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Siems C, Valentine RJ, Wang Q, Duke J, Brunsvold M, Reed AB. Risk factors for lower extremity vascular complications in adult patients on veno-arterial extracorporeal membrane oxygenation. J Vasc Surg 2023; 77:1174-1181. [PMID: 36639061 DOI: 10.1016/j.jvs.2022.11.047] [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: 09/17/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased significantly over the last decade. Prior studies have reported worse mortality for patients with vascular complications on VA-ECMO; however, these were limited by small sample size. The purpose of this study is to investigate predictive risk factors for vascular complications in VA-ECMO patients and their potential impact on mortality. METHODS Patients who underwent peripheral VA-ECMO from January 2011 to December 2021 were identified. Primary outcomes were lower extremity vascular complications and in-hospital mortality. Multivariate stepwise logistic regression models were used to identify predictors of vascular complications and in-hospital mortality. RESULTS A total of 605 VA-ECMO patients (25% female) were identified. The mean age was 56.3 ± 13 years, and 56 (10.4%) were black. In-hospital mortality was 63.8% (n = 386), and VA-ECMO ipsilateral vascular complications occurred in 72 patients (11.9%). Vascular surgical interventions (thromboembolectomy, fasciotomies, amputation, and surgical management of cannula bleeding) were required in 30 patients (41.7%). Same-side arterial and venous cannulas, cannula size, and absence of distal perfusion cannula did not increase risk of vascular complication. Multivariate analysis identified age (odds ratio, 0.948; 95% confidence interval, 0.909-0.988; P = .0116) and pre-existing peripheral arterial disease (odds ratio, 3.489; 95% confidence inteval, 1.146-10.624; P = .0278) as independent predictors of need for vascular surgery interventions. The mortality rate of patients who developed vascular complications was not significantly different compared with the mortality rate of those who did not develop vascular complications (61% vs 64%; P = .92). CONCLUSIONS This study represents one of the largest series to date of lower extremity vascular outcomes in patients undergoing VA-ECMO. Our results confirm the high mortality rate associated with VA-ECMO; however, vascular complications did not represent a risk factor for mortality as previously reported. Same-sided VA-ECMO cannulas, cannula size, and the presence or absence of distal perfusion cannula did not predict vascular complications. Increasing age and presence of peripheral arterial disease are independent predictors of need for vascular surgery intervention in patients on VA-ECMO.
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Affiliation(s)
- Chesney Siems
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - R James Valentine
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Julie Duke
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Brunsvold
- Division of Surgical Critical Care, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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Marrone A, Valentine RJ, Flaherty J, Reed AB. Erector Spinae Block Reduces Opioid Use After Transaxillary First Rib Resection. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.07.117] [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: 10/14/2022]
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3
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Hawkins BM, Li J, Wilkins LR, Carman TL, Reed AB, Armstrong DG, Goodney P, White CJ, Fischman A, Schermerhorn ML, Feldman DN, Parikh SA, Shishehbor MH. SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care. Vasc Med 2022; 27:405-414. [PMID: 35466841 PMCID: PMC9344564 DOI: 10.1177/1358863x221095278] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Beau M. Hawkins
- University of Oklahoma Health Sciences
Center, Oklahoma City, Oklahoma
| | - Jun Li
- University Hospitals Harrington Heart
& Vascular Institute, Cleveland, Ohio
| | - Luke R. Wilkins
- University of Virginia Health System,
Charlottesville, Virginia
| | - Teresa L. Carman
- University Hospitals Harrington Heart
& Vascular Institute, Cleveland, Ohio
| | - Amy B. Reed
- University of Minnesota, Minneapolis,
Minnesota
| | | | | | | | - Aaron Fischman
- Icahn School of Medicine at Mount
Sinai, New York, New York
| | | | | | - Sahil A. Parikh
- NewYork-Presbyterian/Columbia
University Irving Medical Center, New York, New York
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4
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Hawkins BM, Li J, Wilkins LR, Carman TL, Reed AB, Armstrong DG, Goodney P, White CJ, Fischman A, Schermerhorn ML, Feldman DN, Parikh SA, Shishehbor MH. SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS position statement on competencies for endovascular specialists providing CLTI care. J Vasc Surg 2022; 76:25-34. [PMID: 35483980 DOI: 10.1016/j.jvs.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Jun Li
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Luke R Wilkins
- University of Virginia Health System, Charlottesville, Virginia
| | - Teresa L Carman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amy B Reed
- University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Aaron Fischman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Dmitriy N Feldman
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Sahil A Parikh
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Mehdi H Shishehbor
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio
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Konda S, Reed AB. Popliteal artery adventitial cystic disease in an athlete. J Vasc Surg Cases Innov Tech 2022; 8:140-141. [PMID: 35330899 PMCID: PMC8938193 DOI: 10.1016/j.jvscit.2022.01.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
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Hawkins BM, Li J, Wilkins LR, Carman TL, Reed AB, Armstrong DG, Goodney P, White CJ, Fischman A, Schermerhorn ML, Feldman DN, Parikh SA, Shishehbor MH. SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care. J Am Podiatr Med Assoc 2022; 112:22-096. [PMID: 35797232 DOI: 10.7547/22-096] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Beau M Hawkins
- *University of Oklahoma Health Sciences Center, Oklahoma City, OK. Dr. Hawkins represents the American Podiatric Medical Association (APMA)
| | - Jun Li
- †University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Luke R Wilkins
- ‡University of Virginia Health System, Charlottesville, VA. Dr. Wilkins represents the Society of Interventional Radiology
