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Muller M, Yau P, Pham A, Lipsitz EC, DeRose JJ, Cho JS, Shariff S, Indes JE. A comparison of endovascular repair to medical management for acute vs subacute uncomplicated type B aortic dissections. J Vasc Surg 2023; 78:53-60. [PMID: 36889606 DOI: 10.1016/j.jvs.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) has emerged as a viable option of treatment for uncomplicated type B aortic dissection (UTBAD) due to the potential for inducing favorable aortic remodeling. The aim of this study is to compare outcomes of UTBAD treated medically or with TEVAR in either the acute (1 to 14 days) or subacute period (2 weeks to 3 months). METHODS Patients with UTBAD between 2007 and 2019 were identified using the TriNetX Network. The cohort was stratified by treatment type (medical management; TEVAR during the acute period; TEVAR during the subacute period). Outcomes including mortality, endovascular reintervention, and rupture were analyzed after propensity matching. RESULTS Among 20,376 patients with UTBAD, 18,840 were medically managed (92.5%), 1099 patients were in the acute TEVAR group (5.4%), and 437 patients were in the subacute TEVAR group (2.1%). The acute TEVAR group had higher rates of 30-day and 3-year rupture (4.1% vs 1.5%; P < .001; 9.9% vs 3.6%; P < .001) and 3-year endovascular reintervention (7.6% vs 1.6%; P < .001), similar 30-day mortality (4.4% vs 2.9%; P < .068), and lower 3-year survival compared with medical management (86.6% vs 83.3%; P = .041). The subacute TEVAR group had similar rates of 30-day mortality (2.3% vs 2.3%; P = 1), 3-year survival (87.0% vs 88.8%; P = .377) and 30-day and 3-year rupture (2.3% vs 2.3%; P = 1; 4.6% vs 3.4%; P = .388), with significantly higher rates of 3-year endovascular reintervention (12.6% vs 7.8%; P = .019) compared with medical management. The acute TEVAR group had similar rates of 30-day mortality (4.2% vs 2.5%; P = .171), rupture (3.0% vs 2.5%; P = .666), significantly higher rates of 3-year rupture (8.7% vs 3.5%; P = .002), and similar rates of 3-year endovascular reintervention (12.6% vs 10.6%; P = .380) compared with the subacute TEVAR group. There was significantly higher 3-year survival (88.5% vs 84.0%; P = .039) in the subacute TEVAR group compared with the acute TEVAR group. CONCLUSIONS Our results found lower 3-year survival in the acute TEVAR group compared with the medical management group. There was no 3-year survival benefit found in patients with UTBAD who underwent subacute TEVAR compared with medical management. This suggests the need for further studies looking at the necessity for TEVAR when compared with medical management for UTBAD as it is non-inferior to medical management. Higher rates of 3-year survival and lower rates of 3-year rupture in the subacute TEVAR group compared with the acute TEVAR group suggest superiority of subacute TEVAR. Further investigations are needed to determine the long-term benefit and optimal timing of TEVAR for acute UTBAD.
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Affiliation(s)
- Matthew Muller
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
| | - Patricia Yau
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Antoine Pham
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Evan C Lipsitz
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Joseph J DeRose
- Department of Cardiothoracic Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jae S Cho
- Department of Vascular Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Saadat Shariff
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jeffrey E Indes
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Ziapour B, Iafrati MD, Indes JE, Chin-Bong Choi J, Salehi P. Safety and Efficacy of Percutaneous Translumbar Inferior Vena Cava Catheters: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34:1075-1086.e15. [PMID: 36806563 DOI: 10.1016/j.jvir.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/21/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To examine the reported adverse events associated with inferior vena cava (IVC) catheterization and investigate the reasons for discrepancies between reports. MATERIALS AND METHODS Cochrane Library trials register, PubMed, Embase, and Scopus databases were systematically searched for studies that included any terms of IVC and phrases related to catheters or central access. Of the 5,075 searched studies, 137 were included in the full-text evaluation. Of these, 37 studies were included in the systematic review, and the adverse events reported in 16 of these 37 identified studies were analyzed. An inverse-variance random-effects model was used to conduct the meta-analysis. Outcomes were summarized by the incidence rate (IR) and 95% CI. RESULTS Compared with that of catheters <10 F in size (IR, 0.08; 95% CI, 0.03-0.12), the incidence of catheter-related infections per 100 catheter days was 0.2 more for catheters ≥10 F in size (IR, 0.28; 95% CI, 0.25-0.31). In addition, dual-lumen catheters showed 0.13 more malfunction per 100 catheter days (IR, 0.27; 95% CI, 0.16-0.37) than that shown by single-lumen catheters (IR, 0.14; 95% CI, 0.09-0.19). Both differences were statistically significant. Other adverse events were malposition (IR, 0.04; 95% CI, 0.04-0.05), fracture (IR, 0.01; 95% CI, 0.00-0.02), kinking (IR, 0.01; 95% CI, 0.00-0.01), replaced catheter (IR, 0.2; 95% CI, 0.1-0.31), removal (IR, 0.13; 95% CI, 0.1-0.16), IVC thrombosis (IR, 0.01; 95% CI, 0.00-0.03), and retroperitoneal hematoma (IR, 0.01; 95% CI, 0.00-0.01), all per 100 catheter days. CONCLUSIONS Translumbar IVC access is an option for patients with exhausted central veins. Small-caliber catheters cause fewer catheter-related infections, and single-lumen catheters function longer.
