients associated with an advanced venous disease presentation. METHODS A retrospective review between 2012 and 2022 was performed at four tertiary U.S. institutions to identify patients who underwent endovenous closure of their saphenous veins. Patient demographics, state ADI, comorbidities, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, and periprocedural outcomes were included. Pearson's correlation was performed between the CEAP classification and ADI. Poisson regression analysis was performed to identify factors predicting for an increasing CEAP classification at presentation. Variables with P < .05 were deemed significant. RESULTS A total of 2346 patients underwent endovenous saphenous vein closure during the study period, of whom 7 were excluded because of a lack of follow-up data. The mean age was 60.4 ± 14.9 years, 65.9% were women, and 55.4% were White. Of the 2339 patients, 73.3% presented with an advanced CEAP class (≥3). The mean state ADI for the entire cohort was 4.9 ± 3.1. The percent change in the CEAP classification is an increase of 2% and 1% for every level increase in the state ADI for unadjusted (incidence rate ratio [IRR] = 1.02; P < .001) and adjusted (IRR = 1.01; P < .001) models, respectively. Black race has a 12% increased risk of a higher CEAP class on presentation compared with White race (IRR = 1.12; P = .005). Female sex had a 16% lower risk of a higher CEAP presentation compared with male sex (IRR = 0.84; P < .01). CONCLUSIONS Low socioeconomic status, Black race, and male sex are predictive of an advanced CEAP classification on initial presentation. These findings highlight the opportunity for improved mechanisms for identification of venous disease and at-risk patients before advanced disease progression in known disadvantaged patient populations.
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Affiliation(s)
- Misaki M Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
| | | | - Jae Hak Oh
- Georgetown University School of Medicine, Washington, DC
| | - Bianca Cutler
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Yueqi Yan
- Biostatistics and Data Support Center, University of California, Merced, Merced, CA
| | - Harik R Patel
- St. George's University of London, London, United Kingdom
| | - Michael Y Shao
- Division of Vascular Surgery, NorthShore University Health System, Chicago, IL
| | - Nishant Agrawal
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Emely Carmona
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric S Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amna Ali
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
| | - Mariya Kochubey
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
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O'Banion LA, Saadi S, Hasan B, Nayfeh T, Simons JP, Murad MH, Woo K. Lack of patient-centered evaluation of outcomes in intermittent claudication literature. J Vasc Surg 2023; 78:828-836. [PMID: 37044317 DOI: 10.1016/j.jvs.2023.03.497] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Peripheral arterial disease, characterized as arterial atherosclerotic disease, can lead to insufficient flow in the lower extremities and ischemia, with the most common clinical manifestation being intermittent claudication (IC). In 2022, the Society for Vascular Surgery (SVS) developed appropriate use criteria for the management of IC that used this systematic review as a source of evidence. The objective of this study is to synthesize the findings of the systematic review and identify evidence gaps. METHODS A comprehensive search of literature databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted from January 1, 2000, to November 30, 2022. Noncomparative and comparative observational studies and randomized controlled trials were included. Included studies evaluated exercise therapy, endovascular or open revascularization for the treatment of IC. Outcomes of interest (freedom from major adverse limb event, health-related quality of life, and walking distance) were compared in various subgroups (age, sex, diabetes, smoking status, anatomical location of disease, and optimal medical therapy). RESULTS Twenty-six studies reported the outcomes of interest for the evidence map. The general conclusions of the studies that reported freedom from major adverse limb events were that reintervention rates for endovascular therapy at ≥2 years were >20%, major amputation rates were often not reported, and, after endovascular therapy, the 1-month mortality was low (<2%). Quality of life and walking distance data were sparse, limited to only endovascular intervention, and insufficient to make any strong conclusions. CONCLUSIONS IC in patients with peripheral arterial disease poses a significant socioeconomic and health care burden. Major, consequential gaps exist in the IC literature with respect to the assessment of patient reported outcome measures, standardized measures of walking distance and the comparative effectiveness of initial exercise therapy vs invasive intervention. The evidence gaps identified by the Society for Vascular Surgery appropriate use criteria on IC systematic review serve as a guide for future research efforts to optimize care for this patient population.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA. leighann.o'
| | - Samer Saadi
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bashar Hasan
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Tarek Nayfeh
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jessica P Simons
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Mohammad H Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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O'Banion LA. Does an old dog need new tricks? Advancement of limb salvage in treating chronic limb threatening ischemia. J Vasc Surg Cases Innov Tech 2023; 9:101267. [PMID: 37635742 PMCID: PMC10448157 DOI: 10.1016/j.jvscit.2023.101267] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
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Conte MS, O'Banion LA. Apples and oranges? A comparison of BEST-CLI to BASIL-2. J Vasc Surg 2023; 78:265-268. [PMID: 37481274 DOI: 10.1016/j.jvs.2023.05.042] [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] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA.
| | - Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, University of California San Francisco - Fresno Branch Campus, Fresno, CA
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O'Banion LA, Ozsvath K, Cutler B, Kiguchi M. A review of the current literature of ethnic, gender, and socioeconomic disparities in venous disease. J Vasc Surg Venous Lymphat Disord 2023; 11:682-687. [PMID: 37086915 DOI: 10.1016/j.jvsv.2023.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 04/24/2023]
Abstract
Venous disease is prevalent, undertreated, and frequently unrecognized. During the past two decades, new treatment modalities have changed how venous disease is approached. Some of these treatment modalities are only available in certain centers or locations and access to care could be inequitable. Although venous disease affects millions in the United States, we have little understanding of the gender, socioeconomic, and ethnic disparities in both superficial and deep venous disease presentation. In an effort to better understand the treatment of male and female patients from different gender, ethnic, and socioeconomic backgrounds, literature searches were conducted to investigate how these patients were evaluated and treated. PubMed was used to search literature using the terms "venous insufficiency," "superficial venous disease," "venous thromboembolism," "deep vein thrombosis," "DVT," "May-Thurner," and "pulmonary embolism," with gender, sex, racial, and socioeconomic disparities and differences within the keywords. In addition, once articles were discovered, the "similar articles" function was used to expand the search. The included studies were restricted to those reported from 1995 to the present. Given the paucity of data, no study was excluded. It is readily apparent that there is not enough data to make decisions that would modify treatment to affect the outcomes of patients with differing backgrounds and gender. Studies currently are limited to evaluating patients by sex assigned at birth without interrogation of their identified gender. It is imperative that consideration is given to evaluating gender and ethnic differences, because treatment options might need to be tailored accordingly. Outreach and education for underserved patient populations with improvement in access to care must also be incorporated into the healthcare system. Additional work in this area is required. Further data collection and research related to demographic disparities among patients with venous disease is necessary to better understand the differences that could change treatment algorithms tailored to specific groups.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Kathleen Ozsvath
- Division of Vascular Surgery, Department of Surgery, St Peters Health Partners, Albany, NY
| | - Bianca Cutler
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Misaki Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
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Smeds MR, Mendes B, O'Banion LA, Shalhub S. Exploring the pros and cons of using artificial intelligence in manuscript preparation for scientific journals. J Vasc Surg Cases Innov Tech 2023; 9:101163. [PMID: 37235171 PMCID: PMC10205760 DOI: 10.1016/j.jvscit.2023.101163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Matheny H, O'Banion LA. Symptomatic peripheral arterial disease: Aspirin simply is not enough. J Vasc Surg Venous Lymphat Disord 2023; 11:675. [PMID: 37080698 DOI: 10.1016/j.jvsv.2022.09.001] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 04/22/2023]
Affiliation(s)
- Heather Matheny
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno Fresno, CA
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Magee GA, Dubose JJ, Inaba K, Lucero L, Dirks RC, O'Banion LA. Outcomes of vascular trauma associated with an evolution in the use of endovascular management. J Vasc Surg 2023:S0741-5214(23)00551-7. [PMID: 37023834 DOI: 10.1016/j.jvs.2023.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/15/2022] [Revised: 01/05/2023] [Accepted: 02/04/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The availability of endovascular techniques has led to a paradigm shift in the management of vascular injury. While previous reports showed trends towards the increased use of catheter-based techniques, there have been no contemporary studies of practice patterns and how these approaches differ by anatomic distributions of injury. The objective of this study is to provide a temporal assessment of the use of endovascular techniques in the management of torso, junctional (subclavian, axillary, iliac), and extremity injury and to evaluate any association with survival and length of stay. METHODS The American Association for the Surgery of Trauma (AAST) Prospective Observational Vascular Injury Treatment registry (PROOVIT) is the only large multicenter database focusing specifically on the management of vascular trauma. Patients in the AAST PROOVIT registry from 2013-2019 with arterial injuries were queried, and radial/ulnar, and tibial artery injuries were excluded. The primary aim was to evaluate the frequency in use of endovascular techniques over time and by body region. A secondary analysis evaluated the trends for junctional injuries and compared the mortality between those treated with open vs. endovascular repair. RESULTS Of the 3,249 patients included, 76% were male, and overall treatment type was 42% nonoperative, 44% open, 14% endovascular. Endovascular treatment increased an average of 2% per year from 2013-2019 (Range: 17-35%, R2 =.61). The use of endovascular techniques for junctional injuries increased by 5% per year (Range: 33%-63%, R2 =.89). Endovascular treatment was more common for thoracic, abdominal, and cerebrovascular injuries, and least likely in upper and lower extremity injuries. Injury severity score (ISS) was higher for patients receiving endovascular repair in every vascular bed except lower extremity. Endovascular repair was associated with significantly lower mortality than open repair for thoracic (5% vs. 46%, p<.001) and abdominal injuries (15% vs 38%, p<.001). For junctional injuries, endovascular repair was associated with a non-statistically significant lower mortality (19% vs. 29%, p=.099), despite higher ISS (25 vs. 21, p=.003) compared to open repair. CONCLUSION The reported use of endovascular techniques within the PROOVIT registry increased more than 10% over a 6-year period. This increase was associated with improved survival, especially for patients with junctional vascular injuries. Practices and training programs should account for these changes by providing access to endovascular technologies and instruction in the catheter-based skill sets to optimize outcomes in the future.