| | - Teresa L Carman
- †University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Amy B Reed
- §University of Minnesota, Minneapolis, MN. Dr. Reed represents the Society for Vascular Surgery
| | - David G Armstrong
- ‖University of Southern California, Los Angeles, CA. Dr. Armstrong represents APMA
| | - Philip Goodney
- ¶The Dartmouth Institute, Lebanon, NH. Dr. Goodney represents the Vascular and Endovascular Surgery Society
| | | | - Aaron Fischman
- **Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Fischman represents the American College of Radiology
| | - Marc L Schermerhorn
- ††Beth Israel Deaconess Medical Center, Boston, MA. Dr. Schermerhorn represents the Society for Clinical Vascular Surgery
| | | | - Sahil A Parikh
- §§NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Mehdi H Shishehbor
- ‖‖University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH
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Hawkins KE, Valentine RJ, Duke JM, Wang Q, Reed AB. Ankle Brachial Index Use in Peripheral Vascular Interventions for Claudication. J Vasc Surg 2022; 76:196-201. [PMID: 35276260 DOI: 10.1016/j.jvs.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/27/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Ankle brachial index (ABI) is recommended as the first-line noninvasive test to establish a diagnosis of peripheral arterial disease (PAD) in claudicants (Grade 1, Level A evidence). It is also used to monitor progression of disease and assess benefit of treatment after peripheral vascular intervention (PVI). The Upper Midwest Region VQI has a unique balance of participation from vascular surgeons, interventional radiologists, and cardiologists performing PVI. We sought to identify the use of ABI and assess functional outcome of patients undergoing PVI for claudication. METHODS Review of the Upper Midwest Region VQI registry was performed to identify PVI done for claudication from native artery atherosclerotic occlusive disease in non-diabetic patients from 2010 to 2020. PVI performed in patients with infection, tissue loss, rest pain, bypass graft stenoses, and aneurysmal disease was excluded. Primary outcomes included ABI, ambulation status, and functional status pre- and post-PVI. RESULTS A total of 3787 patients (58.0% men, 42.0% female; mean age 68.4 years) who underwent 3830 procedures were identified. 2665 (69.5%) patients had ABI measured: 1803 (47.1%) patients had pre-PVI only, 190 (4.9%) patients had post-PVI only, and 862 (22.5%) patients had pre- and post-PVI ABI measured. 975 (25.5%) patients never had ABI performed. Statistical analysis of all 3787 patients found no change in ambulation (p = 0.33 - 0.95 for all comparisons) or in functional status (p = 0.42 - 0.61 for all comparisons), for all instances of ABI, or lack thereof. A significant number of patients who never had ABI measured decreased from full functional status pre-PVI to only being functional with light work post-PVI (p =0.015). CONCLUSIONS Despite Grade 1, level A evidence, ABI was utilized pre- and post-PVI in only 22.5% of patients undergoing PVI for claudication. Importantly, overall functional status was found to diminish significantly after PVI in those patients who never had an ABI performed. Accurately identifying patients with claudication from PAD with an ABI remains critically important before PVI. Given the lack of overall improvement in ambulation post-PVI noted in this study, identifying the patient who will benefit from PVI for claudication remains elusive.
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Affiliation(s)
- Katherine E Hawkins
- Division of Vascular Surgery, M Health Fairview Vascular Surgery, University of Minnesota, Minneapolis, MN.
| | - R James Valentine
- Division of Vascular Surgery, M Health Fairview Vascular Surgery, University of Minnesota, Minneapolis, MN
| | - Julie M Duke
- Division of Vascular Surgery, M Health Fairview Vascular Surgery, University of Minnesota, Minneapolis, MN
| | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Amy B Reed
- Division of Vascular Surgery, M Health Fairview Vascular Surgery, University of Minnesota, Minneapolis, MN
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Duke JM, Reed AB, Valentine RJ. Emergency Department Visits After Acute Aortic Syndromes. J Vasc Surg 2022; 76:373-377. [PMID: 35182662 DOI: 10.1016/j.jvs.2022.01.137] [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: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Recent reports document a high rate of readmission after hospitalization for acute aortic syndromes (AAS) that include acute aortic dissections (AD), intramural hematomas (IMH), or penetrating aortic ulcers (PAU). We examined the rate of return to the emergency department (ED) to better understand the utilization of emergent health care services after AAS. METHODS Consecutive AAS patients admitted to the vascular surgery service from 2004 to 2020 were included. Patients with type A dissections, arch involvement, or chronic aortic pathology were excluded. The primary outcome was ED visits within 90 days of the original hospitalization. RESULTS The study included 79 subjects (62% men, 38% women; mean age, 64+14 years) with AAS (82% AD, 11% IMH, 6% PAU). A total of 54 ED visits related to the AAS occurred within 90 days of the original discharge, each of which incurred a CT angiogram. Twenty-eight (35%) subjects had a mean of 2+2 ED visits, while 51 (65%) subjects had no ED visits. Ninety percent (25/28) of the first ED visits occurred within 1 month of discharge and 53% (15/28) within one week. 17 (61%) subjects were readmitted to the hospital from the ED. Four subjects were found to have progression of AAS on imaging studies and underwent TEVAR during readmission. Comparing subjects who returned to the ED to those who did not, there were no significant differences in demographics, atherosclerotic risk factors except coronary artery disease, type of AAS, number of antihypertensive medications at admission or discharge, operative intervention, length of initial hospital stay, or discharge status. The chief complaint at the first ED visit was pain (n=17), uncontrolled hypertension (n=5), syncope (n=3), and other (n=3). CONCLUSIONS These data show that one in three patients with AAS returned to the ED within 90 days of initial discharge. Although returning subjects had a higher number of readmissions, few had progression of AAS that required intervention. Because the vast majority were readmitted for medical therapy, early and frequent clinic follow up may help decrease ED visits and readmissions after AAS.
