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Vasquez JF, Sandra V, Faries PL, Rushing A, Vouyouka AG, Rao A, McKinsey JF, Ting W, Finlay D, Tadros RO. Low Serum Albumin Predicts Short-term Adverse Outcomes in Surgical Peripheral Artery Disease Patients. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.456] [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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David N, Cooke PV, George JM, Hrabarchuk EI, Abbott E, Bai H, Rao A, Marin ML, Faries PL, McKinsey JF, Tadros RO. Increased Postoperative TEVAR Complication Risk with Anticoagulation Therapy. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.762] [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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Hrabarchuk EI, Cooke PV, George JM, David N, Abbott E, Bai H, Ting W, Rao A, Marin ML, Faries PL, McKinsey JF, Tadros RO. TEVAR Indications and Outcomes for Patients With Type 2 Diabetes. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.278] [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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Cooke PV, George JM, Hrabarchuk EI, Abbott E, David N, Faries CM, Bai H, Rao A, Marin ML, Faries PL, McKinsey JF, Tadros RO. TEVAR Indications and Outcomes for Patients Aged <50 Years. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.274] [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: 10/18/2022]
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George JM, Berger K, Watchmaker JM, McKinsey JF. Primary external iliac vein aneurysm with generalized venomegaly. J Vasc Surg Cases Innov Tech 2022; 8:33-34. [PMID: 35036671 PMCID: PMC8743186 DOI: 10.1016/j.jvscit.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Justin M. George
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelsey Berger
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer M. Watchmaker
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James F. McKinsey
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
- Correspondence: James F. McKinsey, MD, FACS, Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai W, 425 W 59th St, 7th Fl, New York, NY 10019
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Ilonzo N, George JM, Price L, McKinsey JF. Double-barrel stenting for endovascular repair of a superior mesenteric artery dissecting aneurysm. J Vasc Surg Cases Innov Tech 2021; 7:641-644. [PMID: 34693094 PMCID: PMC8515169 DOI: 10.1016/j.jvscit.2021.07.010] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
The patient was a 58-year-old man with a history of hypertension who had incidentally been found to have a 2.7-cm dissecting fusiform superior mesenteric artery aneurysm involving a long segment of a proximal to distal superior mesenteric artery. Double-lumen anatomy was present, with the true lumen perfusing the proximal and mid-small bowel and the false lumen perfusing the distal small bowel and the ileocolic artery. The patient elected to undergo endovascular repair using double-barrel stenting with self-expanding and balloon-expandable covered stents, as described. Computed tomography angiography after 1 year demonstrated patent stents.
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Affiliation(s)
- Nicole Ilonzo
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Justin M George
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lucyna Price
- Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY
| | - James F McKinsey
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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George J, Tadros RO, Rao A, Png CYM, Han DK, Ilonzo N, Faries PL, McKinsey JF. Duplex Ultrasound Can Successfully Identify Endoleaks and Renovisceral Stent Patency in Patients Undergoing Complex Endovascular Aneurysm Repair. Vasc Endovascular Surg 2020; 55:234-238. [PMID: 33317440 DOI: 10.1177/1538574420980605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Efficacy of duplex ultrasound (DU) surveillance of complex EVAR such as FEVAR and ChEVAR has not been studied. All patients undergoing FEVAR or ChEVAR at a single multihospital institution were retrospectively reviewed. Postoperative surveillance included DU at 1 month and CTA at 3 months. 82 patients met inclusion criteria including 39 (47.6%) ChEVAR and 43 (52.4%) FEVAR cases. DU identified endoleak with aneurysm sac enlargement in 3 cases requiring reintervention. CTA at 3 months detected 2 new endoleaks without growth and 1 renal artery stent occlusion. Replacement of initial postoperative imaging with DU did not result in any missed endoleaks, deaths, ruptures, or branch occlusions.
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Affiliation(s)
- Justin George
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami O Tadros
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajit Rao
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Y Maximilian Png
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel K Han
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Ilonzo
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter L Faries
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James F McKinsey
- 5925Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Price LZ, Safir SR, Faries PL, McKinsey JF, Tang GH, Tadros RO. Shockwave lithotripsy facilitates large-bore vascular access through calcified arteries. J Vasc Surg Cases Innov Tech 2020; 7:164-170. [PMID: 33748555 PMCID: PMC7966846 DOI: 10.1016/j.jvscit.2020.09.002] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022]
Abstract
Background Our objective is to explore the Peripheral Intravascular Lithotripsy (IVL) System in the treatment of calcific access vessels during thoracic endovascular aortic repair (TEVAR), endovascular aortic repair (EVAR), and transcatheter aortic valve intervention. Methods This retrospective, single-center study evaluated the outcomes of patients undergoing TEVAR, EVAR, or transcatheter aortic valve intervention with severe calcific arterial disease between July 2018 and August 2019. Maximum circumferential calcification, length of calcification, and inner/outer diameter measurements were collected with curved planar reformation by medical imaging software (Aquarius APS, TeraRecon, Foster City, Calif). Effective luminal gain was calculated using the minimal inner diameter and the largest bore passed within the vessel lumen. End points included technical success, mortality, adverse events, and requirement for bail out maneuvers. Technical success was defined as successful delivery and deployment of device or endograft. Results Nine patients were included (mean age, 79.3 ± 9.79 years; range, 59-97 years]). four transcatheter aortic valve replacement, one TEVAR, one EVAR, and three fenestrated EVAR. Six patients (66.7%) had more than one artery treated; the segments treated included common iliac artery (seven patients [77.8%]), the external iliac artery (seven patients [77.8%]), and the common femoral artery (one patient [11.1%]). The average inner iliac vessel diameter was 3.38 ± 0.99 mm (range, 1.87-4.72 mm). The average outside diameter of device introduced was 7.2 ± 0.94 (range, 6.3-8.8 mm) with 229% effective luminal gain. Technical success was achieved in 100% of cases with a 0% mortality. Adjunctive measures were needed in five cases (55.6%). One vessel perforation was controlled with covered stent (Viabahn; W. L. Gore & Associates, Flagstaff, Ariz) deployment. Dissection was identified in two cases requiring stent placement. Two cases required the use of the Terumo International Systems SOLOPATH Balloon Expandable TransFemoral System (Terumo Interventional Systems, Somerset, NJ). One case deployed a Viabahn stent applying the "crack and pave" technique. Conclusions As the population of the United States ages, calcified arterial disease will become an everyday clinical conundrum. Furthermore, the procedures for which the IVL system is geared toward facilitating will likely also increase in use. The IVL system is an additional tool in the vascular surgeon's armamentarium to obtain large-bore access in these calcified vessels. Further studies are needed to better assess the clinical effectiveness of the IVL system.
