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Jessula S, Cote C, Khoury M, DeCarlo C, Bellomo TR, Grant-Gorveatt A, Herman C, Smith M, Dua A, Eagleton M, Casey P, Zacharias N. Local Anesthesia for Endovascular Repair of Abdominal Aortic Aneurysm Allows for Accurate Graft Deployment with Durable Results. Ann Vasc Surg 2024; 102:64-73. [PMID: 38301848 DOI: 10.1016/j.avsg.2023.11.033] [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] [Received: 07/20/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Local anesthesia (LA) is sparsely used in endovascular aneurysm repair (EVAR) despite short-term benefit, likely secondary to concerns over patient movement preventing accurate endograft deployment. The objective of this study is to examine the association between anesthesia type and endoleak, sac regression, reintervention, and mortality. METHODS The Vascular Quality Initiative database was queried for all EVAR cases from 2014 to 2022. Patients were included if they underwent percutaneous elective EVAR with anatomical criteria within instructions for use of commercially approved endografts. Multivariable logistic regression with propensity score weighting was used to determine the association between anesthesia type on the risk of any endoleak noted by intraoperative completion angiogram and sac regression. Multivariable survival analysis with propensity score weighting was used to determine the association between anesthesia type and endoleak at 1 year, long-term reintervention, and mortality. RESULTS Thirteen thousand nine hundred thirty two EVARs met inclusion criteria: 1,075 (8%) LA and 12,857 (92%) general anesthesia (GA). On completion angiogram, LA was associated with fewer rates of any endoleaks overall (16% vs. 24%, P < 0.001). On multivariable analysis with propensity score weighting, LA was associated with similar adjusted odds of any endoleak on intraoperative completion angiogram (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.47-0.68) as well as combined type 1a and type 1b endoleaks (OR 0.72, 95% CI 0.47-1.09). Follow-up computed tomography imaging at 1 year was available for 4,892 patients, 377 (8%) LA and 4,515 (92%) GA. At 1 year, LA was associated with similar rate of freedom from any endoleaks compared to GA (0.66 [95% CI 0.63-0.69] vs. 0.71 [95% CI 0.70-0.72], P = 0.663) and increased rates of sac regression (50% vs. 45%, P = 0.040). On multivariable analysis with propensity score weighting, LA and GA were associated with similar adjusted odds of sac regression (OR 1.22, 95% CI 0.97-1.55). LA and GA had similar rates of endoleak at 1 year (hazard ratio [HR] 0.14, 95% CI 0.63-1.07); however, LA was associated with decreased hazards of combined type 1a and 1b endoleaks at 1 year (HR 0.87, 95% CI 0.80-0.96). LA and GA had similar adjusted long-term reintervention rate (HR 0.77, 95% CI 0.44-1.38) and long-term mortality (HR 1.100, 95% CI 079-1.25). CONCLUSIONS LA is not associated with increased adjusted rates of any endoleak on completion angiogram or at 1-year follow-up compared to GA. LA is associated with decreased adjusted rates of type 1a and type 1b endoleak at 1 year, but similar rates of sac regression, long-term reintervention, and mortality. Concerns for accurate graft deployment should not preclude use of LA and LA should be increasingly considered when deciding on anesthetic type for standard elective EVAR.
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Affiliation(s)
- Samuel Jessula
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS.
| | - Claudia Cote
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - Mitri Khoury
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tiffany R Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alexa Grant-Gorveatt
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - Christine Herman
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - Matthew Smith
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Patrick Casey
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Bresler AM, Panthofer A, Kuramochi Y, Olson SL, Eagleton M, Schneider DB, Lyden SP, Blackwelder WC, Uhl CF, Bischoff MS, Matsumura JS, Böckler D. Image-based assessment of aortoiliac aneurysm anatomical characteristics in patients from the global iliac branch study. Langenbecks Arch Surg 2024; 409:135. [PMID: 38649506 PMCID: PMC11035386 DOI: 10.1007/s00423-024-03326-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Endovascular repair is the preferred treatment for aortoiliac aneurysm, with preservation of at least one internal iliac artery recommended. This study aimed to assess pre-endovascular repair anatomical characteristics of aortoiliac aneurysm in patients from the Global Iliac Branch Study (GIBS, NCT05607277) to enhance selection criteria for iliac branch devices (IBD) and improve long-term outcomes. METHODS Pre-treatment CT scans of 297 GIBS patients undergoing endovascular aneurysm repair were analyzed. Measurements included total iliac artery length, common iliac artery length, tortuosity index, common iliac artery splay angle, internal iliac artery stenosis, calcification score, and diameters in the device's landing zone. Statistical tests assessed differences in anatomical measurements and IBD-mediated internal iliac artery preservation. RESULTS Left total iliac artery length was shorter than right (6.7 mm, P = .0019); right common iliac artery less tortuous (P = .0145). Males exhibited greater tortuosity in the left total iliac artery (P = .0475) and larger diameter in left internal iliac artery's landing zone (P = .0453). Preservation was more common on right (158 unilateral, 34 bilateral) than left (105 unilateral, 34 bilateral). There were 192 right-sided and 139 left-sided IBDs, with 318 IBDs in males and 13 in females. CONCLUSION This study provides comprehensive pre-treatment iliac anatomy analysis in patients undergoing endovascular repair with IBDs, highlighting differences between sides and sexes. These findings could refine patient selection for IBD placement, potentially enhancing outcomes in aortoiliac aneurysm treatment. However, the limited number of females in the study underscores the need for further research to generalize findings across genders.
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Affiliation(s)
- Alina-Marilena Bresler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Annalise Panthofer
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yuki Kuramochi
- Vascular Surgery Department, Heart Vascular Thoracic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sydney L Olson
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew Eagleton
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darren B Schneider
- Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sean P Lyden
- Vascular Surgery Department, Heart Vascular Thoracic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William C Blackwelder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christian F Uhl
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jon S Matsumura
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, Division of Vascular Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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3
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Dias-Neto M, Vacirca A, Huang Y, Baghbani-Oskouei A, Jakimowicz T, Mendes BC, Kolbel T, Sobocinski J, Bertoglio L, Mees B, Gargiulo M, Dias N, Schanzer A, Gasper W, Beck AW, Farber MA, Mani K, Timaran C, Schneider DB, Pedro LM, Tsilimparis N, Haulon S, Sweet MP, Ferreira E, Eagleton M, Yeung KK, Khashram M, Jama K, Panuccio G, Rohlffs F, Mesnard T, Chiesa R, Kahlberg A, Schurink GW, Lemmens C, Gallitto E, Faggioli G, Karelis A, Parodi E, Gomes V, Wanhainen A, Habib M, Colon JP, Pavarino F, Baig MS, Gouveia E Melo RECD, Crawford S, Zettervall SL, Garcia R, Ribeiro T, Alves G, Gonçalves FB, Kappe KO, Mariko van Knippenberg SE, Tran BL, Gormley S, Oderich GS. Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms. Ann Surg 2023; 278:568-577. [PMID: 37395613 DOI: 10.1097/sla.0000000000005986] [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: 07/04/2023]
Abstract
OBJECTIVE To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). BACKGROUND FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. METHODS Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. RESULTS A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001). CONCLUSIONS Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.