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Affiliation(s)
- Julie M Duke
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - R James Valentine
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
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Hawkins KE, Valentine RJ, Duke JM, Reed AB. Ankle Brachial Index Use in Peripheral Vascular Intervention for Claudication. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.156] [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: 10/20/2022]
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10
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Duke JM, Reed AB, Valentine RJ. Unexpected Emergency Department Visits After Acute Aortic Syndromes. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.148] [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: 10/20/2022]
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11
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Reed AB, Faizer R, James Valentine R. The impact of pre-existing blood pressure control in patients with acute aortic dissections. Vascular 2021; 30:1051-1057. [PMID: 34530663 DOI: 10.1177/17085381211042152] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Arterial hypertension (HTN) is considered a seminal risk factor for aortic dissection (AD). The purpose of this study is to evaluate whether pre-existing blood pressure (BP) control lessens the extent of dissection and has a favorable impact on outcome of patients with acute AD. METHODS Consecutive acute AD patients who had at least two BPs recorded within the 12 months preceding the AD were retrospectively analyzed. The two most recent BPs were averaged and defined per published guidelines as normal (BP≤ 130/80), Stage I HTN (BP >130/80 and <139/89), or Stage 2 or greater HTN (BP > 140/90). The number of hypertensive medications (MEDs) was also used as a surrogate marker of HTN severity. Patients with known genetic causes of AD were excluded. RESULTS 89 subjects (55% men, 45% women; mean age, 64±14 years) with acute AD (58% Stanford type A and 42% Stanford type B) were included. Two most recent BPs were recorded a mean of 5±3 and 3±2.7 months before the AD, respectively. Twenty-nine (33%) subjects had normal BP, including nine subjects with no history of HTN and on no MEDs. Sixty (67%) subjects had elevated BP, including 21 (35%) with Stage I HTN and 39 (65%) with Stage 2 HTN. Compared to subjects with normal BP, subjects with Stage 1 and Stage 2 HTN were younger (70±13 years vs 62±1 year, p = 0.01), but there were no differences in other demographics, risk factors, comorbidities, or history of drug use. There were no group differences in the distal extent of the dissections, complications requiring thoracic endograft repair, mean length of hospital stay, final discharge status, or 30-day mortality. Compared to the number of MEDs before AD, all three groups had a higher mean number of MEDs to achieve normal BP at discharge that persisted at a mean follow-up of 18±15 months. CONCLUSIONS These data show that approximately one-third of patients with acute AD had well controlled or no antecedent history of HTN. The degree of pre-existing HTN control had no bearing on the type or extent of AD, length of stay, or early outcome. Regardless of the state of HTN control before AD, the consistent and sustained increase in the severity of HTN after AD suggests that the dissection process has a profound and lasting effect on BP regulation. Further studies are indicated to elucidate the pathologic mechanisms involved in AD.
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Affiliation(s)
- Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Rumi Faizer
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - R James Valentine
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
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Humphries MD, Mikityuk A, Harris L, Simons JP, Aulivola B, Bush R, Freischlag JA, Reed AB. Representation of women in vascular surgery science and societies. J Vasc Surg 2021; 74:15S-20S. [PMID: 34303453 DOI: 10.1016/j.jvs.2021.03.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Medical schools and surgical residencies have seen an increase in the proportion of female matriculants, with 30% of current vascular surgery trainees being women over the past decade. There is widespread focus on increasing diversity in medicine and surgery in an effort to provide optimal quality of patient care and the advancement of science. The presence of gender diversity and opportunities to identify with women in leadership positions positively correlates with women choosing to enter traditionally male-dominated fields. The purpose of this study was to evaluate the representation of women in regional and national vascular surgical societies over the last 20 years. METHODS A retrospective review of the meeting programs of vascular surgery societies was performed. Data were collected on abstract presenters, moderators, committee members and chairs, and officers (president, president-elect, vice president, secretary, and treasurer). The data were divided into early (1999-2009) and late (2010-2019) time periods. RESULTS Five regional and five national societies' data were analyzed, including 139 meetings. The mean percentage of female abstract presenters increased significantly from 10.9% in the early period to 20.6% in the late period (P < .001). Female senior authors increased slightly from 8.7% to 11.5%, but this change was not statistically significant (P = .22). Female meeting moderators increased significantly from 7.8% to 17.2% (P < .001), as well as female committee members increased from 10.9% to 20.3% (P = .003). Female committee chairs increased slightly from 10.9% to 16.9%, but this difference was not statistically significant (P = .13). Female society officers increased considerably from 6.4% to 14.8%. (P = .002). Significant variation was noted between societies, with five societies (three regional and two national) having less than 10% women at the officer level in 2019. There was a wide variation noted between societies in the percentage of female abstract presenters (range, 7.6%-34.9%), senior authors (3.9%-17.9%), and meeting moderators (5.4%-40.7%). CONCLUSIONS Over the past two decades, there has been a significant increase in the representation of women in vascular surgery societies among those presenting scientific work, serving as meeting moderators, and serving as committee members. However, the representation of women among committee chairs, senior authors, and society leadership has not kept up pace with the increase noted at other levels. Efforts to recruit women into the field of vascular surgery as well as to support the professional development of female vascular surgeons are facilitated by the presence of women in leadership roles. Increasing the representation of women in vascular society leadership positions may be a key strategy in promoting gender diversity in the vascular surgery field.
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Affiliation(s)
- Misty D Humphries
- Division of Vascular Surgery, University of California Davis Health, Sacramento, Calif.
| | - Angelina Mikityuk
- Division of Vascular Surgery, University of California Davis Health, Sacramento, Calif
| | - Linda Harris
- Division of Vascular Surgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, SUNY, Buffalo, NY
| | - Jessica P Simons
- Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass
| | - Bernadette Aulivola
- Division of Vascular Surgery, Loyola University Health System, Stritch School of Medicine, Chicago, Ill
| | - Ruth Bush
- University of Houston College of Medicine, Houston, Tex
| | | | - Amy B Reed
- Division of Vascular Surgery, University of Minnesota, Minneapolis, Minn
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Li J, Green DL, Santilli S, Ihnat D, James Valentine R, Reed AB. Televascular consultation is one answer to rural vascular surgery shortage. J Telemed Telecare 2021; 28:291-295. [PMID: 33840280 DOI: 10.1177/1357633x211003456] [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] [Indexed: 11/15/2022]
Abstract
Telemedicine provides an opportunity for virtual consultation between physicians and patients in remote locations. We sought to evaluate whether telemedicine consultation for vascular surgery can replace direct visits for patients in remote areas. Patients undergoing telemedicine consultation from 2014-2019 at the Veterans Affairs Medical Center (VAMC) with a large rural catchment area, were reviewed. Primary outcomes included diagnosis, type and number of telemedicine visits, and types of surgical procedures scheduled after initial visit. 574 patients participated in 708 out-patient telemedicine consultations conducted by four vascular surgeons and two advanced practitioners. Visits took place at 21 clinics across Minnesota (n = 305), North Dakota (n = 96), South Dakota (n = 82), Wisconsin (n = 20), and Iowa (n = 2) with an average distance of 159 miles from the VAMC. There were 429 (75%) new patient visits and 279 (25%) follow-ups. After initial telemedicine consultation, 236 (55%) patients were booked for procedures. Telemedicine is feasible for vascular surgery consultation and increases patient convenience with decreased overall travel expense and wait time. Telemedicine can be a viable solution to the shortage of vascular surgeons in the rural United States.