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Affiliation(s)
- Behrad Ziapour
- Department of General Surgery, State University of New York Downstate Health Sciences University, Brooklyn, New York.
| | - Mark D Iafrati
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey E Indes
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Justin Chin-Bong Choi
- Department of Surgery, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Payam Salehi
- Division of Vascular Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Carnevale ML, Koleilat I, Lipsitz EC, Friedmann P, Indes JE. Reply. J Vasc Surg 2021; 73:1113-1114. [PMID: 33632501 DOI: 10.1016/j.jvs.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew L Carnevale
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Issam Koleilat
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Evan C Lipsitz
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jeffrey E Indes
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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Sanon O, Carnevale M, Indes JE, Lipsitz E, Gao Q, Alcabes A, Koleilat I. Incidence of Procedure-Related Complication in Patients Treated with Atherectomy in Femoropopliteal and Tibial Vessels. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.701] [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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Carnevale ML, Phair J, Indes JE, Koleilat I. Digital Footprint of Vascular Surgery Training Programs in the United States and Canada. Ann Vasc Surg 2020; 67:115-122. [DOI: 10.1016/j.avsg.2020.01.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 11/29/2019] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
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Leinbach C, Leung S, Carnevale M, Indes JE, Lipsitz EC, Koleilat I. Outcomes of Femoral Endarterectomy and Femoropopliteal Intervention Versus Endarterectomy and Femoropopliteal Bypass. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.367] [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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Carnevale ML, Koleilat I, Lipsitz EC, Friedmann P, Indes JE. Extended screening guidelines for the diagnosis of abdominal aortic aneurysm. J Vasc Surg 2020; 72:1917-1926. [PMID: 32325228 DOI: 10.1016/j.jvs.2020.03.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The U.S. Preventive Services Task Force (USPSTF) guidelines are the most widely used criteria for screening for abdominal aortic aneurysms (AAA). However, when the USPSTF criteria are applied retrospectively to a group of patients who have undergone treatment for AAA, there are many patients who satisfy none of the AAA screening criteria. The more sensitive Society for Vascular Surgery (SVS) guidelines have expanded the criteria for screening for AAA with the hope of capturing a greater fraction of those individuals who can undergo treatment for their AAA before presenting with AAA rupture. We sought to identify the number of patients who would have been identified as having criteria for screening for AAA by both the USPSTF and SVS criteria, in a cohort of patients who have undergone treatment for AAA. METHODS We assessed demographic, comorbidity, and perioperative complication data for all patients undergoing endovascular and open AAA repair in the Vascular Quality Initiative. Patients meeting each of the screening criteria were identified. Clinical factors and demographic variables were collected. RESULTS We identified 55,197 patients undergoing AAA repair in the Vascular Quality Initiative, including 44,602 patients who underwent endovascular aneurysm repair (EVAR) and 10,595 patients undergoing open repair. Of these, the USPTF guidelines would have identified fewer than one-third of patients (32% EVAR and 33% open repair). Applying the SVS guidelines increased the number meeting criteria for screening by 6% and 12% for the EVAR and open repair cohorts, respectively. Finally, adoption of the expanded SVS guidelines (including the "weak recommendations") would have identified an additional 34% of EVAR patients and 21% of open AAA repair patients. Use of the expanded criteria would have resulted in 27% of patients undergoing EVAR and 33% of patients undergoing open AAA repair who would not have met any screening criteria. In EVAR patients not meeting the criteria, 52% were younger than 65 years had a history of heavy smoking. Of all those who did not meet screening criteria, ruptured AAA was twice as prevalent as those who met screening criteria (8.5% vs 4.4%; P ≤ .0001). CONCLUSIONS Expanding established USPSTF screening guidelines to include the expanded SVS criteria may potentially double the number of patients identified with AAA. Smokers under the age of 65, and elderly patients 70 and older with no smoking history, represent two groups with AAA and potentially twice the risk of presenting with rupture.
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Affiliation(s)
- Matthew L Carnevale
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Issam Koleilat
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Evan C Lipsitz
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey E Indes
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
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Carnevale ML, Zhao Y, Phair J, Scher L, Koleilat I, Lipsitz E, Indes JE. The Impact of Integrated Vascular Surgery Residency Programs on General Surgery Residents. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.085] [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: 11/29/2022]
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Phair J, Carnevale ML, Teveris VG, Koleilat I, Indes JE. Peripheral arterial occlusive disease operative case volume in the final years of 5+2 and 0+5 vascular training paradigms. Surgery 2019; 166:198-202. [PMID: 30967238 DOI: 10.1016/j.surg.2019.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peripheral arterial occlusive disease constitutes a substantial portion of clinical practice in vascular surgery and, as such, trainees must graduate with proficiency in endovascular and open procedures to become capable vascular surgeons. Case volume for 0+5 integrated vascular surgery residents in the chief and junior years was compared with their 5+2 fellowship counterparts for the treatment of peripheral arterial occlusive disease. METHODS In this retrospective review, operative volume for peripheral arterial occlusive disease cases in both vascular training paradigms was evaluated. "Surgeon chief" cases in the final year of residency training, and "surgeon junior" cases for postgraduate year 4 and below were gathered for the integrated vascular surgery residents group. Annual fellow's case volume was collected using cases logged as "surgeon fellow." Procedures were divided by the following anatomic region and compared: aortoiliac, femoropopliteal, and infrapopliteal. Student's t tests were used to assess these differences. RESULTS An aggregate of 887 residents and fellows from 137 programs were identified. Vascular surgery fellows consistently performed 1.7-fold (P < .001) and 1.6-fold (P < .001) more total peripheral cases than their integrated vascular surgery residents chief and junior counterparts, respectively. They also performed 1.8-fold (P = .002) and 1.5-fold (P = .004) more peripheral endovascular cases than their 0+5 chief and junior counterparts respectively. With respect to endovascular treatment of peripheral arterial occlusive disease by subgroup, we found the overall volume of aortoiliac and femoropopliteal increased, whereas infrapopliteal case volume decreased. Vascular surgery fellows were performing many more of these cases per year than the integrated vascular surgery residents chiefs and junior residents. When looking at 3 index open procedures, aortobifemoral bypass, femoropopliteal bypass with vein, and infrapopliteal bypass with vein in the academic year 2017-2018, the vascular surgery fellow trainees performed more cases than the integrated vascular surgery residents chief and junior residents. CONCLUSION Earlier studies have compared the operative volume of vascular surgery fellows and integrated vascular surgery residents in their entire tenure of training. Our study specifically evaluated the years of training that confer the greatest level of autonomy. Vascular surgery fellows are performing more endovascular and open cases than their 0+5 counterparts for peripheral arterial occlusive disease during the final phase of training. These findings suggest that current suspected equipoise of vascular surgery training paradigms may not reflect what is occurring in practice and therefore warrants further investigation.