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Affiliation(s)
- Lucyna Z. Price
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott R. Safir
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
- Correspondence: Scott Safir, MD, Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 4th Fl, New York, NY 10029
| | - Peter L. Faries
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - James F. McKinsey
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gilbert H.L. Tang
- Structural Heart Program, Department of Cardiothoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rami O. Tadros
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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Bannazadeh M, Beckerman WE, Korayem AH, McKinsey JF. Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution. J Vasc Surg 2019; 71:15-22. [PMID: 31718954 DOI: 10.1016/j.jvs.2019.03.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/12/2018] [Accepted: 03/02/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Despite numerous recent pivotal and small-scale trials, real-world endovascular management of juxtarenal aneurysms (JRA), suprarenal aneurysms (SRA), and thoracoabdominal aortic aneurysms (TAAA) remains challenging without consensus best practices. This study evaluated the mortality, graft patency, renal function, complication, and reintervention rates for fenestrated and parallel endografts in complex aortic aneurysms repairs. METHODS This retrospective review of consecutive included patients with JRA, SRA, or TAAA who underwent complex endovascular repair from August 2014 to March 2017 at one high-volume institution. Treatment modality was a single surgeon decision based on patients anatomy and the urgency of the repair. Patient demographics, hospital course, and follow-up visits inclusive of imaging were analyzed. Ruptured aneurysms were excluded. Survival rates and outcomes were determined using the Kaplan-Meier method with log-rank tests. RESULTS Seventy complex endovascular aortic repairs were performed; 38 patients with TAAA were treated with snorkel/sandwich parallel endografts (21 celiac, 28 superior mesenteric arteries, 58 renal arteries) and 32 patients with JRA/SRA were treated by fenestrated endovascular aneurysm repair (FEVAR) with 94 total fenestrations (2 celiac, 30 SMA, 62 renal). The mean patient age was 74.8 ± 10.0 years. Sixty percent were male, and the mean aortic aneurysm diameter was 6.0 ± 1.4 cm. Perioperative mortality was 3.1% (1/32) for FEVAR compared with 2.6% (1/38) for parallel endografts (P = .9). All-cause reintervention rates were 15.6% in FEVAR (5/32) vs 23.6% with parallel endografts (9/38; P = .4). Branch reintervention rates per each branch endograft were 4.3% for FEVAR (4/94; 2 renal stent occlusions, 1 colonic ischemia without technical issue found on reintervention, 1 perinephric hematoma) vs 3.7% for parallel endografts (4/107; 2 renal and 1 celiac stent thromboses, and 1 renal stent kink; P = .41). The endograft branch thrombosis rate was 2.1% in FEVAR (2/94) vs 2.7% in parallel endografts (3/109; P = .77). Reinterventions owing to endoleaks were performed in five patients (2 type I, 2 type III, and 1 gutter endoleak; 13.1%) with parallel grafts vs no endoleak reinterventions in FEVAR. The overall survival and freedom from aneurysm-related mortality at 24 months was 78% and 96.9% in FEVAR vs 73% and 93.4% for parallel endografts (P = .8 and P = .6). The median follow-up was 12 months (range, 1-32 months). CONCLUSIONS Parallel and fenestrated endografts have acceptable and comparable mortality and patency rates in endovascular treatment of JRA, SRA, and TAAA. This study reaffirms that parallel endografts are a safe and viable alternative to fenestrated devices for complex aortic aneurysmal disease despite often treating more urgent patients and more complicated anatomy unable to be treated with FEVAR.
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Affiliation(s)
- Mohsen Bannazadeh
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - William E Beckerman
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - Adam H Korayem
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - James F McKinsey
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY.
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Price LZ, Faries PL, McKinsey JF, Krishnan P, Tang GH, Kovacic JC, Han DK, Tadros RO. Shockwave Lithotripsy Facilitates Large-Bore Vascular Access Through Calcified Arteries. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vasquez JF, Mousavi I, McKinsey JF, Marin ML, Faries PL, Han DK, Ravin R, Tadros RO. IP073. Predicting Aortic Remodeling After Thoracic Aortic Endovascular Repair for Stanford Type B Aortic Dissection Using Aortic Wall Thickness Ratios. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.160] [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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Price LZ, Faries PL, McKinsey JF, Prakash K, Tang GH, Kovacic JC, Tadros RO. The Epidemiology, Pathophysiology, and Novel Treatment of Calcific Arterial Disease. Surg Technol Int 2019; 34:351-358. [PMID: 30825317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Endovascular treatment of arterial diseases has become first-line in most cases due to improved technology. However, until recently, excessive atherosclerotic calcification has been a major limiting factor in the endovascular management of peripheral arterial disease, as well as vascular access for endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR). The Peripheral Intravascular Lithotripsy (IVL) System (Shockwave Medical, Inc., Fremont California) applies pulsatile mechanical energy under fluoroscopic guidance to disrupt calcified lesions. The purpose of this paper is to introduce IVL in the treatment of calcific access vessels in preparation for EVAR and TAVR, as well as peripheral arterial disease applications to enhance luminal gain. Using the IVL System, angioplasty can be performed with lower pressures, which may minimize arterial dissection. Further, the lithotripsy effect on calcium will enhance vessel compliance. We describe several cases where IVL was applied successfully and present additional cases that may have benefitted from the use of this technology.
