1
|
Forman J, Ricotta JJ, Ricotta JJ. "TCAR or nothing": the only options for some complex carotid stenosis. J Vasc Surg Cases Innov Tech 2024; 10:101404. [PMID: 38357654 PMCID: PMC10864852 DOI: 10.1016/j.jvscit.2023.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/16/2023] [Indexed: 02/16/2024] Open
Abstract
Transcervical carotid artery revascularization has emerged as an alternative to carotid endarterectomy and transfemoral carotid artery stenting. We present four cases for which we believe transcervical carotid artery revascularization was the only option to treat the lesions. Each case presented with specific technical challenges that were overcome by intraoperative planning that allowed for safe deployment of the Enroute stent (Silk Road Medical) with resolution of each patient's stenosis.
Collapse
Affiliation(s)
- Jake Forman
- Department of Vascular Surgery, Florida Atlantic University Charles E. Schmidt School of Medicine, Boca Raton, FL
| | - John J. Ricotta
- Department of Vascular Surgery, Florida Atlantic University Charles E. Schmidt School of Medicine, Boca Raton, FL
| | - Joseph J. Ricotta
- Department of Vascular Surgery, Florida Atlantic University Charles E. Schmidt School of Medicine, Boca Raton, FL
| |
Collapse
|
2
|
Rodriguez S, Pomy BJ, Mangipudi S, Sidawy AN, Ricotta JJ, Nguyen BN, Lala S, Macsata R. Single-Institution Learning Curve for Management of Mega-Fistulae Revision. Ann Vasc Surg 2021; 80:130-135. [PMID: 34748944 DOI: 10.1016/j.avsg.2021.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/01/2022]
Abstract
Mega-fistulae are generalized aneurysmal dilations of a high flow (1500-4000 mL/min) autogenous arteriovenous (AV) access which may result in hemorrhage and/or high-output cardiac failure. Current treatment options for mega-fistula include ligation with and without prosthetic jump graft, aneurysmorrhaphy, aneurysmectomy with vein transposition, and imbrication. These options may not be suitable for advanced disease; may leave the patient without working AV access, poor cosmetic results, and possible recurrence. We describe our early experience with a technique of complete mega-fistula resection and replacement with an early use prosthetic graft that both maintains existing AV access and eliminates the need for long-term catheter placement; including lessons learned.
Collapse
Affiliation(s)
- Stephanie Rodriguez
- George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Benjamin J Pomy
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Sowmya Mangipudi
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anton N Sidawy
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - John J Ricotta
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Bao-Ngoc Nguyen
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Salim Lala
- George Washington University Hospital, Department of Surgery, Washington, DC
| | - Robyn Macsata
- George Washington University Hospital, Department of Surgery, Washington, DC
| |
Collapse
|
3
|
Pomy BJ, Devlin J, Lala S, Amdur RL, Ricotta JJ, Sidawy AN, Nguyen BN, Macsata RA. Comparison of contemporary and historical outcomes of elective and ruptured open abdominal aortic aneurysm repair. J Vasc Surg 2021; 75:543-551. [PMID: 34555478 DOI: 10.1016/j.jvs.2021.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recently, open abdominal aortic aneurysm (AAA) repair (OSR) has become less common and will often be reserved for patients with more complex aortic anatomy. Despite improvements in patient management, the reduced surgical volume has raised concerns for potentially worsened outcomes in the contemporary era (2014-2019) compared with an earlier era in which OSR was more widely practiced (2005-2010). In the present study, we compared the 30-day outcomes of open AAA repair between these two eras. METHODS The American College of Surgeons National Quality Improvement Program general database was queried for open AAA repair using the Current Procedural Terminology and International Classification of Diseases, 9th and 10th, codes. The cases were stratified into two groups by operation year: 2005 to 2010 (early) and 2014 to 2019 (contemporary). In each era, the cases were further divided into elective and ruptured groups. The 30-day outcomes, including mortality, major morbidity, postoperative sepsis, and unplanned reoperation, were compared between the contemporary and early eras in the elective and ruptured groups. Preoperative variables with a P value <.25 were adjusted for in the multivariate analysis. RESULTS In the contemporary and early eras, 3749 and 3798 patients had undergone elective OSR and 1148 and 907 had undergone ruptured OSR, respectively. These samples were of similar sizes owing to the National Quality Improvement Program sampling process and our relatively strict inclusion criteria. In the contemporary era, fewer patients were elderly and fewer were smokers or had hypertension or dyspnea in the elective and rupture cohorts. More patients had had American Society of Anesthesiologists class >3 in the elective contemporary era (39% vs 24%; P < .0001). The contemporary elective repair group demonstrated increased 30-day mortality (3.7% vs 3.2%; adjusted odds ratio [aOR], 1.36; P = .006), major adverse cardiac events (5.7% vs 3.4%; aOR, 1.87; P < .0001), and bleeding requiring transfusion (58.5% vs 13.7%; aOR, 8.96; P < .0001). The incidence of pulmonary complications (12.1% vs 15.2%; aOR, 0.80; P = .02) and sepsis (3.7% vs 8.4%; aOR, 0.47; P < .0001) had decreased in the contemporary era, with a similar rate of unplanned reoperations (8.4% vs 7.7%; aOR, 1.16; P = .09). The incidence of renal complications in the contemporary era had increased, with a statistically significant difference. However, the absolute increase of <0.5% was likely not clinically relevant (5.5% vs 5.1%; aOR, 1.23; P = .049). In the ruptured cohort, contemporary repair was associated with increased 30-day mortality (41.4% vs 40%; aOR, 1.53; P < .0001), major adverse cardiac events (25.8% vs 12.8%; aOR, 2.49; P < .0001), and bleeding requiring transfusion (88.2% vs 27%; aOR, 23.03; P < .0001). The incidence of pulmonary complications (36.9% vs 48.1%; aOR, 0.67; P < .0001), sepsis (14.6% vs 23%; aOR, 0.75; P = .03), and unplanned reoperations (18.1% vs 22.7%; aOR, 0.74; P = .008) had decreased in the contemporary OSR group. No differences were detected in the incidence of renal complications. CONCLUSIONS The 30-day mortality has worsened after open AAA repair in the elective and rupture settings despite the improvements in perioperative management over the years. These complications likely stem from increased bleeding events and major cardiac events, which were increased in the contemporary era.