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Affiliation(s)
- Marina Dias-Neto
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Andrea Vacirca
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Ying Huang
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aidin Baghbani-Oskouei
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | | | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tilo Kolbel
- University Medical Center Eppendorf (UKE), Hamburg, Germany
| | - Jonathan Sobocinski
- Vascular Surgery, Aortic Centre, Université de Lille, CHU Lille, France; Université de Lille, INSERM U1008, CHU Lille, France
| | - Luca Bertoglio
- Department of Vascular Surgery, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
- Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Barend Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mauro Gargiulo
- Vascular Surgery, University of Bologna-DIMEC, Italy, and Vascular Surgery Unit, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Nuno Dias
- Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | | | - Warren Gasper
- University of California San Francisco, San Francisco, CA
| | - Adam W Beck
- University of Alabama at Birmingham, Birmingham, AL
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Kevin Mani
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Carlos Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Luis Mendes Pedro
- Department of Vascular Surgery, Centro Hospitalar Universitário Lisboa Norte; Faculdade de Medicina da Universidade de Lisboa; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Lisbon, Portugal
| | | | - Stéphan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris Saclay, Paris, France
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Emília Ferreira
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon; NOVA Medical School, Universidade NOVA de Lisboa, Portugal
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | | | - Fiona Rohlffs
- University Medical Center Eppendorf (UKE), Hamburg, Germany
| | - Thomas Mesnard
- Vascular Surgery, Aortic Centre, Université de Lille, CHU Lille, France; Université de Lille, INSERM U1008, CHU Lille, France
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Andrea Kahlberg
- Department of Vascular Surgery, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Geert Willem Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Charlotte Lemmens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Enrico Gallitto
- Vascular Surgery, University of Bologna-DIMEC, Italy, and Vascular Surgery Unit, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna-DIMEC, Italy, and Vascular Surgery Unit, IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Angelos Karelis
- Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ezequiel Parodi
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Vivian Gomes
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Anders Wanhainen
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Mohammed Habib
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Jesus Porras Colon
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Felipe Pavarino
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Mirza S Baig
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Ryan Eduardo Costeloe De Gouveia E Melo
- Department of Vascular Surgery, Centro Hospitalar Universitário Lisboa Norte; Faculdade de Medicina da Universidade de Lisboa; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Lisbon, Portugal
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich
| | - Sean Crawford
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris Saclay, Paris, France
| | - Sara L Zettervall
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Rita Garcia
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon; NOVA Medical School, Universidade NOVA de Lisboa, Portugal
| | - Tiago Ribeiro
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon; NOVA Medical School, Universidade NOVA de Lisboa, Portugal
| | - Gonçalo Alves
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon; NOVA Medical School, Universidade NOVA de Lisboa, Portugal
| | - Frederico Bastos Gonçalves
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon; NOVA Medical School, Universidade NOVA de Lisboa, Portugal
| | - Kaj Olav Kappe
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | | | - Bich Lan Tran
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | - Sinead Gormley
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gustavo S Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
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Cheng SWK, Eagleton M, Echeverri S, Munoz JG, Holden AH, Hill AA, Krievins D, Ramaiah V. A pilot study to evaluate a novel localized treatment to stabilize small- to medium-sized infrarenal abdominal aortic aneurysms. J Vasc Surg 2023; 78:929-935.e1. [PMID: 37330148 DOI: 10.1016/j.jvs.2023.05.056] [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: 02/27/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE There is no proven therapy to reduce growth rates of small- to medium-sized abdominal aortic aneurysms (AAAs). Ex vivo and animal studies have demonstrated that a novel stabilizing agent, 1,2,3,4,6-pentagalloyl glucose (PGG), delivered locally to the aneurysm sac, can bind to elastin and collagen to re-establish strength and resist enzymatic degradation. We aimed to demonstrate that a one-time administration of PGG solution to the aneurysm wall is safe and potentially effective to slow the growth of small- to medium-sized AAAs. METHODS Patients with small- to medium-sized infrarenal AAAs (maximum diameter <5.5 cm) were recruited. Via transfemoral access, a 14F or 16F dual-balloon delivery catheter was introduced into the aneurysm sac. A single, 3-minute, localized endoluminal infusion of PGG was delivered via a 'weeping' balloon to the aneurysm wall. Independent core laboratory measurements of maximum aneurysm sac diameter and sac volume measurements based on computed tomography angiography (CTA) were used for assessments at 1, 6, 12, 24, and 36 months. The primary endpoints were technical success and safety (major adverse events at 30 days). The secondary endpoint was growth stabilization, defined as freedom from aneurysm sac enlargement (diameter increase >5 mm per year or volume increase of >10% per year). RESULTS Twenty patients (19 male) were enrolled at five centers from May 2019 to June 2022 (mean age, 67.8 years; range, 50-87 years). All procedures were technically successful. The safety profile was consistent with standard interventional procedures. Four patients demonstrated transient elevations of liver enzymes levels that returned to normal by 30 days with no clinical symptoms. Through November 2022, follow-up CTA data is available on the first 11 patients. The average changes in maximum aneurysm diameter from baseline to 6, 12, 24, and 36 months were 0.2 mm, 1.1 mm, 1.2 mm, and 0.8 mm, respectively, and the average changes in volume were 2.0%, 9.6%, 18.1%, and 11.6%, respectively. At 12 months, none of the aneurysms showed growth >5.0 mm, and three had volume growth >10%. CONCLUSIONS The early results of this first-in-human, small cohort study demonstrated that a single, localized PGG administration to patients with small- to medium-sized infrarenal AAAs is safe. Longer term follow-up on all 20 treated patients is needed to better assess the potential impact on aneurysm growth.
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Affiliation(s)
- Stephen W K Cheng
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
| | | | | | | | - Andrew H Holden
- Associate Professor Radiology, Director of Northern Region Interventional Radiology Service, Auckland University School of Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Dainis Krievins
- Pauls Stradins Clinical University Hospital, University of Latvia Faculty of Medicine, Riga, Latvia
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5
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Abdelhalim MA, Tenorio ER, Oderich GS, Haulon S, Warren G, Adam D, Claridge M, Butt T, Abisi S, Dias NV, Kölbel T, Gallitto E, Gargiulo M, Gkoutzios P, Panuccio G, Kuzniar M, Mani K, Mees BM, Schurink GW, Sonesson B, Spath P, Wanhainen A, Schanzer A, Beck AW, Schneider DB, Timaran CH, Eagleton M, Farber MA, Modarai B. Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Vasc Surg 2023; 78:854-862.e1. [PMID: 37321524 DOI: 10.1016/j.jvs.2023.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs). METHODS We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM). RESULTS A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively. CONCLUSIONS FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance.
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Affiliation(s)
- Mohamed A Abdelhalim
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, London, United Kingdom
| | - Emanuel R Tenorio
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Stephan Haulon
- Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, GHPSJ, Université Paris Saclay, Paris, France
| | - Gasper Warren
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Donald Adam
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin Claridge
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Talha Butt
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Said Abisi
- Department of Vascular Surgery, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Nuno V Dias
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
| | - Enrico Gallitto
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Mauro Gargiulo
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Panos Gkoutzios
- Department of Interventional Radiology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
| | - Marek Kuzniar
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Barend M Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert W Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Björn Sonesson
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Paolo Spath
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carlos H Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Bijan Modarai
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, London, United Kingdom.