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Affiliation(s)
- Lucyna Z Price
- Department of Vascular Surgery, Mount Sinai Hospital, New York, New York
| | - Peter L Faries
- Department of Vascular Surgery, Mount Sinai Hospital, New York, New York
| | - James F McKinsey
- Mount Sinai West, Mount Sinai Health System, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Krishnan Prakash
- Department of Vascular Surgery, Mount Sinai Hospital, New York, New York
| | - Gilbert Hl Tang
- Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, Department of Cardiovascular Surgery, Mount Sinai Health System New York, New York
| | - Jason C Kovacic
- Department of Vascular Surgery, Mount Sinai Hospital, New York, New York
| | - Rami O Tadros
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai The Mount Sinai Medical Center, New York, New York
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Li RX, Apostolakis IZ, Kemper P, McGarry MDJ, Ip A, Connolly ES, McKinsey JF, Konofagou EE. Pulse Wave Imaging in Carotid Artery Stenosis Human Patients in Vivo. Ultrasound Med Biol 2019; 45:353-366. [PMID: 30442386 PMCID: PMC6375685 DOI: 10.1016/j.ultrasmedbio.2018.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/29/2018] [Accepted: 07/16/2018] [Indexed: 05/03/2023]
Abstract
Carotid stenosis involves narrowing of the lumen in the carotid artery potentially leading to a stroke, which is the third leading cause of death in the United States. Several recent investigations have found that plaque structure and composition may represent a more direct biomarker of plaque rupture risk compared with the degree of stenosis. In this study, pulse wave imaging was applied in 111 (n = 11, N = 13 plaques) patients diagnosed with moderate (>50%) to severe (>80%) carotid artery stenosis to investigate the feasibility of characterizing plaque properties based on the pulse wave-induced arterial wall dynamics captured by pulse wave imaging. Five (n = 5 patients, N = 20 measurements) healthy volunteers were also imaged as a control group. Both conventional and high-frame-rate plane wave radiofrequency imaging sequences were used to generate piecewise maps of the pulse wave velocity (PWV) at a single depth along stenotic carotid segments, as well as intra-plaque PWV mapping at multiple depths. Intra-plaque cumulative displacement and strain maps were also calculated for each plaque region. The Bramwell-Hill equation was used to estimate the compliance of the plaque regions based on the PWV and diameter. Qualitatively, wave convergence, elevated PWV and decreased cumulative displacement around and/or within regions of atherosclerotic plaque were observed and may serve as biomarkers for plaque characterization. Intra-plaque mapping revealed the potential to capture wave reflections between calcified inclusions and differentiate stable (i.e., calcified) from vulnerable (i.e., lipid) plaque components based on the intra-plaque PWV and cumulative strain. Quantitatively, one-way analysis of variance indicated that the pulse wave-induced cumulative strain was significantly lower (p < 0.01) in the moderately and severely calcified plaques compared with the normal controls. As expected, compliance was also significantly lower in the severely calcified plaques regions compared with the normal controls (p < 0.01). The results from this pilot study indicated the potential of pulse wave imaging coupled with strain imaging to differentiate plaques of varying stiffness, location and composition. Such findings may serve as valuable information to compensate for the limitations of currently used methods for the assessment of stroke risk.
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Affiliation(s)
- Ronny X Li
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Iason Z Apostolakis
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Paul Kemper
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Matthew D J McGarry
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Ada Ip
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Edward S Connolly
- Department of Neurologic Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - James F McKinsey
- Division of Vascular Surgery and Endovascular Interventions, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Elisa E Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA; Department of Radiology, Columbia University Medical Center, New York, New York, USA.
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Wengerter SP, Chang J, McKinsey JF. Late Renal Salvage After Complex Endovascular Aneurysm Repair Complicated by Acute Renal Thrombosis. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.05.082] [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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15
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George J, Tadros RO, Png CYM, Han DK, Fakhoury OE, Faries PL, McKinsey JF. Duplex Ultrasound Can Successfully Identify Endoleaks and Renovisceral Stent Patency in Patients Undergoing Complex Endovascular Aneurysm Repair. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.05.048] [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: 11/27/2022]
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Tadros RO, Png CYM, Han DK, Rao A, Baldwin M, Faries PL, McKinsey JF. IP079. Duplex Ultrasound Can Successfully Identify Endoleaks and Renovisceral Stent Patency in Patients Undergoing Complex Endovascular Aneurysm Repair. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rastan A, McKinsey JF, Garcia LA, Rocha-Singh KJ, Jaff MR, Harlin S, Kamat S, Janzer S, Zeller T. One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial. J Endovasc Ther 2017; 25:100-108. [PMID: 29117818 PMCID: PMC5774616 DOI: 10.1177/1526602817740133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 11/29/2022]
Abstract
Purpose: To report the effectiveness of directional atherectomy for the treatment of popliteal artery occlusive disease. Methods: This subset of the prospective, multicenter, single-arm DEFINITIVE LE trial included 158 patients (mean age 72.0±10.9 years; 82 men) who underwent directional atherectomy in 162 popliteal artery lesions between 2009 and 2011. Forty-eight (30.4%) patients were suffering from critical limb ischemia (CLI). The mean lesion length was 5.8±3.9 cm; 38 (23.5%) arteries were occluded. The primary outcome measure for patients with intermittent claudication (IC) was duplex ultrasound–defined primary patency at 1 year; the outcome for subjects with CLI was freedom from major amputation of the target limb at 1 year. Outcomes and adverse events were independently assessed. Results: Procedure success (≤30% residual stenosis) was achieved in 84.4% of treated lesions; adjunctive stenting was required in 6 (3.7%) of the 162 lesions. The 1-year primary patency rate was 75.0% (IC patients 78.2% and CLI patients 67.5%, p=0.118). The freedom from major amputation in both cohorts was 100%. In both IC and CLI patients, significant improvements were demonstrated at 1 year in the Rutherford category, walking distance, and quality of life in comparison to baseline. Conclusion: This study indicates that directional atherectomy in popliteal arteries leads to favorable technical and clinical results at 1 year for claudicant as well as CLI patients.