Collapse
Affiliation(s)
- Benjamin J Pomy
- Department of Surgery, The George Washington University, Washington, D.C..
| | - Joseph Devlin
- Department of Surgery, The George Washington University, Washington, D.C
| | - Salim Lala
- Department of Surgery, The George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, The George Washington University, Washington, D.C
| | - John J Ricotta
- Department of Surgery, The George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, The George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University, Washington, D.C
| | - Robyn A Macsata
- Department of Surgery, The George Washington University, Washington, D.C
| |
Collapse
|
4
|
Pomy BJ, Rosenfeld ES, Lala S, Lee KB, Sparks AD, Amdur RL, Ricotta JJ, Sidawy AN, Macsata RA, Nguyen BN. Fenestrated Endovascular Aneurysm Repair Affords Fewer Renal Complications than Open Surgical Repair for Juxtarenal Abdominal Aortic Aneurysms in Patients with Chronic Renal Insufficiency. Ann Vasc Surg 2021; 75:349-357. [PMID: 33831525 DOI: 10.1016/j.avsg.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/12/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although fenestrated endovascular aneurysm repair (FEVAR) has been associated with lower morbidity and mortality than open surgical repair (OSR) in juxtarenal aneurysms (JAAA), there is a paucity of data in the literature comparing outcomes of the approaches specifically in patients with chronic renal insufficiency (CRI). We hypothesized that benefits of FEVAR over OSR observed in the general patient population may be diminished in CRI patients due to their heightened vulnerability to renal dysfunction stemming from contrast-induced nephropathy. This study compares 30-day outcomes between FEVAR and OSR for JAAA in patients with non-dialysis dependent CRI. METHODS All adults with estimated glomerular filtration rate (eGFR) < 60 mL/min (but not requiring dialysis) undergoing elective, non-ruptured JAAA repairs were identified in the American College of Surgeons - National Surgical Quality Improvement (ACS-NSQIP) Targeted EVAR and AAA databases from 2012-2018. JAAA were identified by recorded proximal aneurysm extent. FEVAR patients were identified in the Targeted EVAR database as those receiving the "Cook Zenith Fenestrated" endograft. OSR cases were defined as those that required proximal clamp positions "above one renal" or "between SMA & renals." Infra-renal or supra-celiac proximal clamp placement, or cases involving concomitant renal/visceral revascularization were excluded. Thirty-day outcomes including mortality, major adverse cardiovascular events (MACE), pulmonary, and renal complications were compared between FEVAR and OSR groups. RESULTS There were 284 patients with CRI who underwent elective repair of JAAA (FEVAR: 89; OSR: 195). FEVAR patients were significantly older than those undergoing OSR (77.3±7.2 vs. 74.2±7.7, P=0.001) and less likely to be smokers (25.8% vs 42.1%; P = 0.009). Other baseline demographic and pre-operative parameters were comparable between the two groups.Multivariable analysis revealed no significant difference between FEVAR and OSR in 30-day mortality (4.5% vs 4.6%; OR=1.22; 95% CI=0.35 - 4.22; P=0.753) or unplanned re-operation (4.5% vs 5.1%; OR=0.78; 95% CI=0.22 - 2.70; P=0.693). Patients undergoing FEVAR had significantly fewer pulmonary complications (3.4% vs 18.5%; OR=0.12; 95% CI=0.03 - 0.42; P<0.001) and renal dysfunction (3.4% vs 11.8%; OR 0.24 95% CI=0.07 - 0.86; P=0.029) compared to OSR. FEVAR was also associated with significantly shorter ICU and hospital lengths of stay (ICU stay: 0 days vs 3 days, P<0.0001; hospital stay: 3 days vs 8 days, P<0.0001). CONCLUSION For patients with chronic renal insufficiency, FEVAR offered improved perioperative renal morbidity compared to OSR without a corresponding mortality benefit. Future studies will be required to determine long term outcomes of this procedure in this vulnerable population.
Collapse
Affiliation(s)
- Benjamin J Pomy
- The George Washington University Department of Surgery, Washington, District of Columbia.
| | - Ethan S Rosenfeld
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Salim Lala
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - K Benjamin Lee
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Andrew D Sparks
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Richard L Amdur
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - John J Ricotta
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Anton N Sidawy
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Robyn A Macsata
- The George Washington University Department of Surgery, Washington, District of Columbia
| | - Bao-Ngoc Nguyen
- The George Washington University Department of Surgery, Washington, District of Columbia
| |
Collapse
|
5
|
Lee KB, Macsata RA, Lala S, Sparks AD, Amdur RL, Ricotta JJ, Sidawy AN, Nguyen BN. Outcomes of open and endovascular interventions in patients with chronic limb threatening ischemia. Vascular 2020; 29:693-703. [PMID: 33190618 DOI: 10.1177/1708538120971972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Widespread adoption of endovascular therapy for the treatment of chronic limb-threatening ischemia has transformed the field of vascular surgery. In this modern era, we aimed to define where open surgical interventions are of greatest benefit for limb salvage. METHODS Patients who underwent interventions for chronic limb-threatening ischemia were identified in the vascular-targeted lower extremity National Surgical Quality Improvement Program database for open surgical interventions (OPEN) and endovascular surgical interventions (ENDO) from 2011 to 2017. Patients were further stratified based on the criteria of chronic limb-threatening ischemia (rest pain or tissue loss), and the location of the diseased arteries (femoropopliteal or tibioperoneal). The main outcomes measured included 30-day mortality, amputation, and major adverse cardiovascular events. RESULTS A total of 17,193 patients were revascularized for chronic limb-threatening ischemia: 10,532 were OPEN and 6661 were ENDO. OPEN had higher 30-day mortality, major adverse cardiovascular events, pulmonary, renal dysfunction, and wound complications. However, OPEN resulted in significantly lower 30-day major amputation (3.8% vs. 5.0%, odds ratio (OR): 0.83 [0.72-0.97], P = .018). Subgroup analysis revealed a higher mortality rate in OPEN was observed only in tibioperoneal intervention for tissue loss. Major adverse cardiovascular event was higher in OPEN for most subgroups. OPEN for patients with tissue loss had significantly lower amputation rate than ENDO in both femoropopliteal and tibioperoneal subgroups (3.7% vs. 5.1%, OR: 0.76 [0.59-0.98], P = .036, and 4.7% vs. 6.6%, OR: 0.74 [0.57-0.96], P = .024, respectively). The benefit of open surgery in reducing the amputation rate was not seen in patients with rest pain. CONCLUSIONS Open surgical intervention is associated with significantly better limb salvage than endovascular intervention in patients with tissue loss. Surgical options should be given more emphasis as the first-line option in this cohort of patients unless the cardiopulmonary risk is prohibitive.