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Affiliation(s)
- John Phair
- Albert Einstein College of Medicine, Bronx, NY; Division of Vascular Surgery, Montefiore Medical Center, Bronx, NY
| | - Matthew L Carnevale
- Albert Einstein College of Medicine, Bronx, NY; Division of Vascular Surgery, Montefiore Medical Center, Bronx, NY
| | - Victoria G Teveris
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Issam Koleilat
- Albert Einstein College of Medicine, Bronx, NY; Division of Vascular Surgery, Montefiore Medical Center, Bronx, NY
| | - Jeffrey E Indes
- Albert Einstein College of Medicine, Bronx, NY; Division of Vascular Surgery, Montefiore Medical Center, Bronx, NY.
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Chin JA, Skrip L, Sumpio BE, Cardella JA, Indes JE, Sarac TP, Dardik A, Ochoa Chaar CI. Percutaneous endovascular aneurysm repair in morbidly obese patients. J Vasc Surg 2017; 65:643-650.e1. [DOI: 10.1016/j.jvs.2016.06.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022]
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Deery SE, Lancaster RT, Baril DT, Indes JE, Bertges DJ, Conrad MF, Cambria RP, Patel VI. Contemporary outcomes of open complex abdominal aortic aneurysm repair. J Vasc Surg 2016; 63:1195-200. [DOI: 10.1016/j.jvs.2015.12.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/03/2015] [Indexed: 10/21/2022]
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Zarkowsky DS, Hicks CW, Stone DH, Bertges DJ, Indes JE, Kalish JA, Goodney PP. 5 (RF). Renal Injury After EVAR Portends Shortened Survival. Ann Vasc Surg 2015. [DOI: 10.1016/j.avsg.2015.04.006] [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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Ziegler KR, Cruz J, Muhs BE, Indes JE, Sumpio BE, Chaar CI. Iatrogenic Profunda Femoris Stenosis after Superficial Femoral Artery Stenting. Am Surg 2014. [DOI: 10.1177/000313481408000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kenneth R. Ziegler
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Joshua Cruz
- Department Of Diagnostic Radiology Yale New Haven Hospital New Haven, Connecticut
| | - Bart E. Muhs
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Jeffrey E. Indes
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Bauer E. Sumpio
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
| | - Cassius I. Chaar
- Section of Vascular Surgery Department of Surgery Yale University School of Medicine New Haven, Connecticut
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Ziegler KR, Cruz J, Muhs BE, Indes JE, Sumpio BE, Chaar CI. Iatrogenic profunda femoris stenosis after superficial femoral artery stenting. Am Surg 2014; 80:E155-E156. [PMID: 24887776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Kenneth R Ziegler
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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De Martino RR, Brooke BS, Robinson W, Schanzer A, Indes JE, Wallaert JB, Nolan BW, Cronenwett JL, Goodney PP. Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair. Circ Cardiovasc Qual Outcomes 2014; 6:575-81. [PMID: 24046399 DOI: 10.1161/circoutcomes.113.000095] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. METHODS AND RESULTS We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included in-hospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01). CONCLUSIONS In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.
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Hogendoorn W, Schlösser FJ, Aruny JE, Indes JE, Sumpio BE, Muhs BE. Successful Treatment of a Proximal Type I Endoleak With HeliFX EndoAnchors. Ann Vasc Surg 2014; 28:737.e13-7. [DOI: 10.1016/j.avsg.2013.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Indes JE, Muhs BE, Dardik A. First long-term evidence supporting endovascular repair of abdominal aortic aneurysms. Expert Rev Cardiovasc Ther 2014; 11:399-402. [DOI: 10.1586/erc.13.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brown HA, Indes JE. Reply: To PMID 23375438. J Vasc Surg 2013; 58:1444-5. [PMID: 24160318 DOI: 10.1016/j.jvs.2013.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Hilary Ann Brown
- Department of Surgery, Anaesthesia and Radiology, University of the West Indies, Mona, Kingston, Jamaica
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Indes JE, Dardik A. More questions than answers in 6 cases. JAMA Surg 2013; 148:1067. [PMID: 24068112 DOI: 10.1001/jamasurg.2013.3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffrey E Indes
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut2VA Connecticut Healthcare Systems, West Haven
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De Martino RR, Brooke BS, Robinson W, Schanzer A, Indes JE, Wallaert JB, Nolan BW, Cronenwett JL, Goodney PP. Designation as “Unfit for Open Repair” Is Associated With Poor Outcomes After Endovascular Aortic Aneurysm Repair. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.113.000303] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Randall R. De Martino
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Benjamin S. Brooke
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - William Robinson
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Andres Schanzer
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Jeffrey E. Indes
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Jessica B. Wallaert
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Brian W. Nolan
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Jack L. Cronenwett
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
| | - Philip P. Goodney
- From the Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.R.D.M., B.S.B., J.B.W., B.W.N., J.L.C., P.P.G.); University of Massachusetts Memorial Medical Center, Worcester (W.R., A.S.); and Yale School of Medicine, New Haven, CT (J.E.I.)
