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Kania TA, Noorani A, Juneja A, Demissie S, Singh K, Deitch J, Etkin Y, Landis GS, Schor J. Hemodynamic instability in the immediate postoperative setting after transcarotid artery revascularization. Vascular 2023; 31:1151-1160. [PMID: 35618486 DOI: 10.1177/17085381221105178] [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: 11/15/2022]
Abstract
OBJECTIVE Transcarotid artery revascularization (TCAR) is a relatively recent development in the management of carotid artery occlusive disease, the utilization of which is becoming more prevalent. This study aims to evaluate the timing, prevalence, and types of hemodynamic instability after TCAR. METHODS We performed a retrospective review of all TCAR procedures performed at two tertiary care academic medical centers within a single hospital system from 2017 through 2019. Demographics, comorbidities, preoperative patient factors, procedural details, and postoperative data were collected. Patients were assessed over 24 hours postoperatively for stroke, death, myocardial infarction (MI), and hemodynamic instability at 3, 6, 9, 12, and 24 hour intervals. Hemodynamic instability was defined as any vital sign abnormality which required pharmacological intervention with antihypertensive, vasopressor, and/or anti-arrhythmic agents. The incidence and timing of postoperative complications and hemodynamic instability were recorded. RESULTS During the study period, 76 patients 80 TCAR procedures. Out of 80 procedures, 64 (80.0%) were receiving home antihypertensive medication and 28 (35.0%) were symptomatic lesions preoperatively. Intraoperatively, one patient (1.3%) received atropine, 26 (32.5%) received glycopyrrolate, 76 (95%) underwent predilatation, and 16 (20.0%) underwent postdilatation. Postoperatively, a total of 22 cases (27.5%) required medication for acute control of blood pressure or heart rate, which reached a peak of 19 patients (23.8%) within the first 3 hours, and tapered to nine patients (11.3%) by the 24 hour mark. A total of three patients (3.75%) required initiation of pharmacological management after the three-hour mark. Six patients (7.5%) underwent stroke code workup, 4 (5.0%) of whom were confirmed to have stroke on CT. Average time to neurologic event was 3.9 hours. No patients experienced MI or death. Median ICU and hospital days for unstable patients were two and three, respectively, compared to one and one for stable patients. CONCLUSIONS Hemodynamic instability is common after TCAR and reliably presents at or before postoperative hour 3. Hypo- followed by hyper-tension were the most common manifestations of hemodynamic instability. Regardless, unstable patients and stroke patients were more likely to require longer periods of time in the ICU and in the hospital overall. This may have implications for postoperative ICU resource management when deciding to transfer patients out of a monitored setting. Further study is required to establish relationships between pre- and intra-operative risk factors and outcomes such as hemodynamic instability and/or stroke. At present, one should proceed with careful evaluation of preoperative medications, strict management of postoperative hemodynamics, and clear communication among team members should all be employed to optimize outcomes.
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Affiliation(s)
- Thomas A Kania
- Departgment of Surgery, Staten Island University Hospital, Donald and Barbara Zucker SOM at Hofstra/Northwell, Staten Island, NY, USA
| | - Aaquib Noorani
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Amandeep Juneja
- North Shore University Hospital and Long Island Medical Center, Donald and Barbara Zucker SOM at Hofstra/Northwell, New York, NY, USA
| | - Seleshi Demissie
- Departgment of Surgery, Staten Island University Hospital, Donald and Barbara Zucker SOM at Hofstra/Northwell, Staten Island, NY, USA
| | - Kuldeep Singh
- Division of Vascular Surgery, Staten Island University Hospital, Donald and Barbara Zucker SOM at Hofstra/Northwell, Staten Island, NY, USA
| | - Jonathan Deitch
- Vascular and Endovascular Surgery, Texas Health Resources, Harris Methodist Hospital, Ft. Worth, TX USA
| | - Yana Etkin
- North Shore University Hospital and Long Island Medical Center, Donald and Barbara Zucker SOM at Hofstra/Northwell, New York, NY, USA
| | - Gregg S Landis
- North Shore University Hospital and Long Island Medical Center, Donald and Barbara Zucker SOM at Hofstra/Northwell, New York, NY, USA
| | - Jonathan Schor
- Division of Vascular Surgery, Staten Island University Hospital, Donald and Barbara Zucker SOM at Hofstra/Northwell, Staten Island, NY, USA
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Kania T, Kimyaghalam A, Scarsella J, Guerges M, Breier Y, Deitch J, Malekpour F, Schor J, Singh K. Supra-Aortic Arterial Injuries Following Central Venous Catheterization Managed with Percutaneous Closure Devices: A Comprehensive Literature Review of Current Evidence. Ann Vasc Surg 2023; 96:301-307. [PMID: 37169251 DOI: 10.1016/j.avsg.2023.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/11/2021] [Revised: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Inadvertent supra-aortic arterial injuries during central venous catheterization can lead to devastating outcomes. These have been traditionally been managed with open repair or covered stent placement; only recently have percutaneous closure been incorporated into the management of these iatrogenic arterial injuries. METHODS We performed a MEDLINE literature search in the English language, using the PubMed web-based search engine across years 2000 to 2020. This report reviews 34 published case reports and series reporting 71 iatrogenic supra-aortic arterial injuries managed with percutaneous vascular closure devices. RESULTS In our review, the use of a closure device was successful in 87% of cases, even in some cases involving sheath sizes greater than 8F. The devices used in these situations caused minimal complications and offered a quick means to control bleeding. Thus, percutaneous closure devices are a helpful tool that offers an alternative to more invasive open surgical repair. CONCLUSIONS Vascular closure devices offer a minimally invasive and effective approach to the treatment of inadvertent supra-aortic arterial injury following CVC.