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Dias-Neto M, Tenorio ER, Huang Y, Jakimowicz T, Mendes BC, Kölbel T, Sobocinski J, Bertoglio L, Mees B, Gargiulo M, Dias N, Schanzer A, Gasper W, Beck AW, Farber MA, Mani K, Timaran C, Schneider DB, Pedro LM, Tsilimparis N, Haulon S, Sweet M, Ferreira E, Eagleton M, Yeung KK, Khashram M, Varcica A, Lima GB, Baghbani-Oskouei A, Jama K, Panuccio G, Rohlffs F, Chiesa R, Schurink GW, Lemmens C, Gallitto E, Faggioli G, Karelis A, Parodi E, Gomes V, Wanhainen A, Dean A, Colon JP, Pavarino F, E Melo RG, Crawford S, Garcia R, Ribeiro T, Kappe KO, van Knippenberg SEM, Tran BL, Gormley S, Oderich GS. Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. J Vasc Surg 2023; 77:1588-1597.e4. [PMID: 36731757 DOI: 10.1016/j.jvs.2023.01.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/01/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). METHODS We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. RESULTS A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. CONCLUSION Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.
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Affiliation(s)
- Marina Dias-Neto
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Emanuel R Tenorio
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Ying Huang
- The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tilo Kölbel
- University Medical Center Eppendorf (UKE), Hamburg, Germany
| | - Jonathan Sobocinski
- Vascular Surgery, Aortic Centre, Université de Lille, CHU Lille, France; Université de Lille, INSERM, CHU Lille, Lille, France
| | - Luca Bertoglio
- Vita Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Barend Mees
- Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Mauro Gargiulo
- Vascular Surgery, University of Bologna, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Nuno Dias
- Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | | | - Warren Gasper
- University of California San Francisco, San Francisco CA
| | - Adam W Beck
- University of Alabama at Birmingham, Birmingham, AL
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Kevin Mani
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Carlos Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Luis Mendes Pedro
- Department of Vascular Surgery of the Hospital Santa Maria (CHULN) and Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Stéphan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris Saclay, Paris, France
| | - Matt Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Emília Ferreira
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Andrea Varcica
- The University of Texas Health Science Center at Houston, Houston, TX
| | - Guilherme B Lima
- The University of Texas Health Science Center at Houston, Houston, TX
| | | | | | | | - Fiona Rohlffs
- University Medical Center Eppendorf (UKE), Hamburg, Germany
| | - Roberto Chiesa
- Vita Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Geert Willem Schurink
- Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Charlotte Lemmens
- Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Enrico Gallitto
- Vascular Surgery, University of Bologna, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Angelos Karelis
- Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ezequiel Parodi
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Vivian Gomes
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Anders Wanhainen
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anastasia Dean
- Department of Surgical Sciences, Division of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Jesus Porras Colon
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Felipe Pavarino
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Ryan Gouveia E Melo
- Department of Vascular Surgery of the Hospital Santa Maria (CHULN) and Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sean Crawford
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris Saclay, Paris, France
| | - Rita Garcia
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Tiago Ribeiro
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Kaj Olav Kappe
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | | | - Bich Lan Tran
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location VU medical center, Amsterdam, the Netherlands
| | - Sinead Gormley
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gustavo S Oderich
- The University of Texas Health Science Center at Houston, Houston, TX.
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Majumdar M, Hall RP, Feldman Z, Goudot G, Sumetsky N, Jessula S, Kirshkaln A, Bellomo T, Chang D, Cardenas J, Patell R, Eagleton M, Dua A. Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data. J Am Heart Assoc 2023; 12:e027790. [PMID: 36565191 PMCID: PMC9973575 DOI: 10.1161/jaha.122.027790] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG-PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient-centered thrombophrophylaxis. This prospective study aimed to determine if TEG-PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high-risk patients. Methods and Results We conducted a single-center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG-PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG-PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG-PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P<0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02-1.07]; P<0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Conclusions Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high-risk patients may decrease the risk of postoperative thrombotic events.
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Affiliation(s)
- Monica Majumdar
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Ryan P. Hall
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Zachary Feldman
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Guillaume Goudot
- Cardiovascular Research Center, Division of CardiologyMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Natalie Sumetsky
- Department of Epidemiology and StatisticsUniversity of PittsburgPA
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Amanda Kirshkaln
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Tiffany Bellomo
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - David Chang
- Healthcare Research and Policy Development, Codman Center, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Jessica Cardenas
- Center for Translational Injury ResearchUniversity of Texas–HoustonHoustonTX
| | - Rushad Patell
- Division of Hematology/OncologyBeth Israel Deaconess Medical Center/Harvard Medical SchoolBostonMA
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of SurgeryMassachusetts General Hospital/Harvard Medical SchoolBostonMA
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8
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Cooke PV, Png CYM, George JM, Eagleton M, Tadros RO. Higher Surgeon Volume is Associated with Lower Odds of Complication Following TEVAR for Aortic Dissections. J Vasc Surg 2022; 76:884-890. [PMID: 35764226 DOI: 10.1016/j.jvs.2022.06.027] [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: 02/15/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to understand the impact of surgeon volume on outcomes of thoracic endovascular aortic repair (TEVAR) in patients being treated for aortic dissection. METHODS Patients undergoing TEVAR from January 2014 - March 2021 in the Vascular Quality Initiative (VQI) database were analyzed. Patients with aortic dissection who underwent TEVAR were divided into quartiles based on the annual TEVAR volume of their vascular surgeon. The highest quartile, middle two quartiles, and lowest quartile were deemed high volume (HV), moderate volume (MV), and low volume (LV), respectively. Multivariable logistic regressions were performed to compare cohort outcomes in terms any postoperative complication, stroke, spinal cord ischemia, reintervention, and 30-day mortality. A Cox proportional hazard model was used to assess the hazard of overall postoperative mortality. RESULTS Amongst 1,217 patients undergoing TEVAR, 321, 621, and 275 were performed by HV, MV, and LV surgeons, respectively. HV performed >19 annual TEVARs, MV surgeons between 5 and 18, and LV surgeons ≤4. Adjusted odds of any postoperative complication revealed that HV and MV surgeons had lower odds of overall postoperative complications [(OR 0.58, (95% CI 0.30 - 0.85), p = 0.011) and (OR 0.60, (95% CI 0.38 - 0.87), p = 0.008)], respectively when compared to LV patients. HV had lower odds of respiratory complications than LV surgeons complications [(OR 0.42, (95% CI 0.17 - 0.93), p = 0.039)]. Adjusted analysis of outcomes including spinal cord ischemia, stroke, myocardial infarction, 30-day mortality, and overall mortality did not reveal statistically significant differences between cohorts. CONCLUSION Surgeon volume does not to impact 30-day mortality or long-term mortality after TEVAR for aortic dissection, but the odds of overall postoperative complications were lower for HV and MV surgeons when compared to LV surgeons.
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Affiliation(s)
- Peter V Cooke
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital
| | - Justin M George
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai.