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Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, Sosa JA. Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2013; 20:443-55. [DOI: 10.1583/13-4242.1] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [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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Fokkema M, de Borst GJ, Nolan B, Indes JE, Lo RC, Curran T, Buck DB, Moll FL, Schermerhorn ML. Risk of Cranial Nerve Palsy Following Carotid Endarterectomy. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.173] [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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Brown HA, Sullivan MC, Gusberg RG, Dardik A, Sosa JA, Indes JE. Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy. J Vasc Surg 2013; 57:1325-30. [PMID: 23375438 DOI: 10.1016/j.jvs.2012.10.131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/26/2012] [Accepted: 10/27/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Racial disparities in the outcomes of patients undergoing carotid endarterectomy (CEA) have been reported. We sought to examine the contemporary relationship between race and outcomes and to report postdischarge events after CEA. METHODS The American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were reviewed to identify all CEAs performed from 2005 to 2010 by vascular surgeons. The influence of race on outcomes was examined. Multivariate analysis was performed using variables found to be significant on bivariate analysis. The primary outcomes were stroke and mortality. Secondary outcomes were other 30-day complications, including postdischarge events. RESULTS CEA was performed on 29,114 white patients (95.7%) and on 1316 black patients (4.3%); the overall stroke and mortality rates were 1.65% and 0.7%, respectively. The stroke rate was 1.6% for whites and 2.5% blacks (P = .009). The 30-day mortality rate was 0.7% for whites and 1.4% for blacks (P = .002). There was a longer operating time (P < .001) and total length of stay (P < .001), more postoperative pneumonias (P = .049), unplanned intubations (P < .001), ventilator dependence (P < .001), cardiac arrests (P < .001), bleeding requiring transfusions (P = .024), and reoperations within 30 days (P = .021) among black patients. Multivariate logistic regression modeling identified black race as an independent risk factor for 30-day mortality (odds ratio, 1.9; P = .007). Black patients also had a greater proportion of in-hospital deaths than white patients (73.7% vs 43.1%; P = .01). There was no between-group difference in the rate of postdischarge strokes. Thirty-six percent of all strokes occurred after discharge at a mean of 8.3 days, and 54.3% of deaths occurred after discharge at a mean of 11 days. CONCLUSIONS Black race is an independent risk factor for 30-day mortality after CEA. A significant proportion of strokes and deaths occur after discharge in both racial groups evaluated.
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Affiliation(s)
- Hilary A Brown
- Department of Surgery, Yale University School of Medicine, New Haven, Conn 06510, USA
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Abstract
There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery.
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Affiliation(s)
- Jeffrey E Indes
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
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Basco MT, Schlösser FJV, Muhs BE, Indes JE, Blume PA, Key JJ, Aruny JE, Sumpio BE. Lower extremity limb salvage with cryoplasty: a single-center cohort study. Vascular 2012; 20:36-41. [DOI: 10.1258/vasc.2011.oa0309] [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: 11/18/2022]
Abstract
Endovascular techniques have been playing an increasing role in managing lower extremity chronic critical limb ischemia (CLI) in patients considered poor or non-candidates for surgical revascularization secondary to co-morbidities such as coronary artery disease, uncontrolled hypertension, diabetes mellitus or inadequate conduit. This study reviews our recent clinical experience in the treatment of peripheral artery disease solely using cryoplasty. A retrospective cohort study was performed. The cohort consisted of 88 patients who underwent lower extremity revascularization utilizing cryoplasty between December 2003 and August 2007. Indications for intervention included poor wound healing after forefoot amputation or persistent ulceration of the foot, disabling claudication and rest pain. Kaplan–Meier analysis was performed to assess salvage rates. One hundred twenty-six lesions were treated in 88 patients. Technical success rate was 97%. Limb salvage rates were 75 and 63% for patients with critical limbs ischemia after one and three years, respectively. A history of smoking was associated with a threefold increased risk of limb loss. In conclusion, endovascular management of lower extremity lesions with cryoplasty is an emerging and viable paradigm in the treatment of CLI in an attempt to preserve limbs and avoid major amputations.