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Affiliation(s)
- Aljoscha Rastan
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - James F McKinsey
- 2 Division of Vascular Surgery, Mount Sinai Health Care System, New York, NY, USA
| | - Lawrence A Garcia
- 3 Sections of Interventional Cardiology and Vascular Medicine, Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael R Jaff
- 5 VasCore, Massachusetts General Hospital, Boston, MA, USA
| | - Stuart Harlin
- 6 Santa Rosa Medical Center, Vascular and Interventional Radiology, Pensacola, FL, USA
| | - Suraj Kamat
- 7 Alice Heart and Vascular Center, Alice, TX, USA
| | - Sean Janzer
- 8 Einstein Heart and Vascular Institute, Philadelphia, PA, USA
| | - Thomas Zeller
- 1 Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Farber MA, Eagleton MJ, Mastracci TM, McKinsey JF, Vallabhaneni R, Sonesson B, Dias N, Resch T. Results from multiple prospective single-center clinical trials of the off-the-shelf p-Branch fenestrated stent graft. J Vasc Surg 2017; 66:982-990. [DOI: 10.1016/j.jvs.2017.01.068] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
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Bannazadeh M, McKinsey JF. Two-Year Evaluation of Fenestrated and Parallel Branch Endografts for the Treatment of Juxtrarenal, Suprarenal, and Thoracoabdominal Aneurysms at a Single Institution. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.06.019] [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: 10/19/2022]
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Tadros R, Safir SR, Faries PL, Han DK, Ellozy S, Chander RK, McKinsey JF, Marin ML, Stewart AS. Hybrid Repair Techniques for Complex Aneurysms and Dissections Involving the Aortic Arch and Thoracic Aorta. Surg Technol Int 2017; 30:243-247. [PMID: 28693049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aortic aneurysms involving the ascending aorta, aortic arch, and descending thoracic aorta have been a challenging entity to surgically treat for over 60 years. Despite the mortality of the disease, early open surgical procedures also had significant morbidity and mortality. The inherent risk in treating multiple anatomic segments simultaneously led to the innovation of the staged elephant trunk (ET) approach by Borst in 1983. To avoid the thoracotomy and associated complications related to the second stage of the procedure, an endovascular completion paradigm was begun by Volodos in 1991. This theoretical hybrid technique combinined shorter and less elaborate open supra-aortic trunk debranching with less invasive endovascular exclusion and has grown since then in terms of different approaches and case volume. The rise of thoracic endovascular aortic repair (TEVAR) combined with debranching bypass has allowed certain lesions to be treated without a large scale intrathoracic open surgical procedure. The complexity and extensiveness of certain lesions, however, has necessitated a hybrid approach such as the frozen elephant trunk (FET) and the standard ET with second stage TEVAR. The former has been used to treat multifocal degenerative aneurysms, chronic dissections with aneurysm, and acute extensive dissections. After conventional proximal aortic replacement, a stent-graft (SG) is delivered antegrade through the transected arch where it is sutured proximally and then "frozen" distally via endovascular means. The FET has the advantage of avoiding a second stage, but potentially introduces a greater rate of spinal cord ischemia compared to the standard elephant trunk. Improvements on the FET procedure have included the development of more advanced hybrid SG such as the Vascutek® Thoraflex Hybrid graft (Vascutek Ltd, Scotland, UK), which consists of a distal en,dograft sealed to a proximal four-branched Vascutek Gelweave Vascutek Ltd, Scotland, UK) and incorporated sewing collar. While open surgery continues to be a component of complex aortic arch aneurysms, the development of hybrid devices that can bridge the gap between open and endovascular surgery will continue to flourish.
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Affiliation(s)
- Rami Tadros
- Department of Surgery and Radiology, Vascular Surgery Residency Director, Off-site Vascular Lab, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Scott R Safir
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Peter L Faries
- Department of Surgery and Radiology, Vascular Surgery Residency Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Daniel K Han
- Department of Surgery and Radiology, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Sharif Ellozy
- Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, New York, New York
| | - Rajiv K Chander
- Department of Surgery and Radiology, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - James F McKinsey
- Department of Surgery, Systems Chief of Complex Aortic Intervention for Mount Sinai Health System, Mount Sinai West, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Michael L Marin
- Department of Surgery and Radiology, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Allan S Stewart
- Department of Surgery and Radiology, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Abstract
Open repair of abdominal aortic aneurysms (AAAs) or occlusive disease can be complicated by pseudoaneurysm formation and aneurysmal dilatation of native vessels. Reports of reoperation for these new lesions have a mortality rate of 5–17% electively, and 24–88% if ruptured. These complications are commonly several years after initial repair, and progression of other comorbidities can further complicate a repeat exploration. The authors reviewed 5 cases of late complications of open aortic bypass surgery treated with endovascular stent grafting as an alternative to reexploration in patients with increased risk for morbidity and mortality. Over a 6-year experience, 5 patients underwent endovascular stent grafting to repair paraanastomotic aneurysms. Patient records were reviewed and clinical cardiac risk evaluation was performed. Follow-up clinic notes and computed tomography (CT) scans were evaluated. Between October 1996 and February 2002, 5 patients underwent 6 endovascular procedures to repair paraanastomotic aneurysms. Mean period between interventions was 16.6 ±6.27 years (range 10–25); mean age at endovascular procedure 74.2 ±6.37 years (range 67–84). Cardiac clinical risk index increased in 80% of patients by Goldman Risk Index and in 40% by the Modified Cardiac Risk Index. On completion angiography, there was complete exclusion of the paraanastomotic aneurysms in all cases (100%). Length of postoperative stay was 1.5 ±0.547 days. Mean estimated blood loss at conclusion of endovascular procedure was 577 ±546.504 cc (range, 60 cc–1,500 cc). Mean follow-up was 24.4 ±24.593 months (range, 5–67 months). On repeat imaging, all stent grafts remain patent without rupture or endoleak. Endovascular stent grafting to repair late complications of open AAA repair is a viable alternative to reexploration in patients with significant comorbidities. These procedures can be performed without violating the previous surgical planes of sites. The operations can be performed under local anesthesia and with reduced hospitalizations. In patients with increased risk factors, endovascular stent grafting is a less morbid alternative to open surgical techniques.
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Affiliation(s)
- Benjamin J Pearce
- Section of Vascular Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA.
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Rosenthal D, Hungerpiller JC, Seagraves MA, Erdoes LS, Baird DR, McKinsey JF, Lamis PA, Clark MD. Prophylactic Interruption of the Inferior Vena Cava: Immediate and Long-Term Results. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine the effects of prophylactic interruption of the inferior vena cava (IVC) the hospital course of 340 patients who underwent aortic operations with placement of a Moretz IVC clip between 1980 and 1988 was removed: 175 patients had had abdominal aortic aneurysm resection; 143, aortobifemoral by pass; and 22, aortobiiliac endarterectomy or bypass. There were no complica tions related to placement of the IVC clip. After operation, any clinical suspicion of deep vein thrombosis (DVT) or pulmonary embolus (PE) was docu mented by phlebography or pulmonary arteriography, respectively. In the im mediate postoperative period ( < thirty days), only 2 (0.5%) patients had a PE and 10 (2.9%) a DVT. For long-term follow-up extending to eight years (mean ± 42.8 months), 308 patients were available. During long-term follow-up, 2 (0.6%) patients had a PE and 7 (2.2%) a DVT. Limb edema without evidence of DVT occurred in another 7 (2.2%) patients. B-mode ultrasonography of the IVC was performed in 163 patients. The IVC was clearly patent in all but 5 (3%): 1 had had a documented PE in the immediate postoperative period, and the other 4, an asymptomatic occlusion of the IVC during late follow-up. Prophylactic IVC interruption in aortic surgical patients appears not to cause IVC thrombosis, to initiate DVT, or to cause chronic venous insufficiency. The results indicate that it is a safe method of decreasing the incidence of PE, without increasing operative morbidity.