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9
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Zettervall SL, Tenorio ER, Schanzer A, Oderich GS, Timaran CH, Schneider DB, Eagleton M, Farber MA, Gasper WJ, Beck AW, Sweet MP. Secondary interventions after fenestrated/branched aneurysm repairs are common and non-detrimental to long-term survival. J Vasc Surg 2021; 75:1530-1538.e4. [PMID: 34954272 DOI: 10.1016/j.jvs.2021.11.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 08/11/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Secondary interventions are common following endovascular repair of aortic aneurysms. However, the frequency and procedural details of secondary intervention following fenestrated and branched repairs (F/BEVAR) have been less well described, and the impact on long-term survival and aneurysm-related mortality is unknown. METHODS Consecutive patients enrolled as part of a multicenter research consortium in nine independent physician-sponsored investigational device exemption studies from 2005-2020 were evaluated. All secondary interventions performed after the initial procedure were classified as open or percutaneous and as major or minor, as per SVS reporting standards. Secondary interventions were further classified as high or low magnitude according to the physiologic impact of the intervention. Demographics, procedural details, and perioperative outcomes were compared for those who underwent secondary interventions and those who did not. Kaplan-Meier and Cox Proportional Hazard Ratio analysis were utilized to evaluate long-term survival. RESULTS Of 1681 patients who underwent F/BEVAR, 385 (23%) underwent secondary intervention at any point in follow-up. Freedom from reintervention was 82% at 1-year and 59% at 5-year follow up. Mean follow-up was 23 months. The majority of secondary interventions were percutaneous (84%), minor (70%), and low magnitude (81%). Renal stenting (30%) and access related procedures (24%) were the most frequent percutaneous and open procedures, respectively. High magnitude operations were performed in 19% of patients. Technical success was achieved for 94% of secondary interventions and mortality from secondary intervention was less than 1%. Secondary interventions as a whole were associated with improved long-term survival (Hazard Ratio: 0.6 95% Confidence Interval: 0.5-0.7). In subgroup analysis, major (HR: 0.6, 95% CI 0.4-0.8), minor (HR: 0.6, 95% CI: 0.5-0.8), low magnitude (HR 0.5, 95% CI: 0.4-0.7), and percutaneous (HR: 0.6, 95% CI: 0.5-0.7) secondary interventions were associated with improved survival; however high magnitude (HR: 1.0, 95% CI: 0.7-1.5) and open secondary interventions (HR: 1.0, 95% CI: 0.7-1.5) were not. Similarly, when aneurysm-related survival was specifically assessed, low magnitude secondary interventions were found to improve survival (HR: 0.3, 95% CI: 0.1-0.7), while high magnitude secondary interventions (HR: 2.8, 95% CI: 1.4-5.8) and open secondary interventions (HR: 2.7, 95% CI: 1.3-5.5) were associated with increased mortality. CONCLUSIONS Secondary interventions after F/BEVAR are frequent and are typically percutaneous, minor, and low magnitude procedures. While uncommon, high magnitude and open secondary interventions are associated with decreased long-term survival and increased aneurysm-related mortality. These data highlight the importance of close, life-long surveillance, and suggest that a significant rate of secondary intervention should be anticipated, but these do not negatively impact survival.
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Affiliation(s)
| | - Emanuel R Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School. Worcester, MA
| | - Gustavo S Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, TX
| | - Darren B Schneider
- Division of Vascular and Endovascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
| | - Warren J Gasper
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco CA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew P Sweet
- Division of Vascular Surgery, University of Washington, Seattle WA
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Sumpio B, Feldman Z, Eagleton M. First in Man. Ann Surg 2021; 274:e658. [PMID: 34520428 DOI: 10.1097/sla.0000000000005216] [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: 11/25/2022]
Affiliation(s)
- Brandon Sumpio
- Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, 55 Fruit Street, WACC 440, Boston, MA
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Feldman Z, Kim D, Roddy C, Sumpio B, Kwolek C, LaMuraglia G, Eagleton M, Srivastava S. Partial and Complete Explantation of Aortic Endografts in the Modern Era. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.003] [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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12
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Chou E, Sung E, Guo X, Sumpio B, Dua A, Srivastava S, Eagleton M, Conrad M, Mohapatra A. Comparison of Covered and Bare Metal Stents in Chronic Mesenteric Ischemia. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Edman NI, Schanzer A, Crawford A, Oderich GS, Farber MA, Schneider DB, Timaran CH, Beck AW, Eagleton M, Sweet MP. Sex-related outcomes after fenestrated-branched endovascular aneurysm repair for thoracoabdominal aortic aneurysms in the U.S. Fenestrated and Branched Aortic Research Consortium. J Vasc Surg 2021; 74:861-870. [PMID: 33775747 DOI: 10.1016/j.jvs.2021.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/04/2020] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fenestrated-branched endovascular aneurysm repair (FBEVAR) has expanded the treatment of patients with thoracoabdominal aortic aneurysms (TAAAs). Previous studies have demonstrated that women are less likely to be treated with standard infrarenal endovascular aneurysm repair because of anatomic ineligibility and experience greater mortality after both infrarenal and thoracic aortic aneurysm repair. The purpose of the present study was to describe the sex-related outcomes after FBEVAR for treatment of TAAAs. METHODS The data from 886 patients with extent I to IV TAAAs (excluding pararenal or juxtarenal aneurysms), enrolled in eight prospective, physician-sponsored, investigational device exemption studies from 2013 to 2019, were analyzed. All data were collected prospectively, audited and adjudicated by clinical events committees and/or data safety monitoring boards, and subject to Food and Drug Administration oversight. All the patients had been treated with Cook-manufactured patient-specific FBEVAR devices or the Cook t-Branch off-the-shelf device (Cook Medical, Brisbane, Australia). RESULTS Of the 886 patients who underwent FBEVAR, 288 (33%) were women. The women had more extensive aneurysms and a greater prevalence of diabetes (33% vs 26%; P = .043) but a lower prevalence of coronary artery disease (33% vs 52%; P < .0001) and previous infrarenal endovascular aneurysm repair (7.6% vs 16%; P < .001). The women had required a longer operative time from incision to surgery end (5.0 ± 1.8 hours vs 4.6 ± 1.7 hours; P < .001), experienced lower technical success (93% vs 98%; P = .002), and were less likely to be discharged to home (72% vs 83%; P = .009). Despite the smaller access vessels, the women did not have an increased incidence of access site complications. Also, the 30-day outcomes were broadly similar between the sexes. At 1 year, no differences were found between the women and men in freedom from type I or III endoleak (91.4% vs 92.0%; P = .64), freedom from reintervention (81.7% vs 85.3%; P = .10), target vessel instability (87.5% vs 89.2%; P = .31), and survival (89.6% vs 91.7%; P = .26). The women had a greater incidence of postoperative sac expansion (12% vs 6.5%; P = .006). Multivariable modeling adjusted for age, aneurysm extent, aneurysm size, urgent procedure, and renal function showed that patient sex was not an independent predictor of survival (hazard ratio, 0.83; 95% confidence interval, 0.50-1.37; P = .46). CONCLUSIONS Women undergoing FBEVAR demonstrated metrics of increased complexity and had a lower level of technical success, especially those with extensive aneurysms. Compared with the men, the women had similar 30-day mortality and 1-year outcomes, with the exception of an increased incidence of sac expansion. These data have demonstrated that FBEVAR is safe and effective for women and men but that further efforts to improve outcome parity are indicated.