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Affiliation(s)
- Maria T Basco
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
| | - Felix J V Schlösser
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
| | - Bart E Muhs
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
- Department of Radiology
| | - Jeffrey E Indes
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
| | | | - Jonathan J Key
- Department of Orthopaedics and Rehabilitation, Section of Podiatric Surgery, Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | | | - Bauer E Sumpio
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
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Mandawat A, Mandawat A, Sosa JA, Muhs BE, Indes JE. Endovascular Repair Is Associated With Superior Clinical Outcomes in Patients Transferred for Treatment of Ruptured Abdominal Aortic Aneurysms. J Endovasc Ther 2012; 19:88-95. [DOI: 10.1583/11-3651.1] [Citation(s) in RCA: 17] [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] [Indexed: 10/14/2022]
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Suckow BD, Goodney PP, Cambria RA, Bertges DJ, Eldrup-Jorgensen J, Indes JE, Schanzer A, Stone DH, Kraiss LW, Cronenwett JL. Predicting functional status following amputation after lower extremity bypass. Ann Vasc Surg 2012; 26:67-78. [PMID: 22176876 PMCID: PMC3339378 DOI: 10.1016/j.avsg.2011.07.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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: 02/22/2011] [Revised: 07/15/2011] [Accepted: 07/23/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Some patients who undergo lower extremity bypass (LEB) for critical limb ischemia ultimately require amputation. The functional outcome achieved by these patients after amputation is not well known. Therefore, we sought to characterize the functional outcome of patients who undergo amputation after LEB, and to describe the pre- and perioperative factors associated with independent ambulation at home after lower extremity amputation. METHODS Within a cohort of 3,198 patients who underwent an LEB between January, 2003 and December, 2008, we studied 436 patients who subsequently received an above-knee (AK), below-knee (BK), or minor (forefoot or toe) ipsilateral or contralateral amputation. Our main outcome measure consisted of a "good functional outcome," defined as living at home and ambulating independently. We calculated univariate and multivariate associations among patient characteristics and our main outcome measure, as well as overall survival. RESULTS Of the 436 patients who underwent amputation within the first year following LEB, 224 of 436 (51.4%) had a minor amputation, 105 of 436 (24.1%) had a BK amputation, and 107 of 436 (24.5%) had an AK amputation. The majority of AK (75 of 107, 72.8%) and BK amputations (72 of 105, 70.6%) occurred in the setting of bypass graft thrombosis, whereas nearly all minor amputations (200 of 224, 89.7%) occurred with a patent bypass graft. By life-table analysis at 1 year, we found that the proportion of surviving patients with a good functional outcome varied by the presence and extent of amputation (proportion surviving with good functional outcome = 88% no amputation, 81% minor amputation, 55% BK amputation, and 45% AK amputation, p = 0.001). Among those analyzed at long-term follow-up, survival was slightly lower for those who had a minor amputation when compared with those who did not receive an amputation after LEB (81 vs. 88%, p = 0.02). Survival among major amputation patients did not significantly differ compared with no amputation (BK amputation 87%, p = 0.14, AK amputation 89%, p = 0.27); however, this part of the analysis was limited by its sample size (n = 212). In multivariable analysis, we found that the patients most likely to remain ambulatory and live independently despite undergoing a lower extremity amputation were those living at home preoperatively (hazard ratio [HR]: 6.8, 95% confidence interval [CI]: 0.94-49, p = 0.058) and those with preoperative statin use (HR: 1.6, 95% CI: 1.2-2.1, p = 0.003), whereas the presence of several comorbidities identified patients less likely to achieve a good functional outcome: coronary disease (HR: 0.6, 95% CI: 0.5-0.9, p = 0.003), dialysis (HR: 0.5, 95% CI: 0.3-0.9, p = 0.02), and congestive heart failure (HR: 0.5, 95% CI: 0.3-0.8, p = 0.005). CONCLUSIONS A postoperative amputation at any level impacts functional outcomes following LEB surgery, and the extent of amputation is directly related to the effect on functional outcome. It is possible, based on preoperative patient characteristics, to identify patients undergoing LEB who are most or least likely to achieve good functional outcomes even if a major amputation is ultimately required. These findings may assist in patient education and surgical decision making in patients who are poor candidates for lower extremity bypass.
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Affiliation(s)
- Bjoern D Suckow
- Division of Vascular Surgery, University of Utah Hospital, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Jonker FHW, van Keulen JW, Schlosser FJV, Indes JE, Moll FL, Verhagen HJM, Muhs BE. Thoracic aortic pulsatility decreases during hypovolemic shock: implications for stent-graft sizing. J Endovasc Ther 2011; 18:491-6. [PMID: 21861735 DOI: 10.1583/10-3374.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the thoracic aortic pulsatility during hypovolemic shock in an experimental porcine model. METHODS The circulating blood volume of 7 healthy Yorkshire pigs was gradually lowered until the subjects had lost 40% of their normal blood volume. Intravascular ultrasound was used to assess the aortic pulsatility in normovolemic and hypovolemic state at the level of the ascending and descending thoracic aorta. RESULTS The mean aortic pulsatility at the level of the ascending aorta decreased from 15.9% ± 7.2% (range 6.3%-25.7%) in normovolemia to 6.2% ± 2.8% (range 2.9%-10.7%, p = 0.018) in hypovolemia. At the level of the descending thoracic aorta, the mean aortic pulsatility decreased from 8.7% ± 2.8% (range 4.4%-12.2%) at baseline to 5.6% ± 2.5% (range 1.5%-9.5%, p = 0.028) in hypovolemia. The maximum mean aortic diameter, obtained in cardiac systole, was significantly smaller as well at both evaluated levels during hypovolemic shock compared with the mean diameter in normovolemia. CONCLUSION The thoracic aortic diameter and pulsatility decreased significantly during hypovolemic shock in this porcine model, most impressively at the level of the ascending aorta. Electrocardiographically-gated imaging may not be necessary for hypovolemic patients with acute aortic disease requiring endovascular repair because of the minimal aortic pulsatility.
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Indes JE. Effect of Physician and Hospital Experience on Patient Outcomes for Endovascular Treatment of Aortoiliac Occlusive Disease. ACTA ACUST UNITED AC 2011; 146:966-71. [DOI: 10.1001/archsurg.2011.187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mandawat A, Mandawat A, Sosa JA, Muhs BE, Indes JE. PS52. Superior Short-Term Clinical Outcomes in Patients with Ruptured Abdominal Aortic Aneurysms Transferred for Endovascular Repair. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.091] [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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Gargiulo NJ, O'Connor DJ, Indes JE, Feinberg E, Lipsitz EC, Suggs WD. Is the length of follow-up evaluation in published reports on the treatment of infrainguinal occlusive disease decreasing? Am J Surg 2011; 202:179-83. [PMID: 21601823 DOI: 10.1016/j.amjsurg.2010.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is increasing pressure for the rapid development and implementation of new techniques and procedures. This study examined whether or not there has been a trend toward increasingly short follow-up times for studies evaluating the treatment of lower-extremity occlusive disease. METHODS A search was performed of PubMed using the term "femoropopliteal occlusive disease" from 1976 to 2006. Reports describing the open and/or endovascular treatment of femoropopliteal occlusive disease were classified according to the number of patients, method of treatment, and follow-up time. RESULTS A total of 103 of the 435 reports met the inclusion criteria. Average follow-up times from 1976 to 1986 were a mean of 43.3 months and a median of 38.8 months, from 1986 to 1996 were a mean of 32.4 months and a median of 16.9 months, from 1996 to 2006 were a mean of 22.6 months and a median of 16.5 months. CONCLUSIONS The number of reports on femoropopliteal occlusive disease treatment has increased. The length of follow-up period was 2- to 3-fold longer for reports on open procedures compared with those on endovascular procedures. Whether length of follow-up evaluation and reporting intervals should be standardized warrants further investigation.