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Affiliation(s)
- David Rosenthal
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - John C. Hungerpiller
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Mary Annette Seagraves
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Luke S. Erdoes
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - David R. Baird
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - James F. McKinsey
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Pano A. Lamis
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Michael D. Clark
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
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Rosenthal D, McKinsey JF, Erdoes LS, Hungerpillar JC, Clark MD, Lamis PA, Whitehead T, Laszlo Pallos L. Ruptured Abdominal Aortic Aneurysm: Factors Affecting Survival and Long-Term Results. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although elective resection of an abdominal aortic aneurysm (AAA) is now a safe operation, the mortality related to a ruptured abdominal aortic aneurysm (rAAA) remains significant. To evaluate factors affecting survival and the long- term results after rAAA, a ten-year review of 47 patients was performed. The operative mortality rate was 43% (20/47) compared with 2.6% for 147 elective AAA patients during this period. Factors adversely affecting survival were blood pressure <90 mmHg on arrival to the hospital, perioperative cardiac arrest, delay in time from diagnosis to treatment > six hours, age > seventy-five years, massive transfusion, and free intraperitoneal rupture. In follow-up extending to five years the survivors of rAAA at one (92%) and five (53%) years had no discernible differences in quality of life or long- term survival compared with age- and sex-matched patients who had elective AAA resection during the same time interval. When an rAAA occurs and any three of the adverse variables noted above are present, the mortality rate exceeds 90%. These patients remained ventilator dependent and in the ICU from one to sixty-seven days, accumulating hospital charges from $7,000 to $214,000. It appears that the most effective means of reducing mortality statistics in this inordinately low-salvage, yet high-cost sub group of patients, is to prevent rupture of an AAA by elective resection.
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Affiliation(s)
- David Rosenthal
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - James F. McKinsey
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - Luke S. Erdoes
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - John C. Hungerpillar
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - Michael D. Clark
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - Pano A. Lamis
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - Travis Whitehead
- Department of Vascular Surgery, Georgia Baptist Medical Center, Georgia State University
| | - L. Laszlo Pallos
- Department of Management, Georgia State University, Atlanta, Georgia
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Rosenthal D, McKinsey JF, Clark MD, Hungerpiller JC, Lamis PA, Laszlo Pallos L. Ischemic Colitis Following Ruptured Abdominal Aortic Aneurysm. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During a six-year period, 47 patients underwent operation for ruptured abdominal aortic aneurysm (rAAA) with a mortality rate of 38% (18/47): of the 39 patients surviving the initial surgery, 9 (23%) developed ischemic colitis. All 9 patients demonstrated hyperdynamic cardiovascular changes consistent with sepsis: decreased systemic vascular resistance (SVR) (mean 852 dynes/sec/cm2) and increased cardiac index (mean 3.8 L/min/m2). This "septic picture" in the postoperative period, before the onset of any gastrointestinal (GI) symptoms (diarrhea with/without blood), led the authors to question bowel viability. Flexible sigmoid colonoscopy identified ischemic colitis in all patients and sigmoid colectomy was performed in 4; 3 of these patients survived. Of the 5 remaining patients managed nonoperatively, 3 survived. When hyperdynamic cardiovascular changes were recognized "early" (< forty-eight hours) and ischemic colitis was diagnosed (5 patients), all patients survived. However, when ischemic colitis was diagnosed "late" (> forty-eight hours) after operation in 4 patients, only 1 (25%) survived. In patients who suffer an rAAA and demonstrate cardiodynamic signs of sepsis (especially falling SVR) in the immediate postoperative period (< forty-eight hours), immediate bedside sigmoid colonoscopy to rule out ischemic colitis is warranted. Similarly, when patients develop "late" cardiodynamic signs of sepsis during recuperation from rAAA, even before the onset of GI symptoms, sigmoid colonoscopy should be performed. If severe ischemic colitis is documented, aggressive management with frequent colonoscopy and possibly sigmoid resection is indicated, for this may offer the only chance of survival in these catastrophically ill patients.
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Affiliation(s)
- David Rosenthal
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - James F. McKinsey
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Michael D. Clark
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - John C. Hungerpiller
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - Pano A. Lamis
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia
| | - L. Laszlo Pallos
- Department of Management, Georgia State University, Atlanta, Georgia
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Meyerson SL, Shakur UM, Skelly CL, Loth F, McKinsey JF, Schwartz LB. Relationship Between Preoperative Duplex Vein Mapping and Intraoperative Longitudinal Impedance in Infrainguinal Vein Grafts. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400503] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
The importance of favorable vein size, resistance, and impedance for the sustained success of infrainguinal vein grafting procedures has repeatedly been demonstrated. Estimating these properties preoperatively, however, has been problematic. Ultrasonic vein mapping is a reliable technique for measuring vein diameters at venous pressures, but it is unknown whether these data accurately assess the resistive potential of the conduit in the arterial circulation. The purpose of this study was to compare vein diameter measured preoperatively with vein graft longitudinal impedance measured intraoperatively. Patients who had undergone both preoperative vein mapping and intraoperative impedance studies at the time of infrainguinal bypass were included (December 1995-April 1999). Vein mapping was performed using B-mode ultrasound with a 10 MHz probe. The dimensions of the specific vein segment used for reconstruction were tabulated and its mean diameter (D̄) was calculated. At the time of operation, following reconstruction, transgraft blood pressure gradient (δP) and blood flow (Q) waveforms were recorded by using digital data acquisition. Longitudinal impedance (ZL) was calculated as δP/Q at each harmonic following Fourier transformation and the area under the curve from 0 to 4 Hz designated as ∫ZL. Twenty-three bypasses in 22 patients were studied (D̄ = 3.5 ±0.2 mm, range 1.6-5.5 mm; ∫ZL= 37 ±4 x 103 dyne cm-5, range 13-95 X 103 dyne cm-5). D̄ significantly correlated with ∫ZL (slope = -0.454, p < 0.05), albeit with a fairly low correlation coefficient ( r2 = 0.23). D̄ > 3.6 mm was predictive of graft patency at 12 months (D̄ > 3.6 mm 100% vs D̄ < 3.6 mm 57 ±20%; p = 0.02). Larger veins identified by preoperative mapping have, in general, more favorable intraoperative resistive characteristics as defined by a lower JZL. However, some veins thought to have small diameters (< 3.6 mm) may still demonstrate sufficiently low ∫ZL when grafted to remain patent.
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Affiliation(s)
| | | | | | | | | | - Lewis B. Schwartz
- Department of Surgery, Section of Vascular Surgery, University of Chicago, Chicago, Illinois
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26
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Abstract
Excision of atheromatous plaque is an attractive option for the minimally invasive treatment of peripheral arterial disease. Approved for use in 2003, the SilverHawk Plaque Exicison System (FoxHollow Technologies, Redwood City, CA) is a catheter-based plaque excision device allowing percutaneous removal of atheromatous material. This device represents the most recent generation of atherectomy tools. Overall experience with plaque debulking in the peripheral arteries spans almost two decades, and understanding of the technique continues to evolve. This article reviews the technology, current practices, and data on plaque excision.