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Affiliation(s)
- Natasha I Edman
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash; Medical Scientist Training Program, University of Washington, Seattle, Wash
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, Mass
| | - Allison Crawford
- Division of Vascular Surgery, University of Massachusetts, Worcester, Mass
| | - Gustavo S Oderich
- Advanced Endovascular Aortic Program, Division of Vascular and Endovascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Carlos H Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, Tex
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
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Dua A, Thondapu V, Rosovsky R, Hunt D, Latz C, Waller HD, Manchester S, Patell R, Romero J, Ghoshhajra B, Eagleton M, Brink J, Hedgire S. Deep vein thrombosis protocol optimization to minimize healthcare worker exposure in coronavirus disease-2019. J Vasc Surg Venous Lymphat Disord 2021; 9:299-306. [PMID: 32795617 PMCID: PMC7418643 DOI: 10.1016/j.jvsv.2020.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/02/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE There are no societal ultrasound (US) guidelines detailing appropriate patient selection for deep vein thrombosis (DVT) imaging in patients with COVID-19, nor are there protocol recommendations aimed at decreasing exposure time for US technologists. We aimed to provide COVID-19-specific protocol optimization recommendations limiting US technologist exposure while optimizing patient selection. METHODS A novel two-pronged algorithm was implemented to limit the DVT US studies on patients with COVID-19 prospectively, which included direct physician communication with the care team and a COVID-19-specific imaging protocol was instated to reduce US technologist exposure. To assess the pretest risk of DVT, the sensitivity and specificity of serum d-dimer in 500-unit increments from 500 to 8000 ng/mL and a receiver operating characteristic curve to assess performance of serum d-dimer in predicting DVT was generated. Rates of DVT, pulmonary embolism, and scan times were compared using t-test and Fisher's exact test (before and after implementation of the protocol). RESULTS Direct physician communication resulted in cancellation or deferral of 72% of requested examinations in COVID-19-positive patients. A serum d-dimer of >4000 ng/mL yielded a sensitivity of 80% and a specificity of 70% (95% confidence interval, 0.54-0.86) for venous thromboembolism. Using the COVID-19-specific protocol, there was a significant (50%) decrease in the scan time (P < .0001) in comparison with the conventional protocol. CONCLUSIONS A direct physician communication policy between imaging physician and referring physician resulted in deferral or cancellation of a majority of requested DVT US examinations. An abbreviated COVID-19-specific imaging protocol significantly decreased exposure time to the US technologist.
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Affiliation(s)
- Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Vikas Thondapu
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Rachel Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - David Hunt
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Christopher Latz
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - H David Waller
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Scott Manchester
- Vascular Laboratory, Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Rushad Patell
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Javier Romero
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Matthew Eagleton
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - James Brink
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Sandeep Hedgire
- Department of Radiology, Massachusetts General Hospital, Boston, Mass
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Sumpio BJ, Png CYM, Harrington A, Root D, McLaughlin R, Manchester S, Latz CA, Feldman ZM, Eagleton M, Dua A. Utility of unilateral versus bilateral venous reflux studies for venous insufficiency. J Vasc Surg Venous Lymphat Disord 2021; 9:1297-1301. [PMID: 33529718 DOI: 10.1016/j.jvsv.2021.01.004] [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: 08/05/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Duplex ultrasonography is the reference standard for diagnosing chronic venous insufficiency. Bilateral venous reflux ultrasound studies are among the most time-consuming and physically demanding tests for vascular ultrasound technologists to perform. Furthermore, if a venous procedure is required, many insurance policies require that a diagnostic venous ultrasound scan for reflux must be performed within 1 year of the procedure. If the intervention is scheduled for >1 year after the ultrasound scan, the insurance company might require a repeat venous ultrasound scan before granting insurance authorization. Hence, ordering bilateral venous duplex ultrasound scans to evaluate for reflux when an intervention might only be performed on one limb within the year could be a waste of time and resources. The aim of the present study was to determine the utility of ordering bilateral vs unilateral studies to evaluate for reflux in patients with suspected chronic venous insufficiency and to determine whether a resource-saving potential exists for vascular laboratories through optimization of the process of ordering venous duplex ultrasound studies. METHODS A retrospective review of all patients who had undergone bilateral lower extremity ultrasound scanning to evaluate for reflux from January 1, 2016 to December 31, 2016 at the Massachusetts General Hospital vascular laboratory was performed. The demographics, indications for ultrasound scanning, comorbidities, time required to perform the ultrasound study, and interval to intervention were documented. The data were analyzed using SPSS statistical software (IBM Corp, Armonk, NY). RESULTS During the study period, 13,854 ultrasound studies had been performed in our vascular laboratory, of which 606 (4.4%) had been bilateral ultrasound scans for venous insufficiency. The time allotted for a bilateral study was 2 hours. Of the 606 studies evaluated, 152 (25.1%) showed no evidence of reflux, 284 (46.9%) showed bilateral lower extremity reflux, and 170 (28.1%) showed only venous insufficiency in one leg. Venous ablation, phlebectomy, and/or sclerotherapy were performed for 28.7% of the patients. However only 6.2% of patients had undergone venous procedures on both legs within 1 year after the ultrasound studies. Ablation was the most common procedure performed (54.6%), followed by phlebectomy (27.%) and sclerotherapy (17.9%). Overall, 94.7% of patients had not undergone a venous procedure on both legs within 1 year after the ultrasound studies and, hence, would have required a repeat duplex ultrasound scan to ensure insurance coverage for future procedures. CONCLUSIONS Most bilateral ultrasound scans for venous insufficiency will not result in an intervention. Thus, most patients (95%) could have undergone a unilateral scan before the initial intervention instead of bilateral duplex ultrasound scanning.
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Affiliation(s)
- Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anita Harrington
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Drena Root
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Robert McLaughlin
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Scott Manchester
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Zachary M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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Schanzer A, Beck AW, Eagleton M, Farber MA, Oderich G, Schneider D, Sweet MP, Timaran C. Reply. J Vasc Surg 2020; 72:2219-2220. [DOI: 10.1016/j.jvs.2020.07.057] [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] [Received: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
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Schanzer A, Beck AW, Eagleton M, Farber MA, Oderich G, Schneider D, Sweet MP, Crawford A, Timaran C. Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair. J Vasc Surg 2020; 72:849-858. [DOI: 10.1016/j.jvs.2019.11.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/03/2019] [Indexed: 01/13/2023]
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Axtell A, Eagleton M, Conrad M, Isselbacher E, Sundt T, Jassar A. Total Arch Replacement and Frozen Elephant Trunk for Acute Complicated Type B Dissection. Ann Thorac Surg 2020; 110:e213-e216. [DOI: 10.1016/j.athoracsur.2019.12.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 11/27/2022]
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Latz CA, DeCarlo C, Boitano L, Png CYM, Patell R, Conrad MF, Eagleton M, Dua A. Blood type and outcomes in patients with COVID-19. Ann Hematol 2020; 99:2113-2118. [PMID: 32656591 PMCID: PMC7354354 DOI: 10.1007/s00277-020-04169-1] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 01/28/2023]
Abstract
This study aimed to determine if there is an association between ABO blood type and severity of COVID-19 defined by intubation or death as well as ascertain if there is variability in testing positive for COVID-19 between blood types. In a multi-institutional study, all adult patients who tested positive for COVID-19 across five hospitals were identified and included from March 6th to April 16th, 2020. Hospitalization, intubation, and death were evaluated for association with blood type. Univariate analysis was conducted using standard techniques and logistic regression was used to determine the independent effect of blood type on intubation and/or death and positive testing. During the study period, there were 7648 patients who received COVID-19 testing throughout the institutions. Of these, 1289 tested positive with a known blood type. A total of 484 (37.5%) were admitted to hospital, 123 (9.5%) were admitted to the ICU, 108 (8.4%) were intubated, 3 (0.2%) required ECMO, and 89 (6.9%) died. Of the 1289 patients who tested positive, 440 (34.2%) were blood type A, 201 (15.6%) were blood type B, 61 (4.7%) were blood type AB, and 587 (45.5%) were blood type O. On univariate analysis, there was no association between blood type and any of the peak inflammatory markers (peak WBC, p = 0.25; peak LDH, p = 0.40; peak ESR, p = 0.16; peak CRP, p = 0.14) nor between blood type and any of the clinical outcomes of severity (admission p = 0.20, ICU admission p = 0.94, intubation p = 0.93, proning while intubated p = 0.58, ECMO p = 0.09, and death p = 0.49). After multivariable analysis, blood type was not independently associated with risk of intubation or death (referent blood type A; blood type B: AOR: 0.72, 95% CI: 0.42–1.26, blood type AB: AOR: 0.78, CI: 0.33–1.87, blood type O: AOR: 0.77, CI: 0.51–1.16), rhesus factor positive (Rh+): AOR: 1.03, CI: 0.93–1.86. Blood type A had no correlation with positive testing (AOR: 1.00, CI: 0.88–1.13), blood type B was associated with higher odds of testing positive for disease (AOR: 1.28, CI: 1.08–1.52), AB was also associated with higher odds of testing positive (AOR: 1.37, CI: 1.02–1.83), and O was associated with a lower risk of testing positive (AOR: 0.84, CI: 0.75–0.95). Rh+ status was associated with higher odds of testing positive (AOR: 1.23, CI: 1.003–1.50). Blood type was not associated with risk of intubation or death in patients with COVID-19. Patients with blood types B and AB who received a test were more likely to test positive and blood type O was less likely to test positive. Rh+ patients were more likely to test positive.