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Affiliation(s)
- Thomas Kania
- Staten Island University Hospital, Staten Island, NY.
| | | | | | - Mina Guerges
- Staten Island University Hospital, Staten Island, NY
| | - Yuli Breier
- Touro College of Osteopathic Medicine, New York, NY
| | | | | | | | - Kuldeep Singh
- Staten Island University Hospital, Staten Island, NY
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Deitch J, Yates CJ, Hamblin PS, Kevat D, Shahid I, Teale G, Lee I. Prevalence of gestational diabetes mellitus, maternal obesity and associated perinatal outcomes over 10 years in an Australian tertiary maternity provider. Diabetes Res Clin Pract 2023; 203:110793. [PMID: 37343727 DOI: 10.1016/j.diabres.2023.110793] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The International Association of Diabetes in Pregnancy Study Groups (IADPSG) gestational diabetes mellitus (GDM) criteria have been heavily scrutinised with concerns that the consequent GDM prevalence increase has not been associated with improved perinatal outcomes. AIMS At a tertiary hospital in Melbourne, Australia we aimed to evaluate prevalence trends for GDM, type 2 diabetes (T2DM), maternal obesity and large-for-gestational age (LGA) and assess changes in perinatal outcomes following IADPSG criteria uptake in 2015. METHODS A retrospective cohort study of singleton births from 20 weeks' gestation was conducted between 1st January 2011 and 31st December 2020. Maternal characteristics and perinatal outcomes were extracted from medical records. RESULTS 52,795 pregnancies were included. GDM prevalence increased 2.7 times from 8.9% in 2011 to 23.7% in 2020 and increased annually by 8.59% (95%CI 7.77, 9.42). The rate of T2DM increased annually by 11.69% (95%CI 7.72, 16.67). Obesity prevalence increased annually by 3.18% (95%CI 2.58, 3.78). Induction of labour (IOL) prevalence increased annually by 8.35% (95%CI 5.69, 11.06). LGA prevalence remained unchanged. Increasing maternal obesity was the major contributing factor for LGA prevalence. CONCLUSIONS From 2011 to 2020 GDM, obesity and T2DM prevalence increased significantly, with associated increased IOL, without change in LGA rates. Prospective studies are required to explore interactions between GDM, obesity, LGA and obstetric interventions.
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Affiliation(s)
- J Deitch
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - C J Yates
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - P S Hamblin
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - D Kevat
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Obstetric Medicine, Western Health, St Albans, Victoria, Australia
| | - I Shahid
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - G Teale
- Department of Obstetrics & Gynaecology, Western Health, St Albans, Victoria, Australia
| | - I Lee
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Singh K, Guerges M, Rost A, Russo N, Aparajita R, Schor J, Deitch J. Endovascular Management of Bleeding Aortoenteric Fistula May be Feasible as a Definitive Repair. Ann Vasc Surg 2022; 83:378.e1-378.e5. [PMID: 35108559 DOI: 10.1016/j.avsg.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/02/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
Aorto-enteric fistula (AEF) is a complication with devastating sequelae and significant morbidity. Although open surgery remains primary treatment endovascular approach may be used as a temporary bridge but rarely as a definitive therapy. We present a case of a patient who presented with a secondary AEF, due to hemodynamic instability we chose to treat the fistula with an aortic endograft. The patient underwent bowel resection due to bowel obstruction with omental patch over the aortic rent, 6 weeks of antibiotics. Patient is now at 8-year follow-up without evidence of infection. Although there is scarce literature on this topic, endovascular treatment of bleeding AEF may be feasible as a definitive option. Due to high risk of graft infection we recommend close observation and suppressive antibiotics.