Collapse
Affiliation(s)
- K Benjamin Lee
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Robyn A Macsata
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Salim Lala
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Andrew D Sparks
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, DC, USA
| | - John J Ricotta
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University, Washington, DC, USA
| |
Collapse
|
6
|
Rosenfeld ES, Macsata RA, Lala S, Lee KB, Pomy BJ, Ricotta JJ, Sparks AD, Amdur RL, Sidawy AN, Nguyen BN. Open surgical repair of juxtarenal abdominal aortic aneurysms in the elderly is not associated with increased thirty-day mortality compared with fenestrated endovascular grafting. J Vasc Surg 2020; 73:1139-1147. [PMID: 32919026 DOI: 10.1016/j.jvs.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endovascular repair of juxtarenal abdominal aortic aneurysms (JAAAs) with fenestrated grafts (fenestrated endovascular aneurysm repair [FEVAR]) has been reported to decrease operative mortality and morbidity compared with open surgical repair (OSR). However, previous comparisons of OSR and FEVAR have not necessarily included patients with comparable clinical profiles and aneurysm extent. Although FEVAR has often been chosen as the first-line therapy for high-risk patients such as the elderly, many patients will not have anatomy favorable for FEVAR. At present, a paucity of data has examined the operative outcomes of OSR in elderly patients for JAAAs relative to FEVAR. Therefore, we chose to perform a propensity-matched comparison of OSR and FEVAR for JAAA repair in patients aged ≥70 years. METHODS Patients aged ≥70 years who had undergone elective nonruptured JAAA repairs from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted endovascular aneurysm repair (EVAR) and AAA databases. Patients who had undergone FEVAR were identified in the targeted EVAR database as those who had received the Cook Zenith Fenestrated endograft (Cook Medical, Bloomington, Ind). Because our study specifically examined JAAAs, those patients who had undergone OSR with supraceliac proximal clamping or concomitant renal/visceral revascularization were excluded. A 1:1 propensity-match algorithm matched the OSR and FEVAR patients by preoperative clinical and demographic characteristics, operative indications, and aneurysm extent. The 30-day outcomes, including mortality, major adverse cardiovascular events, and pulmonary and renal complications, were compared between the propensity-matched OSR and FEVAR groups. RESULTS A 1:1 propensity match was achieved, and the final analysis included 136 OSR patients and 136 FEVAR patients. No significant differences were found in 30-day mortality (4.4% vs 3.7%; odds ratio [OR], 1.21; 95% confidence interval [CI], 0.36-4.06; P = .759) between the OSR and FEVAR groups. OSR was associated with a higher incidence of major adverse cardiovascular events compared with FEVAR; however, the trend was not statistically significant (8.1% vs 3.7%; OR, 2.31; 95% CI, 0.78-6.82; P = .131). Compared with FEVAR, the OSR group had significantly greater rates of pulmonary complications (19.1% vs 3.7%; OR, 6.19; 95% CI, 2.30-16.67; P < .001) and renal complications (8.1% vs 2.2%; OR, 3.90; 95% CI, 1.06-14.31; P = .040). CONCLUSIONS In the samples assessed in the present study, the results with OSR of JAAAs in the elderly did not differ from those of FEVAR with respect to 30-day mortality despite a greater incidence of pulmonary and renal complications. Although FEVAR should remain the first-line therapy for JAAAs in elderly patients, OSR might be an acceptable alternative for select patients with anatomy unfavorable for FEVAR.
Collapse
Affiliation(s)
- Ethan S Rosenfeld
- Department of Surgery, The George Washington University, Washington, D.C..
| | - Robyn A Macsata
- Department of Surgery, The George Washington University, Washington, D.C
| | - Salim Lala
- Department of Surgery, The George Washington University, Washington, D.C
| | - K Benjamin Lee
- Department of Surgery, The George Washington University, Washington, D.C
| | - Benjamin J Pomy
- Department of Surgery, The George Washington University, Washington, D.C
| | - John J Ricotta
- Department of Surgery, The George Washington University, Washington, D.C
| | - Andrew D Sparks
- Department of Surgery, The George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, The George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, The George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University, Washington, D.C
| |
Collapse
|
7
|
Rosenfeld ES, Macsata RA, Nguyen BN, Lala S, Ricotta JJ, Pomy BJ, Lee KB, Sparks AD, Amdur RL, Sidawy AN. Thirty-day outcomes of open abdominal aortic aneurysm repair by proximal clamp level in patients with normal and impaired renal function. J Vasc Surg 2020; 73:1234-1244.e1. [PMID: 32890718 DOI: 10.1016/j.jvs.2020.08.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/04/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) has often been reserved in contemporary practice for complex aneurysms requiring a suprarenal or supraceliac proximal clamp level. The present study investigated the associated 30-day outcomes of different proximal clamp levels in OSR of complex infrarenal/juxtarenal AAA in patients with normal renal function and those with chronic renal insufficiency (CRI). METHODS All patients undergoing elective OSR of infrarenal and juxtarenal AAA were identified in the American College of Surgeons National Surgical Quality Improvement Program-targeted AAA database from 2012 to 2018. The patients were stratified into two cohorts (normal renal function [estimated glomerular filtration rate, ≥60 mL/min] and CRI [estimated glomerular filtration rate, <60 mL/min and no dialysis]) before further substratification into groups by the proximal clamp level (infrarenal, inter-renal, suprarenal, and supraceliac). The 30-day outcomes, including mortality, renal and pulmonary complications, and major adverse cardiovascular event rates, were compared within each renal function cohort between proximal clamp level groups using the infrarenal clamp group as the reference. Supraceliac clamping was also compared with suprarenal clamping. RESULTS A total of 1284 patients with normal renal function and 524 with CRI were included in the present study. The proximal clamp levels for the 1808 patients were infrarenal for 1080 (59.7%), inter-renal for 337 (18.6%), suprarenal for 279 (15.4%), and supraceliac for 112 (6.2%). In the normal renal function cohort, no difference was found in 30-day mortality with any clamp level. Increased 30-day acute renal failure was only observed in the supraceliac vs infrarenal clamp level comparison (5.9% vs 1.5%; adjusted odds ratio [aOR], 3.97; 95% confidence interval [CI], 1.04-5.18; P = .044). In the CRI cohort, supraceliac clamping was associated with an increased rate of renal composite complications (22.7% vs 5.6%; aOR, 8.81; 95% CI, 3.17-24.46; P < .001) and ischemic colitis (13.6% vs 3.0%; aOR, 4.78; 95% CI, 1.38-16.62; P = .014) compared with infrarenal clamping and greater 30-day mortality (13.6% vs 2.4%; aOR, 6.00; 95% CI, 1.14-31.55; P = .034) and renal composite complications (22.7% vs 10.8%; aOR, 2.87; 95% CI, 1.02-8.13; P = .047) compared with suprarenal clamping. Suprarenal clamping was associated with greater renal dysfunction (10.8% vs 5.6%; aOR, 2.77; 95% CI, 1.08-7.13; P = .035) compared with infrarenal clamping, with no differences in mortality. No differences were found in 30-day mortality or morbidity for inter-renal clamping compared with infrarenal clamping in either cohort. No differences were found in major adverse cardiovascular events with higher clamp levels in either cohort. CONCLUSIONS In elective OSR of infrarenal and juxtarenal AAAs for patients with CRI, this study found a heightened mortality risk with supraceliac clamping and increased renal morbidity with suprarenal clamping, though these effects were not present for patients with normal renal function. Every effort should be made to keep the proximal clamp level as low as possible, especially in patients with CRI.
