Browsing by Subject "vascular surgery"

Now showing 1 - 4 of 4
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    Failure Mode Analysis of the Endologix Endograft
    (Elsevier, 2016-09) Lemmon, Gary W.; Motaganahalli, Rahgu L.; Chang, Tiffany; Slaven, James; Aumiller, Ben; Kim, Bradford J.; Dalsing, Michael C.; Department of Surgery, IU School of Medicine
    Objective Type III (T-III) endoleaks following endovascular aneurysm repair (EVAR) remain a major concern. Our center experienced a recent concentration of T-III endoleaks requiring elective and emergency treatment and prompted our review of all EVAR implants over a 40-month period from April 2011 until August 2014. This report represents a single center experience with T-III endoleak management with analysis of factors leading to the T-III-related failure of EVAR. Methods A retrospective review of all the operative reports, medical records, and computed tomography scans were reviewed from practice surveillance. Using Society for Vascular Surgery aneurysm reporting standards, we analyzed the morphology of the aneurysms before and after EVAR implant using computed tomography. Index procedure and frequency of reinterventions required to maintain aneurysm freedom from rupture were compared across all devices using SAS v 9.4 (SAS Institute, Inc, Cary, NC). Major adverse events (MAEs) requiring secondary interventions for aneurysm treatment beyond primary implant were analyzed for methods of failure. Aneurysm morphology of patients requiring EVAR was compared across all endograft devices used for repair. For purposes of MAE analysis, patients receiving Endologix (ELX) endograft were combined into group 1; Gore, Cook, and Medtronic endograft patients were placed into group 2. Results Overall, technical success and discharge survival were achieved in 97.3% and 98% of patients regardless of device usage. There was no significant device related difference identified between patient survival or freedom from intervention. MAEs involving aneurysm treatment were over seven-fold more frequent with ELX (group 1) vs non-ELX (group 2) endografts (P < .01). Group 1 patients with aneurysm diameters larger than 65 mm were associated with a highly significant value for development of a T-III endoleak (odds ratio, 11.16; 95% confidence interval, 2.17, 57.27; P = .0038). Conclusions While EVAR technical success and survival were similar across all devices, ELX devices exhibited an unusually high incidence of T-III endoleaks when implanted in abdominal aortic aneurysms with a diameter of more than 65 mm. Frequent reinterventions were required for Endologix devices for prevention of aneurysm rupture due to T-III endoleaks.
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    Impact of Integrated Vascular Residencies on Academic Productivity within Vascular Surgery Divisions
    (Elsevier, 2017-02) Kim, Bradford J.; Valsangkar, Nakul P.; Liang, Tiffany W.; Murphy, Michael P.; Zimmers, Teresa A.; Bell, Teresa M.; Davies, Mark G.; Koniaris, Leonidas G.; Department of Surgery, School of Medicine
    Background Changing training paradigms in vascular surgery have been introduced to reduce overall training time. Herein, we sought to examine how shortened training for vascular surgeons may have influenced overall divisional academic productivity. Methods Faculty from the top 55 surgery departments were identified according to National Institutes of Health (NIH) funding. Academic metrics of 315 vascular surgery, 1,132 general surgery, and 2,403 other surgical specialties faculty were examined using institutional Web sites, Scopus, and NIH Research Portfolio Online Reporting Tools from September 1, 2014, to January 31, 2015. Individual-level and aggregate numbers of publications, citations, and NIH funding were determined. Results The mean size of the vascular divisions was 5 faculty. There was no correlation between department size and academic productivity of individual faculty members (R2 = 0.68, P = 0.2). Overall percentage of vascular surgery faculty with current or former NIH funding was 20%, of which 10.8% had major NIH grants (R01/U01/P01). Vascular surgery faculty associated with integrated vascular training programs demonstrated significantly greater academic productivity. Publications and citations were higher for vascular surgery faculty from institutions with both integrated and traditional training programs (48 of 1,051) compared to those from programs with integrated training alone (37 of 485) or traditional fellowships alone (26 of 439; P < 0.05). Conclusions In this retrospective examination, academic productivity was improved within vascular surgery divisions with integrated training programs or both program types. These data suggest that the earlier specialization of integrated residencies in addition to increasing dedicated vascular training time may actually help promote research within the field of vascular surgery.
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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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    Superficial Temporal Artery Pseudoaneurysm Presenting as A Suspected Sebaceous Cyst
    (Elsevier, 2016-12) Rood, Loren K.; Department of Emergency Medicine, School of Medicine
    A 20-year-old man presented to the emergency department (ED) requesting to have a “cyst” on his scalp drained. The patient stated that he had first noticed the cyst about 1.5 years ago, which seemed to develop after he was hit on the head during an altercation. He reported that it was drained in this ED 6 to 8 months earlier but that it did not resolve. On examination, the left temporal scalp had a 2-cm indurated cystic subcutaneous lesion that was minimally tender, without any drainage or overlying erythema. The patient was advised that it appeared to be sebaceous cyst, which would likely recur until formally excised. Because of his mild discomfort, he opted for incision and drainage pending his clinic referral. After alcohol preparation and local anesthesia, the incision yielded only brisk bleeding that was easily controlled with fingertip pressure but required suture placement for complete hemostasis. The lesion was felt to be faintly pulsatile while holding pressure. Point of care (POC) ultrasound evaluation performed with a high frequency linear array probe revealed the cyst (Figure 1) to be a superficial temporal artery (STA) pseudoaneurysm. Standard B mode imaging clearly showed turbulent blood flow (Video 1). Color Doppler ultrasound imaging (Video 2) showed the typical swirling of blood within the aneurysm (the “yin-yang” sign). Vascular surgery was consulted and arrangements were made for outpatient excision of the lesion. At surgery approximately 1 month later, the lesion was confirmed to be a pseudoaneurysm.