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Affiliation(s)
- Kuldeep Singh
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
| | - Mina Guerges
- Department of Vascular Surgery, Staten Island University Hospital SI, NY.
| | - Amy Rost
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
| | - Nicholas Russo
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
| | - Ritu Aparajita
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
| | - Jonathan Schor
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
| | - Jonathan Deitch
- Department of Vascular Surgery, Staten Island University Hospital SI, NY
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Kania TA, Noorani A, Juneja A, Deitch J, Etkin Y, Landis GS, Schor J. Monitoring of Hemodynamics Associated With Carotid Surgery. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.215] [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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Singh K, Juneja A, Bajaj T, Voto C, Schor J, Zia S, Deitch J. Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage. Vasc Endovascular Surg 2020; 55:204. [PMID: 33118465 DOI: 10.1177/1538574420966452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kuldeep Singh
- 7601Staten Island University Hospital, Staten Island, NY, USA
| | - Amandeep Juneja
- 7601Staten Island University Hospital, Staten Island, NY, USA
| | | | - Christian Voto
- 115985University of New England College of Osteopathic Medicine, Biddeford, ME, USA
| | - Jonathan Schor
- 7601Staten Island University Hospital, Staten Island, NY, USA
| | - Saqib Zia
- 7601Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Deitch
- 7601Staten Island University Hospital, Staten Island, NY, USA
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Singh K, Ruan QZ, Schor J, Lachhar G, Saha S, Deitch J. Thigh Compartment Syndrome After Thrombolytic Therapy of an Occluded Lower Extremity Bypass Graft. Vasc Endovascular Surg 2020; 54:752-755. [PMID: 32783501 DOI: 10.1177/1538574420947855] [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: 11/17/2022]
Abstract
Compartment syndrome is caused by increased pressure within fascial compartment. We present a unique case of a thigh compartment syndrome that occurred after overnight catheter delivered Tissue plasminogen activator (tPA) thrombolysis of an acutely thrombosis femoral-to above knee popliteal artery Propaten® PTFE (WL Gore & Associates, Flagstaff, AZ) bypass graft. The condition was treated by emergency fasciotomy and the patient recovered uneventfully.
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Affiliation(s)
- Kuldeep Singh
- Division of Vascular and Endovascular Surgery, 7601Staten Island University Hospital Northwell Health, Staten Island, NY, USA.,465154Zucker School of Medicine, Hofstra/Northwell, Garden City, NY, USA
| | - Qing Zhao Ruan
- Division of Vascular and Endovascular Surgery, 7601Staten Island University Hospital Northwell Health, Staten Island, NY, USA
| | - Jonathan Schor
- Division of Vascular and Endovascular Surgery, 7601Staten Island University Hospital Northwell Health, Staten Island, NY, USA.,465154Zucker School of Medicine, Hofstra/Northwell, Garden City, NY, USA
| | - Garry Lachhar
- Division of Vascular and Endovascular Surgery, 7601Staten Island University Hospital Northwell Health, Staten Island, NY, USA.,465154Zucker School of Medicine, Hofstra/Northwell, Garden City, NY, USA
| | - Sumit Saha
- 136414School of Medicine, City University of New York, New York, NY, USA
| | - Jonathan Deitch
- Division of Vascular and Endovascular Surgery, 7601Staten Island University Hospital Northwell Health, Staten Island, NY, USA.,465154Zucker School of Medicine, Hofstra/Northwell, Garden City, NY, USA
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Juneja A, Zia S, Abeysekara A, Shams S, Singh K, Schor J, Deitch J. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have no effect on the outcomes of endovascular revascularization in tibial arterial occlusive disease. Vascul Pharmacol 2020; 131:106764. [PMID: 32629143 DOI: 10.1016/j.vph.2020.106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/13/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
The effects of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs) on angiogenesis, myocardial remodeling and intermittent claudication have been studied. Clinical studies have shown reduced re-intervention after cardiac stenting with the use of ACEI/ARBs. We hypothesized that the use of ACEI/ARBs decreases re-interventions after endovascular revascularization in tibial artery disease (TAD) patients. This is a retrospective study comparing the effects of ACEI/ARBs on the outcomes after endovascular revascularization for TAD. We divided all patients that underwent endovascular revascularization into Angiotensin converting enzyme inhibitor/Angiotensin receptor blockers (ACEI/ARBs) and No Angiotensin converting enzyme inhibitor/Angiotensin receptor blockers (NoACEI/ARBs) groups. A total of 360 patients underwent endovascular intervention for TAD. One hundred and ninety-six (54%) patients, 124 (57%) males, were on ACEI/ARBs after endovascular intervention for TAD, whereas 164(46%) patients, 87 (53%) males were not. The groups were well matched in the demographic variables except higher incidence of congestive heart failure, coronary artery disease and dialysis in the ACEI/ARBs group (p = .001, 0.02, 0.01 respectively). Reintervention rates were not associated with ACEI/ARBs use (p = .097). Even when corrected for statin use and antiplatelet therapy, no difference was seen in the reintervention rates in the two groups (p = .535, 0.547 respectively). Primary patency, assisted primary patency and secondary patency did not differ with the use of ACEI/ARBs (p = .244 0.096,0.060 respectively). No difference was seen in overall survival between the two groups (p = .690). ACEI/ARBs do not appear to affect the patency and reintervention rates for patients undergoing endovascular revascularization for TAD.
