1
|
Krishnan P, Farhan S, Zidar F, Krajcer Z, Metzger C, Kapadia S, Moore E, Nazif T, Garland T, Zhang M, Khera S, Sharafuddin M, Patel VI, Bacharach JM, Coady P, Schermerhorn ML, Shames ML, Rahimi S, Panneton JM, Elkins C, Foteh M. Cross-Seal IDE Trial: Prospective, Multicenter, Single-Arm Study of the Cross-Seal Suture-Mediated Vascular Closure Device System. Circ Cardiovasc Interv 2024:e013842. [PMID: 38708595 DOI: 10.1161/circinterventions.123.013842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/06/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND An increasing number of interventional procedures require large-sheath technology (>12F) with a favorable outcome with endovascular rather than open surgical access. However, vascular complications are a limitation for the management of these patients. This trial aimed to determine the effectiveness and safety of the Cross-Seal suture-mediated vascular closure device in obtaining hemostasis at the target limb access site following interventional procedures using 8F to 18F procedural sheaths. METHODS The Cross-Seal IDE trial (Investigational Device Exemption) was a prospective, single-arm, multicenter study in subjects undergoing percutaneous endovascular procedures utilizing 8F to 18F ID procedural sheaths. The primary efficacy end point was time to hemostasis at the target limb access site. The primary safety end point was freedom from major complications of the target limb access site within 30 days post procedure. RESULTS A total of 147 subjects were enrolled between August 9, 2019, and March 12, 2020. Transcatheter aortic valve replacement was performed in 53.7% (79/147) and percutaneous endovascular abdominal/thoracic aortic aneurysm repair in 46.3% (68/147) of subjects. The mean sheath ID was 15.5±1.8 mm. The primary effectiveness end point of time to hemostasis was 0.4±1.4 minutes. An adjunctive intervention was required in 9.2% (13/142) of subjects, of which 2.1% (3/142) were surgical and 5.6% (8/142) endovascular. Technical success was achieved in 92.3% (131/142) of subjects. Freedom from major complications of the target limb access site was 94.3% (83/88). CONCLUSIONS In selected patients undergoing percutaneous endovascular procedures utilizing 8F to 18F ID procedural sheath, Cross-Seal suture-mediated vascular closure device achieved favorable effectiveness and safety in the closure of the large-bore arteriotomy. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03756558.
Collapse
Affiliation(s)
- Prakash Krishnan
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Serdar Farhan
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Frank Zidar
- Department of Cardiology, Austin Heart, TX (F.Z.)
| | - Zvonimir Krajcer
- Department of Vascular Surgery, Texas Heart Institute, Houston (Z.K.)
| | - Christopher Metzger
- Department of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.)
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, OH (S. Kapadia)
| | - Erin Moore
- Department of Vascular Surgery, River City Clinical Research, Jacksonville, FL (E.M.)
| | - Tamim Nazif
- Department of Cardiology, Columbia University, New York, NY (T.N.)
| | - Ty Garland
- Department of Vascular Surgery, Vascular Institute of the Rockies, Denver, CO (T.G.)
| | - Ming Zhang
- Department of Cardiology, Swedish Medical Center, Seattle, WA (M.Z.)
| | - Sahil Khera
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Mel Sharafuddin
- Department of Vascular Surgery, University of Iowa, Iowa City (M.S.)
| | - Virendra I Patel
- New York Presbyterian, Columbia University, New York, NY (V.I.P.)
| | | | - Paul Coady
- Department of Cardiology, Lankenau Medical Center, Wynnewood, PA (P.C.)
| | - Marc L Schermerhorn
- Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.L. Schermerhorn)
| | - Murray L Shames
- Department of Vascular Surgery, University of South Florida, Tampa (M.L. Shames)
| | - Saum Rahimi
- Department of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.R.)
| | - Jean M Panneton
- Department of Vascular Surgery, Sentara Vascular Specialists, Norfolk, VA (J.P.)