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Affiliation(s)
- Christopher A Latz
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA.
| | - Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
| | - Laura Boitano
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
| | - Rushad Patell
- Division of Hematology, Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital (MGH), 15 Parkman Street, Boston, MA, 02214-3117, USA
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Motta F, Oderich G, Schanzer A, Timaran C, Schneider D, Sweet M, Beck A, Eagleton M, Farber M. Fenestrated-branched Endovascular Aortic Repair (F-BEVAR) is a Safe and Effective Option for Octogenarians in Treating Complex Aortic Aneurysm (CAA) Compared to Non-octogenarians. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.183] [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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Wang LJ, Mohebali J, Goodney P, Patel V, Conrad M, Eagleton M, Clouse WD. The Effect of Clinical Coronary Disease Severity on Outcomes of Carotid Endarterectomy With and Without Combined Coronary Bypass. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.01.011] [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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Wang LJ, Tsougranis G, Ergul E, Pendleton AA, Clouse WD, Eagleton M, Conrad MF. NESVS10. Outcomes of Lower Extremity Bypass After Failed Endovascular or Open Revascularization Are Inferior to Bypasses Without Prior Intervention. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.114] [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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Berriochoa C, Reddy CA, Dorsey S, Campbell S, Poblete-Lopez C, Schlenk R, Spencer A, Lee J, Eagleton M, Tendulkar RD. The Residency Match: Interview Experiences, Postinterview Communication, and Associated Distress. J Grad Med Educ 2018; 10:403-408. [PMID: 30154970 PMCID: PMC6108351 DOI: 10.4300/jgme-d-17-01020.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Interview experiences and postinterview communication during the residency match process can cause distress for applicants, and deserve further study. OBJECTIVE We both quantified and qualified the nature of various interview behaviors during the 2015-2016 National Resident Matching Program (NRMP) Match and collected applicant perspectives on postinterview communication and preferences for policy change. METHODS An anonymous, 31-question survey was sent to residency candidates applying to 8 residency programs at a single academic institution regarding their experiences at all programs where they interviewed. RESULTS Of 6693 candidates surveyed, 2079 (31%) responded. Regarding interview experiences, applicants reported being asked at least once about other interviews, marital status, and children at the following rates: 72%, 38%, and 17%, respectively, and such questions arose at a reported mean of 25%, 14%, and 5% of programs, respectively. Female applicants were more frequently asked about children than male applicants (22% versus 14%, P < .0001). Overall, 91% of respondents engaged in postinterview communication. A total of 70% of respondents informed their top program that they had ranked it highly; 70% of this subset reported associated distress, and 78% reported doing this to improve match success. A total of 71% would feel relief if postinterview communication was actively discouraged, and 51% would prefer applicants to be prohibited from notifying programs of their rank. CONCLUSIONS Applicants to several residency programs reported being asked questions that violate the NRMP Code of Conduct. The majority of applicants would prefer postinterview communication to be more regulated and less prevalent.
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Miler R, Kang J, Sowa P, Eagleton M, Parodi FE. Novel Application of Branched Endograft for Preservation of Pelvic Circulation. Ann Vasc Surg 2017; 46:207.e1-207.e3. [PMID: 28893709 DOI: 10.1016/j.avsg.2017.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Endovascular repair of a proximal anastomotic pseudoaneurysm (APSA) of an end-to-side aortobifemoral bypass (ABF) can lead to pelvic ischemia. We present a novel application of branched aortic endograft to repair such pseudoaneurysm while preserving flow into the ABF and native aortoiliac system. METHODS A 71-year-old male with history of aortoiliac occlusive disease resulting in lifestyle limiting claudication was treated with an aortobifemoral bypass in 1999. The patient developed an 8.8 cm pseudoaneurysm at the aortic anastomosis. CTA demonstrated patent right common and internal iliac arteries with an occluded right external iliac artery and occluded left common and external iliac arteries. RESULTS A 24 × 80 mm endograft with an 8 × 15 mm posterior branch based on the Cook Zenith device (Bloomington, IN) was delivered via a right femoral artery exposure. The preloaded wire of the main body was snared via left brachial access. A 10F sheath was advanced into the side branch of the graft to deliver a 10 × 10-mm Bard Fluency (Covington, Georgia) stent graft into the right common iliac artery. The branch was reinforced proximally with an 8 × 17 mm Boston Scientific Express (Marlborough, MA) stent. The patient was discharged after 5 days. At 1 month, CTA demonstrated patent ABF, patent branch graft into the pelvis, and exclusion of the pseudoaneurysm. CONCLUSIONS Branch grafts can provide minimally invasive revision of a failing ABF, in this case an APSA, while preserving pelvic circulation and lower extremity perfusion.
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Miler R, Sowa P, Eagleton M, Parodi F. Novel Application of Branched Endograft for Preservation of Pelvic Circulation. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.03.159] [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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Wohlauer M, Brier C, Kuramochi Y, Eagleton M. Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair. Ann Vasc Surg 2017; 42:198-204. [PMID: 28359793 DOI: 10.1016/j.avsg.2017.03.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/02/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. METHODS One thousand eighty nine consecutive patients with juxtarenal and thoracoabdominal aortic aneurysms considered high risk for open surgery from a single institution who underwent FEVAR from 2001 to 2014 were included in the study. Risk factors for all-cause mortality were identified via a Cox regression model on time to death. RESULTS The patients with severe hypoalbuminemia (albumin <2.4 g/dL) had significantly increased 30-day mortality (P = 0.025, odds ratio [OR]: 4.967 (95% CI: 1.385-17.814, normal versus severe) and 2-year mortality P = 0.006, OR: 2.4, 95% CI: 1.05-5.73, normal versus severe), as well as increased 30-day complication rates P = 0.026, OR: 1.91, 95% CI: 0.9-4.17, normal versus severe). A univariate analysis for 30-day mortality revealed no significant difference in median age: 75.1 vs. 72.5 years (alive at 30 days (Q1, Q3: 69.8, 80.1) versus expired (Q1, Q3: 69.3, 77.8), P = 0.24. CONCLUSIONS Patients with hypoalbuminemia have significantly increased mortality risk. Albumin level is regulated by nutritional intake and inflammation due to chronic disease, which make it a useful part of a preoperative frailty assessment. Further studies are needed to identify whether optimizing nutrition status will affect albumin levels or decrease mortality.