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Affiliation(s)
- Leila Mureebe
- Division of Vascular Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv 2016; 7:923-33. [PMID: 25147039 DOI: 10.1016/j.jcin.2014.05.006] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [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: 03/17/2014] [Revised: 05/02/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and effectiveness of directional atherectomy (DA) for endovascular treatment of peripheral arterial disease (PAD) in infrainguinal arteries in patients with claudication or critical limb ischemia. BACKGROUND To date, no prospective, multicenter, independently-adjudicated study has evaluated the effectiveness and durability of DA in the treatment of PAD. Previous DA studies have not been prospectively powered to evaluate any differences in outcomes in patients with and without diabetes. METHODS DEFINITIVE LE (Determination of EFfectiveness of the SilverHawk(®) PerIpheral Plaque ExcisioN System (SIlverHawk Device) for the Treatment of Infrainguinal VEssels / Lower Extremities) prospectively enrolled subjects at 47 multinational centers with an infrainguinal lesion length up to 20 cm. Primary endpoints were defined as primary patency at 12 months for claudicants and freedom from major unplanned amputation for critical limb ischemia (CLI) subjects. A pre-specified statistical hypothesis evaluated noninferiority of primary patency in diabetic versus nondiabetic claudicants. Independent angiographic and sonographic core laboratories assessed outcomes, and events were adjudicated by a clinical events committee. RESULTS A total of 800 subjects were enrolled. The 12-month primary patency was 78% (95% confidence interval: 74.0% to 80.6%) in claudicants, with a 77% rate in the diabetic subgroup versus 78% in the nondiabetic subgroup (noninferior, p < 0.001). The rate of freedom from major unplanned amputation of the target limb at 12 months in CLI subjects was 95% (95% confidence interval: 90.7% to 97.4%). Periprocedural adverse events included embolization (3.8%), perforation (5.3%), and abrupt closure (2.0%). The bail-out stent rate was 3.2%. CONCLUSIONS The DEFINITIVE LE study demonstrated that DA is a safe and effective treatment modality at 12 months for a diverse patient population with either claudication or CLI. Furthermore, DA was shown to be noninferior for treating PAD in patients with diabetes compared with those without diabetes. (Study of SilverHawk/TurboHawk in Lower Extremity Vessels [DEFINITIVE LE]; NCT00883246).
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Affiliation(s)
- James F McKinsey
- Division of Vascular Surgery, New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, New York.
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Michael R Jaff
- Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Lawrence A Garcia
- Sections of Interventional Cardiology and Vascular Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Rastan A, McKinsey JF, Garcia LA, Rocha-Singh KJ, Jaff MR, Noory E, Zeller T. One-Year Outcomes Following Directional Atherectomy of Infrapopliteal Artery Lesions: Subgroup Results of the Prospective, Multicenter DEFINITIVE LE Trial. J Endovasc Ther 2015; 22:839-46. [PMID: 26445814 DOI: 10.1177/1526602815608610] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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
PURPOSE To report a subgroup analysis of the prospective, multicenter, single-arm DEFINITIVE LE trial to assess the effectiveness of directional atherectomy for the treatment of infrapopliteal artery lesions at 1 year. METHODS In the DEFINITIVE LE trial, follow-up assessments occurred up to 1 year postprocedure. Of the 800 patients enrolled, 145 subjects with 189 infrapopliteal lesions met the criteria for this analysis. Seventy (48.3%) and 75 (51.7%) patients were suffering critical limb ischemia (CLI) and intermittent claudication, respectively; 68.3% (99/145) had diabetes. The mean lesion length was 58±44 mm (all lesions); 20.2% were occluded. The primary endpoint for patients with claudication was duplex ultrasound-derived primary patency, while for subjects with CLI it was freedom from major amputation of the target limb at 1 year. Endpoints and adverse events were independently assessed. RESULTS Procedure success (≤30% residual stenosis) was achieved in 84% of treated lesions. The 1-year primary patency rate was 84% (claudicants 89.6% and CLI patients 78%, p=0.11), and the freedom from major amputation rate was 97.1% (claudicants 100% and CLI 93.8%, p=0.03). In both claudication and CLI patients, significant improvements in Rutherford category and objective measures of walking distance and quality of life were seen at 1 year in comparison to baseline. CONCLUSION This study demonstrates that directional atherectomy in infrapopliteal arteries results in promising technical and clinical results at 1 year for claudicant as well as CLI patients.
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Affiliation(s)
- Aljoscha Rastan
- Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - James F McKinsey
- Division of Vascular Surgery, New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, NY, USA
| | - Lawrence A Garcia
- Sections of Interventional Cardiology and Vascular Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael R Jaff
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, MA, USA
| | - Elias Noory
- Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Zeller
- Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Garcia LA, Jaff MR, Rocha-Singh KJ, Zeller T, Bosarge C, Kamat S, McKinsey JF. A Comparison of Clinical Outcomes for Diabetic and Nondiabetic Patients Following Directional Atherectomy in the DEFINITIVE LE Claudicant Cohort. J Endovasc Ther 2015; 22:701-11. [PMID: 26250748 DOI: 10.1177/1526602815599550] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a subset analysis that evaluated the hypothesis that directional atherectomy for peripheral artery disease in diabetic claudicants has noninferior primary patency at 12 months compared with nondiabetic claudicants. METHODS DEFINITIVE LE, a US/European multicenter study, assessed the effectiveness of directional atherectomy using SilverHawk/TurboHawk systems for treatment of peripheral artery disease in the superficial femoral, popliteal, and infrapopliteal arteries. Of the 800 patients enrolled in the study, only the 598 claudicant patients (mean age 69.5±10.4 years; 336 men) who were classified at baseline as Rutherford category 1-3 were eligible for this subset analysis. Of these, 46.8% (280/598) had diabetes. Follow-up to 12 months included duplex ultrasound examination, functional assessments, and adverse event evaluations. Independent angiographic and duplex ultrasound core laboratories assessed primary patency and secondary endpoints; a clinical events committee adjudicated adverse events. RESULTS Although diabetics had significantly more baseline comorbidities, 12-month primary patency (77.0%) was no different than for nondiabetics (77.9%; superiority p=0.98; noninferiority p<0.001) across all anatomic territories treated. Freedom from clinically driven target lesion revascularization was no different between diabetics (83.8%) and nondiabetics (87.5%) overall (p=0.19) or by lesion locations. Secondary clinical outcomes (Rutherford category, ankle-brachial index, and walking impairment) improved at 12 months for both diabetics and nondiabetics. CONCLUSION Noninferior 12-month patency rates demonstrate that directional atherectomy is an effective treatment in diabetic as well as nondiabetic claudicants. Directional atherectomy remains an attractive treatment option, improving luminal diameters without stents, which preserves future treatment options for both diabetic and nondiabetic patients with progressive, diffuse vascular disease.