| | - Craig Elkins
- Department of Vascular Surgery, INTEGRIS Baptist Medical Center, Oklahoma City, OK (C.E.)
| | - Mazin Foteh
- Department of Vascular Surgery, Cardiothoracic and Vascular Surgeons, Austin, TX (M.F.)
| |
Collapse
|
2
|
Moore E, Wohlauer MV, Dorosh J, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff RF, Lucero L, Ali A, Koleilat I, Batarseh P, Talathi S, Rivera A, Humphries MD, Ly K, Harroun N, Smith BK, Darelli-Anderson AM, Choudhry A, Hammond E, Costanza M, Khetarpaul V, Cosentino A, Watson J, Afifi R, Mouawad NJ, Tan TW, Sharafuddin M, Quevedo JP, Nkansah R, Shibale P, Shalhub S, Lin JC. Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease. Vascular 2024:17085381241240679. [PMID: 38520224 DOI: 10.1177/17085381241240679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. METHODS The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. RESULTS A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78 days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. CONCLUSIONS Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.
Collapse
Affiliation(s)
- Ethan Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Dorosh
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| | - Mahmood Kabeil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rafael D Malgor
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh A O'Banion
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Gabriel Lopez-Pena
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Riley Gillette
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert F Cuff
- Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Leah Lucero
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Issam Koleilat
- Department of Surgery, RWJ/Barnabas Health, Toms River, NJ, USA
| | - Paola Batarseh
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Sonia Talathi
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Aksim Rivera
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin Ly
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Nikolai Harroun
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brigitte K Smith
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Asad Choudhry
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Eric Hammond
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Michael Costanza
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Vipul Khetarpaul
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Cosentino
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Watson
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nicolas J Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Center for Research and Innovation, Bay City, MI, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mel Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Judith P Quevedo
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Reggie Nkansah
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Palcah Shibale
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Sherene Shalhub
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Judith C Lin
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| |
Collapse
|
3
|
Haruguchi H, Suemitsu K, Isogai N, Murakami M, Fujihara M, Iwadoh K, Menk J, Ookubo H, Ogawa T, Kirksey L, Misra S, Santos A, Laurich C, Abul-Khoudoud O, Friedman A, Gallo V, Aal AKA, Sharafuddin M, Madassery S, Dexter D, Joels C, Hussain S, Bagla S, Hull J, Ross J, Hoggard J, Wiechmann B, Atray N, Cooper R, Mawla N, Kafie F, Suemitsu K, Isogai N, Fujihara M, Murakami M, Fuchinoue S, Iwadoh K, Ogawa T, Holden A, Wickremesekera K. IN.PACT AV access randomized trial: Japan cohort outcomes through 12 months. Ther Apher Dial 2023. [PMID: 36606683 DOI: 10.1111/1744-9987.13966] [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: 07/21/2022] [Revised: 11/21/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE There is a lack of adjudicated and prospectively randomized published outcomes on the use of drug-coated balloons (DCB) to treat dysfunctional arteriovenous fistula in Asian patients. This post hoc subgroup analysis of 112 Japanese participants from the global IN.PACT AV Access trial reports outcomes through 12 months. MATERIALS AND METHODS Participants were treated with DCB (n = 58) or standard non-coated percutaneous transluminal angioplasty (PTA) balloons (n = 54). Outcomes included target lesion primary patency (TLPP), access circuit primary patency, and safety. RESULTS Through 6 months, TLPP was 86.0% (49/57) in the DCB group and 49.1% (26/53) in the PTA group (p < 0.001). Through 12 months, TLPP was 67.3% (37/55) in the DCB group and 43.4% (23/53) in the PTA group (p = 0.013). CONCLUSION In this post hoc analysis of Japanese participants from the IN.PACT AV Access trial, participants treated with DCB had higher TLPP through 6 and 12 months compared with PTA.