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Affiliation(s)
- Nicholas J Gargiulo
- Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Jonker FHW, Mojibian H, Schlösser FJV, Botta DM, Indes JE, Moll FL, Muhs BE. The impact of hypovolaemic shock on the aortic diameter in a porcine model. Eur J Vasc Endovasc Surg 2010; 40:564-71. [PMID: 20727795 DOI: 10.1016/j.ejvs.2010.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 07/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the impact of hypovolaemic shock on the aortic diameter in a porcine model, and to determine the implications for the endovascular management of hypovolaemic patients with traumatic thoracic aortic injury (TTAI). MATERIALS AND METHODS The circulating blood volume of seven Yorkshire pigs was gradually lowered in 10% increments. At 40% volume loss, an endograft was deployed in the descending thoracic aorta, followed by gradual fluid resuscitation. Potential changes in aortic diameter during the experiment were recorded using intravascular ultrasound (IVUS). RESULTS The aortic diameter decreased significantly at all evaluated levels during blood loss. The ascending aortic diameter decreased on average with 38% after 40% blood loss (range 24-62%, p = 0.018), the descending thoracic aorta with 32% (range 18-52%, p = 0.018) and the abdominal aorta with 28% (range 15-39%, p = 0.018). The aortic diameters regained their initial size during fluid resuscitation. CONCLUSION The aortic diameter significantly decreases during blood loss in this porcine model. If these changes take place in hypovolaemic TTAI patients as well, it may have implications for thoracic endovascular aortic repair (TEVAR). Increased oversizing of the endograft, or additional computed tomography (CT) or IVUS imaging after fluid resuscitation for more adequate aortic measurements, may be needed in TTAI patients with considerable blood loss.
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Affiliation(s)
- F H W Jonker
- Section of Vascular Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
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Indes JE, Shah HJ, Jonker FHW, Ohki T, Veith FJ, Lipsitz EC. Subintimal angioplasty is superior to SilverHawk atherectomy for the treatment of occlusive lesions of the lower extremities. J Endovasc Ther 2010; 17:243-50. [PMID: 20426648 DOI: 10.1583/09-2821.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the outcomes of atherectomy versus subintimal angioplasty (SIA) in patients with lower extremity arterial occlusive disease. METHODS From September 2005 through July 2006, 27 patients (17 women; mean age 65 years, range 37-85) underwent atherectomy of 46 lesions (11 TASC C/D occlusions) with the SilverHawk device. Results were compared to 67 patients (34 men; mean age 69 years, range 46-92) undergoing SIA for 67 lower extremity arterial occlusions from July 1999 through June 2004. RESULTS Technical success in the atherectomy cohort was 100%. In the 11 patients with occlusions, symptoms improved in 10 and worsened in 1, but 9 (82.0%) of the 11 patients required reintervention, and 8 (72.7%) patients with occlusive lesions re-occluded. Endovascular reintervention was required to maintain primary patency in only 2 (12.5%) of 16 patients treated for stenotic lesions. At 1 year, the assisted primary patency was 37.7% in the atherectomy group. In the 11 patients with occlusive lesions, the patency rates were 36.8% and 12.3% at 6 and 9 months, respectively, versus 100% and 83.3% at the same time intervals in patients with stenotic lesions. SIA was technically successful in 56 (83.6%) of 67 occlusions. The assisted primary patency and limb salvage rates of the entire group (intention-to-treat) at 12 and 24 months were 59.2% and 45.0%, respectively, while the assisted primary patency of the 56 technically successful SIAs at 12 and 24 months were 70.7% and 53.8%, respectively. Limb salvage for the entire group (intention-to-treat) was 90.6% and 87.9% at 12 and 24 months, respectively. CONCLUSION Atherectomy may yield acceptable primary patency and limb salvage in patients with stenotic lesions. Many of the patients treated for occlusive lesions require reintervention. Based on patency and limb salvage, SIA appears superior to atherectomy for the treatment of lower extremity occlusive disease.
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Affiliation(s)
- Jeffrey E Indes
- Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Indes JE. Commentary: endovascular versus open revascularization for chronic mesenteric ischemia: power in numbers from experienced centers. J Endovasc Ther 2010; 17:554-5. [PMID: 20681775 DOI: 10.1583/09-2935c2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jeffrey E Indes
- Yale University School of Medicine, New Haven, CT 06520 USA.
