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Starnes BW, Rajani RR, Rossi P, Singh N, Benarroch-Gampel J, Cho JS, Nassiri N, Smeds MR, Kalapatapu V, Stern JR, Kabutey NK, Corvera J. Early survival benefit of a low-profile endograft in blunt traumatic aortic injury. J Vasc Surg 2024:S0741-5214(24)01077-2. [PMID: 38677660 DOI: 10.1016/j.jvs.2024.04.051] [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: 01/16/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES To demonstrate the safety and effectiveness of a low-profile thoracic endograft (19-23 French) in subjects with blunt traumatic aortic injury. METHODS A prospective, multicenter study assessed the RelayPro thoracic endograft for the treatment of traumatic aortic injury. Fifty patients were enrolled at 16 US centers between 2017-2021. The primary endpoint was 30-day all-cause mortality. RESULTS Cohort was mostly male (74%) with a mean age of 42.4 ± 17.2 years treated for traumatic injuries (4% Grade 1, 8% Grade 2, 76% Grade 3; 12% Grade 4) due to motor vehicle collision (80%). The proximal landing zone was proximal to the left subclavian artery in 42% and access was primarily percutaneous (80%). Most (71%) were treated with a non-bare stent (NBS) endograft. Technical success was 98% (one early Type Ia endoleak). All-cause 30-day mortality was 2% (compared with an expected rate of 8%), with an exact two-sided 95% CI, 0.1%, 10.6% below the performance goal upper limit of 25%. Kaplan-Meier analysis estimated freedom from all-cause mortality to be 98% at 30 days through four years (95% CI, 86.6-99.7%). Kaplan-Meier estimated freedom from major adverse events, all-cause mortality, paralysis, and stroke, of 98.0% at 30 days and 95.8% from six months to four years (95% CI, 84.3-98.9%). There were no strokes and one case of paraplegia (2%) during follow-up. CONCLUSIONS RelayPro was safe and effective and may provide an early survival benefit in the treatment of blunt traumatic aortic injury.
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Affiliation(s)
| | - Ravi R Rajani
- Emory University School of Medicine and Grady Health System, Atlanta, GA
| | | | | | | | - Jae S Cho
- University Hospitals Cleveland, Cleveland, OH
| | | | | | | | | | | | - Joel Corvera
- Indiana University School of Medicine, Indianapolis, IN
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2
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Ebertz DP, Bose S, Smith JA, Sarode AL, Ambani RN, Cho JS, Kumins NH, Kashyap VS, Colvard BD. Direct oral anticoagulants over warfarin at discharge associated with improved survival and patency in infra-geniculate bypasses with prosthetic conduits. J Vasc Surg 2024; 79:609-622.e2. [PMID: 37984756 DOI: 10.1016/j.jvs.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE There is no consensus on the optimal anticoagulant regimen following lower extremity bypass. Historically, warfarin has been utilized for prosthetic or compromised vein bypasses. Direct-acting oral anticoagulants (DOACs) are increasingly replacing warfarin in this context, but their efficacy in bypass preservation has not been well-studied. Recent studies have shown that DOACs may improve outcomes following bypasses; however, it is unclear if this is dependent upon type of bypass conduit. The goal of this study was to evaluate whether a difference exists between vein and prosthetic infra-geniculate bypasses outcomes based on the anticoagulant utilized on discharge, warfarin or DOAC. METHODS The Vascular Quality Initiative infra-inguinal bypass database was queried for all patients who underwent an infra-geniculate bypass and were anticoagulation-naive at baseline but were discharged on either warfarin or DOACs. A survival analysis was performed for patients up to 1 year to determine whether the choice of discharge anticoagulation was associated with differences between those with vein vs prosthetic conduits in overall survival, primary patency, risk of amputation, or risk of major adverse limb events (MALE). A multivariable Cox proportional hazards analysis was performed to control for differences in baseline demographic factors between the groups. RESULTS During the study period (2003-2020), 57,887 patients underwent infra-geniculate bypass. Of these, 3230 (5.5%) were anticoagulated on discharge. There was a similar distribution of anticoagulation between vein (n = 1659; 51.4%) and prosthetic conduits (n = 1571; 48.6%). Thirty-two percent were discharged on DOACs, and 68.0% were discharged on warfarin. For prosthetic conduits, being discharged on a DOAC was associated with improved outcomes on univariate and multivariable analyses revealing lower risk of overall mortality (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.41-0.93; P = .021), loss of primary patency (HR, 0.70; 95% CI, 0.55-0.89; P = .003), risk of amputation (HR, 0.71; 95% CI, 0.54-0.93; P = .013), and risk of MALE (HR, 0.80; 95% CI, 0.64-1.00; P = .048). Patients with a vein bypass had improved univariate outcomes for survival and primary patency; however, with multivariable analysis, there were no significant differences in outcomes between DOAC and warfarin. CONCLUSIONS Anticoagulation-naive patients who underwent an infra-geniculate prosthetic bypass had higher rates of overall survival, bypass patency, amputation-free survival, and freedom from MALE when discharged on a DOAC compared with warfarin. Those with vein bypasses had similar outcomes regardless of the choice of anticoagulation.
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Affiliation(s)
- David P Ebertz
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
| | - Saideep Bose
- Division of Vascular and Endovascular Surgery, Department of Surgery, St Louis University, St Louis, MO
| | - Justin A Smith
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Anuja L Sarode
- University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
| | - Ravi N Ambani
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Jae S Cho
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Norman H Kumins
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Vikram S Kashyap
- Division of Vascular Surgery, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Benjamin D Colvard
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
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3
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Chung JM, Wogsland AA, Bose S, Schilz R, Onders RP, Cho JS. Temporary diaphragm pacing for patients at risk of prolonged mechanical ventilation after extensive aortic repair. J Vasc Surg Cases Innov Tech 2023; 9:101319. [PMID: 37860728 PMCID: PMC10582765 DOI: 10.1016/j.jvscit.2023.101319] [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: 05/26/2023] [Accepted: 08/24/2023] [Indexed: 10/21/2023] Open
Abstract
Objective Prolonged mechanical ventilation (MV) after extensive aortic reconstructive surgery is common. Studies have demonstrated that diaphragm pacing (DP) improves lung function in patients with unilateral diaphragm paralysis. The goal of this study is to determine whether this technology can be applied to complex aortic repair to reduce prolonged MV and other respiratory sequelae. Methods A retrospective review was performed of patients who underwent temporary DP after extensive aortic reconstructive surgery between 2019 and 2022. The primary end point was prolonged MV incidence. Other measured end points included diaphragm electromyography improvement, length of hospitalization, duration of intensive care unit stay, and reintubation rates. Results Fourteen patients deemed at high risk of prolonged MV based on their smoking and respiratory history underwent DP after extensive aortic repair. The mean age was 70.2 years. The indications for aortic repair were a thoracoabdominal aortic aneurysm (n = 8, including 2 ruptured, 2 symptomatic, and 1 mycotic), a perivisceral aneurysm (n = 4), and a perivisceral coral reef aorta (n = 2). All patients had a significant smoking history (active or former) or other risk factors for ventilator-induced diaphragmatic dysfunction and prolonged MV. The mean total duration of MV postoperatively was 31.9 hours (range, 8.1-76.5 hours). The total average pacing duration was 4.4 days. Two patients required prolonged MV, with an average of 75.4 hours. Two patients required reintubation. No complications related to DP wire placement or removal occurred. Conclusions DP is safe and feasible for patients at high risk of pulmonary insufficiency after extensive aortic reconstructive surgery.
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Affiliation(s)
- Jane M. Chung
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Saideep Bose
- Division of Vascular Surgery, Saint Louis University Hospital, St. Louis, MO
| | - Robert Schilz
- Division of Pulmonary Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Raymond P. Onders
- Division of General Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
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Alrazim AM, Burk JK, Wilder TJ, Park WM, Yoon WJ, Cho JS. Recurrent symptomatic aortic aneurysm in a young girl with tuberous sclerosis complex and review of the literature. J Vasc Surg Cases Innov Tech 2023; 9:101261. [PMID: 38106352 PMCID: PMC10725066 DOI: 10.1016/j.jvscit.2023.101261] [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: 03/17/2023] [Accepted: 06/06/2023] [Indexed: 12/19/2023] Open
Abstract
An abdominal aortic aneurysm is a rare occurrence in pediatric populations. When present, it is usually associated with an underlying etiology such as a connective tissue disorder, inflammatory process, or noninflammatory medial degeneration. In the present report, we describe the case of a girl with tuberous sclerosis complex who underwent successful emergency open repair of a symptomatic infrarenal abdominal aortic aneurysm and recurrent type IV thoracoabdominal aortic aneurysm.