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Affiliation(s)
- Max Wohlauer
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; Division of Vascular Surgery, Department of Surgery, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI.
| | - Corey Brier
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Yuki Kuramochi
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Matthew Eagleton
- Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
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Arafat A, Roselli EE, Idrees JJ, Feng K, Banaszak L, Eagleton M, Menon V, Svensson LG. Stent Grafting Acute Aortic Dissection: Comparison of DeBakey Extent IIIA Versus IIIB. Ann Thorac Surg 2016; 102:1473-1481. [DOI: 10.1016/j.athoracsur.2016.04.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/11/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Schoenhagen P, Roselli EE, Harris CM, Eagleton M, Menon V. Online network of subspecialty aortic disease experts: Impact of “cloud” technology on management of acute aortic emergencies. J Thorac Cardiovasc Surg 2016; 152:39-42. [DOI: 10.1016/j.jtcvs.2016.02.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
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Aggarwal B, Raymond CE, Randhawa MS, Roselli E, Jacob J, Eagleton M, Kralovic DM, Kormos K, Holloway D, Menon V. Transfer Metrics in Patients With Suspected Acute Aortic Syndrome. Circ Cardiovasc Qual Outcomes 2014; 7:780-2. [DOI: 10.1161/circoutcomes.114.000988] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bhuvnesh Aggarwal
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Chad E. Raymond
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Mandeep S. Randhawa
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Eric Roselli
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Jessen Jacob
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Matthew Eagleton
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Damon M. Kralovic
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Kristopher Kormos
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - David Holloway
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
| | - Venu Menon
- From the Departments of Internal Medicine (B.A., M.S.R., J.J.), Emergency Medicine (D.M.K., K.K, D.H.), Cardiovascular Medicine (C.E.R., V.M.), Cardiothoracic Surgery (E.R.), and Vascular Surgery (M.E.), Cleveland Clinic, OH
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Quiñones-Baldrich WJ, Holden A, Mertens R, Thompson MM, Sawchuk AP, Becquemin JP, Eagleton M, Clair DG. Prospective, multicenter experience with the Ventana Fenestrated System for juxtarenal and pararenal aortic aneurysm endovascular repair. J Vasc Surg 2013; 58:1-9. [DOI: 10.1016/j.jvs.2012.12.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/26/2022]
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Brown CR, Greenberg RK, Wong S, Eagleton M, Mastracci T, Hernandez AV, Rigelsky CM, Moran R. Family history of aortic disease predicts disease patterns and progression and is a significant influence on management strategies for patients and their relatives. J Vasc Surg 2013; 58:573-81. [PMID: 23809203 DOI: 10.1016/j.jvs.2013.02.239] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 10/18/2012] [Revised: 02/11/2013] [Accepted: 02/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND While a positive family history (FH) is a known risk factor for developing an aneurysm, its association with the extent of disease has not been established. We evaluated the influence of a FH of aortic disease with respect to the pattern and distribution of aortic aneurysms in a given patient. METHODS AND RESULTS From November 1999 to November 2011, 1263 patients were enrolled in physician-sponsored endovascular device trials to treat aortic aneurysms. Of the 555 patients who were alive and returning for follow-up, we obtained 426 (77%) family histories. Three-dimensional imaging studies were used to identify the presence of aneurysms; 36% (155/426) of patients had a FH of aortic aneurysms and 5% (21/155) had isolated intracranial aneurysms. A logistic regression model was used to compare aortic morphology between patients with a positive or negative FH for aneurysms. Patients with a positive FH of aortic aneurysms were younger at their initial aneurysm (63 vs 70 years; P < .0001), more frequently had proximal aortic involvement (root: odds ratio [OR], 5.4; P < .0001; ascending: OR, 2.9; P < .001; thoracic: OR, 2.2; P = .01) with over 50% of FH patients ultimately developing suprarenal aortic involvement (P = .0001) and had a greater incidence of bilateral iliac artery aneurysm (OR, 1.8; P = .03). CONCLUSIONS FH is an important tool that provides insight into the expected behavior of the untreated aorta and has significant implications for the development of treatment strategies. These findings should be used to guide patient's management with regard to treatment, follow-up paradigms, genetic testing, and screening of other family members.
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Affiliation(s)
- Chase R Brown
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 2010; 140:S171-8. [DOI: 10.1016/j.jtcvs.2010.07.061] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/20/2010] [Indexed: 11/29/2022]
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Coscas R, Greenberg RK, Mastracci TM, Eagleton M, Kang WC, Morales C, Hernandez AV. Associated factors, timing, and technical aspects of late failure following open surgical aneurysm repairs. J Vasc Surg 2010; 52:272-81. [PMID: 20670772 DOI: 10.1016/j.jvs.2010.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Raphael Coscas
- Department of Vascular and Endovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Abstract
The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends the use of a permanent vascular access for pediatric hemodialysis (HD) patients; however, central venous catheters are the most common vascular access used among children. In children receiving HD, central venous catheters, while suboptimal, are the most common vascular access used. As such, it is imperative that pediatric HD providers optimize vascular access techniques. We report outcomes of arteriovenous fistula (AVF) creation by a single surgeon in pediatric HD patients dialyzed at a single center. We further describe our experience and outcomes with the use of the operating microscope in the United States in children receiving HD under 15 kg in weight and as young as 4 years of age. AVF usage rates as well as short- and long-term patency rates can be quite high with proper management. We further illustrate that the Fistula First principles can be applied to the pediatric population in the setting of a single surgeon with single center experience. As such, we have surpassed the current NKF-DOQI recommendation of 50% fistula use in prevalent HD patients.
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Affiliation(s)
- Deepa H Chand
- Pediatric Nephrology and Hypertension, Akron Children's Hospital, Akron, Ohio 44308, USA.
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Moise MA, Alvarez-Tostado JA, Clair DG, Greenberg RK, Lyden SP, Srivastava SD, Eagleton M, Sarac TS, Kashyap VS. Endovascular management of chronic infrarenal aortic occlusion. J Endovasc Ther 2009; 16:84-92. [PMID: 19281286 DOI: 10.1583/08-2526.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To review our experience with the endovascular treatment of chronic infrarenal aortic occlusion with regard to technical success and midterm patency, as well as perioperative mortality and morbidity. METHODS A retrospective review was performed of patients who presented from January 1, 2000, to December 31, 2005, with a diagnosis of chronic infrarenal aortic occlusion (TASC D) treated with endovascular techniques. In this time period, 31 patients (22 women; mean age 63 years) underwent attempted recanalization of the occluded aorta and iliac arteries. Claudication was the most common presenting symptom (14, 45%). Patients were treated solely with angioplasty and stenting or thrombolysis followed by angioplasty/stenting based on surgeon preference. RESULTS Technical success was 93%. The 2 failures were individual cases of wire-induced iliac artery perforation and failed access; both patients were treated with bypass grafting. Nine (29%) patients had thrombolysis prior to angioplasty. There were no perioperative deaths. Postoperative ankle-brachial indexes increased significantly from preoperative values (p<0.0001). There were 3 technical complications: 1 (3%) iatrogenic iliac artery injury and 2 (6%) perioperative limb thromboses requiring intervention. Other complications included 6 (19%) access site events and 5 (16%) episodes of acute renal dysfunction, 2 requiring permanent dialysis. Over a mean follow-up of 12 months, there was no limb loss. At 1 and 3 years, the primary/secondary patency rates were 85%/100% and 66%/90%, respectively. CONCLUSION Endovascular therapy for chronic infrarenal aortic occlusion has a high technical success rate, with good midterm primary and secondary patency rates. However, renal dysfunction can occur; the etiology is likely multifactorial from contrast volumes, embolization, and/or renal arterial disease.