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Affiliation(s)
- Jing Li
- Division of Vascular Surgery, University of Minnesota Medical Center, USA
| | | | | | - Dan Ihnat
- Veterans Affairs Medical Center, USA
| | - R James Valentine
- Division of Vascular Surgery, University of Minnesota Medical Center, USA
| | - Amy B Reed
- Division of Vascular Surgery, University of Minnesota Medical Center, USA
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Reed AB, Valentine RJ, Faizer R. The Impact of Pre-existing Blood Pressure Control in Patients With Acute Aortic Dissections. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.081] [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: 10/23/2022]
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15
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McCormick M, Li J, Monteagudo L, Fazeli P, Reed AB, Valentine RJ. Giant Cell Aortitis Masquerading as Intramural Hematoma. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.072] [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: 11/30/2022]
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16
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Reed AB, Green D, Li J, Santilli S, Ihnat D, Orrechia P, Valentine R. Televascular Consultation Is the Answer to Rural Vascular Surgery Shortage. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.083] [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: 10/23/2022]
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17
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Shames M, Owens K, Robinson WP, Reed AB, Lee JT, Jordan W, Sheahan M. Vascular Surgery Program Director Work Hours and Compensation Do Not Align With Accreditation Council for Graduate Medical Education-Proposed Requirements. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.049] [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: 10/24/2022]
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Walsh J, Sharma G, Ashley SW, Smink D, Reed AB, Potts J, Belkin M. General Surgery Programs Afford Trainees Bound for Vascular Surgery Fellowships Increased Vascular Case Experience. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.375] [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: 10/24/2022]
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19
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Reed AB. Escalating cost to find a spot. J Vasc Surg 2020; 72:304. [PMID: 32553401 DOI: 10.1016/j.jvs.2019.09.056] [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: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
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Doenges JE, Reed AB. Vascular surgery presence in carotid endarterectomy YouTube videos. J Vasc Surg 2020; 72:1453-1456. [PMID: 32330597 DOI: 10.1016/j.jvs.2020.04.018] [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: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE YouTube videos have become a common resource for trainees to learn about surgical procedures. Carotid endarterectomy (CEA) is one example procedure that may be performed by multiple specialties and with a variety of techniques. Little is known about educational content and the representation of vascular surgeons in these videos. We sought to compare the educational quality of CEA YouTube videos, techniques demonstrated, and prevalence of each specialty. METHODS YouTube was programmatically searched for the terms "carotid endarterectomy," "carotid endarterectomy surgery," "carotid endarterectomy technique," "carotid endarterectomy CEA," and "carotid artery surgery." Videos that met inclusion criteria were analyzed for surgical technique, procedural steps, surgeon specialty, video length, and date. Videos were determined to have high-quality educational content if the video included English-language captions or narration and demonstrated key steps of the procedure: division of the common facial vein; exposure of the common, external, and internal carotid arteries; vascular control and clamping; and arteriotomy, endarterectomy, and arteriotomy closure. RESULTS Forty-six videos met inclusion criteria. Vascular surgery was associated with 12 (26.1%) CEA videos, cardiac surgery with 13 (28.3%), and neurosurgery with 14 (30.4%). Surgeon specialty was unknown for seven (17.4%) videos. Eight videos were high quality, of which vascular surgery was associated with three (37.5%). Conventional endarterectomy was the most common technique demonstrated, whereas a total of seven videos demonstrated eversion technique. Vascular and cardiac surgeons were more likely to demonstrate patch angioplasty than neurosurgeons, who exclusively performed primary closure (P < .05). Compared with cardiac surgeons, vascular surgeon CEA videos had more views (25,956 ± 9613 vs 1200 ± 368; P < .05) and were more likely to be published by user accounts with an academic affiliation (11 vs 6; P < .05). Vascular surgery videos were older than videos by cardiac surgeons (6.0 ± 1.1 years vs 3.0 ± 0.5 years; P < .05) and neurosurgeons (6.0 ± 1.1 years vs 3.1 ± 0.8 years; P < .05). CONCLUSIONS Despite more views, the field of vascular surgery is under-represented in YouTube videos demonstrating CEA. Vascular surgery videos tend to be older and make up a minority of high-quality videos. As more learners turn to YouTube for information about surgical procedures, vascular surgeons should expand their online presence through the production and collection of high-quality videos for trainees.
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Affiliation(s)
- Jack E Doenges
- Medical School, University of Minnesota, Minneapolis, Minn
| | - Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
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Reed AB, Self P, Rosenberg M, Faizer R, Valentine RJ. Pre-emptive thoracic endovascular aortic repair is unnecessary in extended type A (DeBakey type I) aortic dissections. J Vasc Surg 2020; 72:1206-1212. [PMID: 32035774 DOI: 10.1016/j.jvs.2019.11.055] [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: 09/05/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pre-emptive thoracic endovascular aortic repair (TEVAR) improves late survival and limits progression of disease after type B aortic dissection, but the potential value of pre-emptive TEVAR has not been evaluated after type A dissection extending beyond the aortic arch (DeBakey type I). The purpose of this study was to compare disease progression and need for aortic intervention in survivors of acute, extended type A (ExTA) dissections after initial repair of the ascending aorta versus acute type B aortic dissections. METHODS Consecutive patients presenting with ExTA or type B dissections between 2011 and 2018 were studied. Forty-three patients with ExTA and 44 with type B dissections who survived to discharge and had follow-up imaging studies were included in the analysis. Study end points included progression of aortic disease (>5 mm growth or extension), need for intervention, and death. RESULTS The groups were not different for age, sex, atherosclerotic risk factors, or extent of dissection distal to the left subclavian artery. Following emergent ascending aortic repair, five ExTA patients (12%) underwent TEVAR within 4 months after discharge. Despite optimal medical treatment, 29 type B patients (66%) underwent early or late TEVAR (P < .001). During a mean follow-up of 38 ± 30 months, 38 ExTA patients (88%) did not require intervention-23 (53%) of whom showed no disease progression. In comparison, during a mean follow-up of 18 ± 6 months, 14 type B patients (32%) did not require intervention-nine (20%) of whom showed no disease progression (P = .003). There was one aortic-related late death in the ExTA group and two in the type B group. Compared with ExTA patients, type B patients had significantly worse intervention-free survival and intervention/growth-free survival (log rank, P < .001). CONCLUSIONS In contrast with type B dissections, these midterm results demonstrate that one-half of ExTA aortic dissections show no disease progression in the thoracic or abdominal aorta, and few require additional interventions. After initial repair of the ascending aorta, pre-emptive TEVAR does not seem to be justified in patients with acute, ExTA dissections.