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Affiliation(s)
- Ayman M. Alrazim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Joshua K. Burk
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Travis J. Wilder
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Woosup Michael Park
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - William J. Yoon
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
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Kumins NH, Ambani RN, Bose S, King AH, Cho JS, Colvard B, Kashyap VS. Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2023; 57:680-688. [PMID: 36961838 DOI: 10.1177/15385744231165988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Single branched thoracic endografts (SBTEs) have been designed for pathology requiring zone 2 seal during thoracic endovascular aortic repair (TEVAR). Numerous criteria must be met to allow for their implantation. Our aim was to analyze anatomic suitability for a next generation SBTE. METHODS We reviewed 150 TEVAR procedures between 2015 and 2019. Proximal seal was: zone 0 in 21 (16%), zone 1 in 4 (3%), zone 2 in 52 (40%), zone 3 in 45 (35%), and zone 4 or distal in 7 (5%). We analyzed the Zone 2 patient's angiograms and CT angiograms using centerline software to measure arterial diameters and length in relation to the left common carotid artery (LCCA), left subclavian artery (LSA) and proximal extent of aortic disease to determine if patients met anatomic criteria of a novel SBTE. RESULTS Zone 2 average age was 64.4 ± 16.3 years; 34 patients were male (65%). Indications for repair were aneurysm (N = 9, 17%), acute dissection (N = 14, 27%), chronic dissection with aneurysmal degeneration (N = 7, 13%), intramural hematoma (N = 9, 17%), penetrating aortic ulcer (N = 5, 10%), and blunt traumatic aortic injury (BTAI, N = 8, 15%). LSA revascularization occurred in 27 patients (52%). Overall, 20 (38.5%) of the zone 2 patients met anatomic criteria. Patients with dissection met anatomic criteria less frequently than aneurysm (33% [10 of 30] vs 64% [9 of 14]). Patients treated for BTAI rarely met the anatomic criteria (1 of 8, 13%). The main anatomic constraints were an inadequate distance from the LCCA to the LSA takeoff and from the LCCA to the start of the aortic disease process. CONCLUSION Less than half of patients who require seal in zone 2 met criteria for this SBTE. Patients with aneurysms met anatomic criteria more often than those with dissection. The device would have little applicability in treating patients with BTAI.
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Affiliation(s)
- Norman H Kumins
- Department of Vascular Surgery, The Heart and Vascular Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - Ravi N Ambani
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Saideep Bose
- Division of Vascular and Endovascular Surgery, Department of Surgery, St Louis University, St Louis, MO, USA
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Vikram S Kashyap
- Division of Vascular Surgery, Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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6
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Smith JA, Kandala J, Turner JT, Cho JS, Shishehbor MH. Off-the-shelf percutaneous deep vein arterialization for no-option chronic limb-threatening ischemia related to Buerger disease. J Vasc Surg Cases Innov Tech 2023; 9:101211. [PMID: 37388665 PMCID: PMC10300406 DOI: 10.1016/j.jvscit.2023.101211] [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: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 07/01/2023] Open
Abstract
Percutaneous deep venous arterialization (pDVA) is an important technique in the pursuit of limb salvage for a certain high-risk subset of patients with chronic limb-threatening ischemia (CLTI) considered to have "no option" owing to the lack of tibial or pedal targets for revascularization. pDVA seeks to establish an arteriovenous connection at the level of the tibial vessels, in addition to tibial and/or pedal venoplasty, to provide a pathway for arterial perfusion via the tibial and/or plantar venous system. A commercial system for pDVA exists; however, it is not yet approved by the U.S. Food and Drug Administration. In the present report, we detail a method of pDVA that uses commercially available devices for a patient with no-option CLTI related to Buerger disease.
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Affiliation(s)
- Justin A. Smith
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jagdesh Kandala
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jason Ty Turner
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Mehdi H. Shishehbor
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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7
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Muller M, Yau P, Pham A, Lipsitz EC, DeRose JJ, Cho JS, Shariff S, Indes JE. A comparison of endovascular repair to medical management for acute vs subacute uncomplicated type B aortic dissections. J Vasc Surg 2023; 78:53-60. [PMID: 36889606 DOI: 10.1016/j.jvs.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) has emerged as a viable option of treatment for uncomplicated type B aortic dissection (UTBAD) due to the potential for inducing favorable aortic remodeling. The aim of this study is to compare outcomes of UTBAD treated medically or with TEVAR in either the acute (1 to 14 days) or subacute period (2 weeks to 3 months). METHODS Patients with UTBAD between 2007 and 2019 were identified using the TriNetX Network. The cohort was stratified by treatment type (medical management; TEVAR during the acute period; TEVAR during the subacute period). Outcomes including mortality, endovascular reintervention, and rupture were analyzed after propensity matching. RESULTS Among 20,376 patients with UTBAD, 18,840 were medically managed (92.5%), 1099 patients were in the acute TEVAR group (5.4%), and 437 patients were in the subacute TEVAR group (2.1%). The acute TEVAR group had higher rates of 30-day and 3-year rupture (4.1% vs 1.5%; P < .001; 9.9% vs 3.6%; P < .001) and 3-year endovascular reintervention (7.6% vs 1.6%; P < .001), similar 30-day mortality (4.4% vs 2.9%; P < .068), and lower 3-year survival compared with medical management (86.6% vs 83.3%; P = .041). The subacute TEVAR group had similar rates of 30-day mortality (2.3% vs 2.3%; P = 1), 3-year survival (87.0% vs 88.8%; P = .377) and 30-day and 3-year rupture (2.3% vs 2.3%; P = 1; 4.6% vs 3.4%; P = .388), with significantly higher rates of 3-year endovascular reintervention (12.6% vs 7.8%; P = .019) compared with medical management. The acute TEVAR group had similar rates of 30-day mortality (4.2% vs 2.5%; P = .171), rupture (3.0% vs 2.5%; P = .666), significantly higher rates of 3-year rupture (8.7% vs 3.5%; P = .002), and similar rates of 3-year endovascular reintervention (12.6% vs 10.6%; P = .380) compared with the subacute TEVAR group. There was significantly higher 3-year survival (88.5% vs 84.0%; P = .039) in the subacute TEVAR group compared with the acute TEVAR group. CONCLUSIONS Our results found lower 3-year survival in the acute TEVAR group compared with the medical management group. There was no 3-year survival benefit found in patients with UTBAD who underwent subacute TEVAR compared with medical management. This suggests the need for further studies looking at the necessity for TEVAR when compared with medical management for UTBAD as it is non-inferior to medical management. Higher rates of 3-year survival and lower rates of 3-year rupture in the subacute TEVAR group compared with the acute TEVAR group suggest superiority of subacute TEVAR. Further investigations are needed to determine the long-term benefit and optimal timing of TEVAR for acute UTBAD.
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Affiliation(s)
- Matthew Muller
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
| | - Patricia Yau
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Antoine Pham
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Evan C Lipsitz
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Joseph J DeRose
- Department of Cardiothoracic Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jae S Cho
- Department of Vascular Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Saadat Shariff
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jeffrey E Indes
- Department of Vascular and Endovascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Smith JA, Yang L, Chen L, Kumins N, Cho JS, Harth K, Wong V, Kashyap V, Colvard B. Trends and outcomes associated with intravascular ultrasound use during femoropopliteal revascularization in the Vascular Quality Initiative. J Vasc Surg 2023; 78:209-216.e1. [PMID: 36944390 DOI: 10.1016/j.jvs.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Intravascular ultrasound (IVUS) use in lower extremity interventions is growing in popularity owing to its imaging in the axial plane, superior detail in imaging lesion characteristics, and its enhanced ability to delineate lesion severity and extent compared with catheter angiograms. However, there are conflicting data regarding whether IVUS affects outcomes. The purpose of this study was to assess the effect associated with IVUS implementation in femoropopliteal interventions. METHODS This retrospective cohort study used Vascular Quality Initiative data. Patients undergoing an index endovascular femoropopliteal revascularization from 2016 to 2021 were included. Patients were differentiated by whether or not IVUS was used to assess the femoropopliteal segment during intervention (no IVUS, IVUS). Propensity score matching, based on preoperative demographics and measures of disease severity was used. Primary outcomes were major amputation-free survival (AFS), femoropopliteal reintervention-free survival (RFS), and primarily patent survival (PPS) at 12 months. RESULTS IVUS use grew steadily throughout the study period, comprising 0.6% of interventions in 2016 and increasing to 8.2% of interventions by 2021; growth was most dramatic in ambulatory surgical center or office-based laboratory settings where IVUS use grew from 4.4% to 43% to 47% of interventions. In unmatched cohorts, patients receiving interventions using IVUS tended to have lower prevalence of multiple cardiovascular comorbidities (eg, congestive heart failure, hypertension, diabetes, and dialysis dependence) and presented more often with claudication and less often with chronic limb-threatening ischemia (CLTI). Intraoperatively, IVUS was used more often in complex femoropopliteal lesions (Transatlantic Intersociety grade D vs A), and more often in conjunction with stenting and/or atherectomy. IVUS use was associated with improved AFS, but similar RFS and PPS at 12 months. However, in multivariable analysis IVUS was not associated with any of the primary outcomes independently; rather, all outcomes were influenced primarily by CLTI, dialysis dependence, and prior major amputation status; technical outcomes (ie, RFS and PPS loss) were further driven by complexity of lesion (worse in Transatlantic Intersociety grade D vs A lesions) and treatment setting (ie, ambulatory surgical center or office-based laboratory setting associated with increased hazard for RFS and PPS loss). CONCLUSIONS IVUS implementation in femoropopliteal interventions is growing, with rapid adoption among interventions in ambulatory surgical centers and office-based laboratories. IVUS was not associated with an effect on technical outcomes at 12 months; improvement in major AFS was observed; however, multivariable analysis suggests this finding may be an effect of confounding by multiple factors highly associated with IVUS use, namely, in patients with lower prevalence of CLTI, dialysis dependence, and prior major amputations, thus conveying baseline lower risk for major amputation and death.