Collapse
Affiliation(s)
- Ethan S Rosenfeld
- Department of Surgery, The George Washington University, Washington, D.C..
| | - Robyn A Macsata
- Department of Surgery, The George Washington University, Washington, D.C
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University, Washington, D.C
| | - Salim Lala
- Department of Surgery, The George Washington University, Washington, D.C
| | - John J Ricotta
- Department of Surgery, The George Washington University, Washington, D.C
| | - Benjamin J Pomy
- Department of Surgery, The George Washington University, Washington, D.C
| | - K Benjamin Lee
- Department of Surgery, The George Washington University, Washington, D.C
| | - Andrew D Sparks
- Department of Surgery, The George Washington University, Washington, D.C
| | - Richard L Amdur
- Department of Surgery, The George Washington University, Washington, D.C
| | - Anton N Sidawy
- Department of Surgery, The George Washington University, Washington, D.C
| |
Collapse
|
8
|
Lee KB, Chaudhry S, Lala S, Ricotta JJ, Sidawy AN, Amdur RL, Macsata RA, Nguyen BN. Failed Prior Endovascular Interventions Do Not Affect 30-day Cardiovascular or Limb-related Outcomes of Infrainguinal Bypasses for Chronic Limb Threatening Ischemia. Ann Vasc Surg 2020; 71:315-320. [PMID: 32768547 DOI: 10.1016/j.avsg.2020.07.028] [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: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is often hypothesized that failed prior endovascular intervention could adversely affect the outcome of subsequent infrainguinal bypass in the corresponding limb. However, this perception is not well supported in the literature because of conflicting data. The aim of this study is to address this controversial issue via analysis of a multicenter prospectively collected database. METHODS Patients who underwent infrainguinal bypass for chronic limb threatening ischemia (CLTI) were identified in the targeted American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2017. These patients were stratified into 4 groups: first time femoral-popliteal bypass, femoral-popliteal bypass after failed prior endovascular revascularization, first time femoral-tibial bypass, and femoral-tibial bypass after failed prior endovascular revascularization. Thirty-day outcomes including mortality, graft patency, major amputations, and major organ dysfunction were measured. RESULTS We identified 7,044 patients who underwent surgical bypasses for CLTI. Patients were mostly well matched among the 4 groups except for differences in sex, hypertension, and preoperative renal function. In terms of major adverse cardiovascular events and major adverse limb events, femoral-popliteal or femoral-tibial bypasses after failed prior endovascular intervention had comparable 30-day outcomes to first-time bypasses. However, patients with failed prior endovascular intervention had increased rates of postoperative wound infection, required significantly more blood transfusions, and had longer operative time. CONCLUSIONS Failed prior endovascular intervention does not adversely affect 30-day outcomes of subsequent infrainguinal bypass surgery in mortality, limb salvage, or other major cardiovascular complications.
Collapse
Affiliation(s)
- K Benjamin Lee
- Department of Surgery, George Washington University, Washington, DC.
| | | | - Salim Lala
- Department of Surgery, George Washington University, Washington, DC
| | - John J Ricotta
- Department of Surgery, George Washington University, Washington, DC
| | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, DC
| | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, DC
| | - Robyn A Macsata
- Department of Surgery, George Washington University, Washington, DC
| | - Bao-Ngoc Nguyen
- Department of Surgery, George Washington University, Washington, DC
| |
Collapse
|
9
|
Rosenfeld ES, Nguyen BNH, Lee KB, Lala S, Ricotta JJ, Sparks AD, Amdur RL, Sidawy AN, Macsata RA. Effect of Proximal Clamp Position on the Outcomes of Open Abdominal Aortic Aneurysm Repair in Patients with Chronic Renal Insufficiency. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Chaudhry SA, Macsata RA, Ricotta JJ, Sparks AD, Lee KB, Rosenfeld ES, Lala S, Amdur RL, Sidawy AN, Nguyen BNH. Comparison of Contemporary and Earlier Outcomes of Endovascular and Open Repair for Elective, Symptomatic, and Ruptured Abdominal Aortic Aneurysms. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.711] [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]
|
11
|
Lee KB, Rosenfeld ES, Macsata RA, Lala S, Ricotta JJ, Sparks AD, Amdur RL, Sidawy AN, H Nguyen BN. Retroperitoneal Approach Is Associated with Lower Mortality Than Transperitoneal Approach in Emergent/Non-Ruptured Open Abdominal Aortic Aneurysm Repair. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1319] [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]
|
12
|
Lee KB, Lu J, Macsata RA, Patel D, Yang A, Ricotta JJ, Amdur RL, Sidawy AN, Nguyen BN. Inferior mesenteric artery replantation does not decrease the risk of ischemic colitis after open infrarenal abdominal aortic aneurysm repair. J Vasc Surg 2018; 69:1825-1830. [PMID: 30591291 DOI: 10.1016/j.jvs.2018.09.046] [Citation(s) in RCA: 13] [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: 06/21/2018] [Accepted: 09/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ischemic colitis after an open abdominal aortic aneurysm (AAA) repair remains a serious complication with a nationally reported rate of 1% to 6% in elective cases and up to 60% after an aneurysmal rupture. To prevent this serious complication, inferior mesenteric artery (IMA) replantation is performed at the discretion of the surgeon based on his or her intraoperative findings, despite the lack of clear evidence to support this practice. The purpose of this study was to determine whether replantation of the IMA reduces the risk of ischemic colitis and improves the overall outcome of AAA repair. METHODS Patients who underwent open infrarenal AAA repair were identified in the multicenter American College of Surgeons National Surgical Quality Improvement Program Targeted AAA Database from 2012 to 2015. Emergency cases, patients with chronically occluded IMAs, ruptured aneurysms with evidence of hypotension, and patients requiring visceral revascularization were excluded. The remaining elective cases were divided into two groups: those with IMA replantation (IMA-R) and those with IMA ligation. We measured the 30-day outcomes including mortality, morbidity, and perioperative outcomes. A multivariable logistic regression model was used for data analysis, adjusting for clinically relevant covariates. RESULTS We identified 2397 patients who underwent AAA repair between 2012 and 2015, of which 135 patients (5.6%) had ischemic colitis. After applying the appropriate exclusion criteria, there were 672 patients who were included in our study. This cohort was divided into two groups: 35 patients with IMA-R and 637 patients with IMA ligation. There were no major differences in preoperative comorbidities between the two groups. IMA-R was associated with increased mean operative time (319.7 ± 117.8 minutes vs 242.4 ± 109.3 minutes; P < .001). Examination of 30-day outcomes revealed patients with IMA-R had a higher rate of return to the operating room (20.0% vs 7.2%; P = .006), a higher rate of wound complications (17.1% vs 3.0%; P = .001), and a higher incidence of ischemic colitis (8.6% vs 2.4%; P = .027). There were no significant differences in mortality, pulmonary complications, or renal complications between the two groups. In multivariable analysis, IMA-R was a significant predictor of ischemic colitis and wound complications. CONCLUSIONS These data suggest that IMA-R is not associated with protection from ischemic colitis after open AAA repair. The role of IMA-R remains to be identified.