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Affiliation(s)
- Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Joseph J Dubose
- Division of Trauma and Acute Care Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kenji Inaba
- Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Leah Lucero
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Rachel C Dirks
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
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Anderson KM, Lucero L, Scheidt J, Lee CS, Ramos CR, O'Banion LA, Kundi R, Magee GA, Rajani R, Inaba K, Kauvar DS. The Characteristics and Results of Endovascular Devices in Trauma (CREDiT) study: Multi-institutional results. Injury 2023:S0020-1383(23)00285-1. [PMID: 37005135 DOI: 10.1016/j.injury.2023.03.029] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Endovascular techniques are increasingly used to repair major traumatic vascular injuries, but most endovascular implants are not designed/approved for trauma-specific indications. No inventory guidelines exist for the devices used in these procedures. We aimed to describe the use and characteristics of endovascular implants used for repair of vascular injuries to allow for better inventory management. METHODS This CREDiT study is a six-year retrospective cohort analysis of endovascular procedures performed for repair of traumatic arterial injuries at five participating US trauma centers. For each treated vessel, procedural and device details were recorded and outcomes assessed with the aim of defining the range of implants and sizes used for these interventions. RESULTS A total of 94 cases were identified; 58 (61%) were descending thoracic aorta, 14 (15%) axillosubclavian, 5 carotid, 4 abdominal aortic, 4 common iliac, 7 femoropopliteal, and 1 renal. Vascular surgeons performed 54% of cases, trauma surgeons 17%, IR/CT Surgery 29%. Systemic heparin was administered in 68% and procedures were performed a median of 9 h after arrival (IQR 3-24 h). Primary arterial access was femoral in 93% of cases, 49% were bilateral. Brachial/radial access was used primarily in 6 cases, and secondary to femoral in 9. The most common implant was self-expanding stent graft; 18% used >1 stent. Implants ranged in diameter and length based on vessel size. Five of 94 implants underwent reintervention (1 open surgery) at a median of 4d postop (range 2-60d). Two occlusions and 1 stenosis were present at follow-up at a median of 1 month (range 0-72 m). CONCLUSIONS Endovascular reconstruction of injured arteries requires a broad range of implant types, diameters, and lengths which should be readily available in trauma centers. Stent occlusions/stenoses are rare and can typically be managed by endovascular means.
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Affiliation(s)
- Kemp M Anderson
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Leah Lucero
- University of California San Francisco-Fresno, Fresno, CA, United States
| | - Justin Scheidt
- San Antonio Uniformed Services Health Education Consortium-Brooke Army Medical Center, Joint Base San Antonio, TX, United States
| | - Christina S Lee
- San Antonio Uniformed Services Health Education Consortium-Brooke Army Medical Center, Joint Base San Antonio, TX, United States
| | | | - Leigh Ann O'Banion
- University of California San Francisco-Fresno, Fresno, CA, United States
| | - Rishi Kundi
- University of Maryland-R Adams Cowley Shock Trauma Center, Baltimore, MD, United States
| | - Gregory A Magee
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Ravi Rajani
- Emory University-Grady Memorial Hospital, Atlanta, GA, United States
| | - Kenji Inaba
- University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - David S Kauvar
- Brooke Army Medical Center, Joint Base San Antonio, United States.
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O'Banion LA, Ali A, Kochubey M, Yan Y, Fallentine J, Oh JH, Patel HR, Shao MY, Agrawal N, Carmona E, Hager ES, Kiguchi M. Type IV Hypersensitivity Reaction After Cyanoacrylate Venous Closure. Ann Vasc Surg 2023. [DOI: 10.1016/j.avsg.2022.12.045] [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: 01/21/2023]
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Qumsiyeh Y, Siada S, Yan Y, Dirks R, Ali A, Daneshvar M, O'Banion LA. Carotid endarterectomy is safe for octogenarians. J Vasc Surg 2023; 77:176-181. [PMID: 35940506 DOI: 10.1016/j.jvs.2022.07.169] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) has demonstrated superior results in stroke risk reduction for patients with symptomatic and asymptomatic high-grade carotid stenosis. However, this benefit has long been questioned for the elderly and high-risk populations. In the present study, we aimed to provide high-volume, single-institution data with long-term follow-up examining the risk factors for postoperative stroke and stroke-free survival stratified by age for asymptomatic and symptomatic patients undergoing CEA. METHODS A single-institution retrospective review of 840 consecutive patients who had undergone CEA from 2011 to 2018 was performed, inclusive of both symptomatic and asymptomatic operative indications. The primary end point was perioperative stroke within 30 days of surgery. The secondary end points were late stroke, death, and myocardial infarction. Patients aged >80 years were compared with those aged <80 years to examine freedom from stroke and death. Statistically significant differences were defined as those with P < .05. RESULTS A total of 840 patients were evaluated with a median follow-up of 416 ± 1244 days. Of the 840 patients, 499 (59%) were men, and 604 (72%) were White. The mean age was 72 ± 9 years, with 202 (24%) aged ≥80 years. CEA was performed for symptomatic disease in 305 patients (36%), of whom 143 (47%) had had strokes and 162 (53%) had had transient ischemic attacks. The overall 30-day postoperative stroke rate was 1.0% (eight patients; 0.6% for asymptomatic and 1.6% for symptomatic; P = .147). Compared with younger patients, octogenarians had had a similar stroke rate after CEA (1.5% vs 0.8%; P = .407). Hispanic race was an independent risk factor for postoperative stroke. White race and preoperative statin use both appeared to be protective. Kaplan-Meier survival curves demonstrated decreased a 5-year stroke-free survival in patients aged ≥80 years (P = .031). However, overall, the estimated 5-year survival was similar to the U.S. general population across both age groups. CONCLUSIONS CEA for octogenarians is safe and effective for both symptomatic and asymptomatic populations with excellent 30-day outcomes and long-term survival mirroring that of the general population.