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Affiliation(s)
- Justin A Smith
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Lucy Yang
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lin Chen
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Norman Kumins
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Karem Harth
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Virginia Wong
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Vikram Kashyap
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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Yoon WJ, Mani K, Han SM, Lee CJ, Cho JS, Wanhainen A. Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation. JVS Vasc Sci 2023; 4:100116. [PMID: 37496886 PMCID: PMC10366580 DOI: 10.1016/j.jvssci.2023.100116] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 07/28/2023] Open
Abstract
Objective Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis [TBE]) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair. However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic simulations. Methods Eleven patients who had undergone TBE implantation were included. Three-dimensional aortic arch geometries were constructed from the pre- and post-TBE implantation computed tomography images. The resulting 22 three-dimensional aortic arch geometries were then discretized into finite element meshes for computational fluid dynamic simulations. Inflow boundary conditions were prescribed using normal physiological pulsatile circulation. Outlet boundary conditions consisted of Windkessel models with previously published values. Blood flow, modeled as Newtonian fluid, simulations were performed with rigid wall assumptions using SimVascular's incompressible Navier-Stokes solver. We compared well-established hemodynamic descriptors: pressure, flow rate, time-averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), and percent area with an OSI of >0.2. Data were presented on the stented portion of the LSA. Results TBE implantation was associated with a small decrease in peak LSA pressure (153 mm Hg; interquartile range [IQR], 151-154 mm Hg vs 159 mm Hg; IQR, 158-160 mm Hg; P = .005). No difference was observed in peak LSA flow rates before and after implantation: 40.4 cm3/ (IQR, 39.5-41.6 cm3/s) vs 41.3 cm3/s (IQR, 37.2-44.8 cm3/s; P = .59). There was a significant postimplantation increase in TAWSS (15.2 dynes/cm2 [IQR, 12.2-17.7 dynes/cm2] vs 6.2 dynes/cm2 [IQR, 5.7-10.3 dynes/cm2]; P = .003), leading to decreases in both the OSI (0.088 [IQR, 0.063 to -0.099] vs 0.1 [IQR, 0.096-0.16]; P = .03) and percentage of area with an OSI of >0.2 (10.4 [IQR, 5.8-15.8] vs 15.7 [IQR, 10.7-31.9]; P = .13). Neither LSA side branch angulation (median, 81°, IQR, 77°-109°) nor moderate compression (16%-58%) seemed to have an impact on the pressure, flow rate, TAWSS, or percentage of area with an OSI of >0.2 in the stented LSA. Conclusions The implantation of TBE produces modest hemodynamic disturbances that are unlikely to result in clinically relevant changes.
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Affiliation(s)
- William J. Yoon
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Sukgu M. Han
- Comprehensive Aortic Center, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Cheong J. Lee
- Division of Vascular Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Department of Surgical and perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Kumins NH, Wogsland AA, Smith J, Patel A, Cho JS, Colvard B, Kashyap VS. Management and Outcome of Non-Aneurysmal Primary Aortic Infection. Vasc Endovascular Surg 2023; 57:222-229. [PMID: 36453193 DOI: 10.1177/15385744221143659] [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: 12/03/2022]
Abstract
INTRODUCTION Aortic infection without prior intervention or aneurysm is exceedingly rare. We report the presentation, diagnosis, management, and outcome of patients with this unusual entity. METHODS Retrospective chart and imaging review of patients with primary aortic infection. RESULTS 5 patients (3 male, mean age 71.2 years) presented between 2014 and 2022. All had abdominal, back, or flank pain. Four had constitutional symptoms. All were evaluated with a complete blood count; 3 had leukocytosis. Both serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated in the 4 patients evaluated with these tests. All were studied with peripheral blood culture on the first hospital day prior to any antibiotic administration. Blood culture was positive in only 1 patient. Computed tomography (CT) scan showed periaortic inflammation without aneurysm in all. Fluorodeoxyglucose positron emission tomography (PET) was obtained in 3 and a radiolabeled leukocyte single-photon emission CT (SPECT) scan was performed in 2. All demonstrated periaortic concentration of the radioisotope consistent with inflammation or infection. Intraoperative cultures were positive in 3. One patient who had a negative intraoperative culture was examined with broad range polymerase chain reaction (PCR) and DNA sequencing which identified a causative bacterium. The other patient with a negative intraoperative culture had periaortic abscess but was on antibiotics preoperatively, potentially confounding the culture. All patients underwent in-situ repair with rifampin impregnated polyester (N = 2), cryopreserved aortic allograft (N = 2), or autogenous femoral vein (N = 1). No patient developed recurrent infection or aortic related complications following surgery with an average follow up of 31.8 months (range 8-88 months). CONCLUSIONS Patients with primary aortic infection present similarly with the triad of abdominal or back pain, laboratory markers of infection, and imaging demonstrating periaortic inflammation. Patients were treated successfully with in-situ repair. Preoperative identification of a causative organism was difficult, and PCR may be useful to help identify an organism.
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Affiliation(s)
- Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Aric A Wogsland
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justin Smith
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Avkash Patel
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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11
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Smith JA, So KL, Kashyap VS, Cho JS, Colvard B, Kumins NH. Outcome after revascularization with paclitaxel-coated devices in patients with chronic limb-threatening ischemia. J Vasc Surg 2023; 77:1742-1750. [PMID: 36754247 DOI: 10.1016/j.jvs.2023.01.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Data regarding the safety and efficacy of paclitaxel (PTX)-coated peripheral arterial devices for femoropopliteal artery (FPA) atherosclerotic disease is derived from studies that mainly evaluated patients with claudication. Outcomes of PTX treatment for patients with chronic limb-threatening ischemia (CLTI) is incompletely defined. This study compares outcome in patients with CLTI treated with and without PTX. METHODS We retrospectively studied patients who underwent FPA intervention for an indication of CLTI in the Vascular Quality Initiative peripheral vascular intervention database from 2016 to 2020. Patients who had concomitant iliac or tibial interventions were included. One limb per patient was studied. Propensity score matching based on demographics, comorbidities, indication, and pharmacological therapy was performed to generate balanced cohorts. Kaplan-Meier survival analysis and multivariate Cox regression compared limb salvage, overall survival, primary patency, and major adverse limb events (MALE) between patients treated with and without PTX. RESULTS Demographics, comorbidities, indications, and procedural details were similar between 14,065 PTX and 14,065 non-PTX propensity-matched patients. Kaplan-Meier analysis at 18-month follow-up demonstrated that the PTX group compared with the non-PTX group had a significantly higher rates of limb salvage (89.2% vs 86.5%; P < .001), primary patency (80.3% vs 76.9%; P < .001), and freedom from MALE (72.6% vs 67.9%; P < .001). Multivariate analysis also showed that PTX treatment was associated with a lower risk of major amputation (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.67-0.82; P < .001), loss of primary patency (HR, 0.80; 95% CI, 0.74-0.87; P < .001), and MALE (HR, 0.77; 95% CI, 0.72-0.82; P < .001). Overall, 21% of patients had a prior ipsilateral peripheral vascular intervention. Removing these patients from the analysis yielded similar results at 18 months. Overall survival at 54 months was not statistically different between the PTX and non-PTX groups in the overall cohort (73.5 vs 71.3%; P = .07), but significant in the de-novo treated patients (73.9% vs 70.7%; P = .02).Multivariate analyses showed a lower mortality risk in the PTX patients (HR, 0.93; 95% CI, 0.87-0.98; P = .02). CONCLUSIONS FPA intervention with a PTX-coated device is associated with improved limb salvage, primary patency, and freedom from MALE at the 18-month follow-up compared with uncoated devices. This benefit was not associated with an increase in all-cause mortality out to 4.5 years. Further study is necessary to determine the optimal role for PTX in the treatment of the FPA for patients with CLTI and to understand its long-term outcome.
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Affiliation(s)
- Justin A Smith
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Kristine L So
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
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12
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Lim S, Kwan S, Colvard BD, d'Audiffret A, Kashyap VS, Cho JS. Impact of Interfacility Transfer of Ruptured Abdominal Aortic Aneurysm Patients. J Vasc Surg 2022; 76:1548-1554.e1. [PMID: 35752382 DOI: 10.1016/j.jvs.2022.05.020] [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: 11/22/2021] [Revised: 04/12/2022] [Accepted: 05/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Interfacility transfer (IT) of patients with ruptured (r) abdominal aortic aneurysm (AAA) occurs not infrequently for a higher level of care. This study evaluates using contemporary administrative database the impact of IT on mortality after rAAA repair. METHODS Healthcare Cost and Utilization Project Database for NY (2016) and NJ/MD/FL (2016-2017) were queried using ICD-10th edition to identify patients who underwent open and endovascular repair of AAA. Hospitals were categorized into quartiles (Q) per overall volume. Mortality rates of IT vs non-transferred (NT) rAAA patients per treatment modality (open [rOAR] vs. endovascular [rEVAR]) were compared. Cox proportional hazard model was used to estimate hazard ratios (HR) for mortality. RESULTS 1475 patients presented with rAAA of whom 672 (45.6%) were not treated. Of the remaining 803 patients, 226 (28.1%) were transferred; 50 (22.1%) died without a repair after IT. The remaining 752 patients (176 IT + 576 NT) underwent 491 rEVARs and 261 rOARs. Baseline characteristics were similar between IT and NT patients except for higher proportion of Blacks (P=.03), lower-income families (P=.049) and rOAR (45.5% vs 31.4%, p=.001) in IT patients. Overall mortality rates were similar between NT (30.2%) and IT (27.3%, P=.46). On sub-group analysis, operative mortality rates after rEVAR were similar between NT and IT patients, without differences among hospital quartiles. After rOAR, however, operative mortality rates were lower in IT patients, largely due to improved outcomes in Q4 hospitals (P=.001, Q4 vs Q1, 2 & 3). Cox regression analysis demonstrated age (HR 1.03, CI 1.00-1.06, P=.02) and low-volume hospitals (Q1-3) (HR 1.89, CI 1.02-3.51, P=.04) are predictors of mortality. Total charges were similar ($286,727 IT vs $265,717 NT, P=.38). CONCLUSIONS Less than 30% of rAAA patients deemed to be a candidate for repair are transferred. IT does not affect mortality rates after rEVAR, irrespective of hospital volume. For rOAR candidates, however, regionalization of care with prompt transfer to a high-volume center improves the survival benefits without increased health care cost.