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Affiliation(s)
- Lawrence A Garcia
- Sections of Interventional Cardiology and Vascular Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Michael R Jaff
- The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | | | - Suraj Kamat
- Christus Spohn Hospital Alice, Alice, TX, USA
| | - James F McKinsey
- Division of Vascular Surgery, New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, NY, USA
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30
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Egorova NN, Siracuse JJ, McKinsey JF, Nowygrod R. Trend, Risk Factors, and Costs of Clostridium difficile Infections in Vascular Surgery. Ann Vasc Surg 2015; 29:792-800. [PMID: 25595110 DOI: 10.1016/j.avsg.2014.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Starting in December 2013, the Hospital Inpatient Quality Reporting Program included Clostridium difficile infection (CDI) rates as a new publically reported quality measure. Our goal was to review the trend, hospital variability in CDI rates, and associated risk factors and costs in vascular surgery. METHODS The rates of CDI after major vascular procedures including aortic abdominal aneurysm (AAA) repair, carotid endarterectomy or stenting, lower extremity revascularization (LER), and LE amputation were identified using Nationwide Inpatient Sample database for 2000-2011. Risk factors associated with CDI were analyzed with hierarchical multivariate logistic regression. Extra costs, length of stay (LOS), and mortality were assessed for propensity-matched hospitalizations with and without CDI. RESULTS During the study period, the rates of CDI after vascular procedures had increased by 74% from 0.6 in 2000 to 1.05% in 2011, whereas the case fatality rate was stable at 9-11%. In 2011, the highest rates were after ruptured aortic abdominal aneurysm (rAAA) repair (3.3%), followed by lower extremity amputations (2.3%) and elective open AAA (1.3%). The rates of CDI increased after all vascular procedures during the 12 years. The highest increase was after endovascular LER (151.8%) and open rAAA repair (135.7%). In 2011, patients who had experienced CDI had median LOS of 15 days (interquartile range, 9-25 days) compared with 8.3 days for matched patients without CDI, in-hospital mortality 9.1% (compared with 5.0%), and $13,471 extra cost per hospitalization. The estimated cost associated with CDI in vascular surgery in the United States was ∼$98 million in 2011. Hospital rates of CDI varied from 0 to 50% with 3.5% of hospitals having infection rates ≥5%. Factors associated with CDI included multiple chronic conditions, female gender, surgery type, emergent and weekend hospitalizations, hospital transfers, and urban locations. CONCLUSIONS Despite potential reduction of infection rates as evidenced by the experience of hospitals with effective interventions, CDI is increasing among vascular surgery patients. It is associated with prolonged LOS, increased mortality, and higher costs.
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Affiliation(s)
- Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jeffrey J Siracuse
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY; Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA
| | - James F McKinsey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Roman Nowygrod
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
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31
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McKinsey JF, Egorova N. Endovascular Versus Open Repair of Thoracoabdominal Aneurysms: Long-Term Results. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.07.069] [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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Nowygrod R, Egorova NN, Siracuse JJ, McKinsey JF. PS54. Clostridium difficile Infections in Vascular Surgery Patients: Evaluation of Incidence, Risk Factors and Costs. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.110] [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: 10/25/2022]
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Ilonzo N, Egorova NN, Sosunov EA, McKinsey JF, Nowygrod R. PS58 Changes in and Factors Affecting Failure to Rescue Mortality After Elective Abdominal Aortic Aneurysm Repair: 1995-2011. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Siracuse JJ, Gill HL, Cassidy SP, Messina MD, Catz D, Egorova N, Parrack I, McKinsey JF. Endovascular treatment of lesions in the below-knee popliteal artery. J Vasc Surg 2014; 60:356-61. [PMID: 24650745 DOI: 10.1016/j.jvs.2014.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Endovascular interventions are increasing; however, there are little data regarding outcomes of complex interventions involving the below-knee popliteal/P3 artery. This study evaluated the short-term and long-term results and predictors of success of below-knee popliteal artery endovascular interventions. METHODS This was a retrospective review of a prospectively maintained endovascular lower extremity database of all patients with below-knee popliteal interventions from 2004 to 2012. Patient demographics, angiographic findings, interventions, primary and secondary patency, limb loss, and mortality were recorded. Analysis was performed using Kaplan-Meier life-table and multivariate analysis, with P < .05 indicating significance. RESULTS There were 221 patients (56% male) with below-knee popliteal/P3 artery lesions. Mean age was 73 ± 11.2 years. Claudication was present in 22% and critical limb ischemia (CLI) in 78%. Mean lesion length was 10 ± 8.5 cm, with 45% having total occlusions. Treatment included percutaneous transluminal angioplasty (PTA) with or without a stent (47%), atherectomy (ATH) with or without PTA/stent (52%), and stenting with PTA and ATH (3%). Complications included embolization (0.4%), hematoma (2.7%), pseudoaneurysm (1.3%), and dissection (7%). Freedom from restenosis (peak systolic velocity ratio >2.4) was 65% at 1 year. Independent predictors of restenosis were CLI (hazard risk [HR], 4.4; 95% confidence interval [CI], 1.9-9.9) and stenting combined with PTA and ATH (HR, 2.7; 95% CI, 1.01-7.4). Primary assisted and secondary patencies were 95% and 85% at 1 year. ATH with PTA had lower short-term restenosis in diabetic patients compared with nondiabetic patients (95% vs 78% at 4 months). Limb loss was 18% at 4 years. Mortality was 24% at 4 years. Statin use was protective against primary restenosis (HR, 0.39; 95% CI, 0.23-0.67) and death (HR, 0.5; 95% CI, 0.28-1.0). CONCLUSIONS Endovascular intervention for lesions involving the below-knee popliteal artery is a safe and effective therapy for claudication and CLI. Diabetic patients benefit most from ATH with PTA. Statin use is protective against restenosis and mortality and should be the standard of care in patients undergoing peripheral endovascular interventions.