Collapse
Affiliation(s)
| | - Jinny Lu
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Robyn A Macsata
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Darshan Patel
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Alexander Yang
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - John J Ricotta
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Richard L Amdur
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Anton N Sidawy
- Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Bao-Ngoc Nguyen
- Department of Surgery, The George Washington University Hospital, Washington, DC
| |
Collapse
|
13
|
Lee KB, Sebastian R, Lu J, Ricotta JJ, Amdur R, Sidawy AN, Macsata R, Nguyen BN. IP207. Surgical Bypass Has Better Limb Salvage Compared With Endovascular Intervention in Patients With Infrapopliteal Occlusive Disease and Tissue Loss. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.190] [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]
|
14
|
Endicott KM, Zettervall SL, Lu J, Amdur R, Ricotta JJ, Sidawy AN, Macsata R, Nguyen BN. IP201. Selective Use of Fasciotomy With Emergent Lower Extremity Embolectomy Demonstrates Comparable 30-Day Amputation Rates. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.187] [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]
|
15
|
Zettervall SL, Lu J, Endicott KM, Sparks AD, Ricotta JJ, Sidawy AN, Macsata R, Nguyen BN. PC008. Concomitant Carotid-subclavian Bypass Is Associated With an Increased 30-day Stroke Risk in Patients Who Undergo Thoracic Endovascular Aortic Repair With Coverage of the Left Subclavian Artery. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.249] [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]
|
16
|
Hafiz S, Zubowicz EA, Abouassaly C, Ricotta JJ, Sava JA. Extremity Vascular Injury Management: Good Outcomes Using Selective Referral to Vascular Surgeons. Am Surg 2018; 84:140-143. [PMID: 29428042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Revascularization after extremity vascular injury has long been considered an important skill among trauma surgeons. Increasingly, some trauma surgeons defer vascular repair in response to training or practice patterns. This study was designed to document results of extremity revascularization surgery to evaluate trauma surgeon outcomes and judicious referral of more complex injuries to vascular surgeons (VAS). The trauma registry of an urban level I trauma center was used to identify all patients from 2003 to 2013 who underwent an early (<24 hours) procedure for urgent management of acute injury to extremity vessels. Patients were managed by trauma (TRA) versus VAS based on the practice pattern of the on-call trauma surgeon. Injury and outcome variables were recorded. Of 115 patients, 84 patients were revascularized by trauma and 31 vascular surgeries. There was no difference in complication rates or frequency of any type of complication associated with repairs performed by VAS or TRA. There were similar rates between the two groups for patients with multiple injuries, such as venous, bone or tendon, and nerve injury to the affected extremity. One VAS patient and two TRA patients developed compartment syndrome. In appropriately selected patients, trauma surgeons achieve good outcomes after revascularization of injured extremities.
Collapse
|
17
|
Hafiz S, Zubowicz EA, Abouassaly C, Ricotta JJ, Sava JA. Extremity Vascular Injury Management: Good Outcomes Using Selective Referral to Vascular Surgeons. Am Surg 2018. [DOI: 10.1177/000313481808400136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
Revascularization after extremity vascular injury has long been considered an important skill among trauma surgeons. Increasingly, some trauma surgeons defer vascular repair in response to training or practice patterns. This study was designed to document results of extremity revascularization surgery to evaluate trauma surgeon outcomes and judicious referral of more complex injuries to vascular surgeons (VAS). The trauma registry of an urban level I trauma center was used to identify all patients from 2003 to 2013 who underwent an early (<24 hours) procedure for urgent management of acute injury to extremity vessels. Patients were managed by trauma (TRA) versus VAS based on the practice pattern of the on-call trauma surgeon. Injury and outcome variables were recorded. Of 115 patients, 84 patients were revascularized by trauma and 31 vascular surgeries. There was no difference in complication rates or frequency of any type of complication associated with repairs performed by VAS or TRA. There were similar rates between the two groups for patients with multiple injuries, such as venous, bone or tendon, and nerve injury to the affected extremity. One VAS patient and two TRA patients developed compartment syndrome. In appropriately selected patients, trauma surgeons achieve good outcomes after revascularization of injured extremities.
Collapse
Affiliation(s)
- Shabnam Hafiz
- Department of Trauma and Burn Services, MedStar Washington Hospital Center, Washington, DC
| | - Elizabeth A. Zubowicz
- Department of Trauma and Burn Services, MedStar Washington Hospital Center, Washington, DC
| | - Chadi Abouassaly
- Department of Trauma and Burn Services, MedStar Washington Hospital Center, Washington, DC
| | - John J. Ricotta
- Department of Trauma and Burn Services, MedStar Washington Hospital Center, Washington, DC
| | - Jack A. Sava
- Department of Trauma and Burn Services, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
18
|
Abstract
Adventitial cystic disease of the venous system is a rare occurrence with only 8 reported cases in the world literature. The most commonly involved segment has been the common femoral vein, resulting in luminal compromise and presenting with extremity swelling. Painless swelling of the right lower extremity in a 37-year-old man was diagnosed as iliofemoral thrombosis by duplex examination. Thrombolysis revealed smooth luminal defects of the external iliac vein, which prompted surgical exploration. Iliofemoral thrombectomy exposed multiloculated adventitial cysts of the distal external iliac vein. The preferred surgical intervention in the literature has been transadventitial or transluminal evacuation of the mucoid cysts with removal of cystic wall. These are excellent options when there is no associated venous thrombosis, wall thickening, or persistent venous stenosis after drainage. This is the first reported case associated with deep venous thrombosis. In this situation resection of the involved segment followed by venous reconstruction might be the preferred option.
Collapse
Affiliation(s)
- Antonios P Gasparis
- Department of Surgery, Division of Vascular Surgery, SUNY Stony Brook University Hospital, NY, USA.
| | | | | |
Collapse
|
19
|
Iranmanesh S, Ricotta JJ. Current management of acute type B aortic dissection. World J Surg Proced 2015; 5:208-216. [DOI: 10.5412/wjsp.v5.i2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/23/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
Acute type B aortic dissection (TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair (TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.