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Affiliation(s)
- Amandeep Juneja
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Saqib Zia
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA.
| | - Aravinda Abeysekara
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Sara Shams
- Department of Radiology, Stanford University, CA, USA
| | - Kuldeep Singh
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Schor
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Deitch
- Department of Vascular Surgery, Staten Island University Hospital, Staten Island, NY, USA
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Juneja A, Singh K, Cooper M, Guerges M, Schor J, Deitch J. Quality of Life Is Improved with Radical Debulking for Severe Chronic Lymphedema. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Singh K, Juneja A, Bajaj T, Voto C, Schor J, Zia S, Deitch J. Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage. Vasc Endovascular Surg 2020; 54:430-435. [PMID: 32489155 DOI: 10.1177/1538574420925586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. METHODS We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. RESULTS A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. CONCLUSIONS Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.
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Affiliation(s)
- Kuldeep Singh
- Staten Island University Hospital, Staten Island, NY, USA
| | | | - Tushar Bajaj
- Staten Island University Hospital, Staten Island, NY, USA.,Kern Medical Center, Bakersfield, CA, USA
| | - Christian Voto
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA
| | - Jonathan Schor
- Staten Island University Hospital, Staten Island, NY, USA
| | - Saqib Zia
- Staten Island University Hospital, Staten Island, NY, USA
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Russo N, Deitch J, Schor J, Saha S, Lachhar G, Singh K. Peripheral Vascular Complication of Transgender Reassignment Surgery. Ann Vasc Surg 2020; 69:448.e15-448.e18. [PMID: 32474149 DOI: 10.1016/j.avsg.2020.05.015] [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: 03/07/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gender-reassignment surgeries are technically challenging and associated with detrimental vascular complications. METHODS A 49 year-old female status-post phalloplasty presented with peripheral vascular complication resulting in disabling claudication. Initial anastomotic attempt was rendered nonviable to sustain the constructed phallus resulting in superficial femoral artery stenosis. Covered stent placement corrected the stenosis and alleviated the claudication. RESULTS As gender-reassignment surgeries increase, greater understanding of potential vascular complications is needed. Involvement of multidisciplinary teams is necessary to optimize patient safety and outcomes. CONCLUSIONS Vascular surgery should play a larger role in these complex revascularizations and vessel anastomoses to ensure quality blood flow to the reconstructed genitalia.
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Affiliation(s)
- Nicholas Russo
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Jonathan Deitch
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY; Zucker School of Medicine, Hofstra/Northwell, Garden City, NY
| | - Jonathan Schor
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY; Zucker School of Medicine, Hofstra/Northwell, Garden City, NY
| | - Sumit Saha
- School of Medicine, City University of New York, New York, NY
| | - Garry Lachhar
- School of Medicine, St. George's University, West Indies, Grenada
| | - Kuldeep Singh
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY; Zucker School of Medicine, Hofstra/Northwell, Garden City, NY.