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Affiliation(s)
- Sungho Lim
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Rush Medical College/Rush University Medical Center, Chicago, IL
| | - Stephen Kwan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Benjamin D Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Alexandre d'Audiffret
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Rush Medical College/Rush University Medical Center, Chicago, IL
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH.
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13
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Smith JA, Chen L, Yang L, Wong V, Harth K, Kumins NH, Cho JS, Kashyap VS, Colvard B. Intravascular Ultrasound Confers No Benefit in Aortoiliac Revascularization. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Cho JS. Unraveling the enigma of an aberrant subclavian artery (arteria lusoria). J Vasc Surg 2022; 75:1349-1350. [PMID: 35314040 DOI: 10.1016/j.jvs.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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15
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Patel AJ, Ambani RN, Sarode AL, King AH, Baeza CR, Elgudin Y, Colvard BD, Kumins NH, Kashyap VS, Sabik JF, Cho JS. Outcomes of Great Vessel Debranching to Facilitate Thoracic Endovascular Aortic Repair. J Vasc Surg 2022; 76:53-60.e1. [PMID: 35149157 DOI: 10.1016/j.jvs.2022.01.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES With the expanding application of endovascular technology, the need to deploy into zone 0 has been encountered on occasion. This study evaluates the outcomes of great vessel debranching (GVD) as a method of extending the proximal landing zone (PLZ) to facilitate thoracic endovascular aortic repair (TEVAR). METHODS A single-center retrospective review of all patients who underwent GVD followed by TEVAR between May 2013 and December 2020 was conducted. The primary outcome was primary patency of all targeted vessels, with all-cause perioperative mortality as a secondary outcome. Kaplan-Meier analysis was used to account for censoring the mortality and primary patency. The extent of hybrid aortic repairs was characterized into type I: GVD + TEVAR without ascending aorta or aortic arch reconstruction; type II: GVD + TEVAR with ascending aorta reconstruction; and type III: GVD + TEVAR with ascending aorta and aortic arch reconstruction with an elephant trunk (surgical or "frozen"). RESULTS There were 42 patients (23 males [54.8%], mean age of 62.2 ± 11.2 years) who underwent GVD with 122 vessels revascularized (42 innominate, 42 left common carotid [LCCA], and 38 left subclavian [LSA] arteries). The indication for TEVAR was aneurysmal degeneration from aortic dissection in 32 (76.2%) patients, thoracic aneurysm in 9 (21.4%) patients, and perforated aortic ulcer in 1 (2.4%) patient. Median duration between GVD and TEVAR was 82 days. Mean follow-up was 25.7 ± 23.5 months. Type I repair was performed in 4, type II in 16, and type III in 22 patients. Perioperative mortality, stroke, and paraplegia rates were 9.5%, 7.1%, and 2.4%, respectively. Neither the extent of repair (p = 0.80) nor a prior history of aortic repair (p = 0.90) was associated with early mortality. Late deaths (>30 days) occurred in 6 of 38 patients who survived the perioperative period. At 36 months, the survival estimate was 68.6% (95% CI: 45.7% - 83.4%); the overall primary patency of the innominate artery, LCCA, and LSA was 100%, 89.5%, and 94.1%, respectively. The primary assisted patency rate was 100% for all vessels. CONCLUSIONS GVD is a safe and effective means of extending the PLZ into zone 0 with outstanding primary patency rates. Further studies are needed to confirm the safety and longer-term durability in these patients.
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Affiliation(s)
- Avkash J Patel
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ravi N Ambani
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anuja L Sarode
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cristian R Baeza
- Division of Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D Colvard
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph F Sabik
- Division of Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Kim AH, King AH, Schmaier AH, Cho JS. Persistent disseminated intravascular coagulation despite correction of endoleaks after thoracoabdominal endovascular aneurysm repair. J Vasc Surg Cases Innov Tech 2021; 7:730-733. [PMID: 34754997 PMCID: PMC8564492 DOI: 10.1016/j.jvscit.2021.08.012] [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] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 12/02/2022]
Abstract
Disseminated intravascular coagulation (DIC) is a rare complication of endovascular aortic repair, commonly associated with type I or type III endoleaks. DIC is also known as consumption coagulopathy because excessive thrombin formation and secondary fibrinolysis leads to consumption of coagulation factors with hyperfibrinolysis and activation of platelets, which can lead to excessive bleeding. We present the case of an 80-year-old woman who had undergone thoracic endovascular aortic repair for a type B aortic dissection that was complicated by a series of recurrent endoleak-induced DICs requiring multiple thoracic endovascular aortic repair extensions to cover the entire thoracoabdominal aorta. The DIC persisted despite the resolution of the endoleaks.
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Affiliation(s)
- Ann H Kim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Alvin H Schmaier
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
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17
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King AH, Kim AH, Kwan S, Lee J, Schmaier AH, Kumins NH, Harth KC, Wong VL, Colvard BD, Kashyap VS, Cho JS. Elevated Neutrophil to Lymphocyte Ratio is Associated with Worse Outcomes after Carotid Endarterectomy in Asymptomatic Patients. J Stroke Cerebrovasc Dis 2021; 30:106120. [PMID: 34597986 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/10/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Management of carotid artery stenosis (CAS) remains controversial and proper patient selection critical. Elevated neutrophil to lymphocyte ratio (NLR) has been associated with poor outcomes after vascular procedures. The effect of NLR on outcomes after carotid endarterectomy (CEA) in asymptomatic and symptomatic patients is assessed. MATERIALS AND METHODS A retrospective review was conducted of all patients between 2010 and 2018 with carotid stenosis >70% as defined by CREST 2 criteria. A total of 922 patients were identified, of whom 806 were treated with CEA and 116 non-operatively with best medical therapy (BMT). Of patients undergoing CEA, 401 patients (290 asymptomatic [aCEA], 111 symptomatic [sCEA]) also had an available NLR calculated from a complete blood count with differential. All patients treated with BMT were asymptomatic and had a baseline NLR available. Kaplan-Meier analysis assessed composite ipsilateral stroke or death over 3 years. RESULTS In sCEA group, the 3-year composite stroke/death rates did not differ between NLR < 3.0 (22.9%) vs NLR > 3.0 (38.1%) (P=.10). In aCEA group, patients with a baseline NLR >3.0 had an increased risk of 3-year stroke/death (42.6%) compared to both those with NLR <3.0 (9.3%, P<.0001) and those treated with BMT (23.6%, P=.003). In patients with NLR <3.0, aCEA showed a superior benefit over BMT with regard to stroke or death (9.3% vs. 26.2%, P=.02). However, in patients with NLR >3.0, there was no longer a benefit to prophylactic CEA compared to BMT (42.6% vs. 22.2%, P=.05). Multivariable analysis identified NLR >3.0 (HR, 3.23; 95% CI, 1.93-5.42; P<.001) and congestive heart failure (HR, 2.18; 95% CI, 1.33-3.58; P=.002) as independent risk factors for stroke/death in patients with asymptomatic carotid artery stenosis. CONCLUSIONS NLR >3.0 is associated with an increased risk of late stroke/death after prophylactic CEA for asymptomatic carotid artery stenosis, with benefits not superior to BMT. NLR may be used to help with selecting asymptomatic patients for CEA. The effect of NLR and outcomes in symptomatic patients requires further study. Better understanding of the mechanism(s) for NLR elevation and medical intervention strategies are needed to modulate outcome risk in these patients.