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Affiliation(s)
- Yazen Qumsiyeh
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA.
| | - Sammy Siada
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA
| | - Yueqi Yan
- Biostatistics and Data Support Center, University of California, Merced, CA
| | - Rachel Dirks
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA
| | - Amna Ali
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA
| | - Meelod Daneshvar
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco-Fresno, Fresno, CA
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Qumsiyeh Y, O'Banion LA, Dirks R, Ali A, Daneshvar M, Siada S. Primary arterial closure after carotid endarterectomy is a safe and expeditious technique in appropriately selected patients. Am J Surg 2022; 224:1438-1441. [PMID: 36241481 DOI: 10.1016/j.amjsurg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/17/2022] [Accepted: 10/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) remains a safe and durable operation for both symptomatic and asymptomatic carotid stenosis, however conflicting evidence exists on the benefit of patch angioplasty and its effects on post-operative outcomes. METHODS A retrospective review of all patients undergoing CEA from 2011 to 2018 was performed. RESULTS Of 851 patients, primary closure was performed in 277 (33%). Patients with primary closure were older (74 vs 72, p = 0.001), symptomatic (39% vs 34%, p = 0.024), and male (69% vs 31% p < 0.001), with a higher incidence of diabetes mellitus (47% vs 39%, p = 0.046) and ESRD (4% vs 2%, p = 0.015). Restenosis rates were similar (7% vs 8%, p = 0.67). Operative time was shorter for primary closure (87 ± 28 vs 102 ± 26 min, p < 0.001). There were no differences in 30-day ipsilateral stroke rates (1% vs 1%, p = 0.51) or stroke-free survival. CONCLUSIONS Primary arterial closure is safe and expeditious in appropriately selected high-risk patients.
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Affiliation(s)
- Yazen Qumsiyeh
- Department of Surgery, University of California San Francisco, Fresno, CA, USA.
| | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco, Fresno, CA, USA
| | - Rachel Dirks
- Department of Surgery, University of California San Francisco, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco, Fresno, CA, USA
| | - Meelod Daneshvar
- Department of Surgery, University of California San Francisco, Fresno, CA, USA
| | - Sammy Siada
- Department of Surgery, University of California San Francisco, Fresno, CA, USA
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Siada SS, Dirks RC, Davis JW, O'Banion LA. Endovascular treatment of axillosubclavian arterial injuries is a safe alternative to open repair. Am J Surg 2022; 224:1385-1387. [PMID: 36270818 DOI: 10.1016/j.amjsurg.2022.10.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Injuries to the axillosubclavian arteries are rare, comprising 5% of all extremity trauma. This study aims to examine contemporary outcomes of traumatic axillosubclavian injuries. METHODS A retrospective review was performed on patients admitted with innominate, subclavian, and/or axillary artery injuries to a level 1 trauma center from 2011 to 2021. Patients undergoing endovascular repair were compared to those with open repair. RESULTS Thirty two patients met inclusion criteria. Injuries were approached open in 22 (59%) cases and endovascular in 10 (27%). There was no difference in 30-day mortality or hospital length of stay between endovascular and open repair. Endovascular repairs had shorter operative times (1.9 vs 3.1 h, p = 0.009) and lower blood loss (72 vs 1662 mL, p < 0.001). CONCLUSIONS Endovascular repair of axillosubclavian arterial injuries demonstrate similar outcomes to open repair. Significantly shorter operative times and lower blood loss suggest potential decreased morbidity.
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Affiliation(s)
- Sammy S Siada
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - Rachel C Dirks
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - James W Davis
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA. leighann.o'
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Logan MS, O'Banion LA. Webinars, podcasts, Tweetorials, oh my! J Vasc Surg 2022; 76:853-854. [PMID: 36150776 DOI: 10.1016/j.jvs.2022.05.009] [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] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Meryl Simon Logan
- Texas A & M University College of Medicine, Central Texas VA Healthcare System, Temple, TX; Department of Defense, United States Air Force, Joint Base San Antonio, San Antonio, TX.
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O'Banion LA. Hemoglobin A1c monitoring practices may not predict outcomes, but A1C values do, especially in treatment of intermittent claudication. J Vasc Surg 2022; 76:265. [PMID: 35738782 DOI: 10.1016/j.jvs.2022.03.002] [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] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
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22
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Siada SS, Matheny H, Qumsiyeh Y, Eckroth-Bernard K, Dirks R, O'Banion LA. Neighborhood Deprivation Trends in Patients Undergoing Carotid Endarterectomy. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.370] [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'Banion LA, Dirks RC, Siada SS, Dubose JJ, Inaba K, Byerly S, Rajani RR, Morrison JJ, Lucero L, Magee GA. Risk factors for stroke in penetrating carotid trauma-An analysis from the PROOVIT Registry. J Trauma Acute Care Surg 2022; 92:717-722. [PMID: 34991129 DOI: 10.1097/ta.0000000000003519] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penetrating carotid injuries are associated with an up to 20% risk of stroke. This study evaluated patients in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial, with the aim of determining factors associated with stroke and stroke or death. METHODS Penetrating extracranial carotid injuries in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial registry from 2012 to 2020 were queried. Isolated external carotid injuries were excluded. Patients with documented postinjury in-hospital stroke were compared with those without. Significant predictors (p < 0.1) for stroke and stroke or death on univariate analysis were included in multivariate analyses. RESULTS One hundred two patients from 17 institutions were included. Mean age was 35 ± 18 years, and 80% were male. Average Glasgow Coma Scale (GCS) score on presentation was 9 ± 5, with an Injury Severity Score [ISS] of 22 ± 13. Operative management occurred in 51% of patients who were significantly more hypotensive (systolic blood pressure: 109 vs. 131 mm Hg; p = 0.015) with a lower initial pH (7.17 vs. 7.31; p = 0.001) and presented with hard signs of vascular injury (74% vs. 26%; p < 0.001). Overall stroke rate was 17% (23% operative vs. 10% nonoperative, p = 0.076). Rate of stroke or death was 27% (64% operative and 36% nonoperative). On multivariate analysis, lower GCS (p = 0.05) and completion angiography (p = 0.04) were associated with stroke. Likewise lower GCS (p = 0.015) and ISS (p = 0.04) were associated with stroke or death. CONCLUSION Penetrating carotid trauma undergoing operative management had a stroke rate of 23%. Low GCS on arrival and need for completion angiography are independently associated with postinjury in-hospital stroke, whereas low GCS on arrival and ISS were associated with stroke or death. The ideal treatment strategy remains elusive, thus a dedicated multicenter study may help to achieve higher fidelity data on this rare but devastating injury. LEVEL OF EVIDENCE Prognostic and Epidemiological, Level III.