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Affiliation(s)
- Jeffrey J Siracuse
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY.
| | - Heather L Gill
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Stephen P Cassidy
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Mark D Messina
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Diana Catz
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Natalia Egorova
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Inkyong Parrack
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
| | - James F McKinsey
- Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY
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Selmon MR, Schwindt AG, Cawich IM, Chamberlin JR, Das TS, Davis TP, George JC, Janzer SF, Lopez LA, McDaniel HB, McKinsey JF, Pigott JP, Raja ML, Reimers B, Schreiber TL. Final Results of theChronic Total OcclusionCrossing With theOcelot System II (CONNECT II) Study. J Endovasc Ther 2013; 20:770-81. [DOI: 10.1583/13-4380mr.1] [Citation(s) in RCA: 25] [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] [Indexed: 10/25/2022]
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36
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Siracuse JJ, Cassidy S, Messina M, Catz D, Egorova N, Gill HL, McKinsey JF. Endovascular Interventions on the Below Knee Popliteal Artery: Four-Year Results. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.08.052] [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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37
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Heyer EJ, Mergeche JL, Bruce SS, Ward JT, Stern Y, Anastasian ZH, Quest DO, Solomon RA, Todd GJ, Benvenisty AI, McKinsey JF, Nowygrod R, Morrissey NJ, Connolly ES. Statins reduce neurologic injury in asymptomatic carotid endarterectomy patients. Stroke 2013; 44:1150-2. [PMID: 23404722 DOI: 10.1161/strokeaha.111.000362] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Statins are neuroprotective in a variety of experimental models of cerebral injury. We sought to determine whether patients taking statins before asymptomatic carotid endarterectomy exhibit a lower incidence of neurological injury (clinical stroke and cognitive dysfunction). METHODS A total of 328 patients with asymptomatic carotid stenosis scheduled for elective carotid endarterectomy consented to participate in this observational study of perioperative neurological injury. RESULTS Patients taking statins had a lower incidence of clinical stroke (0.0% vs 3.1%; P=0.02) and cognitive dysfunction (11.0% vs 20.2%; P=0.03). In a multivariate regression model, statin use was significantly associated with decreased odds of cognitive dysfunction (odds ratio, 0.51 [95% CI, 0.27-0.96]; P=0.04). CONCLUSIONS Preoperative statin use was associated with less neurological injury after asymptomatic carotid endarterectomy. These observations suggest that it may be possible to further reduce the perioperative morbidity of carotid endarterectomy. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597883.
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Affiliation(s)
- Eric J Heyer
- Department of Anesthesiology, Columbia University, New York, NY, USA.
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McKinsey JF, Kim IK, Sosunov E, Moskowitz A, Egorova N. Thoracic Aortic Dissection and Thoracoabdominal Acute Type B Aortic Dissections Have Superior Survival When Treated With Thoracic Endovascular Aneurysm Repair and Open Surgery Compared to Medical Therapy: Outcomes from the National Medicare Database. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.024] [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: 11/28/2022]
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39
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Kim IK, Egorova NN, McKinsey JF. RR8. Directional Atherectomy Has Equivalent Outcomes to Percutaneous Transluminal Angioplasty and Stenting (PTA/Stent) in Patients with Severely Diseased Femoropopliteal Lesions: Justification to Leave Nothing. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.217] [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: 11/27/2022]
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40
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Aiello FA, Meltzer AJ, Cohen B, Espiritu M, Burmeister J, Hoque R, McKinsey JF, Shrikhande G. PS166. Risk Factors for Prevalence and Progression of Asymptomatic Carotid Disease in Patients with Peripheral Arterial Disease. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.177] [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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41
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Yen M, Egorova NN, Moskowitz AJ, Sosunov EA, McKinsey JF, Nowygrod R. PS154. Trends in Outpatient Treatment of Vascular Diseases. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.171] [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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42
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Meltzer AJ, Da Silva P, Aiello FA, McKinsey JF, Schneider DB, Shrikhande GV. Clinical Significance of the Clopidogrel-Proton Pump Inhibitor Interaction After Peripheral Endovascular Intervention. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2011.11.086] [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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43
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Gallagher KA, Meltzer AJ, Khan S, Ravin RA, Connelly P, Schneider DB, McKinsey JF, Dayal R. The Effect of Cancer on Percutaneous Intervention for Infrainguinal Peripheral Artery Disease: Are Patency Rates Impacted? J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.09.027] [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: 10/16/2022]
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44
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Khan SZ, Khan MA, Bradley B, Dayal R, McKinsey JF, Morrissey NJ. Utility of duplex ultrasound in detecting and grading de novo femoropopliteal lesions. J Vasc Surg 2011; 54:1067-73. [DOI: 10.1016/j.jvs.2011.03.282] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 03/29/2011] [Accepted: 03/30/2011] [Indexed: 10/17/2022]
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45
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Gallagher KA, Meltzer AJ, Ravin RA, Graham A, Shrikhande G, Connolly PH, Aiello F, Dayal R, McKinsey JF. Endovascular Management as First Therapy for Chronic Total Occlusion of the Lower Extremity Arteries:Comparison of Balloon Angioplasty, Stenting, and Directional Atherectomy. J Endovasc Ther 2011; 18:624-37. [DOI: 10.1583/11-3539.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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46
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Gallagher KA, Meltzer AJ, Ravin RA, Graham A, Connolly P, Escobar G, Shrikhande G, McKinsey JF. Gender Differences in Outcomes of Endovascular Treatment of Infrainguinal Peripheral Artery Disease. Vasc Endovascular Surg 2011; 45:703-11. [DOI: 10.1177/1538574411418008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Andrew J. Meltzer
- Division of Vascular Surgery, New York Presbyterian Hospital, The University Hospitals of Weill Cornell and Columbia, New York, NY, USA
| | - Reid A. Ravin
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Ashley Graham
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Peter Connolly
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Guillermo Escobar
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Gautam Shrikhande
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - James F. McKinsey
- Division of Vascular Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
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Kim IK, Egorova N, Khan SZ, Melzer AJ, McKinsey JF. Comparative Analysis of Femoropopliteal Versus Tibial Lesion Characteristics that Predict Endovascular Therapy Success. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.06.063] [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: 12/01/2022]
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Kim IK, Egorova N, McKinsey JF. Geographic location does not limit innovative technology: Broad spread assimilation of endovascular aortic aneurysm repair (EVAR). J Am Coll Surg 2011. [DOI: 10.1016/j.jamcollsurg.2011.06.263] [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: 11/25/2022]
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49
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Egorova N, Kleinman LC, Moskowitz A, McKinsey JF. PS34. Comparing Open and Endovascular Repair of Abdominal Aortic Aneurysm Accounting for Clinical Judgment. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.082] [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: 10/18/2022]
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50
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Khan SZ, Ravin R, Bradley B, Kim IK, McKinsey JF. PVSS12. Prior Endovascular Intervention Does Not Negatively Impact on Lower Extremity Bypass Procedures. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.023] [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: 10/18/2022]
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