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Affiliation(s)
- Amy B Reed
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn.
| | - Patrick Self
- Division of Interventional Radiology, Department of Radiology, University of Minnesota Medical Center, Minneapolis, Minn
| | - Michael Rosenberg
- Division of Interventional Radiology, Department of Radiology, University of Minnesota Medical Center, Minneapolis, Minn
| | - Rumi Faizer
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn
| | - R James Valentine
- Division of Vascular Surgery, Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minn
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Yu PC, Aplin B, Reed AB. Angiosarcoma of the abdominal aorta after endovascular aneurysm repair. J Vasc Surg Cases Innov Tech 2019; 5:506-508. [PMID: 31763509 PMCID: PMC6861570 DOI: 10.1016/j.jvscit.2019.07.003] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022] Open
Abstract
Primary aortic sarcoma is a rare diagnosis that carries a poor prognosis. This case report features a 68-year-old man, treated 4 years earlier with an endovascular aortic aneurysm repair, who presented with fever, low back discomfort, and abdominal pain. Given the concern for an infected endograft, the patient underwent explantation and replacement with a cadaveric aortoiliac cryograft. Ultimately, the pathology returned as an angiosarcoma. Although endovascular aortic aneurysm repair is the gold standard for abdominal aortic aneurysm repair in patients with suitable anatomy, there are trade-offs associated with less invasive approaches compared with open approaches.
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Affiliation(s)
| | | | - Amy B. Reed
- M Health Fairview, University of Minnesota, Minneapolis, Minn
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Bailey SR, Beckman JA, Dao TD, Misra S, Sobieszczyk PS, White CJ, Wann LS, Bailey SR, Dao T, Aronow HD, Fazel R, Gornik HL, Gray BH, Halperin JL, Hirsch AT, Jaff MR, Krishnamurthy V, Parikh SA, Reed AB, Shamoun F, Shugart RE, Yucel EK. ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria for Peripheral Artery Intervention: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, and Society for Vascular Medicine. J Am Coll Cardiol 2019; 73:214-237. [PMID: 30573393 DOI: 10.1016/j.jacc.2018.10.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Aziz F, Lehman EB, Reed AB. Increased Duration of Operating Time for Carotid Endarterectomy Is Associated with Increased Mortality. Ann Vasc Surg 2016; 36:166-174. [DOI: 10.1016/j.avsg.2016.02.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 10/21/2022]
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Aziz F, Azab A, Schaefer E, Reed AB. Endovascular Repair of Ruptured Abdominal Aortic Aneurysm Is Associated with Lower Incidence of Post-operative Acute Renal Failure. Ann Vasc Surg 2016; 35:147-55. [DOI: 10.1016/j.avsg.2016.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/28/2015] [Accepted: 01/11/2016] [Indexed: 11/16/2022]
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26
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Aziz F, Lehman EB, Reed AB. Unplanned return to operating room after lower extremity arterial bypass is an independent predictor for hospital readmission. J Vasc Surg 2016; 63:678-87.e2. [PMID: 26527425 PMCID: PMC6370484 DOI: 10.1016/j.jvs.2015.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/10/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hospital readmissions after surgical operations are considered serious complications and have an impact on health care-associated costs. The Centers for Medicare and Medicaid Services strongly encourage identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the "gold standard" treatment for severe, symptomatic peripheral arterial disease. The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery. METHODS The 2013 lower extremity revascularization-targeted American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and generalized 2013 general and vascular surgery NSQIP Participant Use Data File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery. RESULTS A total of 2646 patients (65% male, 35% female) were identified in the NSQIP database who underwent lower extremity open revascularization during the year 2013. Indications for operations included tissue loss (39%), rest pain (32%), and severe claudication (25%). Preoperative ankle-brachial indices were 0.4 to 0.9 (32%) and <0.4 (16.5%). A total of 425 patients (16%) were readmitted within 30 days of index operation. Risk factors associated with readmission included wound complication (odds ratio [OR], 8.54; 95% confidence interval [CI], 6.68-10.92; P < .001), need for reoperation (OR, 5.95; 95% CI, 4.45-7.97; P < .001), postoperative myocardial infarction (OR, 2.19; 95% CI, 1.25-3.83; P = .006), wound dehiscence (OR, 8.45; 95% CI, 4.54-15.71; P < .001), organ or space surgical site infection (OR, 7.62; 95% CI, 2.89-20.14; P < .001), postoperative pneumonia (OR, 2.66; 95% CI, 1.28-5.52; P = .009), progressive renal insufficiency (OR, 4.12; 95% CI, 1.52-11.11; P = .005), superficial surgical site infection (OR, 7.37; 95% CI, 5.31-10.23; P < .001), urinary tract infection (OR, 2.67; 95% CI, 1.42-5.01; P = .002), and deep wound infection (OR, 14.0; 95% CI, 7.62-24.80; P < .001). CONCLUSIONS Readmission after lower extremity bypass surgery is a serious complication. Various factors put a patient at high risk for readmission. Return to the operating room, wound infection, amputation, deep venous thrombosis, and major reintervention on bypass are independent risk factors for hospital readmission. Return to the operating room is associated with a 5.95-fold increase in hospital readmission.
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Affiliation(s)
- Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa.
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Amy B Reed
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa
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27
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Calderon D, El-Banayosy A, Koerner MM, Reed AB, Aziz F. Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries. Tex Heart Inst J 2015; 42:537-9. [PMID: 26664305 DOI: 10.14503/thij-14-4728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft-a well-described technique to avoid limb ischemia-enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation.