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Affiliation(s)
- Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Ann H Kim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Stephen Kwan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jasmine Lee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Alvin H Schmaier
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Karem C Harth
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Virginia L Wong
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Benjamin D Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
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Lim S, Kwan S, Colvard BD, d'Audiffret A, Kashyap VS, Cho JS. Effect of Interfacility Transfer of Ruptured Abdominal Aortic Aneurysm Patients. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Smith JA, Bose S, Sarode A, Cho JS, Colvard B. Effect of intravascular ultrasound on clinical outcomes after thoracic endovascular aortic repair for blunt thoracic aortic injury. J Vasc Surg 2021; 75:448-454.e2. [PMID: 34506893 DOI: 10.1016/j.jvs.2021.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/03/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) for blunt traumatic aortic injuries (BTAIs) can be complicated by inaccurate aortic measurements at the initial computed tomography angiography secondary to hypovolemic shock. The use of intravascular ultrasound (IVUS) has been proposed for more accurate aortic sizing, with prior data demonstrating larger aortic sizes measured by IVUS, potentially altering the vast majority of chosen endograft sizes. At present, and to the best of our knowledge, no studies have examined whether IVUS affects the clinical outcomes. The purpose of the present study was to examine the effect of IVUS on the clinical outcomes after TEVAR for BTAIs. METHODS A retrospective cohort study was performed of patients who had undergone TEVAR for BTAIs in the VQI registry. The cohorts were defined by the use of IVUS. The primary outcomes were mortality and reintervention at 1 year. RESULTS A total of 919 patients who had undergone TEVAR for BTAIs were included in the present analysis. The IVUS patients had presented with higher injury severity scores (36.2 vs 42; P = .0004) largely because of more extremity and external trauma. IVUS was more often used for patients with grade III injuries (49.1% vs 56.9%; P = .02) and less often for patients with rupture (21.1% vs 12.4%; P = .001). A trend toward a delay in TEVAR was seen for the patients for whom IVUS was used (1.8 vs 3.5 days; P = .38), with additional trends toward reduced intraoperative resuscitation and blood loss. The hemodynamic status of the patients and differences in aortic or endograft sizes could not be assessed with the available data. IVUS use was not associated with any differences in survival or reintervention rates in-hospital or at 1 year (Kaplan-Meier survival estimates: 0.91 no IVUS vs 0.92 IVUS; P = .46). Fifteen aortic-related reinterventions occurred across the entire patient cohort for all-available follow-up with comparable rates of type I endoleaks (1 no IVUS vs 2 IVUS), with no recorded cases of sizing-related complications such as device rupture, migration, or dissection. CONCLUSIONS IVUS usage during TEVAR for BTAIs was associated with clinical scenarios in which patients were more stable and interventions to address BTAIs can be delayed. Despite this, the overall clinical outcomes were similar between cases in which IVUS was used and for which it was not.
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Affiliation(s)
- Justin A Smith
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Saideep Bose
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anuja Sarode
- Research in Surgical Outcomes and Effectiveness, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Mitchell MA, Natour AK, Hares K, King AH, Kabbani L, Kashyap VS, Cho JS. The Effect of Neutrophil-lymphocyte Ratio on 10-year Survival Outcomes Following Elective Open and EVAR Procedures. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.342] [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]
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Bose S, Smith J, Ambani R, Sarode AL, Cho JS, Kumins N, Kashyap VS, Colvard B. Direct Oral Anticoagulants Started After Infrageniculate Bypass Reduce Three-Year Mortality When Compared With Warfarin. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Smith JA, Sarode AL, Stern JR, Cho JS, Colvard B. Physician-Modified Endografts Are Associated With a Survival Benefit Over Parallel Grafting in More Extensive Aortic Aneurysms. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.326] [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]
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Lim S, Kwan S, Cho Y, Park T, Colvard B, d'Audiffret A, Kashyap V, Cho JS. Discrepant Effects of Case Volume on Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Repair. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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King AH, Smith J, Evans N, Cho JS, Zacharias M, Carman T, Kashyap VS, Harth KC. Carotid Duplex Velocity Alterations Among Left Ventricular Assist Device Patients: Need for a Shift in Criteria? J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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King AH, Kwan S, Schmaier AH, Kumins NH, Harth KC, Colvard BD, Wong VL, Kashyap VS, Cho JS. Elevated neutrophil to lymphocyte ratio is associated with decreased amputation-free survival after femoropopliteal percutaneous revascularization. INT ANGIOL 2021; 40:442-449. [PMID: 34142540 DOI: 10.23736/s0392-9590.21.04699-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An elevated neutrophil-lymphocyte ratio (NLR) is a biomarker associated with adverse outcomes after cardiovascular surgery. This study evaluates the association of preoperative NLR with clinical outcomes after peripheral vascular intervention (PVI) of the femoropopliteal segments. METHODS A retrospective review identified 488 patients who underwent percutaneous interventions of femoropopliteal arteries between 2011 and 2018 and had a pre-procedural complete blood count with differential with normal white blood cell count within 30 days prior to intervention. Amputation-free survival (AFS), survival, and freedom from major amputation were assessed using Kaplan-Meier methods. Cohorts of patients with NLR <3 (Low), 3-4 (Mid), and >4 (High) were compared using univariate and multivariable statistical models. In these analyses NLR was analyzed as a continuous variable to correlate with clinical outcomes. RESULTS Mean age was 71.7 ± 12.8 years and males constituted 55.5%. The majority of patients presented with chronic limb threatening ischemia (CLTI, 78.5%). Increasing NLR was correlated with increasing rates of comorbidities, except for smoking history. The 30-day mortality rates increased with increasing NLR: 1.4%, 4.3%, and 7.0% for Low (<3), Mid (3-4) and High (>4) NLR groups, respectively (P =.005). Patients with a lower pre-operative NLR achieved significantly greater amputation-free survival at 4-year follow-up: low NLR, 65.5%; mid NLR, 37.5%; and high NLR, 17.6% (P <.0001). By multivariable analysis, increasing NLR, advanced age, CLTI, and dialysis-dependent renal failure reduced AFS. CONCLUSIONS Elevated NLR is an independent predictor of decreased AFS following percutaneous interventions of femoropopliteal segments. Further research on identification and modulation of risk factors for high NLR are warranted.
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Affiliation(s)
- Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen Kwan
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alvin H Schmaier
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Karem C Harth
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Colvard
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Virginia L Wong
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University, Cleveland, OH, USA -
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Kumins NH, King AH, Ambani RN, Cho JS, Harth KC, Wong VL, Colvard B, Bose S, Thomas JP, Kashyap VS. Paclitaxel-coated peripheral arterial devices are associated with improved overall survival and limb salvage in patients with chronic limb-threatening ischemia. J Vasc Surg 2021; 74:1682-1688.e1. [PMID: 34090989 DOI: 10.1016/j.jvs.2021.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Paclitaxel (PTX)-coated peripheral arterial devices have been shown to decrease femoropopliteal artery restenosis and the need for reintervention compared with non-PTX-coated devices. The data regarding PTX efficacy and safety come from randomized controlled trials that almost exclusively enrolled patients with claudication. The outcomes of PTX treatment in patients who present with chronic limb-threatening ischemia (CLTI) are unknown. This study compares long-term outcomes in patients with CLTI treated with and without PTX. METHODS We retrospectively reviewed 983 patients with CLTI treated with femoropopliteal artery angioplasty, atherectomy, stent, or combination between 2011 and 2019. Procedures were performed with additional proximal or distal tibial interventions as needed. Kaplan-Meier survival analysis and multivariable Cox-regression analysis compared overall survival (OS), amputation-free survival (AFS), freedom from major amputation (ff-MA), and freedom from target vessel revascularization (ff-TVR) between patients treated with and without PTX. RESULTS Demographics, comorbidities, and Rutherford class were similar between 574 PTX (58.5%) and 409 non-PTX (41.6%) patients except that non-PTX patients were more likely to be male (56.2% vs 49.7%), dialysis dependent (19.6% vs 14.3%), and have higher average creatinine (2.3 vs 1.8 mg/dL). Through 4-year follow-up, the PTX group demonstrated a significant increase in OS (56.2% vs 43.9%, P = .013), AFS (52.6% vs 36.1%, P < .0001), ff-MA (87.4% vs 78.7%, P = .0007), and ff-TVR (77.6% vs 70.6%, P = .012). Multivariable Cox-regression analysis demonstrated that PTX treatment was associated with improved OS, AFS, ff-MA, and ff-TVR. CONCLUSIONS In patients with CLTI, treatment with a PTX-coated device is associated with improved OS, AFS, ff-MA, and ff-TVR through 4-year follow-up. PTX-coated devices may be especially beneficial in patients who present with CLTI.
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Affiliation(s)
- Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio.
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Ravi N Ambani
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Karem C Harth
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Virginia L Wong
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Saideep Bose
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jones P Thomas
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
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Park JH, Lai TF, Chang CS, Huang WC, Cho JS, Liao Y. A Nonlinear Association between Neighborhood Walkability and Risks of Sarcopenia in Older Adults. J Nutr Health Aging 2021; 25:618-623. [PMID: 33949628 DOI: 10.1007/s12603-021-1588-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Neighborhood walkability has been found to be positively related to physical activity and negatively associated with risks of noncommunicable diseases. However, limited studies have examined its association with sarcopenia in older adults. Thus, this study aimed to examine the association between neighborhood walk score and risks of sarcopenia in a sample of older Taiwanese adults. DESIGN AND SETTING This study was a cross-sectional investigation using telephone-based survey. PARTICIPANTS A nationwide telephone-based survey targeting older adults (≥ 65 years) was conducted in Taiwan. MEASUREMENTS Data on neighborhood walkability (determined by walk score of residential neighborhood), sarcopenia scores (measured by SARC-F), and personal characteristics were obtained. The relationships between walk score and risks of sarcopenia were examined using generalized additive models. RESULTS A total of 1,056 older adults participated in the survey. In model 1 (sex and age) and model 2 (full-adjusted model), a nonlinear association between neighborhood walk score and risks of sarcopenia was observed. Results showed that risks of sarcopenia appear to be lower in neighborhoods with a 40-walk score (Car-Dependent; most errands require a car) and an 80-walk score (Very Walkable) and highest in the neighborhood with a 60-walk score (Somewhat Walkable). CONCLUSIONS The study revealed a nonlinear relationship between neighborhood walkability and risks of sarcopenia in older adults in Asian context. Results provided information to urban designers and public health practitioners that more walkable neighborhood may not necessarily protect older adults from risks of sarcopenia.