Collapse
|
20
|
Ricotta JJ, Upchurch GR, Landis GS, Kenwood CT, Siami FS, Tsilimparis N, Ricotta JJ, White RA. The influence of contralateral occlusion on results of carotid interventions from the Society for Vascular Surgery Vascular Registry. J Vasc Surg 2014; 60:958-64; discussion 964-5. [PMID: 25260471 DOI: 10.1016/j.jvs.2014.04.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/10/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Data on the influence of contralateral carotid occlusion (CCO) on carotid endarterectomy (CEA) are conflicting and are absent for carotid artery stenting (CAS). This study evaluated the influence of CCO on CEA and CAS. METHODS We evaluated patients with and without CCO in the Society for Vascular Surgery Vascular Registry. Primary outcome was a composite of periprocedural death, stroke, or myocardial infarction (MI) (major adverse cardiovascular events [MACE]) and its individual components. Further analysis was done to identify the influence, if any, of symptom status on outcomes. RESULTS There were 1128 CAS and 666 CEA patients with CCO. CAS patients were more often symptomatic with a greater incidence of coronary artery disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and New York Heart Association class >III. Absolute risk of periprocedural MACE (2.7% for CAS vs. 4.2% for CEA), death (1.1% for CAS vs. 0.7% for CEA), stroke (2.1% for CAS vs. 3.1% for CEA), and MI (0.3% for CAS vs. 0.6% for CEA) was statistically equivalent for both. This equivalence was maintained when patients with CCO were segregated according to symptom status and after adjusting for periprocedural risk. There were 16,646 patients without contralateral occlusion (5698 CAS; 10,948 CEA). Patients without contralateral occlusion with CEA have better outcomes in periprocedural MACE (1.8% for patients without contralateral occlusion vs 4.2% for patients with CCO), and stroke (1.1% for patients without contralateral occlusion vs. 3.1% for patients with CCO) (P < .0001 for both). In CAS patients, CCO did not significantly affect periprocedural MACE (3.2% for patients without contralateral occlusion vs. 2.7% for patients with CCO), death (0.8% for patients without contralateral occlusion vs. 1.0% for patients with CCO), stroke (2.3% for patients without contralateral occlusion vs. 2.1% for patients with CCO), or MI (0.6% for patients without contralateral occlusion vs. 0.3% for patients with CCO). In CEA patients, CCO increased MACE, primarily by increasing stroke rates in asymptomatic (0.7% vs. 2.0%; P = .0095) and symptomatic (1.7% vs. 4.9%; P = .0012) patients. CONCLUSIONS Although CEA is preferred in patients without contralateral occlusion, regardless of symptom status, based on lower rates of periprocedural MACE, death, and stroke, the benefit of CEA is lost in patients with CCO because of increased stroke rates in CCO patients after CEA but not after CAS regardless of symptom status. The results of CAS and CEA in patients with CCO are equivalent and within acceptable American Heart Association guidelines.
Collapse
Affiliation(s)
| | - Gilbert R Upchurch
- Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | | | - Christopher T Kenwood
- Department of Vascular Surgery and Endovascular Therapy, New England Research Institutes, Inc, Watertown, Mass
| | - Flora S Siami
- Department of Vascular Surgery and Endovascular Therapy, New England Research Institutes, Inc, Watertown, Mass.
| | | | | | - Rodney A White
- Harbor University of California Los Angeles (UCLA), Los Angeles, Calif
| |
Collapse
|
21
|
Park BD, Azefor N, Huang CC, Ricotta JJ. Trends in Treatment of Ruptured Abdominal Aortic Aneurysm: Impact of Endovascular Repair and Implications for Future Care. J Am Coll Surg 2013; 216:745-54; discussion 754-5. [DOI: 10.1016/j.jamcollsurg.2012.12.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
|
22
|
Tsilimparis N, Ricotta JJ. Part two: Against the motion. Fenestrated endografts should not be restricted to a small number of specialized centers. Eur J Vasc Endovasc Surg 2013; 45:204-7. [PMID: 23333097 DOI: 10.1016/j.ejvs.2013.01.010] [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: 10/27/2022]
Affiliation(s)
- N Tsilimparis
- Department of Vascular Surgery and Endovascular Therapy, Heart and Vascular Institute, Northside Hospital, 980 Johnson Ferry Road NE, Suite 1040, Atlanta, GA 30342, USA
| | | |
Collapse
|
23
|
Ricotta JJ, Gillespie DL, Geraghty PJ, Brothers TE, Kenwood CT, Siami FS, Ricotta JJ, White RA. Contemporary Results of Carotid Endarterectomy (CEA) in “Normal-Risk” Patients From the Society for Vascular Surgery (SVS) Vascular Registry. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2012.11.028] [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: 10/27/2022]
|
24
|
Stain SC, Cogbill TH, Ellison EC, Britt L, Ricotta JJ, Calhoun JH, Baumgartner WA. In Brief. Curr Probl Surg 2012. [DOI: 10.1067/j.cpsurg.2012.06.007] [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: 11/22/2022]
|
25
|
Stain SC, Cogbill TH, Ellison EC, Britt L, Ricotta JJ, Calhoun JH, Baumgartner WA. Surgical Training Models: A New Vision. Curr Probl Surg 2012; 49:565-623. [DOI: 10.1067/j.cpsurg.2012.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
26
|
Ricotta JJ, Upchurch GR, Landis GS, Kenwood CT, Siami FS, Ricotta JJ, White RA. SS25. The Influence of Contralateral Occlusion on Results of Carotid Interventions from the Society for Vascular Surgery (SVS) Vascular Registry™. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Pradka SP, Akbari CM, Ricotta JJ, Keshishian JM. Durability of saphenous vein grafts: 44-year follow-up of a saphenous vein interposition graft in a pediatric patient. J Vasc Surg 2012; 56:216-8. [PMID: 22521803 DOI: 10.1016/j.jvs.2011.12.057] [Citation(s) in RCA: 2] [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: 10/22/2011] [Revised: 12/19/2011] [Accepted: 12/22/2011] [Indexed: 11/25/2022]
Abstract
We report the 44-year follow-up of a 9-year-old girl who underwent a saphenous vein interposition graft in 1964 after suffering extensive pelvic trauma with complete disruption of the right common femoral artery. The patient recovered from this injury and experienced no disability or pain until 2008, when she suddenly developed numbness in the right leg. Evaluation at that time showed a new occlusion of the saphenous vein graft, and she underwent uneventful repeat revascularization with autogenous vein. To our knowledge, this 44-year patency is the longest reported for a saphenous vein graft.
Collapse
Affiliation(s)
- Sarah P Pradka
- Division of Vascular Surgery, Washington Hospital Center, Washington, DC 20010, USA.
| | | | | | | |
Collapse
|
28
|
Pradka SP, Trankiem CT, Ricotta JJ. Pylephlebitis and acute mesenteric ischemia in a young man with inherited thrombophilia and suspected foodborne illness. J Vasc Surg 2012; 55:1769-72. [PMID: 22520365 DOI: 10.1016/j.jvs.2011.12.055] [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] [Received: 10/13/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 01/31/2023]
Abstract
We report on a young man who developed complicated pylephlebitis after foodborne illness. Despite antibiotics and resection of the focus of infectious colitis, he developed extensive small bowel infarction. He was treated with anticoagulation, local thrombolytic infusion, and resection of irreversibly ischemic small bowel. Thrombophilia workup demonstrated heterozygosity for factor V Leiden and the prothrombin G20210A mutation. The complications of pylephlebitis can be minimized by using systemic anticoagulation, thrombectomy, and/or local thrombolytic infusion along with antibiotics and surgical management of the infection. Evaluation for thrombophilic states should be considered, particularly if a patient does not respond to initial therapy.
Collapse
Affiliation(s)
- Sarah P Pradka
- Division of Vascular Surgery, Washington Hospital Center, Washington, DC 20010, USA.
| | | | | |
Collapse
|
29
|
Abstract
AVFs differ in their characteristics, natural history, and response to interventions. These differences need to be considered when planning treatment. Endovascular treatments have emerged as a mainstay of treatment of all types of AVMs. They can be used as definitive therapy for acquired arteriovenous malformation, in remote or high-risk locations, and in elderly or otherwise debilitated patients. Endovascular control is often helpful in open repair of acquired AVF. Endovascular techniques are essential in the management of congenital AVF and are the first line of interventional therapy. In these cases, repeated interventions are the rule, and careful imaging and planning is the key to success.