Collapse
Affiliation(s)
| | | | - Naoko Isogai
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | | | | | | | | | | - Tomonari Ogawa
- Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Loftus RW, Dexter F, Goodheart MJ, McDonald M, Keech J, Noiseux N, Pugely A, Sharp W, Sharafuddin M, Lawrence WT, Fisher M, McGonagill P, Shanklin J, Skeete D, Tracy C, Erickson B, Granchi T, Evans L, Schmidt E, Godding J, Brenneke R, Persons D, Herber A, Yeager M, Hadder B, Brown JR. The Effect of Improving Basic Preventive Measures in the Perioperative Arena on Staphylococcus aureus Transmission and Surgical Site Infections: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e201934. [PMID: 32219407 PMCID: PMC11071519 DOI: 10.1001/jamanetworkopen.2020.1934] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Importance Surgical site infections increase patient morbidity and health care costs. The Centers for Disease Control and Prevention emphasize improved basic preventive measures to reduce bacterial transmission and infections among patients undergoing surgery. Objective To assess whether improved basic preventive measures can reduce perioperative Staphylococcus aureus transmission and surgical site infections. Design, Setting, and Participants This randomized clinical trial was conducted from September 20, 2018, to September 20, 2019, among 19 surgeons and their 236 associated patients at a major academic medical center with a 60-day follow-up period. Participants were a random sample of adult patients undergoing orthopedic total joint, orthopedic spine, oncologic gynecological, thoracic, general, colorectal, open vascular, plastic, or open urological surgery requiring general or regional anesthesia. Surgeons and their associated patients were randomized 1:1 via a random number generator to treatment group or to usual care. Observers were masked to patient groupings during assessment of outcome measures. Interventions Sustained improvements in perioperative hand hygiene, vascular care, environmental cleaning, and patient decolonization efforts. Main Outcomes and Measures Perioperative S aureus transmission assessed by the number of isolates transmitted and the incidence of transmission among patient care units (primary) and the incidence of surgical site infections (secondary). Results Of 236 patients (156 [66.1%] women; mean [SD] age, 57 [15] years), 106 (44.9%) and 130 (55.1%) were allocated to the treatment and control groups, respectively, received the intended treatment, and were analyzed for the primary outcome. Compared with the control group, the treatment group had a reduced mean (SD) number of transmitted perioperative S aureus isolates (1.25 [2.11] vs 0.47 [1.13]; P = .002). Treatment reduced the incidence of S aureus transmission (incidence risk ratio; 0.56; 95% CI, 0.37-0.86; P = .008; with robust variance clustering by surgeon: 95% CI, 0.42-0.76; P < .001). Overall, 11 patients (4.7%) experienced surgical site infections, 10 (7.7%) in the control group and 1 (0.9%) in the treatment group. Transmission was associated with an increased risk of surgical site infection (8 of 73 patients [11.0%] with transmission vs 3 of 163 [1.8%] without; risk ratio, 5.95; 95% CI, 1.62-21.86; P = .007). Treatment reduced the risk of surgical site infection (hazard ratio, 0.12; 95% CI, 0.02-0.92; P = .04; with clustering by surgeon: 95% CI, 0.03-0.51; P = .004). Conclusions and Relevance Improved basic preventive measures in the perioperative arena can reduce S aureus transmission and surgical site infections. Trial Registration ClinicalTrials.gov Identifier: NCT03638947.