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Zia S, Juneja A, Shams S, Faheem B, Shariff MA, Singh K, Schor J, Deitch J. Contemporary outcomes of infrapopliteal atherectomy with angioplasty versus balloon angioplasty alone for critical limb ischemia. J Vasc Surg 2019; 71:2056-2064. [PMID: 31727459 DOI: 10.1016/j.jvs.2019.08.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/16/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Limited data exist comparing atherectomy (At) with balloon angioplasty for infrapopliteal peripheral arterial disease. The objective of this study was to compare the outcomes of infrapopliteal At with angioplasty vs angioplasty alone in patients with critical limb ischemia. METHODS This is a retrospective, single-center, longitudinal study comparing patients undergoing either infrapopliteal At with angioplasty or angioplasty alone for critical limb ischemia, between January 2014 and October 2017. The primary outcome was primary patency rates. Secondary outcomes were reintervention rates, assisted primary patency, secondary patency, major adverse cardiac events, major adverse limb events, amputation-free survival, overall survival, and wound healing rates. Data were analyzed in multivariate generalized linear models with log rank tests to determine survival in Kaplan-Meier curves. RESULTS There were 342 infrapopliteal interventions, 183 percutaneous balloon angioplasty (PTA; 54%), and 159 atherectomies (At) with PTA (46%) performed on 290 patients, with a mean age of 67 ± 12 years; 61% of the patients were male. The PTA and At/PTA groups had similar demographics, tissue loss (79% vs 84%; P = .26), ischemic rest pain (21% vs 16%; P = .51), mean follow-up (19 ± 9 vs 20 ± 9 months; P = .32), mean number of vessels treated (1.7 ± 0.8 vs 1.9 ± 0.8; P = .08) and the mean lesion length treated (6.55 ± 5.00 cm vs 6.02 ± 4.00 cm; P = .08), respectively. Similar 3-month (96 ± 1% vs 94 ± 1%), 6-month (85 ± 2% vs 86 ± 3%), 12-month (68 ± 3% vs 69 ± 4%), and 18-month (57 ± 4% vs 62 ± 4%) primary patency rates were seen in the two groups (P = .87). At/PTA patients had significantly higher reintervention rates as compared with the PTA patients (28% vs 16%; P = .02). Similar assisted primary patency rates (67 ± 4% vs 69 ± 4%; P = .78) and secondary patency rates (61 ± 4% vs 66 ± 4%; P = .98) were seen in the PTA and At/PTA groups at 18 months. The 30-days major adverse cardiac event rates (3% vs 2%; P = .13) and 30-day major adverse limb event rates (5% vs 4%; P = .2) were similar in both groups. Wound healing rates (72 ± 3% vs 75 ± 2%; P = .12), 1-year amputation-free survival (68 ± 4.1% vs 70 ± 2%; P = .5), and 1-year overall survival (76 ± 4% vs 78 ± 4%; P = .39) rates did not differ in the PTA and At/PTA groups. THE At/PTA group had higher local complication rates (7 [4%] vs 1 [0.5%]; P = .03) CONCLUSIONS: At with angioplasty provides similar patency rates compared with angioplasty alone for infrapopliteal peripheral arterial disease, but associated with higher reintervention and local complication rates. Further appropriately designed studies are required to determine the exact role of At in this subset of patients.
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Affiliation(s)
- Saqib Zia
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY.
| | - Amandeep Juneja
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Sara Shams
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Beenish Faheem
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Masood A Shariff
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Kuldeep Singh
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Jonathan Schor
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Jonathan Deitch
- Division of Vascular and Endovascular Surgery, Staten Island University Hospital Northwell Health, Staten Island, NY
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Zia S, Ayoob F, Abeysekera A, Elabbasy F, Melnikau S, Singh K, Schor J, Deitch J. IP035. Effect of Novel Oral Anticoagulants and Warfarin Therapy on the Incidence of Endoleak and Reintervention After Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.143] [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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Zia S, Singh K, Juneja A, Schor J, Deitch J. Safety and Feasibility of Transradial Access for Noncoronary and Peripheral Vascular Interventions. Ann Vasc Surg 2018; 53:255-261. [DOI: 10.1016/j.avsg.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/02/2018] [Accepted: 04/01/2018] [Indexed: 11/25/2022]
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15
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Zia S, Juneja A, Shams S, Faheem B, Shariff MA, Singh K, Schor J, Deitch J. SS16. Contemporary Outcomes of Infrapopliteal Atherectomy versus Balloon Angioplasty Alone for Critical Limb Ischemia at a Tertiary Care Teaching Institution. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Babinska A, Azari B, Salifu M, Liu R, Jiang XC, Sobocka M, Boo D, Khoury G, Deitch J, Marmur J, Ehrlich Y, Kornecki E. The F11 receptor (F11R/JAM-A) in atherothrombosis: Overexpression of F11R in atherosclerotic plaques. Thromb Haemost 2017. [DOI: 10.1160/th06-08-0454] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryF11R is the gene name for an adhesion protein, called the F11-receptor, aka JAM-A, which under normal physiological conditions is expressed constitutively on the surface of platelets and localized within tight junctions of endothelial cells (EC). Previous studies of the interactions between human platelets and EC suggested that F11R/JAM-A plays a crucial role in inflammatory thrombosis and atherosclerosis. The study reported here obtained in-vivo confirmation of this conclusion by investigating F11R/JAM-A protein and mRNA in patients with aortic and peripheral vascular disease and in an animal model of atherosclerosis. Molecular and immunofluorescence determinations revealed very high levels of F11R/JAM-A mRNA and F11R/JAM-A protein in atherosclerotic plaques of cardiovascular patients. Similar results were obtained with 12-week-old atherosclerosis-prone apoE-/- mice, an age in which atherosclerotic plaques are well established. Enhanced expression of the F11R/JAM-A message in cultured EC from human aortic and venous vessels was observed following exposure of the cells to cytokines. Determinations of platelet adhesion to cultured EC inflamed by combined cytokine treatment in the presence of F11R/JAM-A – antagonists provided data indicating that de novo expression of F11R/JAM-A on the luminal surface of inflamed EC has an important role in the conversion of EC to a thrombogenic surface. Further studies of these interactions under flow conditions and under in-vivo settings could provide a final proof of a causal role for F11R/JAM-A in the initiation of thrombosis. Based on our invitro and in-vivo studies to date, we propose that therapeutic drugs which antagonize the function of F11R/JAM-A should be tested as novel means for the prevention and treatment of atherosclerosis, heart attacks and stroke.