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28
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Aziz F, Sybert M, Reed AB. Open Repair of Ruptured Abdominal Aortic Aneurysm in Nonagenarians Is Associated With Substantially High Mortality. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.06.106] [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: 10/23/2022]
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29
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Aziz F, Patel M, Ortenzi G, Reed AB. Incidence of Postoperative Deep Venous Thrombosis Is Higher among Cardiac and Vascular Surgery Patients as Compared with General Surgery Patients. Ann Vasc Surg 2015; 29:661-9. [DOI: 10.1016/j.avsg.2014.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 10/23/2022]
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30
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Matsumura JS, Stroupe KT, Lederle FA, Kyriakides TC, Ge L, Freischlag JA, Ketteler ER, Kingsley DD, Marek JM, Massen RJ, Matteson BD, Pitcher JD, Langsfeld M, Corson JD, Goff JM, Kasirajan K, Paap C, Robertson DC, Salam A, Veeraswamy R, Milner R, Kasirajan K, Guidot J, Lal BK, Busuttil SJ, Lilly MP, Braganza M, Ellis K, Patterson MA, Jordan WD, Whitley D, Taylor S, Passman M, Kerns D, Inman C, Poirier J, Ebaugh J, Raffetto J, Chew D, Lathi S, Owens C, Hickson K, Dosluoglu HH, Eschberger K, Kibbe MR, Baraniewski HM, Matsumura J, Endo M, Busman A, Meadows W, Evans M, Giglia JS, El Sayed H, Reed AB, Ruf M, Ross S, Jean-Claude JM, Pinault G, Kang P, White N, Eiseman M, Jones R, Timaran CH, Modrall JG, Welborn MB, Lopez J, Nguyen T, Chacko JK, Granke K, Vouyouka AG, Olgren E, Chand P, Allende B, Ranella M, Yales C, Whitehill TA, Krupski WC, Nehler MR, Johnson SP, Jones DN, Strecker P, Bhola MA, Shortell CK, Gray JL, Lawson JH, McCann R, Sebastian MW, Tetterton JK, Blackwell C, Prinzo PA, Lee N, Padberg FT, Cerveira JJ, Lal BK, Zickler RW, Hauck KA, Berceli SA, Lee WA, Ozaki CK, Nelson PR, Irwin AS, Baum R, Aulivola B, Rodriguez H, Littooy FN, Greisler H, O'Sullivan MT, Kougias P, Lin PH, Bush RL, Guinn G, Cagiannos C, Pillack S, Guillory B, Cikrit D, Lalka SG, Lemmon G, Nachreiner R, Rusomaroff M, O'Brien E, Cullen JJ, Hoballah J, Sharp WJ, McCandless JL, Beach V, Minion D, Schwarcz TH, Kimbrough J, Ashe L, Rockich A, Warner-Carpenter J, Moursi M, Eidt JF, Brock S, Bianchi C, Bishop V, Gordon IL, Fujitani R, Kubaska SM, Behdad M, Azadegan R, Agas CM, Zalecki K, Hoch JR, Carr SC, Acher C, Schwarze M, Tefera G, Mell M, Dunlap B, Rieder J, Stuart JM, Weiman DS, Abul-Khoudoud O, Garrett HE, Walsh SM, Wilson KL, Seabrook GR, Cambria RA, Brown KR, Lewis BD, Framberg S, Kallio C, Barke RA, Santilli SM, d'Audiffret AC, Oberle N, Proebstle C, Lee Johnson L, Jacobowitz GR, Cayne N, Rockman C, Adelman M, Gagne P, Nalbandian M, Caropolo LJ, Pipinos II, Johanning J, Lynch T, DeSpiegelaere H, Purviance G, Zhou W, Dalman R, Lee JT, Safadi B, Coogan SM, Wren SM, Bahmani DD, Maples D, Thunen S, Golden MA, Mitchell ME, Fairman R, Reinhardt S, Wilson MA, Tzeng E, Muluk S, Peterson NM, Foster M, Edwards J, Moneta GL, Landry G, Taylor L, Yeager R, Cannady E, Treiman G, Hatton-Ward S, Salabsky B, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Rapp JH, Reilly LM, Perez SL, Yan K, Sarkar R, Dwyer SS, Kohler TR, Hatsukami TS, Glickerman DG, Sobel M, Burdick TS, Pedersen K, Cleary P, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Back M, Bandyk D, Johnson B, Shames M, Reinhard RL, Thomas SC, Hunter GC, Leon LR, Westerband A, Guerra RJ, Riveros M, Mills JL, Hughes JD, Escalante AM, Psalms SB, Day NN, Macsata R, Sidawy A, Weiswasser J, Arora S, Jasper BJ, Dardik A, Gahtan V, Muhs BE, Sumpio BE, Gusberg RJ, Spector M, Pollak J, Aruny J, Kelly EL, Wong J, Vasilas P, Joncas C, Gelabert HA, DeVirgillio C, Rigberg DA, Cole L. Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial. J Vasc Surg 2015; 61:59-65. [DOI: 10.1016/j.jvs.2014.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
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Abstract
Renal trauma is predominantly secondary to blunt trauma and is managed nonoperatively. Endovascular interventions are reserved for patients with a significant vascular injury recognized early. Renal injuries are uncommon among intra-abdominal injuries and account for a minority of injuries treated by the vascular specialist.
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Affiliation(s)
- Emelia N Bittenbinder
- Pennsylvania State University College of Medicine, Division of Vascular Surgery, Penn State Milton S Hershey Medical Center, Heart and Vascular Institute, 500 University Drive Hershey, PA 17033
| | - Amy B Reed
- Pennsylvania State University College of Medicine, Division of Vascular Surgery, Penn State Milton S Hershey Medical Center, Heart and Vascular Institute, 500 University Drive Hershey, PA 17033.
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32
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Aziz F, Brehm CE, El-Banyosy A, Han DC, Atnip RG, Reed AB. Arterial Complications in Patients Undergoing Extracorporeal Membrane Oxygenation via Femoral Cannulation. Ann Vasc Surg 2014; 28:178-83. [DOI: 10.1016/j.avsg.2013.03.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/24/2013] [Accepted: 03/19/2013] [Indexed: 11/26/2022]
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Drew RC, Muller MD, Blaha CA, Mast JL, Heffernan MJ, Estep LE, Cui J, Reed AB, Sinoway LI. Renal vasoconstriction is augmented during exercise in patients with peripheral arterial disease. Physiol Rep 2013; 1:e00154. [PMID: 24400156 PMCID: PMC3871469 DOI: 10.1002/phy2.154] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 09/13/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 11/09/2022] Open
Abstract
Peripheral arterial disease (PAD) patients have augmented blood pressure increases during exercise, heightening their cardiovascular risk. However, it is unknown whether patients have exaggerated renal vasoconstriction during exercise and if oxidative stress contributes to this response. Eleven PAD patients and 10 controls (CON) performed 4-min mild, rhythmic, plantar flexion exercise of increasing intensity (0.5-2 kg) with each leg (most and least affected in PAD). Eight patients also exercised with their most affected leg during ascorbic acid (AA) infusion. Renal blood flow velocity (RBFV; Doppler ultrasound), mean arterial blood pressure (MAP; Finometer), and heart rate (HR; electrocardiogram [ECG]) were measured. Renal vascular resistance (RVR), an index of renal vasoconstriction, was calculated as MAP/RBFV. Baseline RVR and MAP were similar while HR was higher in PAD than CON (2.08 ± 0.23 vs. 1.87 ± 0.20 au, 94 ± 3 vs. 93 ± 3 mmHg, and 72 ± 3 vs. 59 ± 3 bpm [P < 0.05] for PAD and CON, respectively). PAD had greater RVR increases during exercise than CON, specifically during the first minute (PAD most: 26 ± 5% and PAD least: 17 ± 5% vs. CON: 3 ± 3%; P < 0.05). AA did not alter baseline RVR, MAP, or HR. AA attenuated the augmented RVR increase in PAD during the first minute of exercise (PAD most: 33 ± 4% vs. PAD most with AA: 21 ± 4%; P < 0.05). In conclusion, these findings suggest that PAD patients have augmented renal vasoconstriction during exercise, with oxidative stress contributing to this response.