Collapse
Affiliation(s)
| | | | | | | | - John Keech
- Department of Anesthesia, University of Iowa, Iowa City
| | | | - Andrew Pugely
- Department of Anesthesia, University of Iowa, Iowa City
| | - William Sharp
- Department of Anesthesia, University of Iowa, Iowa City
| | | | | | - Mark Fisher
- Department of Anesthesia, University of Iowa, Iowa City
| | | | - Jennifer Shanklin
- Department of Anesthesia, University of Iowa, Iowa City
- now with Allina Health Surgical Specialists, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Dionne Skeete
- Department of Anesthesia, University of Iowa, Iowa City
| | - Chad Tracy
- Department of Anesthesia, University of Iowa, Iowa City
| | | | | | - Lance Evans
- Department of Anesthesia, University of Iowa, Iowa City
| | - Eli Schmidt
- Department of Anesthesia, University of Iowa, Iowa City
| | | | | | | | - Alexia Herber
- Department of Anesthesia, University of Iowa, Iowa City
| | - Mark Yeager
- Department of Anesthesia, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Brent Hadder
- Department of Anesthesia, University of Iowa, Iowa City
| | - Jeremiah R Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| |
Collapse
|
5
|
Guan J, Laroia S, Sharafuddin M, Policeni B. Abstract No. 450 A new standardized interventional radiology learning curriculum: preliminary experience from a single residency program. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
6
|
Comerota AJ, Kearon C, Gu CS, Julian JA, Goldhaber SZ, Kahn SR, Jaff MR, Razavi MK, Kindzelski AL, Bashir R, Patel P, Sharafuddin M, Sichlau MJ, Saad WE, Assi Z, Hofmann LV, Kennedy M, Vedantham S. Endovascular Thrombus Removal for Acute Iliofemoral Deep Vein Thrombosis. Circulation 2019; 139:1162-1173. [PMID: 30586751 DOI: 10.1161/circulationaha.118.037425] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The ATTRACT trial (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) previously reported that pharmacomechanical catheter-directed thrombolysis (PCDT) did not prevent postthrombotic syndrome (PTS) in patients with acute proximal deep vein thrombosis. In the current analysis, we examine the effect of PCDT in ATTRACT patients with iliofemoral deep vein thrombosis. METHODS Within a large multicenter randomized trial, 391 patients with acute deep vein thrombosis involving the iliac or common femoral veins were randomized to PCDT with anticoagulation versus anticoagulation alone (No-PCDT) and were followed for 24 months to compare short-term and long-term outcomes. RESULTS Between 6 and 24 months, there was no difference in the occurrence of PTS (Villalta scale ≥5 or ulcer: 49% PCDT versus 51% No-PCDT; risk ratio, 0.95; 95% CI, 0.78-1.15; P=0.59). PCDT led to reduced PTS severity as shown by lower mean Villalta and Venous Clinical Severity Scores ( P<0.01 for comparisons at 6, 12, 18, and 24 months), and fewer patients with moderate-or-severe PTS (Villalta scale ≥10 or ulcer: 18% versus 28%; risk ratio, 0.65; 95% CI, 0.45-0.94; P=0.021) or severe PTS (Villalta scale ≥15 or ulcer: 8.7% versus 15%; risk ratio, 0.57; 95% CI, 0.32-1.01; P=0.048; and Venous Clinical Severity Score ≥8: 6.6% versus 14%; risk ratio, 0.46; 95% CI, 0.24-0.87; P=0.013). From baseline, PCDT led to greater reduction in leg pain and swelling ( P<0.01 for comparisons at 10 and 30 days) and greater improvement in venous disease-specific quality of life (Venous Insufficiency Epidemiological and Economic Study Quality of Life unit difference 5.6 through 24 months, P=0.029), but no difference in generic quality of life ( P>0.2 for comparisons of SF-36 mental and physical component summary scores through 24 months). In patients having PCDT versus No-PCDT, major bleeding within 10 days occurred in 1.5% versus 0.5% ( P=0.32), and recurrent venous thromboembolism over 24 months was observed in 13% versus 9.2% ( P=0.21). CONCLUSIONS In patients with acute iliofemoral deep vein thrombosis, PCDT did not influence the occurrence of PTS or recurrent venous thromboembolism. However, PCDT significantly reduced early leg symptoms and, over 24 months, reduced PTS severity scores, reduced the proportion of patients who developed moderate-or-severe PTS, and resulted in greater improvement in venous disease-specific quality of life. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00790335.