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Tyson AC, Tonelli CM, Parikh S, Alkhatib A, Zia S, Singh K, Deitch J, Schor JA. IP137. BMI Does Not Influence Complication Rate After Carotid Endarterectomy. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.172] [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: 11/30/2022]
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18
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Tesic G, Tyson CA, Zia S, Schor J, Deitch J, Singh K. IP101. Comparison and Short-term Outcomes in Patients Undergoing Axillobifemoral and Axillounifemoral Bypass Graft. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Page M, Green S, McBain B, Surace S, Deitch J, Lyttle N, Mrocki M, Buchbinder R. SAT0508 Manual Therapy and Exercise for Rotator Cuff Disease: A Cochrane Review. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3071] [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: 11/04/2022]
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20
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Tyson AC, Amira A, D'Alessandro MR, Singh K, Zia S, Schor J, Deitch J. IP101. Routine Postoperative Cardiac Testing Is Unnecessary Following Carotid Endarterectomy. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.088] [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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21
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D'Alessandro MR, Schor J, Tyson AC, Singh K, Zia S, Deitch J. IP209. Perioperative Complications Increase Risk of Deep Vein Thrombosis in Patients Undergoing Infrainguinal Bypass. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.142] [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] [Indexed: 11/29/2022]
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22
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D'Alessandro MR, Singh K, Tyson AC, Schor J, Zia S, Deitch J. IP095. Congestive Heart Failure Portends Worse Outcome in Patients Undergoing Carotid Endarterectomy. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Nagarsheth K, Schor J, Singh K, Zia S, Deitch J, D'Alessandro M. Predictors of Hospital Length of Stay Following Endovascular Abdominal Aortic Aneurysm Repair: Analysis of Patients From the National Surgical Quality Improvement Program. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.04.123] [Citation(s) in RCA: 3] [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: 10/23/2022]
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24
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Nagarsheth KH, Schor J, Singh K, D'Alessandro M, Zia S, Deitch J. Independent Predictors of Readmission After Femoral-to-Popliteal Artery Bypass Grafting in Diabetics. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2014.11.035] [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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25
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Nagarsheth KH, Schor J, D'Alessandro M, Singh K, Deitch J. Left Subclavian Artery Occlusion During Thoracic Endovascular Aortic Repair in the Elderly Is Associated With Significant Morbidity. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2014.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Nagarsheth KH, Alam A, Schor J, Singh K, Zia S, Deitch J. PS22 Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Are Outcomes Improving? J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Zia S, Khan MA, Singh K, Schor J, Deitch J. National Trends in Endovascular and Open Renal Artery Interventions for Renal Artery Stenosis and the Impact of Recent Randomized Controlled Trials. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.07.043] [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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28
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Singh K, Yakoub D, Schor J, Deitch J, Scheiner J, Dossa C. Endovascular Treatment of Shunt-Induced Carotid Pseudoaneurysm: Less Invasive but Still a Big Risk. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Khan MA, Singh K, Schor J, Deitch J. Feasibility of Concurrent Thoracic and Abdominal Aortic Endovascular Repair. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Singh K, Deitch J, Wang ML. PS192. Aortoiliac Thrombus Complicating Inflammatory Bowel Disease. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Singh K, Wang ML, Rubinshteyn V, Sticco C, Deitch J. Case report: doxycycline instillation used to treat a high-output lymphatic fistula secondary to needle puncture. J Wound Care 2011; 20:171-2. [PMID: 21537304 DOI: 10.12968/jowc.2011.20.4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous reports have documented the use of doxycycline as a sclerosing agent in the treatment of recurrent pleural effusion and pneumothoracies. However, little is currently known of its use in the closure of lymphatic fistulae. This paper presents a case in which an infusion of doxycycline was used in a patient who had developed the unusual complication of a high-output lymphatic fistula, following a femoral needle puncture. As no standard of care has been established in the treatment of this problem, we embarked on a minimally-invasive course of action, using doxycycline as a sclerosing agent. We found this treatment to be effective, with no complications.