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Affiliation(s)
- J-H Park
- Jeong Su Cho, Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan 49241, Korea, ; Liao Yung, Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taiwan,
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Kim HJ, Park HS, Shin CS, Cho JS, Lee T. Paraplegia after Open Repair of Suprarenal Abdominal Aortic Aneurysm. Vasc Specialist Int 2020; 36:248-251. [PMID: 33408291 PMCID: PMC7790699 DOI: 10.5758/vsi.200078] [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: 11/30/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 11/20/2022] Open
Abstract
Spinal cord ischemia after open repair of abdominal aortic aneurysm (AAA) is an unpredictable and devastating complication. We present a case report of a patient who developed paraplegia 6 hours after open repair of suprarenal AAA. A 74-year-old man presented with asymptomatic 5.5-cm suprarenal AAA, for which he underwent open repair under general anesthesia. The paraplegia was identified 6 hours after the operation. Postoperative magnetic resonance imaging showed T2 signal hyperintensity and swelling of the spinal cord, which were consistent findings with subacute spinal cord infarction. Although intravenous steroid was administered and lumbar cerebral spinal fluid drainage was instituted, his neurological outcome did not improve. He was discharged after vigorous rehabilitation but still has paraplegia and requires wheelchair for ambulation.
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Affiliation(s)
- Hyo Jun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Sik Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae S Cho
- Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Allotey JK, King AH, Kumins NH, Wong VL, Harth KC, Cho JS, Kashyap VS. Systematic review of hemostatic agents used in vascular surgery. J Vasc Surg 2020; 73:2189-2197. [PMID: 33253866 DOI: 10.1016/j.jvs.2020.10.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/17/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemostatic agents are routinely used in vascular surgery to complement proper suture techniques and decrease the risk of perioperative bleeding. A relative lack of comparative research studies have left surgeons with the option of choosing hemostatic agents based on their personal experience. The present review has highlighted the efficacy and safety of hemostatic agents and categorized them according to their primary mechanism of action and cost. METHODS A systematic search strategy encompassing hemostatic agent products was deployed in the PubMed database. Single-center and multicenter, randomized, controlled trials with >10 patients were included in the present study. RESULTS We reviewed 12 studies on the efficacy and safety of hemostatic agents compared with manual compression or other hemostatic agents. Using the time to hemostasis as the primary end point, all studies had found hemostatic agents to be significantly more efficient than manual compression. Likewise, adhesives (high pressure sealants) and dual agents (containing biologically active and absorbable components) were found to be more efficient, but costlier, than agents with either biologically active or absorbable components only. Agents with porcine or bovine constituents were found to trigger anaphylactic reactions in rare cases. Additionally, the absence of fibrin stabilizing factor XIII in a brand of fibrin sealant was speculated to reduce the affinity of the fibrin sealant for the expanded polytetrafluoroethylene graft. The cost of agents varied greatly depending on their active ingredient. CONCLUSIONS Hemostatic agents appear to be highly effective at decreasing the risk of bleeding during surgical procedures. Although some hemostatic agents were demonstrated to achieve hemostasis faster than others, most are able to control bleeding within <10 minutes. Based on the limited data, the least expensive agents might suffice for limited suture lines used in routine procedures.
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Affiliation(s)
- Jonathan K Allotey
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alexander H King
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Virginia L Wong
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Karem C Harth
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Ravishankar P, Harrison King A, Thomas JP, Clementina Harth K, Colvard BD, Louise Wong V, Cho JS, Kumins NH, Kashyap VS. Time to Traverse Lesion Association with Outcomes in Lower Extremity Revascularization for Peripheral Artery Disease. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Scariano GN, Kim AH, King AH, Turner JT, Cho JS, Kumins NH, Harth KC, Kashyap VS. The Clinical Impact of Incidental Findings in Neck Computed Tomography Angiography. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.090] [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]
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Kumins NH, King AH, Ambani RN, Thomas JP, Bose S, Wong VL, Harth KC, Cho JS, Colvard B, Kashyap VS. Paclitaxel-Coated Peripheral Arterial Devices are Associated with Reduced Mortality in Younger Patients. Ann Vasc Surg 2020; 70:70-78. [PMID: 32795647 DOI: 10.1016/j.avsg.2020.08.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Paclitaxel-coated devices have been shown to decrease restenosis when used in the femoropopliteal artery. Recent reports have suggested a possible risk of increased late mortality in patients treated with paclitaxel. It has been suggested that younger patients and those with limited comorbidities may be at higher risk. Our objective was to analyze long-term mortality based on patient age comparing treatment with paclitaxel to uncoated devices. METHODS We performed a retrospective review of 1,170 consecutive patients who underwent femoropopliteal percutaneous intervention by angioplasty, atherectomy, stent placement, or combination between 2011 and 2018. Patients were grouped by age at the time of procedure: <60 years old (n = 244, 20.9%), 60-80 years old (n = 635, 54.3%), and >80 years old (n = 291, 24.9%). Within each group, patients were further divided by use of paclitaxel. The primary outcome measure was survival assessed by Kaplan-Meier analysis. Differences between the groups were analyzed with analysis of variance. Multivariable analysis was performed using Cox proportional hazard models. RESULTS Of the 1,170 patients who underwent femoropopliteal percutaneous intervention, 654 (55.9%) received a paclitaxel-coated device during treatment and 516 (44.1%) did not. Mean age of the overall patient cohort was 70.4 ± 12.6 years and 663 (56.7%) were male. When comparing the groups by age we found an increase in age but a decrease in the proportion of patients who smoke. The use of paclitaxel-coated devices was similar across the groups (<60 years old, 56.2%; 60-80 years old, 57.0%; >80 years old, 52.6%; P = 0.45). Demographics and comorbidities were similar between the patients treated with and without paclitaxel within each age group except more males in the <60-year-old group treated without paclitaxel and more patients with chronic limb threatening ischemia in the >80-year-old group treated with paclitaxel. In patients <60 and 60-80 years old paclitaxel use was associated with increased survival at 4 years: <60 (80.7% vs. 64.4%; P = 0.04); 60-80 (63.2% vs. 55.1%; P = 0.04). Survival was similar in the >80-year-old group (46.6% vs. 32.8%; P = 0.65). CONCLUSIONS Our data suggest that the use of paclitaxel-coated arterial devices is not associated with increased mortality. On the contrary, our data show that younger patients treated with paclitaxel show improved survival compared with those treated without paclitaxel. Paclitaxel-coated devices may be used with continued caution especially in patients at high risk for restenosis.
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Affiliation(s)
- Norman H Kumins
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
| | - Alexander H King
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Ravi N Ambani
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Jones P Thomas
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Saideep Bose
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Virginia L Wong
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Karem C Harth
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Jae S Cho
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Benjamin Colvard
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Vikram S Kashyap
- Division of Vascular and Endovascular Therapy, Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
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King AH, Ambani RN, Harth KC, Kashyap VS, Kumins NH, Wong VL, Baele HR, Cho JS. Frequency of perigraft hygroma after open aortic reconstruction. J Vasc Surg 2020; 72:154-161. [DOI: 10.1016/j.jvs.2019.10.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/07/2019] [Indexed: 11/15/2022]
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Cho JS, Jang BK, Lee SM, Lee IJ, Lee CH. Factors affecting the dormancy and germination of bleeding heart [Lamprocapnos spectabilis (L.) Fukuhara] seeds. Plant Biol (Stuttg) 2020; 22:514-521. [PMID: 31965672 DOI: 10.1111/plb.13089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
Information on the optimal conditions to promote the germination of Lamprocapnos spectabilis (L.) Fukuhara seeds is limited; consequently, this study was conducted to establish the requirements to break seed dormancy and promote germination. The selected seeds had morphophysiological dormancy and had not begun embryo development. To study the dormancy breaking and embryo development processes, seeds were subjected to constant or changing temperature treatments during moist stratification. High temperature and humidity resulted in vigorous embryo growth, with the longest embryos occurring after 1 month of incubation at 20 °C. At 4 °C, the seeds required incubation period of at least 3 months to germinate. Embryo growth and germination were higher with changing high and low temperatures than under a constant temperature, and changing temperatures also considerably changed the endogenous hormone levels, embryo development and germination. Bioactive gibberellin (GA) content was higher in seeds incubated at 20 °C for 1 month, then at 4 °C for 2 months. The content of endogenous abscisic acid in seeds subjected to the same treatment decreased by 97.6% compared with that of the untreated seeds. Embryo growth and seed germination require changing high and low temperatures; however, exogenous GA3 could substitute for high temperatures, as it also causes accelerated germination. In this study, the seeds of L. spectabilis were identified as an intermediate simple type, a sub-level of morphophysiologically dormant seeds.