Collapse
Affiliation(s)
- Anthony J Comerota
- Inova Heart and Vascular Institute, Inova Alexandria Hospital, VA (A.J.C.)
| | - Clive Kearon
- Thrombosis and Atherosclerosis Research Institute (C.K.), McMaster University, Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada (C.K., C.-S.G., J.A.J.)
| | - Chu-Shu Gu
- Department of Oncology (C.-S.G., J.A.J.), McMaster University, Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada (C.K., C.-S.G., J.A.J.)
| | - Jim A Julian
- Department of Oncology (C.-S.G., J.A.J.), McMaster University, Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada (C.K., C.-S.G., J.A.J.)
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (S.Z.G.)
| | - Susan R Kahn
- Jewish General Hospital, Lady Davis Institute, Center for Clinical Epidemiology, Montreal, QC, Canada (S.R.K.)
| | - Michael R Jaff
- Newton-Wellesley Hospital, and Harvard Medical School, Boston, MA (M.R.J.)
| | | | - Andrei L Kindzelski
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.L.K.)
| | - Riyaz Bashir
- Department of Medicine, Temple University Hospital, Philadelphia, PA (R.B.)
| | - Parag Patel
- Department of Radiology, Medical College of Wisconsin, Milwaukee (P.P.)
| | - Mel Sharafuddin
- Division of Vascular Surgery, University of Iowa, Iowa City (M.S.)
| | - Michael J Sichlau
- Vascular and Interventional Professionals LLC, Hinsdale, IL (M.J.S.)
| | - Wael E Saad
- Department of Radiology, University of Michigan, Ann Arbor (W.E.S.)
| | - Zakaria Assi
- Toledo Radiological Associates, Vascular & Interventional Radiology, OH (Z.A.)
| | | | | | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, MO (S.V.)
| | | |
Collapse
|
7
|
Hosn MA, Xu J, Sharafuddin M, Corson JD. Visceral Artery Aneurysms: Decision Making and Treatment Options in the New Era of Minimally Invasive and Endovascular Surgery. Int J Angiol 2019; 28:11-16. [PMID: 30880885 DOI: 10.1055/s-0038-1676958] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/17/2023] Open
Abstract
The abdominal viscera blood supply is derived from anterior branches of the abdominal aorta. Visceral artery aneurysms (VAAs) include aneurysms of the following arteries and their branches: the celiac artery, the hepatic artery, the splenic artery, the superior mesenteric artery, the inferior mesenteric artery, the pancreaticoduodenal artery, and the gastroduodenal artery. Overall VAAs comprise < 2% of all types of arterial aneurysms. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging. The incidental finding of a VAA frequently leaves clinicians with a dilemma as to the best course of management. The focus of this review is on current treatment options and management guidelines for both symptomatic and asymptomatic VAAs.
Collapse
Affiliation(s)
- Maen Aboul Hosn
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jun Xu
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mel Sharafuddin
- Department of Surgery, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John D Corson
- Department of Surgery, the University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
8
|
Shahin H, Reddy G, Sharafuddin M. Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency. J Vasc Surg 2006. [DOI: 10.1016/j.jvs.2006.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Shahin H, Reddy G, Sharafuddin M. Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency. J Vasc Surg 2006. [DOI: 10.1016/j.jvs.2006.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Abstract
To detect a renal artery stenosis and assess its hemodynamic and functional significance in five breath holds. In a single MR exam, T1 weighted FLASH and T2 weighted fast spin echo techniques are used to assess renal morphology, multiphase 3D gadolinium (Gd) MRA to evaluate the renal arteries, and a segmented EPI cine phase-contrast technique to measure renal artery blood flow. A standardized image analysis is performed to assess kidney size, corticomedullar differentiation (CMD), parenchymal enhancement, the degree of renal artery stenosis, abnormalities in blood flow pattern, and any associated abdominal vascular disease. Multiphase 3D-Gd-MRA accurately assesses atherosclerotic renal artery disease particularly in the presence of an associated aortic aneurysm. Delayed parenchymal enhancement, loss of CMD, and decrease in kidney size can be detected. In combination with decreased systolic velocity components, the diagnosis of a hemodynamically and functionally significant stenosis can be made. High-resolution single-phase 3D-Gd-MRA is preferable for evaluation of fibromuscular dysplasia or hypoplastic vessels. The combination of different breath hold techniques in a single, standardized MR exam allows to detect the hemodynamic and functional significance of a renal artery stenosis.