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Affiliation(s)
- K Singh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Staten Island University Hospital, Staten Island, New York, USA.
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32
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Lugo J, Jang J, Patel R, Yu A, Lantis J, Deitch J, Leitman I. Demographic And Laboratory Data May Predict Positive Temporal Artery Biopsy. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.084] [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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33
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Kedees MH, Babinska A, Swiatkowska M, Deitch J, Mahmood Hussain M, Ehrlich YH, Kornecki E. Expression of a recombinant protein of the platelet F11 receptor (F11R) (JAM-1/JAM-A) in insect cells: F11R is naturally phosphorylated in the extracellular domain. Platelets 2009. [DOI: 10.1080/09537100500186466] [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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34
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Deitch J, Robinson H, Kirk J, Sorrentino N. Renovascular Hypertension: Lesion Detection, Patient Selection, Treatment Options and Results. Curr Hypertens Rev 2009. [DOI: 10.2174/157340209788166931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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35
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Robinson H, Shams J, Kirk J, Sorrentino N, Deitch J. Percutaneous treatment of a traumatic renal-caval arteriovenous fistula presenting as high output cardiac failure. Ann Vasc Surg 2008; 23:256.e9-12. [PMID: 18774687 DOI: 10.1016/j.avsg.2008.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 05/05/2008] [Accepted: 06/15/2008] [Indexed: 11/30/2022]
Abstract
A 67-year-old dialysis-dependent man presented to the cardiology service with worsening high output cardiac failure and was found to have a harsh, right-sided abdominal bruit on examination. Of significance, he had undergone several laparotomies related to a stab wound experienced 7 years earlier. A computed tomography scan revealed right renal artery pseudoaneurysms with fistulous communication to the vena cava. Successful percutaneous coil embolization and cyanoacrylate gluing enabled fistula closure without renal infarction. Symptoms of cardiac failure ultimately resolved following treatment. Catheter-based therapies provide minimally invasive and effective strategies for treating complicated fistulas involving the renal vasculature.
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Affiliation(s)
- Handel Robinson
- Department of Vascular Surgery, Beth Israel Medical Center, New York, NY 10003, USA
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36
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Kedees MH, Babinska A, Swiatkowska M, Deitch J, Hussain MM, Ehrlich YH, Kornecki E. Expression of a recombinant protein of the platelet F11 receptor (F11R) (JAM-1/JAM-A) in insect cells: F11R is naturally phosphorylated in the extracellular domain. Platelets 2005; 16:99-109. [PMID: 15823866 DOI: 10.1080/09537100400010329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The F11 receptor (F11R/JAM) is a member of the immunoglobulin superfamily localized on the membrane surface of human platelets and a component of tight junctions of endothelial and epithelial cells. F11R was demonstrated to participate in the adhesion of human platelets to cytokine-inflamed endothelial cells (EC), indicating an important role for F11R in inflammatory thrombosis and atherosclerosis. Domains responsible for the formation of tight junctions, the adhesion of platelets to EC, activation of platelets resulting in granule release, the activation of IIb/3 integrin and platelet aggregation, were identified in the external portion of F11R. To further examine critical sites of F11R, we utilized the baculovirus system to generate the F11R recombinant protein with the sequence of the extracellular domain, in two types of insect cells, Sf9 and H5. The F11R recombinant protein was detected in the cytoplasm of both infected Sf9 and H5 insect cells, but only infected H5 cells secreted a soluble F11R protein. The purified recombinant F11R proteins, obtained from both types of insect cells, were recognizeable by a conformation-dependent monoclonal antibody, M.Ab.F11, directed against domains within the N-terminus and the first Ig-like fold of F11R. Assessment of the phosphorylation state in the recombinant F11R protein revealed phosphorylation of serine, threonine and tyrosine amino acid residues within the external domain. Real-time biomolecular interaction analysis, performed to assess kinetic constants associated with the binding of active molecules to the purified recombinant F11R protein revealed high affinity binding of the phosphorylated recombinant protein by M.Ab.F11 with K(a) of 5.47 x 10(6) and K(d) of 1.83 x 10(-7), comparable to values measured with intact human platelets. The findings reported here provide new information on specific domains of F11R that can lead to the generation of therapeutic agents expected to be useful in the treatment of cardiovascular diseases.