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Affiliation(s)
- Leigh Ann O'Banion
- From the Division of Vascular Surgery, Department of Surgery (L.A.OB., R.C.D., S.S.S., L.L.), University of California San Francisco-Fresno, Fresno, California; Division of Trauma and Critical Care (J.J.D., J.J.M.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; Division of Vascular and Endovascular Surgery and Division of Trauma and Critical Care, Department of Surgery (K.I., G.A.M.), University of Southern California, Los Angeles, California; Division of Trauma and Critical Care, Department of Surgery (S.B.), University of Miami, Jackson Memorial Hospital Ryder Trauma Center, Miami, Florida; and Division of Vascular Surgery and Endovascular Therapy, Department of Surgery (R.R.R.), Emory University School of Medicine, Atlanta, Georgia
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O'Banion LA, Kochubey M, Tenet M, Collins T, Ali A, Dirks R, Siada S, Cutler B, Kiguchi M. Thrombotic Complications after Thermal and Nonthermal Endovenous Ablation: Outcomes of a Multicenter Real-World Experience. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2021.12.013] [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: 11/16/2022]
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O'Banion LA, Magee GA. Reply. J Vasc Surg 2022; 75:771. [DOI: 10.1016/j.jvs.2021.11.054] [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] [Received: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
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Magee GA, O'Banion LA. Reply. J Vasc Surg 2021; 75:1496. [PMID: 34921968 DOI: 10.1016/j.jvs.2021.11.068] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Gregory A Magee
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif
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O'Banion LA, Woo K. Balancing Quality and Quantity in Optimizing Health Care Resource Utilization. JAMA Netw Open 2021; 4:e2138907. [PMID: 34905013 DOI: 10.1001/jamanetworkopen.2021.38907] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
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O'Banion LA, Kiguchi MM. Reply. J Vasc Surg Venous Lymphat Disord 2021; 9:1600-1601. [PMID: 34657673 DOI: 10.1016/j.jvsv.2021.07.004] [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] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
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29
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O'Banion LA, Qumsiyeh Y, Dirks R, Rome C, Prentice A. The Lower Extremity Amputation Protocol (LEAP): A Pathway to Successful Ambulation. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Dorosh J, Wohlauer MV, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff R, Lin JC. Impact of COVID-19 on Patients Undergoing Scheduled Operations for Venous Disease. J Vasc Surg 2021. [PMCID: PMC8376828 DOI: 10.1016/j.jvs.2021.06.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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O'Banion LA, Yoon W, Politano A, Brooke BS, Fox CJ, Kiang SC, Chandra V, Zhou W, Bowens N, Woo K, Vartanian SM, Magee GA. Popliteal Scoring Assessment for Vascular Extremity Injuries in Trauma Score Fulfills the Need for a New Reporting Standard in Lower Extremity Vascular Trauma. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.293] [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: 11/29/2022]
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Lucero L, Dhawan D, O'Banion LA. Surgical Management of Carotid Stump Syndrome. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.471] [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: 11/28/2022]
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Kochubey M, Dirks R, Kiguchi MM, Cutler B, Kliewer J, O'Banion LA. Opportunity Cost Comparison of Venous Closures: Radiofrequency Versus Cyanoacrylate Ablative Techniques. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.296] [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: 11/15/2022]
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O'Banion LA, Kiguchi MM. Reply. J Vasc Surg Venous Lymphat Disord 2021; 9:1350-1351. [PMID: 34399943 DOI: 10.1016/j.jvsv.2021.03.013] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Leigh Ann O'Banion
- Department of Surgery, University of California, San Francisco Fresno, Fresno, Calif
| | - Misaki M Kiguchi
- Division of Vascular Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, DC
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Drudi LM, Nishath T, Ma X, Mouawad NJ, O'Banion LA, Shalhub S. The impact of the COVID-19 pandemic on wellness among vascular surgeons. Semin Vasc Surg 2021; 34:43-50. [PMID: 34144747 PMCID: PMC9710729 DOI: 10.1053/j.semvascsurg.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work-home life concerns.