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Affiliation(s)
- J S Cho
- Major in Horticulture, School of Applied Plant Science & Biotechnology, Chungbuk National University, Cheongju, Republic of Korea
- Brain Korea 21 Center for Bio-Resource Development, Chungbuk National University, Cheongju, Republic of Korea
| | - B K Jang
- Major in Horticulture, School of Applied Plant Science & Biotechnology, Chungbuk National University, Cheongju, Republic of Korea
- Brain Korea 21 Center for Bio-Resource Development, Chungbuk National University, Cheongju, Republic of Korea
| | - S M Lee
- Environmental Agriculture Research Division, Gyeongsangnam-do Agricultural Research & Extension Service, Jinju, Republic of Korea
| | - I J Lee
- School of Applied Biosciences, Kyungpook National University, Daegu, Republic of Korea
| | - C H Lee
- Major in Horticulture, School of Applied Plant Science & Biotechnology, Chungbuk National University, Cheongju, Republic of Korea
- Brain Korea 21 Center for Bio-Resource Development, Chungbuk National University, Cheongju, Republic of Korea
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King AH, Schmaier AH, Harth KC, Kumins NH, Wong VL, Zidar DA, Kashyap VS, Cho JS. Elevated neutrophil-lymphocyte ratio predicts mortality following elective endovascular aneurysm repair. J Vasc Surg 2020; 72:129-137. [PMID: 32037083 DOI: 10.1016/j.jvs.2019.10.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The neutrophil-lymphocyte ratio (NLR) is an inexpensive and useful inflammatory marker that incorporates the balance of the innate (neutrophil) and adaptive (lymphocyte) immune responses. Data exist on the association between NLR and mortality in various coronary diseases and in cancer surgery, but there is a paucity of data on the impact of preoperative NLR on vascular surgical outcomes. The aim of this study was to evaluate the relationship between preoperative NLR and elective endovascular aortic aneurysm repair (EVAR) outcome. METHODS A retrospective review of all patients who underwent elective EVAR at a single institution between 2010 and 2018 was conducted (n = 373). Only patients who had a preoperative complete blood count with differential within 30 days of their operation were included. The NLR was computed by dividing the absolute neutrophil count by the absolute lymphocyte count. A receiver operating characteristic curve was used to determine the optimal cutoff value of NLR with the strongest association with mortality. NLR was dichotomized so that patients with NLR above the threshold were at increased risk of mortality compared with those below it. Continuous variables were analyzed using Wilcoxon nonparametric signed-rank test and categorical variables with the Fisher exact test. A comparison of NLR and mortality was completed using Kaplan-Meier survival analysis. Cox regression analysis was used to evaluate factors associated with mortality through 5-year follow-up. RESULTS Overall, 108 patients were included in this study. An NLR ≥ 4.0 was found to be associated with mortality (P < .0001). Thirty-two patients composed the High-NLR (NLR ≥ 4.0) group and the remaining 76 patients formed the Low-NLR (NLR < 4.0) group. Baseline characteristics were similar between groups, except that the High-NLR group was older (77.9 vs 74.4; P = .047). At a mean of 36.4 months follow-up, the overall mortality rate was 32.4%. Although there were no differences in the perioperative period, the Kaplan-Meier estimates of mortality were significantly greater in the High-NLR group at 1, 2, and 5 years postoperatively (P < .0001). The mean preoperative NLR of the deceased was higher (5.94 ± 5.20; median, 4.75; interquartile range, 3.17-7.83) than those who survived (2.87 ± 1.61; median, 2.53; interquartile range, 1.97-3.49) (P < .0001). Secondary interventions and sac enlargement rates were similar between groups. On univariable analysis, NLR (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.10-1.23; P < .0001), age (HR, 1.06; 95% CI, 1.02-1.11; P = .004), and aneurysm diameter (HR, 1.04; 95% CI, 1.01-1.07; P = .003) were associated with mortality. On multivariable analysis, NLR (HR, 1.19; 95% CI, 1.12-1.27; P < .0001), age (HR, 1.06; 95% CI, 1.01-1.11; P = .026), and aneurysm diameter (HR, 1.04; 95% CI, 1.02-1.07; P = .003) were associated with mortality. CONCLUSIONS Patients with an elevated preoperative NLR, irrespective of other comorbidities, may represent a previously unrecognized subset of patients who are at heightened risk of mortality after elective EVAR. A complete blood count with differential is an inexpensive test that may be used as a prognostic indicator for outcome after EVAR. Further research is warranted to identify clinical, pathological, or anatomical factors associated with an elevated NLR and to determine modifiable factors, which may help improve long-term survival.
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Affiliation(s)
- Alexander H King
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alvin H Schmaier
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Karem C Harth
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norman H Kumins
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Virginia L Wong
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David A Zidar
- Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vikram S Kashyap
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Kumins NH, King AH, Ambani RN, Thomas JP, Bose S, Shishehbor MH, Li J, Wong VL, Harth KC, Cho JS, Kashyap VS. Paclitaxel-coated peripheral artery devices are not associated with increased mortality. J Vasc Surg 2020; 72:968-976. [PMID: 31917036 DOI: 10.1016/j.jvs.2019.10.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Long-term safety concerns have been raised that the use of paclitaxel-coated balloons and stents is linked to excess mortality. Our objective was to compare outcomes in patients treated with paclitaxel vs uncoated devices and to analyze long-term mortality. METHODS We conducted a retrospective single-institution review of 1170 consecutive patients who underwent femoropopliteal percutaneous revascularization by angioplasty, atherectomy, stent placement, or combination between 2011 and 2018. The primary outcome measure was all-cause mortality. Groups were divided into patients who received paclitaxel (n = 652) and those who did not (n = 518). Categorical variables were assessed using χ2 analysis and continuous variables with the Wilcoxon signed rank test. A multivariable analysis was performed using multivariable logistic regression models. Mortality was compared using Kaplan-Meier survival analysis. RESULTS Demographics, risk factors, and Rutherford class were similar between the groups, except that the paclitaxel group was more likely to have diabetes (60.9% vs 55.0%; P = .04), was less likely to be on dialysis (10.7% vs 14.9%; P = .04), and had lower average creatinine concentration (1.6 ± 1.8 mg/dL vs 2.0 ± 2.3 mg/dL; P = .003). There were no differences in all-cause mortality through 2 years between paclitaxel and no-paclitaxel cohorts (25.5% vs 30.3%; log-rank, P = .098). At 3 years and 3.5 years, mortality was significantly lower in the paclitaxel group: year 3, 32.1% vs 39.4% (log-rank, P = .041); year 3.5, 35.2% vs 43.9% (log-rank, P = .027). Survival rates were not significantly different in examining subgroups by diabetes, chronic kidney disease, presence of chronic limb-threatening ischemia, or paclitaxel-coated balloon manufacturer. Multivariable analysis demonstrated that age, dialysis, chronic limb-threatening ischemia, chronic kidney disease, and congestive heart failure were independent risk factors for mortality, whereas paclitaxel use was associated with lower mortality. CONCLUSIONS The use of paclitaxel-coated balloons and stents does not increase mortality compared with uncoated devices out to 3.5 years. Paclitaxel-coated devices can be used with continued caution, especially in patients at increased risk of restenosis. Further long-term studies are needed to determine the risk of late mortality.
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Affiliation(s)
- Norman H Kumins
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio.
| | - Alexander H King
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Ravi N Ambani
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jones P Thomas
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Saideep Bose
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Virginia L Wong
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Karem C Harth
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jae S Cho
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Vikram S Kashyap
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
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Park CS, Gwon A, Ahn HS, Kim GH, Cho JS, Youn HJ. P1535 Interventricular interaction can result in right ventricular dysfunction in interventricular septum involved myocardial infarction patient. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.957] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Previous studies revealed that interventricular septal thickness is related to right ventricular dysfunction after anterior myocardial infarction. This finding suggest that interventricular septal function can affect right ventricular function in myocardial infarction patients. We assumed that right ventricular free wall strain values measured using dedicated software can be affected in the setting of ischemic insult on interventricular septum in long-term follow up.
Methods
The patients diagnosed as acute myocardial infarction due to left anterior descending artery disease who underwent successful revascularization were enrolled. Echocardiographic exams were performed at least 2 times, within 72 hours and 1 year after the revascularization. Strain values of interventricular septum and right ventricular free wall were derived from the raw-dicom images. The analysis was performed using the dedicated software for the measurement of right ventricular strain.
Results
Total 65 patients were enrolled. The values of global left ventricular strain were increased after the follow up. There were no changes in global longitudinal strain of the right ventricle. But longitudinal stain values acquired from right ventricular free walls were decreased even the strain values measured at left ventricle and interventricular septum were improved.
Conclusion
Interventricular septal dysfunction due to ischemic injury can affect long term right ventricular dysfunction. This finding suggests the interventricular dependence between cardiac chambers and can provide the development of heart failure in myocardial infarction patient even after the successful revascularization.