Collapse
Affiliation(s)
- Jennifer A Sexton
- Georgetown University School of Medicine, Georgetown/Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010-3017, USA
| | | |
Collapse
|
30
|
Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease: executive summary. J Vasc Surg 2011; 54:832-6. [PMID: 21889705 DOI: 10.1016/j.jvs.2011.07.004] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In 2008, the Society for Vascular Surgery published guidelines for the treatment of carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treatment of extracranial carotid disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as first line therapy. In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
Collapse
Affiliation(s)
- John J Ricotta
- Washington Hospital Center, Georgetown University School of Medicine, Washington, DC 20010, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 2011; 54:e1-31. [PMID: 21889701 DOI: 10.1016/j.jvs.2011.07.031] [Citation(s) in RCA: 434] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 06/21/2011] [Accepted: 07/12/2011] [Indexed: 11/30/2022]
Affiliation(s)
- John J Ricotta
- Washington Hospital Center, Georgetown University School of Medicine, Washington, DC 20010, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Eidt JF, Mills J, Rhodes RS, Biester T, Gahtan V, Jordan WD, Hodgson KJ, Kent KC, Ricotta JJ, Sidawy AN, Valentine J. Comparison of surgical operative experience of trainees and practicing vascular surgeons: A report from the Vascular Surgery Board of the American Board of Surgery. J Vasc Surg 2011; 53:1130-9; discussion 1139-40. [DOI: 10.1016/j.jvs.2010.09.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 12/01/2022]
|
33
|
Ricotta JJ, Rhodes RS. Evolution of vascular surgery and vascular surgery training: lessons learned. CIR CIR 2011; 79:53-59. [PMID: 21477519] [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: 05/30/2023]
Abstract
Over the last decade, surgery as a discipline, and vascular surgery in particular, has been faced with a rapid growth in the scope of knowledge and array of techniques to be mastered by the graduating resident and the constraints of work hour limitations. In response, the U.S. vascular surgery community significantly altered its surgical training curriculum. This article will discuss the factors that prompted these changes, the challenges that continue to face vascular surgery education and the expectations for the future. We will also comment on the relevance of this experience to other surgical specialties.
Collapse
|
34
|
O'Leary EA, Sabahi I, Ricotta JJ, Walitt B, Akbari CM. Femoral profunda artery aneurysm as an unusual first presentation of Behcet disease. Vasc Endovascular Surg 2010; 45:98-102. [PMID: 20810402 DOI: 10.1177/1538574410379655] [Citation(s) in RCA: 8] [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] [Indexed: 11/15/2022]
Abstract
Behcet disease is a multisystem inflammatory disorder, rarely found in African Americans. Arterial involvement occurs in less than 8% of patients. Profunda femoral artery aneurysms (PFAAs) are extremely rare and often occur with synchronous aneurysms. We present a case of an African American man diagnosed with Behcet disease from his presentation with PFAA. He was also found to have a synchronous hypogastric artery aneurysm. The patient was immediately treated with corticosteroids and infliximab to control systemic and vascular inflammation, returning 1 month later for surgery. He had a repair of the left PFAA with a common femoral to profunda femoris artery bypass with reversed saphenous vein graft and aneurysmorrhaphy. When a patient presents with an aneurysm in an unusual location, it is important to evaluate for other aneurysms. A careful history and physical examination is also required to see if the aneurysm may be part of an underlying systemic syndrome.
Collapse
|
35
|
Xenos M, Rambhia SH, Alemu Y, Einav S, Labropoulos N, Tassiopoulos A, Ricotta JJ, Bluestein D. Patient-based abdominal aortic aneurysm rupture risk prediction with fluid structure interaction modeling. Ann Biomed Eng 2010; 38:3323-37. [PMID: 20552276 DOI: 10.1007/s10439-010-0094-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 06/01/2010] [Indexed: 11/30/2022]
Abstract
Elective repair of abdominal aortic aneurysm (AAA) is warranted when the risk of rupture exceeds that of surgery, and is mostly based on the AAA size as a crude rupture predictor. A methodology based on biomechanical considerations for a reliable patient-specific prediction of AAA risk of rupture is presented. Fluid-structure interaction (FSI) simulations conducted in models reconstructed from CT scans of patients who had contained ruptured AAA (rAAA) predicted the rupture location based on mapping of the stresses developing within the aneurysmal wall, additionally showing that a smaller rAAA presented a higher rupture risk. By providing refined means to estimate the risk of rupture, the methodology may have a major impact on diagnostics and treatment of AAA patients.
Collapse
Affiliation(s)
- Michalis Xenos
- Department of Biomedical Engineering, Stony Brook University, HSC T18-030, Stony Brook, NY 11794-8181, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Ricotta JJ. Commentary on "Trials in progress". Perspect Vasc Surg Endovasc Ther 2010; 22:92. [PMID: 20858610 DOI: 10.1177/1531003510380273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
37
|
Ricotta JJ, Ricotta JJ. Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: endarterectomy or stent? Perspect Vasc Surg Endovasc Ther 2010; 22:69. [PMID: 20858606 DOI: 10.1177/1531003510381138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
38
|
Ricotta JJ, Ricotta JJ. Contemporary management of carotid bifurcation atherosclerosis for stroke prevention: management options and patient selection. Perspect Vasc Surg Endovasc Ther 2010; 22:5-6. [PMID: 20798070 DOI: 10.1177/1531003510381137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
39
|
Ricotta JJ. Commentary on "Carotid interventions in acute stroke". Perspect Vasc Surg Endovasc Ther 2010; 22:58-59. [PMID: 20798080 DOI: 10.1177/1531003510381520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
40
|
Xenos M, Rambhia S, Alemu Y, Einav S, Ricotta JJ, Labropoulos N, Tassiopoulos A, Bluestein D. Patient based abdominal aortic aneurysm rupture risk prediction combining clinical visualizing modalities with fluid structure interaction numerical simulations. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:5173-5176. [PMID: 21095820 DOI: 10.1109/iembs.2010.5626138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Fluid structure interaction (FSI) simulations of patient-specific fusiform non-ruptured and contained ruptured Abdominal Aortic Aneurysm (AAA) geometries were conducted. The goals were: (1) to test the ability of our FSI methodology to predict the location of rupture, by correlating the high wall stress regions with the rupture location, (2) estimate the state of the pathological condition by calculating the ruptured potential index (RPI) of the AAA and (3) predict the disease progression by comparing healthy and pathological aortas.