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Affiliation(s)
- Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Thamanna Nishath
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Xiya Ma
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, University of California San Francisco–Fresno, Fresno, CA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195,Corresponding author
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O'Banion LA, Dirks R, Saldana-Ruiz N, Farooqui E, Yoon WJ, Pozolo C, Fox CJ, Crally A, Siada S, Nehler MR, Brooke BS, Beckstrom JL, Kiang S, Boggs HK, Chandra V, Ho VT, Zhou W, Lee A, Bowens N, Cho Y, Woo K, Ulloa J, Magee GA. Contemporary outcomes of traumatic popliteal artery injury repair from the popliteal scoring assessment for vascular extremity injury in trauma study. J Vasc Surg 2021; 74:1573-1580.e2. [PMID: 34023429 DOI: 10.1016/j.jvs.2021.04.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/23/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Traumatic popliteal artery injuries are associated with the greatest risk of limb loss of all peripheral vascular injuries, with amputation rates of 10% to 15%. The purpose of the present study was to examine the outcomes of patients who had undergone operative repair for traumatic popliteal arterial injuries and identify the factors independently associated with limb loss. METHODS A multi-institutional retrospective review of all patients with traumatic popliteal artery injuries from 2007 to 2018 was performed. All the patients who had undergone operative repair of popliteal arterial injuries were included in the present analysis. The patients who had required a major lower extremity amputation (transtibial or transfemoral) were compared with those with successful limb salvage at the last follow-up. The significant predictors (P < .05) for amputation on univariate analysis were included in a multivariable analysis. RESULTS A total of 302 patients from 11 institutions were included in the present analysis. The median age was 32 years (interquartile range, 21-40 years), and 79% were men. The median follow-up was 72 days (interquartile range, 20-366 days). The overall major amputation rate was 13%. Primary repair had been performed in 17% of patients, patch repair in 2%, and interposition or bypass in 81%. One patient had undergone endovascular repair with stenting. The overall 1-year primary patency was 89%. Of the patients who had lost primary patency, 46% ultimately required major amputation. Early loss (within 30 days postoperatively) of primary patency was five times more frequent for the patients who had subsequently required amputation. On multivariate regression, the significant perioperative factors independently associated with major amputation included the initial POPSAVEIT (popliteal scoring assessment for vascular extremity injury in trauma) score, loss of primary patency, absence of detectable immediate postoperative pedal Doppler signals, and lack of postoperative antiplatelet therapy. Concomitant popliteal vein injury, popliteal injury location (P1, P2, P3), injury severity score, and tibial vs popliteal distal bypass target were not independently associated with amputation. CONCLUSIONS Traumatic popliteal artery injuries are associated with a significant rate of major amputation. The preoperative POPSAVEIT score remained independently associated with amputation after including the perioperative factors. The lack of postoperative pedal Doppler signals and loss of primary patency were highly associated with major amputation. The use of postoperative antiplatelet therapy was inversely associated with amputation, perhaps indicating a protective effect.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif. leighann.o'
| | - Rachel Dirks
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif
| | - Nallely Saldana-Ruiz
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - Emaad Farooqui
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
| | - William J Yoon
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Davis, Calif
| | - Cara Pozolo
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Davis, Calif
| | - Charles J Fox
- Department of Surgery, Denver Health Medical Center, Denver, Colo
| | - Alexis Crally
- Department of Surgery, Denver Health Medical Center, Denver, Colo
| | - Sammy Siada
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, Fresno, Calif; Division of Vascular Surgery, Department of Surgery, University of Colorado Denver, Denver, Colo
| | - Mark R Nehler
- Division of Vascular Surgery, Department of Surgery, University of Colorado Denver, Denver, Colo
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Julie L Beckstrom
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Sharon Kiang
- Division of Vascular and Endovascular Surgery, Department of General Surgery, Loma Linda University Medical Center, Loma Linda, Calif
| | - Hans K Boggs
- Division of Vascular and Endovascular Surgery, Department of General Surgery, Loma Linda University Medical Center, Loma Linda, Calif
| | - Venita Chandra
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif
| | - Vy T Ho
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, Ariz
| | - Ashton Lee
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, Ariz
| | - Nina Bowens
- Division of Vascular Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, Calif
| | - Yan Cho
- Division of Vascular Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, Calif
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif
| | - Jesus Ulloa
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif
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Potter HA, Alfson DB, Rowe VL, Wadé NB, Weaver FA, Inaba K, O'Banion LA, Siracuse JJ, Magee GA. Endovascular versus open repair of isolated superficial femoral and popliteal artery injuries. J Vasc Surg 2021; 74:814-822.e1. [PMID: 33684481 DOI: 10.1016/j.jvs.2021.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite the increasing use of endovascular therapy for traumatic arterial injuries, little is known about the outcomes of endovascular repair of superficial femoral artery (SFA) and popliteal artery (PA) injuries. In the present study, we compared the characteristics and outcomes of endovascular vs open repair of traumatic SFA and PA injuries. METHODS We performed a retrospective National Trauma Data Bank analysis of trauma patients with a blunt or penetrating injury of the SFA and/or PA who had undergone endovascular or open repair from 2007 to 2014. Multivariate logistic regression was used to compare the outcomes, with propensity score matching used for sensitivity analysis. RESULTS The incidence of SFA and PA injuries was 0.2%, with an overall increase in the annual use of endovascular stent repair from 3.2% in 2007 to 7.6% in 2014 (P = .002). A total of 2,873 patients with an isolated SFA and/or PA injury were included in the present study, of whom 163 (5.7%) had undergone endovascular repair. SFA injuries were more frequently treated with endovascular repair (70% vs 27%) and PA injuries were more often associated with open repair (41.1% vs 54.7%). Open repair was more frequently associated with a concomitant femur fracture or knee dislocation (30.7% vs 38.8%; P = .039). Endovascular repair was not associated with worse in-hospital amputation-free survival (AFS) compared with open repair on univariate analysis (91.1% vs 89.7%; P = .573) or multivariate logistic regression (odds ratio [OR], 1.053; 95% confidence interval [CI], 0.551-2.012; P = .876). Propensity score matching revealed that in-hospital mortality was higher (OR, 3.69; 95% CI, 1.37-9.82; P = .01) and fasciotomy was lower (OR, 0.23; 95% CI, 0.14-0.37; P < .001) in the endovascular repair group, with no significant differences in AFS (OR, 0.86; 95% CI, 0.48-1.67; P = .65). CONCLUSIONS Endovascular repair of SFA and PA injuries has in-hospital AFS comparable to that for open repair, supporting the increasing use of endovascular repair for traumatic SFA and PA injuries in appropriately selected cases. Given the unexpected finding of increased in-hospital mortality after endovascular repair, further studies are necessary to determine the appropriate patient selection and the durability of endovascular repair.