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Indes JE, Mandawat A, Tuggle CT, Muhs B, Sosa JA. Endovascular procedures for aorto-iliac occlusive disease are associated with superior short-term clinical and economic outcomes compared with open surgery in the inpatient population. J Vasc Surg 2010; 52:1173-9, 1179.e1. [PMID: 20691560 DOI: 10.1016/j.jvs.2010.05.100] [Citation(s) in RCA: 60] [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] [Received: 03/27/2010] [Revised: 05/21/2010] [Accepted: 05/25/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There has been a rapid increase in the number of endovascular procedures performed for peripheral artery disease, and especially aorto-iliac occlusive disease (AIOD). Results from single-center reports suggest a benefit for endovascular procedures; however, these benefits may not reflect general practice. We used a population-based analysis to determine predictors of clinical and economic outcomes following open and endovascular procedures for inpatients with AIOD. METHODS All patients with AIOD who underwent open and endovascular procedures in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2004 to 2007, were identified. Independent patient- and provider-related characteristics were analyzed. Clinical outcomes included complications and mortality; economic outcomes included length of stay (LOS) and cost (2007 dollars). Outcomes were compared using χ2, ANOVA, and multivariate regression analysis. RESULTS Four thousand, one hundred nineteen patients with AIOD were identified. Endovascular procedures increased by 18%. Patients who underwent endovascular procedures were more likely to be ≥65 years of age (46% vs 37%), female (54% vs 49%), and in the highest quartile of household income (20% vs 16%), all P<.05. Endovascular patients were more likely to be non-elective (41% vs 20%), in the highest comorbidity index group (8% vs 5%), and with iliac artery disease (67% vs 33%), all P≤.05. In bivariate analysis, endovascular procedures were associated with lower complication rates (16% vs 25%), shorter LOS (2.2 vs 5.8 days), and lower hospital costs ($13,661 vs $17,161), all P<.001. In multivariate analysis, endovascular procedures had significantly lower complication rates and cost, and shorter LOS. CONCLUSIONS Endovascular procedures have superior short-term clinical and economic outcomes compared with open procedures for the treatment of AIOD in the inpatient setting. Further studies are needed to examine long-term outcomes and access-related issues.
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Affiliation(s)
- Jeffrey E Indes
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA.
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Indes JE, Tuggle CT, Mandawat A, Sosa JA. Age-stratified outcomes in elderly patients undergoing open and endovascular procedures for aortoiliac occlusive disease. Surgery 2010; 148:420-8. [DOI: 10.1016/j.surg.2010.05.008] [Citation(s) in RCA: 10] [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: 01/09/2010] [Accepted: 05/14/2010] [Indexed: 11/16/2022]
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Tuggle CT, Sosa JA, Mandawat A, Indes JE. RR27. Effect of Physician and Hospital Experience on Patient Outcomes for Endovascular Treatment of Aortoiliac Occlusive Disease. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.02.245] [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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Jonker FH, Schlosser FJ, Indes JE, Sumpio BE, Botta DM, Moll FL, Muhs BE. Management of Type A Aortic Dissections: A Meta-Analysis of the Literature. Ann Thorac Surg 2010; 89:2061-6. [DOI: 10.1016/j.athoracsur.2009.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 10/29/2009] [Accepted: 11/03/2009] [Indexed: 10/19/2022]
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Jonker FH, Indes JE, Moll FL, Muhs BE. Management of Iatrogenic Injuries of the Supra-aortic Arteries. J Cardiothorac Vasc Anesth 2010; 24:322-9. [DOI: 10.1053/j.jvca.2009.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Indexed: 11/11/2022]
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Jonker FH, Giacovelli JK, Muhs BE, Sosa JA, Indes JE. Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury. J Vasc Surg 2010; 51:565-71. [DOI: 10.1016/j.jvs.2009.10.046] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 09/18/2009] [Accepted: 10/03/2009] [Indexed: 11/16/2022]
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Jonker FHW, Schlösser FJV, Dewan M, Huddle M, Sergi M, Indes JE, Dardik A, Muhs BE. Abdominal aortic aneurysm repair in obese patients: improved outcome after endovascular treatment compared with open surgery. Vasc Endovascular Surg 2009; 44:105-9. [PMID: 20034936 DOI: 10.1177/1538574409351989] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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
PURPOSE To investigate outcomes in obese patients with abdominal aortic aneurysm (AAA) treated with elective open or endovascular repair (EVAR). STUDY DESIGN We compared the outcomes of obese patients with AAA treated with elective open repair and EVAR. Obesity was defined as a body mass index (BMI) > or =30 kg/m( 2). RESULTS A total of 56 patients with a BMI > or =30 kg/m(2) were identified for analysis (mean age 70 +/- 8 years; mean BMI 34 +/- 4 kg/m(2), and 95% [n = 53] were male). Open surgery was performed in 55% (n = 31). The in-hospital complication rate (including nonsurvivors) was significantly increased after open repair compared with EVAR (26% vs 4%, P = .033). Mortality did not differ significantly during 3 years of follow-up (P = .816). Length of stay, intensive care unit (ICU) stay, and need for ventilation were significantly increased after open surgery compared with EVAR. CONCLUSIONS We observed improved short-term outcomes among obese AAA patients after EVAR compared to open repair. Endovascular repair may be preferable in obese patients with AAA.
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Affiliation(s)
- Frederik H W Jonker
- Department of Surgery and Radiology, Sections of Vascular Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, Connecticut, VA Connecticut Healthcare System, West Haven, CT, USA
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Jonker FHW, Schlösser FJV, Moll FL, van Herwaarden JA, Indes JE, Verhagen HJM, Muhs BE. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther 2009; 16:428-40. [PMID: 19702348 DOI: 10.1583/09-2741r.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). METHODS The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63+/-1.5 years) with ABF (n = 71) or AEF (n = 43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. RESULTS Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p = 0.012) and systemic infection (36% versus 9%, p<0.001) compared to patients with ABF. In-hospital mortality was 3% (n = 2) after TEVAR for ABF and 19% (n = 8) after TEVAR for AEF (p = 0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n = 2) of ABF patients and in 37% (n = 16) of AEF patients (p<0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p = 0.018). CONCLUSION TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.