Collapse
Affiliation(s)
- Michalis Xenos
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8181, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Reed AB, Rhodes RS, Biester TW, Ricotta JJ. PP22. Report of the First Vascular Surgery in-Training Examination (VSITE). J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.02.052] [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: 11/17/2022]
|
42
|
Gasparis AP, Kokkosis A, Labropoulos N, Tassiopoulos AK, Ricotta JJ. Venous Outflow Obstruction With Retroperitoneal Kaposi's Sarcoma and Treatment With Inferior Vena Cava Stenting. Vasc Endovascular Surg 2009; 43:295-300. [DOI: 10.1177/1538574408328666] [Citation(s) in RCA: 9] [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] [Indexed: 11/17/2022]
Abstract
A 26-year-old man presented with acute renal insufficiency, and severe lower extremity swelling. Computed tomographic scan revealed retroperitoneal lymphadenopathy encasing both ureters and the inferior vena cava. He underwent placement of ureteral stents to relieve the obstruction and afterward underwent lymph node biopsy, which revealed Kaposi's sarcoma. He subsequently was diagnosed with acquired immunodeficiency syndrome. Abdominal and lower extremity venous duplex ultrasound did not show any evidence of deep vein thrombosis. The inferior vena cava measured 3.5 mm in diameter and was encased by retroperitoneal lymphadenopathy. Bilateral transfemoral venography and intravascular ultrasound demonstrated significant compression of the inferior vena cava below the renal veins. Endovascular treatment was followed with primary stenting under intravascular ultrasound guidance. His symptoms improved with reduction in swelling. At 1-year follow-up, the patient was ambulatory with mild symptoms, and on venography the iliac vein and inferior vena cava stents were widely patent.
Collapse
Affiliation(s)
| | - Angela Kokkosis
- Stony Brook University Medical Center, Stony Brook, New York
| | | | | | - John J. Ricotta
- Stony Brook University Medical Center, Stony Brook, New York
| |
Collapse
|
43
|
Ricotta JJ. Commentary on "Office-based vascular interventions": is it a step forward? Perspect Vasc Surg Endovasc Ther 2008; 20:346-347. [PMID: 19033267 DOI: 10.1177/1531003508329114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
44
|
Ricotta JJ, Pagan J, Xenos M, Alemu Y, Einav S, Bluestein D. Cardiovascular disease management: the need for better diagnostics. Med Biol Eng Comput 2008; 46:1059-68. [PMID: 19002517 DOI: 10.1007/s11517-008-0416-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/09/2008] [Indexed: 11/30/2022]
Abstract
Current diagnostic testing for cardiovascular pathology usually rests on either physiological or anatomic measurement. Multiple tests must then be combined to arrive at a conclusion regarding treatment of a specific pathology. Much of the diagnostic decisions currently made are based on rough estimates of outcomes, often derived from gross anatomic observations or extrapolation of physical laws. Thus, intervention for carotid and coronary disease is based on estimates of diameter stenosis, despite data to suggest that plaque character and lesion anatomy are important determinants of outcome. Similarly, abdominal aortic aneurysm (AAA) intervention is based on maximal aneurysm diameter without regard for arterial wall composition or individual aneurysm geometry. In other words, our current diagnostic tests do not reflect the sophistication of our current knowledge of vascular disease. Using a multimodal approach, computer modeling has the potential to predict clinical outcomes based on a variety of factors including arterial wall composition, surface anatomy and hemodynamic forces. We term this more sophisticated approach "patient specific diagnostics", in which the computer models are reconstructed from patient specific clinical visualizing modalities, and material properties are extracted from experimental measurements of specimens and incorporated into the modeling using advanced material models (including nonlinear anisotropic models) and performed as dynamic simulations using the FSI (fluid structure interaction) approach. Such an approach is sorely needed to improve the effectiveness of interventions. This article will review ongoing work in "patient specific diagnostics" in the areas of carotid, coronary and aneurismal disease. We will also suggest how this approach may be applicable to management of aortic dissection. New diagnostic methods should allow better patient selection, targeted intervention and modeling of the results of different therapies.
Collapse
Affiliation(s)
- John J Ricotta
- Division of Vascular Surgery, Department of Surgery, Health Sciences Center T-19, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Pasklinsky G, Gasparis AP, Labropoulos N, Pagan J, Tassiopoulos AK, Ferretti J, Ricotta JJ. Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options. Vasc Endovascular Surg 2008; 42:601-6. [PMID: 18583306 DOI: 10.1177/1538574408318478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
Collapse
Affiliation(s)
- Garri Pasklinsky
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York 11794-8191, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Pagan J, Ricotta JJ. Commentary: Dubinsky RM, Lai SM. Mortality from combined carotid endarterectomy and coronary artery bypass surgery in the US. Neurology. 2007;68:195-197. Perspect Vasc Surg Endovasc Ther 2008; 20:94-95. [PMID: 18388024 DOI: 10.1177/1531003507310831] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
available at http://www.neurology.org/cgi/ content/abstract/68/3/195.
Collapse
Affiliation(s)
- Jose Pagan
- Department of Surgery, SUNY at Stony Brook Stony Brook, New York, USA
| | | |
Collapse
|
47
|
Gasparis AP, Ricotta JJ. Commentary on "Diagnosis and management of pseudoaneurysms". Perspect Vasc Surg Endovasc Ther 2007; 19:65-6. [PMID: 17437983 DOI: 10.1177/1531003507299665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Antonios P Gasparis
- Department of Surgery, State University of New York at Stony Brook, Stony Brook, New York 11794-8191, USA
| | | |
Collapse
|
48
|
Ricotta JJ. Comparison of results of carotid stenting followed by open heart surgery versus combined carotid endarterectomy and open heart surgery. Perspect Vasc Surg Endovasc Ther 2006; 18:193-4. [PMID: 17060246 DOI: 10.1177/1531003506290892] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- John J Ricotta
- Department of Surgery, SUNY at Stony Brook, Stony Brook, NY, USA
| |
Collapse
|
49
|
Abstract
BACKGROUND Concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are associated with an increased incidence of stroke and death compared to isolated CABG. It is unclear whether this reflects two concurrent operative procedures or the increased risk in patients with more extensive atherosclerosis. METHODS To address this question, a case controlled study was performed using data from the New York State Cardiac Database from 1997 to 1998. Patients who underwent combined CEA-CABG were compared with all isolated CABG patients and a risk-matched cohort of isolated CABG patients. RESULTS The 35,539 isolated CABG patients had fewer postoperative complications than the 744 combined CEA-CABG patients, but also had a lower overall risk profile. The isolated CABG patients had a lower incidence of stroke (2% vs 5.1%), death (2% vs 4.4%), and combined stroke and death (3.7% vs 8.1%) compared with the combined group ( P < .001). After risk-factor matching, no differences in stroke (5% vs 5.1%), death (3.9% vs 4.4%), or combined stroke and death (8.5% vs 8.1%) were observed. CONCLUSIONS Although increased complications are reported after CEA-CABG, these do not differ from those of a risk-matched cohort of isolated CABG patients. Thus, the major morbidity of combined CEA-CABG is due to inherent patient risk and not the addition of CEA to CABG.
Collapse
Affiliation(s)
- John J Ricotta
- State University of New York at Stony Brook, Rm. 19-020, Stony Brook, NY 11794, USA
| | | | | |
Collapse
|
50
|
|