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Affiliation(s)
- Rachel C Drew
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Matthew D Muller
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Cheryl A Blaha
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Jessica L Mast
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Matthew J Heffernan
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Lauren E Estep
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Jian Cui
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Amy B Reed
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Hershey Heart and Vascular Institute, Penn State University College of Medicine Hershey, Pennsylvania
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Aziz F, Reed AB. Outcomes for Ruptured AAA (REVAR And Open AAA Repair) Are Favorable if Performed by Vascular Surgeons Compared with General Surgeons. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.07.085] [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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Drew RC, Muller MD, Blaha CA, Mast JL, Estep LE, Cui J, Reed AB, Sinoway LI. Abstract 530: Renal Vasoconstriction is Augmented during Exercise in Peripheral Arterial Disease Patients: Contributions of Muscle Mechanoreflex and Oxidative Stress. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a530] [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] [Indexed: 11/16/2022]
Abstract
Peripheral arterial disease (PAD) patients have augmented blood pressure increases during exercise. It is unknown whether PAD patients have greater renal vasoconstriction during exercise and how much the muscle mechanoreflex or oxidative stress contribute to this response. Eleven PAD patients and 10 healthy controls (CON) performed 4 minutes of mild, rhythmic, plantarflexion exercise of increasing intensity (0.5-2kg) with each leg (most and least affected legs for PAD). Eight PAD patients also performed exercise with their most affected leg during intravenous, high-dose, ascorbic acid (AA) infusion. Renal blood flow velocity (RBFV; Doppler ultrasound), mean arterial blood pressure (MAP; Finometer), and heart rate (HR; ECG) were measured. Renal vascular resistance (RVR), an index of renal vasoconstriction, was calculated as MAP/RBFV. Statistical analysis involved repeated measures ANOVA and paired samples
t
-tests. Baseline RVR and MAP were similar while HR was higher in PAD compared to CON (RVR: 2.08±0.23 vs. 1.87±0.20 arbitrary units, MAP: 94±3 vs. 93±3 mmHg, and HR: 72±3 vs. 59±3 b.min
-1
(p<0.05) for PAD and CON, respectively). PAD had greater RVR increases from baseline during exercise with both the most and least affected legs compared to CON, specifically during the first minute of exercise (PAD most: 2.08±0.23 to 2.60±0.29 (+26±5%) and PAD least: 1.96±0.24 to 2.22±0.25 (+17±5%) vs. CON: 1.87±0.20 to 1.91±0.20 (+3±3%) for the first minute of exercise, both
p
<0.05). AA infusion did not alter baseline RVR, MAP or HR. AA attenuated the augmented RVR increase in PAD during the first minute of exercise with the most affected leg (PAD most without AA: 2.10±0.31 to 2.78±0.38 (+33±2%) vs. PAD most with AA: 1.88±0.26 to 2.23±0.26 (+21±2%) for the first minute of exercise,
p
<0.05). In conclusion, these findings suggest that PAD patients have augmented renal vasoconstriction during exercise, with the muscle mechanoreflex and oxidative stress contributing to this increased response.
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Affiliation(s)
| | | | | | | | | | - Jian Cui
- Penn State Univ College of Medicine, Hershey, PA
| | - Amy B Reed
- Penn State Univ College of Medicine, Hershey, PA
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Abstract
Peripheral arterial disease (PAD) is an atherosclerotic condition that can provoke symptoms of leg pain ("intermittent claudication") during exercise. Because PAD is often observed with comorbid conditions such hypertension, dyslipidemia, diabetes, cigarette smoking, and/or physical inactivity, the pathophysiology of PAD is certainly complex and involves multiple organ systems. Patients with PAD are at high risk for myocardial infarction, stroke, and all-cause mortality. For this reason, a better physiological understanding of the pathogenesis and treatment options for PAD patients is necessary and forms the basis of this Physiology in Medicine review.
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Affiliation(s)
- Matthew D Muller
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania
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Reed AB, Halpern V, Starr JE. Introduction. J Vasc Surg 2013; 57:1S-2S. [DOI: 10.1016/j.jvs.2012.10.105] [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: 07/14/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022]
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Muller MD, Drew RC, Blaha CA, Mast JL, Cui J, Reed AB, Sinoway LI. Oxidative stress contributes to the augmented exercise pressor reflex in peripheral arterial disease patients. J Physiol 2012; 590:6237-46. [PMID: 23006479 DOI: 10.1113/jphysiol.2012.241281] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Exaggerated blood pressure (BP) responses to dynamic exercise predict cardiovascular mortality in patients with peripheral arterial disease (PAD). However, the underlying mechanisms are unclear and no attempt has been made to attenuate this response using antioxidants. Three physiological studies were conducted in patients with PAD and controls. In Protocol 1, subjects underwent 4 min of low-intensity (0.5-2.0 kg), rhythmic plantar flexion in the supine posture. In Protocol 2, patients with PAD received high-dose ascorbic acid intravenously before exercise. In Protocol 3, involuntary exercise was conducted via electrical stimulation of the tibial nerve. The primary outcome measure was Δ mean arterial pressure (MAP) during the first 20 s of exercise (i.e. the onset of sympathoexcitation by muscle afferents). Compared to controls, patients with PAD had significantly greater ΔMAP during plantar flexion, particularly at 0.5 kg with the most affected leg (11 ± 2 vs. 2 ± 1 mmHg) as well as the least affected leg (7 ± 1 vs. 1 ± 1 mmHg). This augmented response occurred before the onset of claudication pain and was attenuated by ∼50% with ascorbic acid. Electrically evoked exercise also elicited larger haemodynamic changes in patients with PAD compared to controls. Further, the ΔMAP during 0.5 kg plantar flexion inversely correlated with the ankle-brachial index, indicating that patients with more severe resting limb ischaemia have a larger BP response to exercise. The BP response to low-intensity exercise was enhanced in PAD. Chronic limb ischaemia may sensitize muscle afferents and potentiate the BP response to muscle contraction in a dose-dependent manner.
