Browsing by Author "Siracuse, Jeffrey J."

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    Managing Central Venous Access during a Healthcare Crisis
    (Elsevier, 2020-07-15) Chun, Tristen T.; Judelson, Dejah R.; Rigberg, David; Lawrence, Peter F.; Cuff, Robert; Shalhub, Sherene; Wohlauer, Max; Abularrage, Christopher J.; Anastasios, Papapetrou; Arya, Shipra; Aulivola, Bernadette; Baldwin, Melissa; Baril, Donald; Bechara, Carlos F.; Beckerman, William E.; Behrendt, Christian-Alexander; Benedetto, Filippo; Bennett, Lisa F.; Charlton-Ouw, Kristofer M.; Chawla, Amit; Chia, Matthew C.; Cho, Sungsin; Choong, Andrew M.T.L.; Chou, Elizabeth L.; Christiana, Anastasiadou; Coscas, Raphael; De Caridi, Giovanni; Ellozy, Sharif; Etkin, Yana; Faries, Peter; Fung, Adrian T.; Gonzalez, Andrew; Griffin, Claire L.; Guidry, London; Gunawansa, Nalaka; Gwertzman, Gary; Han, Daniel K.; Hicks, Caitlin W.; Hinojosa, Carlos A.; Hsiang, York; Ilonzo, Nicole; Jayakumar, Lalithapriya; Joh, Jin Hyun; Johnson, Adam P.; Kabbani, Loay S.; Keller, Melissa R.; Khashram, Manar; Koleilat, Issam; Krueger, Bernard; Kumar, Akshay; Lee, Cheong Jun; Lee, Alice; Levy, Mark M.; Lewis, C. Taylor; Lind, Benjamin; Lopez-Pena, Gabriel; Mohebali, Jahan; Molnar, Robert G.; Morrissey, Nicholas J.; Motaganahalli, Raghu L.; Mouawad, Nicolas J.; Newton, Daniel H.; Ng, Jun Jie; O’Banion, Leigh Ann; Phair, John; Rancic, Zoran; Rao, Ajit; Ray, Hunter M.; Rivera, Aksim G.; Rodriguez, Limael; Sales, Clifford M.; Salzman, Garrett; Sarfati, Mark; Savlania, Ajay; Schanzer, Andres; Sharafuddin, Mel J.; Sheahan, Malachi; Siada, Sammy; Siracuse, Jeffrey J.; Smith, Brigitte K.; Smith, Matthew; Soh, Ina; Sorber, Rebecca; Sundaram, Varuna; Sundick, Scott; Tomita, Tadaki M.; Trinidad, Bradley; Tsai, Shirling; Vouyouka, Ageliki G.; Westin, Gregory G.; Williams, Michael S.; Wren, Sherry M.; Yang, Jane K.; Yi, Jeniann; Zhou, Wei; Zia, Saqib; Woo, Karen; Surgery, School of Medicine
    Introduction During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns and outcomes of these vascular access teams during the COVID-19 pandemic. Methods We conducted a cross sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. In order to participate in the study, hospitals were required to meet one of the following criteria: a) development of a formal plan for a central venous access line team during the pandemic, b) implementation of a central venous access line team during the pandemic, c) placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice, or d) management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2,657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis® catheters and non-tunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of hospitals. Less than 50% (24, 41%) of the participating sites reported managing thrombosed central lines in COVID-patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions Implementation of a dedicated central venous access line team during a pandemic or other healthcare crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed healthcare system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained ICU, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future healthcare crises.