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Affiliation(s)
- Mamdouh H Kedees
- Department of Anatomy and Cell Biology, State University of New York, Downstate Medical Center at Brooklyn, Brooklyn, NY 11203, USA
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37
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Mousa A, Bernheim J, Dayal R, Deitch J, Henderson P, Hollenbeck S, DeRubertis B, Mahanor EA, Kent KC, Faries PL. Experimental analysis of transvenous ultrasonography in localizing and grading renal artery stenosis. Vascular 2005; 12:301-6. [PMID: 15765911 DOI: 10.1258/rsmvasc.12.5.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study evaluated the potential for transvenous ultrasonography to assess renal artery stenosis (RAS), the most common correctable cause of hypertension in the United States. We developed a porcine model for studying RAS using TVUS. An endovascular ultrasound probe was placed into the inferior vena cava and renal veins to image renal arteries in which stenoses had been surgically created in varied locations and to varied degrees. TVUS was then used to identify and assess these stenotic lesions. The accuracy of TVUS for determining the degree and location of the stenoses was then determined using contrast arteriography as the standard. When compared with arteriography, TVUS identified and properly located all six lesions and correctly quantified the degree of stenosis in five of the six lesions. TVUS is an effective means of assessing the presence, degree, and location of stenotic lesions of the renal arteries in this animal model. Study of this method in humans may be warranted.
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Affiliation(s)
- Albeir Mousa
- Department of Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School, New York, USA
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38
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Arruda VR, Hagstrom JN, Deitch J, Heiman-Patterson T, Camire RM, Chu K, Fields PA, Herzog RW, Couto LB, Larson PJ, High KA. Posttranslational modifications of recombinant myotube-synthesized human factor IX. Blood 2001; 97:130-8. [PMID: 11133752 DOI: 10.1182/blood.v97.1.130] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent data demonstrate that the introduction into skeletal muscle of an adeno-associated viral (AAV) vector expressing blood coagulation factor IX (F.IX) can result in long-term expression of the transgene product and amelioration of the bleeding diathesis in animals with hemophilia B. These data suggest that biologically active F.IX can be synthesized in skeletal muscle. Factor IX undergoes extensive posttranslational modifications in the liver, the normal site of synthesis. In addition to affecting specific activity, these posttranslational modifications can also affect recovery, half-life in the circulation, and the immunogenicity of the protein. Before initiating a human trial of an AAV-mediated, muscle-directed approach for treating hemophilia B, a detailed biochemical analysis of F.IX synthesized in skeletal muscle was carried out. As a model system, human myotubes transduced with an AAV vector expressing F.IX was used. F.IX was purified from conditioned medium using a novel strategy designed to purify material representative of all species of rF.IX in the medium. Purified F.IX was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), N-terminal sequence analysis, chemical gamma-carboxyglutamyl analysis, carbohydrate analysis, assays for tyrosine sulfation, and serine phosphorylation, and for specific activity. Results show that myotube-synthesized F.IX has specific activity similar to that of liver-synthesized F.IX. Posttranslational modifications critical for specific activity, including removal of the signal sequence and propeptide, and gamma-carboxylation of the N-terminal glutamic acid residues, are also similar, but carbohydrate analysis and assessment of tyrosine sulfation and serine phosphorylation disclose differences. In vivo experiments in mice showed that these differences affect recovery but not half-life of muscle-synthesized F.IX.
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Affiliation(s)
- V R Arruda
- Department of Pediatrics and Pathology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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Abstract
Three patients with ovarian cancer who developed gastric outlet obstruction due to loculated ascites in the lesser omental sac are presented. Surgical decompression was utilized, in one case with significant morbidity. Percutaneous drainage under CT or ultrasound guidance allows palliation and avoids potential morbidity and prolonged hospitalization and can be repeated if the condition recurs.
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Affiliation(s)
- W J Mann
- Division of Gynecologic Oncology, State University of New York, Stony Brook 11794-8091
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Abstract
This article examines the cost competitiveness of the food irradiation process. An analysis of the principal factors--the product, physical plant, irradiation source, and financing--that impact on cost is made. Equations are developed and used to calculate the size of the source for planned product throughput, efficiency factors, power requirements, and operating costs of sources, radionuclides, and accelerators. Methods of financing and capital investment are discussed. A series of tables show cost breakdowns of sources, buildings, equipment, and essential support facilities for both a cobalt-60 and a 10-MeV electron accelerator facility. Additional tables present irradiation costs as functions of a number of parameters--power input, source size, dose, and hours of annual operation. The use of the numbers in the tables are explained by examples of calculations of the irradiation costs for disinfestation of grains and radicidation of feed.
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