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Affiliation(s)
- Helen A Potter
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Daniel B Alfson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Niquelle B Wadé
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Los Angeles County+USC Medical Center, University of Southern California, Los Angeles, Calif
| | - Leigh Ann O'Banion
- Vascular Division, Department of Surgery, University of California, San Francisco at Fresno, Fresno, Calif
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
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O'Banion LA, Reynolds KB, Kochubey M, Cutler B, Tefera EA, Dirks R, Kiguchi MM. A comparison of cyanoacrylate glue and radiofrequency ablation techniques in the treatment of superficial venous reflux in CEAP 6 patients. J Vasc Surg Venous Lymphat Disord 2021; 9:1215-1221. [PMID: 33453440 DOI: 10.1016/j.jvsv.2020.12.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/05/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Venous leg ulcers (CEAP [clinical, etiologic, anatomic, pathophysiologic] class 6) represent the most severe form of chronic venous insufficiency. As closure techniques for superficial venous reflux evolve, direct outcome comparisons of treatments are integral, because many studies have already demonstrated that early endovenous intervention improves wound healing. The present study compared the rates of venous wound healing between two techniques of superficial vein closure: ClosureFast radiofrequency ablation (RFA) and adhesive closure (VenaSeal; both Medtronic, Inc, Minneapolis, Minn). METHODS We performed a multi-institutional retrospective review of all patients with CEAP class 6 who had undergone closure of their truncal veins from 2015 to 2020. Patients undergoing ClosureFast RFA were compared with those undergoing VenaSeal adhesive closure. The primary endpoint was the interval to wound healing from initial vein closure. The secondary endpoints included ulcer recurrence and infection rates. Bivariate analysis involved the χ2, Fisher exact, t, and Wilcoxon rank sum tests. Multivariate linear regression analysis was used to examine the factors affecting the time to wound healing in the most predictive model. Statistical significance was defined as P < .05. RESULTS A total of 119 patients with CEAP 6 were included, with a median follow-up of 105 days (interquartile range, 44-208 days). Of the 119 limbs, 68 were treated with RFA and 51 with VenaSeal. Significantly more patients undergoing RFA had had a history of deep vein thrombosis (29% vs 10%; P = .01) and deep venous reflux (82% vs 51%; P = .003). The VenaSeal patients were older (72 years vs 65 years; P = .02) with a greater rate of coronary artery disease (16% vs 37%; P = .01). The median time to wound healing after the procedure was significantly shorter for VenaSeal than for RFA (43 vs 104 days; P = .001). Two RFA patients developed a postprocedure infection. The ulcer recurrence rate was 19.3% (22.1% for RFA vs 13.7% for VenaSeal; P = .25). On multivariate analysis, the treatment modality was the only significant predictor of the time to wound healing. When stratified by ulcer size as small (<3 cm2) vs large (>3 cm2), VenaSeal closure healed the wounds significantly faster for all ulcers. CONCLUSIONS ClosureFast and VenaSeal are both safe and effective treatments to eliminate truncal venous insufficiency. VenaSeal showed a superior time to wound healing compared with ClosureFast in both large and small ulcers.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, Calif. leighann.o'
| | - Kyle B Reynolds
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, D.C
| | - Mariya Kochubey
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, Calif
| | - Bianca Cutler
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, D.C
| | - Eshetu A Tefera
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, D.C
| | - Rachel Dirks
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, Calif
| | - Misaki M Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, D.C
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O'Banion LA, Dirks R, Farooqui E, Kaups K, Qumsiyeh Y, Rome C, Davis J. Outcomes of major lower extremity amputations n dysvascular patients: Room for improvement. Am J Surg 2020; 220:1506-1510. [PMID: 32891397 DOI: 10.1016/j.amjsurg.2020.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Dysvascular patients account for >80% of major amputations in the US. We sought to determine if early mobilization and discharge disposition decreased post-operative hospital length of stay (PO-LOS) and expedited independent ambulation. METHODS A retrospective review of dysvascular patients undergoing major amputations was performed. Primary outcomes included PO-LOS, discharge disposition, and days to ambulation. RESULTS 130 patients were included. Patients evaluated by Physical Therapy (PT) within 1 day of formal amputation had decreased PO-LOS (5.6 vs 6.5 days, p = 0.029). Patients discharged to rehab had a shorter PO-LOS (4 days) than those discharged to SNF or home (8 and 5 days, respectively; p = 0.008). Time to ambulation was shorter for patients discharged to rehab (109 days vs home = 153 days; SNF = 175 days; p = 0.033). CONCLUSION Modifiable factors, including early PT and rehab placement, decreased PO-LOS and expedited time to ambulation. A need exists for a standardized multidisciplinary team approach to improve outcomes.