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    A multi-institutional experience in adventitial cystic disease
    (Elsevier, 2017-01) Motaganahalli, Raghu L.; Smeds, Matthew R.; Harlander-Locke, Michael P.; Lawrence, Peter F.; Fujimura, Naoki; DeMartino, Randall R.; De Caridi, Giovanni; Munoz, Alberto; Shalhub, Sherene; Shin, Susanna H.; Amankwah, Kwame S.; Gelabert, Hugh A.; Rigberg, David A.; Siracuse, Jeffrey J.; Farber, Alik; Debus, E. Sebastian; Behrendt, Christian; Joh, Jin H.; Saqib, Naveed U.; Charlton-Ouw, Kristofer M.; Wittgen, Catherine M.; Department of Surgery, IU School of Medicine
    Background Adventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database. Methods Using a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia. Univariate and multivariate analyses were performed comparing treatment methods and factors associated with recurrent intervention. Life-table analysis was performed to estimate the freedom from reintervention in comparing the various treatment modalities. Results Forty-seven patients (32 men, 15 women; mean age, 43 years) were identified with ACD involving the popliteal artery (n = 41), radial artery (n = 3), superficial/common femoral artery (n = 2), and common femoral vein (n = 1). Lower extremity claudication was seen in 93% of ACD of the leg arteries, whereas patients with upper extremity ACD had hand or arm pain. Preoperative diagnosis was made in 88% of patients, primarily using cross-sectional imaging of the lower extremity; mean lower extremity ankle-brachial index was 0.71 in the affected limb. Forty-one patients with lower extremity ACD underwent operative repair (resection with interposition graft, 21 patients; cyst resection, 13 patients; cyst resection with bypass graft, 5 patients; cyst resection with patch, 2 patients). Two patients with upper extremity ACD underwent cyst drainage without resection or arterial reconstruction. Complications, including graft infection, thrombosis, hematoma, and wound dehiscence, occurred in 12% of patients. Mean lower extremity ankle-brachial index at 3 months postoperatively improved to 1.07 (P < .001), with an overall mean follow-up of 20 months (range, 0.33-9 years). Eight patients (18%) with lower extremity arterial ACD required reintervention (redo cyst resection, one; thrombectomy, three; redo bypass, one; balloon angioplasty, three) after a mean of 70 days with symptom relief in 88%. Lower extremity patients who underwent cyst resection and interposition or bypass graft were less likely to require reintervention (P = .04). One patient with lower extremity ACD required an above-knee amputation for extensive tissue loss. Conclusions This multi-institutional, contemporary experience of ACD examines the treatment and outcomes of ACD. The majority of patients can be identified preoperatively; surgical repair, consisting of cyst excision with arterial reconstruction or bypass alone, provides the best long-term symptomatic relief and reduced need for intervention to maintain patency.
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    Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia
    (Massachusetts Medical Society, 2022-11-07) Farber, Alik; Menard, Matthew T.; Conte, Michael S.; Kaufman, John A.; Powell, Richard J.; Choudhry, Niteesh K.; Hamza, Taye H.; Assmann, Susan F.; Creager, Mark A.; Cziraky, Mark J.; Dake, Michael D.; Jaff, Michael R.; Reid, Diane; Siami, Flora S.; Sopko, George; White, Christopher J.; van Over, Max; Strong, Michael B.; Villarreal , Maria F.; McKean, Michelle; Azene, Ezana; Azarbal, Amir; Barleben, Andrew; Chew, David K.; Clavijo, Leonardo C.; Douville, Yvan; Findeiss, Laura; Garg, Nitin; Gasper, Warren; Giles, Kristina A.; Goodney, Philip P.; Hawkins, Beau M.; Herman, Christine R.; Kalish, Jeffrey A.; Koopmann, Matthew C.; Laskowski, Igor A.; Mena-Hurtado, Carlos; Motaganahalli, Raghu; Rowe, Vincent L.; Schanzer, Andres; Schneider, Peter A.; Siracuse, Jeffrey J.; Venermo, Maarit; Rosenfield, Kenneth; BEST-CLI Investigators; Surgery, School of Medicine
    BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes. METHODS In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event — which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) — or death from any cause. RESULTS In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P<0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P=0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts. CONCLUSIONS Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.)