Collapse
Affiliation(s)
- S O Schoenberg
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
11
|
Salimi Z, Sharafuddin M. Ultrasound appearance of primary carcinoid tumor of the gallbladder associated with carcinoid syndrome. J Clin Ultrasound 1995; 23:435-437. [PMID: 7560158 DOI: 10.1002/jcu.1870230708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Z Salimi
- Department of Radiology, St. Louis University Medical Center, Missouri 63110-0250, USA
| | | |
Collapse
|
12
|
Goodman GM, Martin DS, Klein J, Awwad E, Druce HM, Sharafuddin M. Comparison of a screening coronal CT versus a contiguous coronal CT for the evaluation of patients with presumptive sinusitis. Ann Allergy Asthma Immunol 1995; 74:178-82. [PMID: 7697480] [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: 01/26/2023]
Abstract
BACKGROUND Computed tomography has greatly improved the accuracy of sinus imaging. While contiguous coronal computed tomography scanning of the sinuses provides detailed imaging as compared with plain sinus radiography, this modality is significantly more expensive and involves exposure of the patient to a higher dose of radiation. It has become increasingly common to obtain screening, or non-contiguous, CT scans of the sinuses when screening for the presence of sinusitis. OBJECTIVE To calculate the sensitivity and specificity of the screening coronal CT scan of the sinuses in screening for inflammatory disease using the contiguous coronal CT examination of the sinuses as the standard. METHODS From contiguous coronal computed tomograms of the paranasal sinuses, screening coronal computed tomographic examinations were created for 44 patients. Patients were being screened for the presence of sinusitis in the Comprehensive Sinus Clinic at St. Louis University. The two examinations were reviewed independently and in random order by two neuroradiologists. Using the original examinations as the standard, the sensitivity and specificity of the screening studies were calculated for various situations. RESULTS Overall, a sensitivity of 93.3% and a specificity of 89.3% for the detection of inflammatory disease of the sinuses by the screening examination was observed. CONCLUSIONS The screening coronal computed tomogram of the paranasal sinuses may be useful in the evaluation of the patient with possible sinusitis.
Collapse
Affiliation(s)
- G M Goodman
- Department of Internal Medicine, St. Louis University Medical Center, Missouri, USA
| | | | | | | | | | | |
Collapse
|
13
|
Affiliation(s)
- D S Martin
- Department of Radiology, St. Louis University Medical Center, Missouri 63110-0250, USA
| | | | | | | | | |
Collapse
|
14
|
Abstract
1. Taurine accumulation in intestinal cells of adult and suckling rats reached steady-state after 60 min with an In/Out ratio of 1.46 and 4.66 in the adult and suckling rats respectively. 2. The accumulative capacity of the intestinal strips isolated from suckling rats is almost four times higher than that of adult rats. 3. The steady-state uptake of taurine by the adult and suckling rats intestinal cells is saturable, sodium-dependent and inhibited by ouabain. 4. The calculated Vmax of the mediated component of the steady-state uptake in the suckling rats is three times greater than that of the adult rats, and the affinity is seven fold greater in the suckling as compared to the adult. 5. Taurine influx across the mucosal membrane in the suckling rat is significantly greater than that of the control adult.
Collapse
Affiliation(s)
- M Sharafuddin
- Department of Physiology, Faculty of Medicine, American University of Beirut, Lebanon
| | | | | |
Collapse
|