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Affiliation(s)
- Frederik H W Jonker
- Department of Surgery and Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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Indes JE, Giacovelli JK, Muhs BE, Sosa JA, Dardik A. Outcomes of endovascular and open treatment for chronic mesenteric ischemia. J Endovasc Ther 2009; 16:624-30. [PMID: 19842733 DOI: 10.1583/09-2797.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To measure contemporary practice patterns and compare outcomes of open and endovascular repair for chronic mesenteric ischemia (CMI). METHODS The New York State Health Department Statewide Planning and Research Cooperative System database was queried for the ICD-9-CM codes for CMI for the years 2000 to 2006. In this time period, 6549 patients were evaluated for CMI in New York State. Of these patients, 666 received an intervention and underwent either open (n = 280) or endovascular (n = 347) repair; 39 patients underwent both treatments and were excluded. Trends in operative management and short-term outcomes were analyzed. RESULTS Over the 7-year study period, there was a steady increase in the number of endovascular procedures from 28% in 2000 to 75% in 2006. The overall mortality rate for the 7-year period was significantly lower for endovascular versus open repair (11.0% versus 20.4%, respectively; p = 0.0011). Endovascular repair was associated with a significantly lower rate of mesenteric ischemic complications compared to open repair (6.92% versus 17.1%, respectively; p<0.0001). Moreover, compared with open surgery, endovascular repair resulted in significantly lower rates of cardiac, pulmonary, and infectious complications (p<0.05). Only 37% of patients having open repair were discharged home compared to 55% of patients treated with endovascular procedures (p<0.0001). CONCLUSION The number of patients treated for CMI continues to increase and correlates with the increasing utilization of endovascular procedures. The patients undergoing endovascular treatment had fewer complications, lower in-hospital mortality, and a greater likelihood of being discharged home.
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Affiliation(s)
- Jeffrey E Indes
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Indes JE, Lipsitz EC, Veith FJ, Gargiulo NJ, Privrat AI, Eisdorfer J, Scher LA. Incidence and significance of nonaneurysmal-related computed tomography scan findings in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg 2008; 48:286-90. [PMID: 18572355 DOI: 10.1016/j.jvs.2008.03.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/24/2008] [Accepted: 03/31/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined the frequency and nature of incidental findings seen on computed tomography (CT) scans during preoperative and postoperative follow-up in patients undergoing endovascular aortic aneurysm repair (EVAR). METHODS Between January 1, 2000, and March 1, 2006, 176 consecutive patients who underwent EVAR at our institution were retrospectively reviewed. Patients were included in the study if all preoperative and postoperative surveillance CT scans were performed at our institution. Eighty-two patients, 26 women (32%) and 56 men (68%), met this criterion. Their mean age was 76 years (range, 51-103 years). Official CT scan reports were reviewed. Findings were considered primary incidental if they were noted on preoperative CT scans and secondary incidental if they appeared on surveillance CT scans but not on the preoperative study. Primary and secondary incidental findings were considered either benign (eg, gallstones, diverticulosis) or clinically significant if they warranted further workup (eg, suspicious masses or changes suggestive of malignancy, internal or diaphragmatic hernias, and diverticulitis). The median follow-up was 29 months (range, 3-60 months). Each incidental finding was counted only once, on the first scan in which it appeared. RESULTS Of the 82 patients, 73 (89%) had at least one primary incidental finding, and 14 (19%) of these were clinically significant. Secondary incidental findings, many of which were clinically significant, continued to appear throughout the follow-up period. The most common clinically significant primary incidental finding was the presence of a lung mass (n = 4). The most common clinically significant secondary incidental findings were lung mass (n = 6), liver mass (n = 6), and pancreas mass (n = 3). There was a significant difference in the proportion of men to women in the group with clinically significant incidental findings vs the group without clinically significant incidental findings (P = .03959). Differences between the groups with respect to age or aneurysm size were not significant. CONCLUSION CT scans yielded surprisingly large numbers of both primary and secondary incidental findings, many of which were clinically significant. Primary incidental findings were more common than secondary incidental findings; however, clinically significant findings were found at a consistent rate throughout the study period.
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Affiliation(s)
- Jeffrey E Indes
- Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Fraser JK, Guerra JJ, Nguyen CY, Indes JE, Gasson JC, Nimer SD. Characterization of a cell-type-restricted negative regulatory activity of the human granulocyte-macrophage colony-stimulating factor gene. Mol Cell Biol 1994; 14:2213-21. [PMID: 8114751 PMCID: PMC358581 DOI: 10.1128/mcb.14.3.2213-2221.1994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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] [Indexed: 01/28/2023] Open
Abstract
Human granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates the proliferation and maturation of normal myeloid progenitor cells and can also stimulate the growth of acute myelogenous leukemia (AML) blasts. GM-CSF is not normally produced by resting cells but is expressed by a variety of activated cells including T lymphocytes, macrophages, and certain cytokine-stimulated fibroblasts and endothelial cells. Production of GM-CSF by cultured AML cells has been demonstrated, and GM-CSF expression by normal myeloid progenitors has been postulated to play a role in myelopoiesis. We have investigated the regulation of expression of GM-CSF in AML cell lines, and our results demonstrate the presence of a strong constitutive promoter element contained within 53 bp upstream of the cap site. We have also identified a negative regulatory element located immediately upstream of the positive regulatory element (within 69 bp of the cap site) that is active in AML cell lines but not T cells or K562 CML cells. Competition transfection and mobility shift studies demonstrate that this activity correlates with binding of a 45-kDa protein.
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Affiliation(s)
- J K Fraser
- Department of Medicine, UCLA School of Medicine 90024
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