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Affiliation(s)
- Matthew D Muller
- Penn State University College of Medicine, Heart and Vascular Institute, Hershey, PA 17033, USA
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Reed AB. Delayed Snorkel Revascularization of Left Subclavian Artery After Thoracic Endovascular Aneurysm Repair for Trauma. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.043] [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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Reed AB, Mills J, Eidt J, Dalsing M, Kent KC, Illig K, Money S, Taylor S, Rhodes R, Gahtan V. Integrated Vascular Surgery Residency: The Road to Diversity. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.030] [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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Aziz F, Brehm CE, El-Banyosi A, Han D, Atnip RG, Reed AB. Vascular Complications in Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO). J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Muller MD, Drew RC, Blaha CA, Mast JL, Cui J, Reed AB, Sinoway LI. Abstract 198: Oxidative Stress Mediates the Augmented Muscle Mechanoreflex in Peripheral Arterial Disease Patients. Hypertension 2012. [DOI: 10.1161/hyp.60.suppl_1.a198] [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] [Indexed: 11/16/2022]
Abstract
Background
Exaggerated blood pressure (BP) responses to dynamic exercise predict cardiovascular mortality in peripheral arterial disease (PAD) patients. However, the underlying mechanisms are unclear and no attempt has been made to attenuate this response using antioxidants.
Methods
Three physiological studies were conducted in PAD patients and controls. In Protocol 1, subjects underwent four minutes of low-intensity (0.5-2.0 kg), rhythmic plantar flexion in the supine posture. In Protocol 2, PAD patients received high dose ascorbic acid intravenously prior to exercise. In Protocol 3, involuntary exercise was conducted via electrical stimulation of the tibial nerve. The primary outcome measure was the change in mean arterial pressure (ΔMAP) during the first 20 seconds of exercise (i.e. when mechanoreceptors within skeletal muscle activate the sympathetic nervous system).
Results
Compared to controls, PAD patients had significantly greater ΔMAP during plantar flexion, particularly at 0.5 kg of the most affected leg (11±2 vs. 2±1 mmHg) as well as the least affected leg (7±1 vs. 1±1 mmHg). This augmented response occurred before the onset of claudication pain and was attenuated by ∼50% (i.e. 6 mmHg) in the presence of ascorbic acid. Electrically evoked exercise also elicited larger hemodynamic changes in the PAD patients compared to controls. Further, the ΔMAP during 0.5 kg plantar flexion inversely correlated with the ankle-brachial index, indicating that patients with more severe resting limb ischemia had a larger BP response to exercise.
Conclusions
The BP response to low intensity exercise was enhanced in PAD. Chronic limb ischemia may sensitize muscle afferents and potentiate the autonomic response to muscle contraction in a dose-dependent manner.
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Affiliation(s)
| | | | | | | | - Jian Cui
- Penn State College of Medicine, Hershey, PA
| | - Amy B Reed
- Penn State College of Medicine, Hershey, PA
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Shaw PM, Reed AB. Radiation Safety and Pregnancy: Time for Program Guidelines for Female Vascular Surgeons and Trainees. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.06.056] [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: 10/17/2022]
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Reed AB, Brown K, Bush R, Halpern V, Kibbe M, Killewich L, Mureebe L, Ozsvath K, Rzucidlo E, Starr J. Regarding "predicted shortage of vascular surgeons in the United States: population and workload analysis". J Vasc Surg 2010; 51:1076-7. [PMID: 20347709 DOI: 10.1016/j.jvs.2009.11.060] [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: 11/10/2009] [Revised: 11/11/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
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Reed AB, Rhodes R, Ricotta J. Determining who trains vascular surgery fellows in endovascular techniques. J Vasc Surg 2010; 51:756-9. [PMID: 20045620 DOI: 10.1016/j.jvs.2009.10.109] [Citation(s) in RCA: 7] [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] [Received: 09/15/2009] [Revised: 10/19/2009] [Accepted: 10/19/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Vascular surgery training has evolved from a single clinical year after general surgery training to a multi-year training program to encompass such entities as noninvasive vascular laboratory, office-based procedures, and endovascular techniques. Simultaneously, members of the vascular surgery community have had to undergo significant training to become facile with endovascular techniques. We surveyed vascular surgery trainees on the online Vascular Surgery In-Training Examination (VSITE) in 2008 and 2009 to assess who trained them in percutaneous techniques. METHODS Vascular surgery trainees in the Independent (2-year) and Integrated (5-year) training programs were asked to participate in a survey upon completion of the VSITE in 2008 and 2009. Examinees were asked to select whether vascular surgeons, cardiologists, or interventional radiologists trained them in carotid angioplasty and stenting (CAS), thoracic endografts (TEVAR), endovascular abdominal aortic aneurysm repair (EVAR), renal artery intervention, iliac stenting, superficial femoral artery (SFA), and tibial artery percutaneous interventions. RESULTS Survey response rate was 79.6% (191 of 240). Results of the survey are shown in Table I. In 2009, vascular surgeons provided more than 84% of the training to vascular surgery residents. Only six respondents had >50% of their percutaneous training with interventional radiology and two with cardiologists. CONCLUSION Vascular surgeons involved in resident education have been able to retrain themselves in endovascular techniques such that they are now able to provide greater than 80% of the endovascular experience to vascular surgery residents.
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Affiliation(s)
- Amy B Reed
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
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Reed AB. Midwestern Vascular Surgical Society: new horizons in vascular surgery program. Perspect Vasc Surg Endovasc Ther 2009; 21:213. [PMID: 20628093 DOI: 10.1177/1531003510363161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: Use of fresh cadavers in vascular surgery training. Surgery 2009; 146:757-62; discussion 762-3. [DOI: 10.1016/j.surg.2009.06.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 06/06/2009] [Indexed: 01/22/2023]
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