Strain values of both ventricles Left ventricle after revascularization (n = 65) 1 year later (n = 65) P values Global longitudinal strain (%) -12.84 ± 4.50 -15.62 ± 4.45 <0.001 Septal longitudinal strain (%) -10.77 ± 5.96 -14.02 ± 5.26 <0.001 Right ventricle Global longitudinal strain (%) -19.36 ± 4.57 -19.47 ± 4.83 0.872 Septal longitudinal strain (%) -14.82 ± 4.48 -16.43 ± 6.03 0.055 Free wall longitudinal strain (%) -20.23 ± 5.33 -17.82 ± 5.70 0.010
Abstract P1535 Figure. Right ventricular segmental strain
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Affiliation(s)
- C S Park
- Catholic University Medical College, Seoul, Korea (Republic of)
| | - A Gwon
- Catholic University Medical College, Seoul, Korea (Republic of)
| | - H S Ahn
- Catholic University Medical College, Seoul, Korea (Republic of)
| | - G H Kim
- Catholic University Medical College, Seoul, Korea (Republic of)
| | - J S Cho
- Catholic University Medical College, Seoul, Korea (Republic of)
| | - H J Youn
- Catholic University Medical College, Seoul, Korea (Republic of)
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King AH, Ambani RN, Harth KC, Wong VL, Kumins NH, Kashyap VS, Cho JS. FJVIS 21. Frequency of Perigraft Hygroma After Aortic Reconstruction Using Expanded Polytetrafluoroethylene Versus Dacron Grafts. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lim S, Mora-Pinzon M, Park T, Yoon W, Crisostomo PR, Cho JS. Medical therapy does not confer stroke prevention for all patients: identification of high-risk patients with asymptomatic carotid stenosis is still needed. INT ANGIOL 2019; 38:372-380. [DOI: 10.23736/s0392-9590.19.04143-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kang SW, Park JH, Kim SH, Seo DC, Ok YS, Cho JS. Establishment of optimal barley straw biochar application conditions for rice cultivation in a paddy field. Environ Geochem Health 2019; 41:1793-1803. [PMID: 28845510 DOI: 10.1007/s10653-017-0009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
This study was conducted to establish the optimal application conditions of barley straw biochar (BC) for rice cultivation and to determine the effects of combined application of BC and inorganic fertilizer (IF) on rice cultivation in a paddy field. Based on the characteristics of rice growth in pot-based experiments, the selected optimal application conditions of BC were application of 20 ton ha-1 at 14 days before rice transplanting. The effects of BC application on rice cultivation in a paddy field when using those conditions were then evaluated. Each treatment was separated by a control (Cn), IF, BC, and combined BC + IF treatments, respectively. The rice yields in the BC + IF treatment were 38.6, 21.7, and 24.5% greater than those in the Cn, IF, and BC treatments, respectively. In addition, yield components of rice were significantly improved in the BC + IF treatment relative to the other treatments. Following rice harvest, soil status was improved, showing greater soil aggregation stability, decreased bulk density, and increased porosity in the BC-treated areas compared to those in the Cn- and IF-treated areas. At the time of rice harvesting, soil chemical properties such as pH, EC, SOC, TN, Avail. P2O5, and CEC in the BC-treated areas were improved over those in other areas. The results of this study indicate that using BC as a soil amendment is effective at improving rice cultivation and can benefit the soil environment.
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Affiliation(s)
- S W Kang
- Department of Bio-environmental Sciences, Sunchon National University, Suncheon, 57922, Republic of Korea
| | - J H Park
- School of Plant, Environmental, and Soil Sciences, Louisiana State University AgCenter, Baton Rouge, LA, 70803, USA
| | - S H Kim
- Division of Applied Life Science (BK21 Program) and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - D C Seo
- Division of Applied Life Science (BK21 Program) and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Y S Ok
- O-Jeong Eco-Resilience Institute (OJERI) and Division of Environmental Science and Ecological Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - J S Cho
- Department of Bio-environmental Sciences, Sunchon National University, Suncheon, 57922, Republic of Korea.
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King AH, Harth KC, Kumins NH, Wong VL, Zidar DA, Kashyap VS, Cho JS. Elevated Neutrophil-Lymphocyte Ratio Predicts Mortality After Elective Endovascular Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Allotey JK, King AH, Kumins NH, Wong V, Harth KC, Cho JS, Kashyap VS. IP099. Patients Undergoing Carotid Endarterectomy With a Vascu-Guard Bovine Pericardial Patch May Be at Increased Risk of Bleeding Complications. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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King AH, Harth KC, Kumins NH, Wong V, Zidar D, Kashyap VS, Cho JS. PC036. Elevated Neutrophil-Lymphocyte Ratio Predicts Mortality After Elective Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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King AH, Ambani RN, Harth KC, Kashyap VS, Kumins NH, Wong V, Baele H, Cho JS. IP049. Frequency of Perigraft Hygroma After Aortic Reconstruction Using Expanded Polytetrafluoroethylene Grafts. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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King AH, Kumins NH, Cho JS, Jim J, Motaganahalli RL, Apple JM, Foteh MI, Kashyap VS. IP097. The Duration of Blood Flow Reversal During Transcarotid Artery Revascularization Does Not Affect Outcomes. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Park MW, Her SH, Cho JS, Kim TS, Park HW, Kim DW, Park KM, Chang KY. P5587Guideline-recommended optimal medical therapy in AMI patients undergoing PCI with DES: adherence and clinical outcomes using national health insurance data. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.-W Park
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - S H Her
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - J S Cho
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - T S Kim
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - H W Park
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - D W Kim
- Daejun St. Mary's Hospital, Daejun, Korea Republic of
| | - K M Park
- Ulsan University Hospital, Ulsan, Korea Republic of
| | - K Y Chang
- Seoul St. Mary's Hospital, Seoul, Korea Republic of
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Park MW, Her SH, Cho JS, Park HW, Kim DW, Kim TS, Park KM, Chang KY. P5576Moderate versus high-intensity statin therapy in east asian patients with angina undergoing PCI with DES: a propensity-score matching analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M.-W Park
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - S H Her
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - J S Cho
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - H W Park
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - D W Kim
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - T S Kim
- Daejun St. Mary's hospital, Daejun, Korea Republic of
| | - K M Park
- Ulsan University Hospital, Ulsan, Korea Republic of
| | - K Y Chang
- Seoul St. Mary's Hospital, Seoul, Korea Republic of
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Dansdill D, Halandras PM, Beverly J, Jeske W, Hoppensteadt D, Emanuele M, Fareed J, Cho JS. Synthetic, organic compound vepoloxamer (P-188) potentiates tissue plasminogen activator. J Vasc Surg 2018; 67:294-299. [DOI: 10.1016/j.jvs.2016.03.473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/02/2016] [Indexed: 11/16/2022]
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Goldberg A, Halandras PM, Shea S, Cho JS. Utility of magnetic resonance imaging in establishing a venous pressure gradient in a patient with possible nutcracker syndrome. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvsc.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lim S, Halandras PM, Saqib NU, Ching YA, Villella E, Park T, Son H, Cho JS. Comparison of supramesenteric aortic cross-clamping with supraceliac aortic cross-clamping for aortic reconstruction. J Vasc Surg 2016; 64:941-7. [PMID: 27038834 DOI: 10.1016/j.jvs.2016.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/29/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Supraceliac aortic cross-clamping (SCXC) is routinely used during open aortic reconstruction (OAR) of pararenal aortic disease when suprarenal control is not feasible. On occasion, however, aortic control may be obtained at the supramesenteric level by supramesenteric cross-clamping (SMXC) between the superior mesenteric artery and the celiac axis. The purpose of this study was to compare outcomes between patients who had SMXC vs SCXC during OAR for both aneurysmal and occlusive diseases. METHODS A retrospective chart review identified 69 patients who underwent elective OAR requiring SMXC (n = 18) or SCXC (n = 51). All patients with thoracoabdominal aneurysms and those who had inframesenteric (suprarenal and infrarenal) aortic control were excluded. Propensity score-based matching was performed to adjust for confounding factors in a 1:1 ratio to compare outcomes. Late survival was estimated by Kaplan-Meier methods. RESULTS Propensity score-based matching was performed at a 1:1 ratio; 18 SMXC cases were matched with 18 SCXC cases. The average age was 66.7 years, and men constituted 72%. Baseline characteristics were matched, except for the incidence of peripheral vascular occlusive disease (72.2% in the SMXC group vs 33.3% in the SCXC group; P = .04). A majority (80.6%) of patients underwent OAR for aneurysmal disease (72.2% in the SMXC group, 88.9% in the SCXC group). Intraoperatively, there were no differences in operative times (325 minutes for SMXC vs 298 minutes for SCXC; P = .48), but the SMXC group had a longer renal ischemia time (40 minutes vs 28 minutes; P = .03). There were no significant differences in intraoperative blood loss (2.4 L vs 1.6 L; P = .2) or blood product transfusion requirements (packed red blood cells, 2.2 units vs 1.6 units [P = .5]; Cell Saver, 1.3 L vs 0.7 L [P = .09]). Overall complication rates did not differ significantly (27.8% for SMXC vs 44.4% for SCXC; P = .24). Thirty-day mortality rates did not differ between the two groups (0% for SMXC vs 5.6% for SCXC; P = 1). CONCLUSIONS In this study, there were no differences in early morbidity or mortality between SMXC and SCXC during aortic reconstruction. SMXC, however, can be performed safely and effectively in properly selected patients. A larger, multicenter prospective study would help elucidate the potential benefits.
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Affiliation(s)
- Sungho Lim
- Department of Surgery, Loyola University Medical Center, Maywood, Ill
| | - Pegge M Halandras
- Department of Surgery, Loyola University Medical Center, Maywood, Ill
| | - Naveed U Saqib
- Department of Cardiothoracic and Vascular Surgery, University of Texas Houston Medical Center, Houston, Tex
| | - Y Avery Ching
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex
| | - Edward Villella
- Department of Surgery, Loyola University Medical Center, Maywood, Ill
| | - Taeyoung Park
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Hyunju Son
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Jae S Cho
- Department of Surgery, Loyola University Medical Center, Maywood, Ill.
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