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Affiliation(s)
- Mireille A Moise
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Sarac TP, Altinel O, Kashyap V, Bena J, Lyden S, Sruvastava S, Eagleton M, Clair D. Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia. J Vasc Surg 2008; 47:485-491. [DOI: 10.1016/j.jvs.2007.11.046] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 10/28/2007] [Accepted: 11/17/2007] [Indexed: 11/28/2022]
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Woodrum DT, Ford J, Sinha I, Pearce C, Hannawa K, Grigoryants V, Ailawadi G, Henke P, Eagleton M, Stanley J, Upchurch GR. Gender differences in rat aortic smooth muscle cell matrix metalloproteinase-9. J Am Coll Surg 2004. [DOI: 10.1016/j.jamcollsurg.2004.05.230] [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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Haulon S, Greenberg RK, Khwaja J, Turc A, Srivastava SD, Eagleton M, Lyden SP, Ouriel K. Aortic dissection in the setting of an infrarenal endoprosthesis: a fatal combination. J Vasc Surg 2003; 38:1121-4. [PMID: 14603225 DOI: 10.1016/s0741-5214(03)00931-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/25/2022]
Abstract
Approximately 6 months after the successful implantation of an abdominal aortic endovascular graft, a patient suffered an acute aortic dissection. The false lumen of the dissection terminated in the excluded aneurysm sac, resulting in a lack of outflow. Extreme true lumen compression eliminated blood flow within the distal aorta, resulting in the patient's demise.
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Affiliation(s)
- Stephan Haulon
- Department of Vascular Surgery, Cleveland Clinic Foundation, Ohio, 44195, USA
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Abstract
This study was designed to test the hypothesis that unexpected alcohol withdrawal-like syndrome (AWLS) is more common following aortic, but not other, vascular or nonvascular procedures. All patients undergoing open aortic surgery at our institution in 1997 who survived at least 48 hr were identified, as were those undergoing carotid endarterectomy, infrainguinal bypass, and total colectomy. AWLS was defined as prolonged confusion or agitation and response to conventional treatment for withdrawal, providing that all other sources had been ruled out or a significant history was present. Our results show that, for unknown reasons, AWLS is more common after aortic surgery than after other vascular and high-stress, nonaortic intraabdominal procedures at our institution, and is associated with increased length of stay and morbidity. Because prophylaxis may improve outcome, better efforts to identify patients at risk are required.
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Affiliation(s)
- K A Illig
- Division of Vascular Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 652, Rochester, NY 14642, USA.
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Ashley RL, Wald A, Eagleton M. Premarket evaluation of the POCkit HSV-2 type-specific serologic test in culture-documented cases of genital herpes simplex virus type 2 [see comment]. Sex Transm Dis 2000; 27:266-9. [PMID: 10821598 DOI: 10.1097/00007435-200005000-00005] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The genital herpes epidemic continues, in part, because patients with subclinical or atypical presentations cannot be identified by most herpes simplex virus (HSV) antibody tests. A new product, POCkit HSV-2, has been developed to rapidly and accurately detect antibodies to HSV type 2 (HSV-2) in capillary blood or serum. GOAL Sera from patients with culture-documented genital or oral herpes were tested to determine the sensitivity and specificity of the POCkit HSV-2 rapid point-of-care antibody test (Diagnology, Belfast, Northern Ireland). STUDY DESIGN Sera from 50 patients with culture-documented HSV type 1 (9 oral, 41 genital) and from 253 patients with genital HSV-2 were tested by POCkit HSV-2 for HSV-2 antibodies. Each subject had a positive culture for HSV within 6 months of serum collection. Sera were preselected to include only those that were seropositive to the respective virus subtype by University of Washington Western blot. RESULTS Compared with viral culture and Western blot analysis, sensitivity of the POCkit HSV-2 test for HSV-2 antibody was 96%; specificity was 98%. CONCLUSION This test provides rapid, accurate identification of HSV-2 antibody in subjects with established HSV infections.
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Affiliation(s)
- R L Ashley
- Department of Laboratory Medicine, University of Washington, Seattle, USA
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Williams JP, Eagleton M, Hernady E, Schell M, Illig K, Green R, Rubin P. Effectiveness of fractionated external beam radiation in the inhibition of vascular restenosis. Cardiovasc Radiat Med 1999; 1:257-64. [PMID: 11272370 DOI: 10.1016/s1522-1865(99)00016-5] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND From the clinical oncologic experience, fractionation of the radiation dose offers a better therapeutic window, both with respect to effectiveness and unwanted side effects. Thus, we undertook a pilot study in a rodent model, using a single dose of 15 Gy compared with fractionation schedules of 5 or 10 daily applications of 3 Gy. MATERIALS AND METHODS Using a previously described rat angioplasty model, animals were randomly assigned to one of four groups: unilateral balloon injury, sham irradiation; unilateral balloon injury, bilateral 15 Gy single dose irradiation; unilateral balloon injury, bilateral 3 Gy x 5 daily fractions; or unilateral balloon injury, bilateral 3 Gy x 10 daily fractions. RESULTS AND CONCLUSIONS All three radiation groups demonstrated a clear inhibition of neointimal hyperplasia. We therefore offer evidence for the effectiveness of fractionated radiation as a means to inhibit vascular restenosis in a rat carotid model. However, the 3 Gy x 5 schedule was less effective than either the 3 Gy x 10 schedule or the 15 Gy single dose. This study must be repeated using longer time points to provide proof of principle.
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Affiliation(s)
- J P Williams
- Department of Radiation Oncology, University of Rochester Medical Center, New York, USA.
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Ashley RL, Eagleton M, Pfeiffer N. Ability of a rapid serology test to detect seroconversion to herpes simplex virus type 2 glycoprotein G soon after infection. J Clin Microbiol 1999; 37:1632-3. [PMID: 10203544 PMCID: PMC84860 DOI: 10.1128/jcm.37.5.1632-1633.1999] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [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
Sera (n = 188) from 29 patients with first-episode genital herpes simplex virus type 2 (HSV-2) infections were tested by POCkit-HSV-2 and Western blot (WB) to determine the speed of seroconversion. The median time to detection of HSV-2 antibody was 13 days (range, 3 to 102 days) by the POCkit-HSV-2 test versus 13 days (range, 2 to 58 days) for WB.
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Affiliation(s)
- R L Ashley
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
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Ashley RL, Eagleton M. Evaluation of a novel point of care test for antibodies to herpes simplex virus type 2. Sex Transm Infect 1998; 74:228-9. [PMID: 9849565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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Rubin P, Willaims J, Eagleton M, Green R, Okunieff P. Use and effectiveness of fractionated external irradiation to inhibit neointimal hyperplasia in the angioplastied rat carotid. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80225-3] [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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Norman JE, Eagleton M. Occupational hazard of infection in the operating theatre. Br Med J (Clin Res Ed) 1981; 282:1875. [PMID: 6786665 PMCID: PMC1506428 DOI: 10.1136/bmj.282.6279.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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