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Affiliation(s)
- Leigh Ann O'Banion
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Rachel Dirks
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Emaad Farooqui
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Krista Kaups
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Yazen Qumsiyeh
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Cambia Rome
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - James Davis
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
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O'Banion LA, Pozolo CG, Fox C, Brooke B, Kiang S, Chandra V, Zhou W, Cho Y, Ulloa J, Magee GA. Contemporary Outcomes of Traumatic Popliteal Artery Injury Repair. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.07.009] [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: 11/28/2022]
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O'Banion LA, Wu B, Eichler CM, Reilly LM, Conte MS, Hiramoto JS. Cryopreserved saphenous vein as a last-ditch conduit for limb salvage. J Vasc Surg 2017; 66:844-849. [PMID: 28502546 DOI: 10.1016/j.jvs.2017.03.415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In patients lacking autogenous vein suitable for infrainguinal bypass, cryopreserved saphenous vein (CSV) allograft (CryoLife, Inc, Kennesaw, Ga) may be an acceptable alternative. The purpose of this study was to examine outcomes of CSV conduit for infrainguinal revascularization. METHODS Between February 2008 and August 2015, 70 patients underwent infrainguinal bypass grafts in 73 limbs using CSV. All patients lacked suitable arm or leg vein. Demographic data and patient outcomes were retrospectively collected using electronic medical records. RESULTS The mean age of our cohort was 70 ± 14 years, and 36 (51%) were male; 47 (67%) were white, 39 (56%) had coronary artery disease, 27 (39%) had diabetes, 56 (80%) had hypertension, and 50 (71%) were former or current smokers. Median follow-up was 304 days (interquartile range, 130-991 days). Indications for the index operation included rest pain (27%), tissue loss (55%), and prosthetic graft infection (18%); 62 of 73 (85%) bypasses were performed for critical limb ischemia, and 45 of 73 (62%) were redo operations. Distal targets included superficial femoral artery or popliteal (38%), tibial (55%), and pedal (7%). All grafts had a minimum diameter of 3 mm. At 30 days, 55 of 64 grafts (86%) were patent; 9 were lost to early follow-up. The only significant risk factors associated with 30-day failure were ABO mismatch (43% vs 10%; P = .05) and donor blood type B or AB (40% vs 9%; P = .03). Estimated overall 1-year primary patency was 35%. In a multivariate analysis, nonblack race (P = .05), donor B or AB blood type (P = .01), and bypass to a tibial or pedal target (P = .05) were independently associated with loss of primary patency. There were 20 (27%) major amputations, and all grafts in these limbs had occluded at the time of amputation. Of the 33 limbs with ischemic tissue loss that had long-term follow-up, 17 of 33 (52%) went on to graft occlusion, 10 of 33 (30%) had a major amputation, and 24 of 33 (73%) had complete healing of the index wound. CONCLUSIONS In the setting of a multidisciplinary team with aggressive wound care, CSV may be a reasonable choice for infrainguinal revascularization in patients with ischemic tissue loss who lack autogenous conduit. However, poor midterm to long-term patency suggests that optimal selection of patients is needed to derive meaningful clinical benefit.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Bian Wu
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Charles M Eichler
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Linda M Reilly
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Jade S Hiramoto
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
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O'Banion LA, Wu B, Eichler CM, Reilly LM, Conte MS, Hiramoto JS. Cryopreserved Saphenous Vein: Last-Ditch Conduit for Limb Salvage? J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.05.024] [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: 10/21/2022]
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Abstract
The radiocephalic fistula dates back to the 1960s with good long-term survival and a low incidence of complications. The standard practice of creating an end cephalic vein to side radial artery fistula (ETS) has a high incidence of early thrombosis and failure to mature, which limits its efficacy. The hypothesis is that a 1.3- to 1.5-cm side-to-side with distal vein ligation anastomosis (STS) is associated with a lower early thrombosis rate and higher primary patency rate. We retrospectively evaluated all radiocephalic fistulas created at our hospital from January 1, 2012, to December 31, 2012, comparing a 1.3- to 1.5-cm STS anastomosis to the ETS anastomosis. Primary endpoints were patency at three and six months and the secondary outcome was suitability for cannulation. An ETS anastomosis resulted in an early thrombosis rate, 3-month cannulation rate, and 6-month primary patency rate of 14, 30, and 48 per cent, respectively. Outcomes from the STS technique were significantly improved with no early thrombosis (P < 0.05), 3-month cannulation rate of 67 per cent (P < 0.03), and a primary patency of 75 per cent (P = 0.03). A STS radiocephalic fistula with distal vein ligation is superior to the ETS radiocephalic fistula. Early thrombosis, 6-month primary patency, and cannulation rates were significantly improved.
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Affiliation(s)
- Leigh Ann O'Banion
- Department of Surgery University of California San Francisco at Fresno, Fresno, California, USA
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