1,458 results on '"Malas, Mahmoud"'
Search Results
2. Racial Disparity in Perioperative Aspirin Utilization Impacts Survival of Black Patients Undergoing Lower Extremity Bypass Surgery
- Author
-
Hamouda, Mohammed, Mehtsun, Winta, Jackson, Benjamin, Malas, Mahmoud, and Gaffey, Ann
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
3. Difficult Decisions: What To Use When the Ideal Bypass Conduit is not Available in Critical Limb Ischemia Patients?
- Author
-
Hamouda, Mohammed, Zarrintan, Sina, Vootukuru, Nishita R, Quatromoni, Jon G, Malas, Mahmoud, and Gaffey, Ann
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
4. Outcomes of Carotid Artery Revascularization Procedures in Patients with High-grade Bilateral Stenosis
- Author
-
Elsayed, Nadin, Nakhaei, Pooria, Alsaigh, Tom, Motaganahalli, Raghu L, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
5. The Impact of Postoperative Stroke and Myocardial Infarction on 1-Year Mortality Following Carotid Revascularization Using the VQI Database
- Author
-
Abdelkarim, Ahmed, Hamouda, Mohammed, Abdalla, Mohamed, Zarrintan, Sina, Malas, Mahmoud, and Columbo, Jesse A
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Good Health and Well Being ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
6. The Impact of Concomitant Proximal Carotid Interventions on Revascularization and Outcomes
- Author
-
Lin, Chung-Fu, Thandra, Sneha, Ho, Casey, Elsayed, Nadin, Zarrintan, Sina, Malas, Mahmoud, and Gaffey, Ann
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
7. Association Between Ambulatory Status and Outcomes of Carotid Endarterectomy
- Author
-
Vootukuru, Nishita R, Zarrintan, Sina, Elsayed, Nadin, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
8. Optimal Revascularization Method After Carotid Artery Stenting Restenosis
- Author
-
Nakhaei, Pooria, Hamouda, Mohammed, Moghaddam, Marjan, Elsayed, Nadin, Abdelkarim, Ahmed, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
9. The Impact of Obesity on Outcomes of Infrainguinal Bypass vs Endovascular Therapy in Patients With Peripheral Artery Disease
- Author
-
Kricfalusi, Mikayla, Hamouda, Mohammed, Abdelkarim, Ahmed, Farber, Alik, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
10. The Impact Of Timing Of Thoracic Endovascular Aortic Repair On The Postoperative Outcomes Of Patients With Uncomplicated Type B Aortic Dissection
- Author
-
Veranyan, Narek, Hamouda, Mohammed, Elsayed, Nadin, Alnouri, Omar, Goodney, Philip, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
11. The Effect of Smoking Cessation on Outcomes of Thoracic Endovascular Aortic Repair
- Author
-
Farah, Marc, Straus, Sabrina, Gaffey, Ann, Wang, Grace J, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
12. Seven Years of the Transcarotid Artery Revascularization Surveillance Project, Comparison to Transfemoral Stenting and Endarterectomy
- Author
-
Straus, Sabrina, Yadavalli, Sai Divya, Allievi, Sara, Sanders, Andrew P, Malas, Mahmoud, Wang, Grace J, Kashyap, Vikram, Cronenwett, Jack, Motaganahalli, Raghu L, Nolan, Brian, Eldrup-Jorgensen, Jens, and Schermerhorn, Marc L
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Good Health and Well Being ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
13. Hyperabduction During Balloon Inflation in the Subclavian Vein as a Test for Thoracic Outlet Syndrome
- Author
-
Shibbani, Kamel, Malas, Mahmoud, and Justino, Henri
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Cardiovascular - Published
- 2024
14. Long-Term Outcomes in the Smoking Claudicant after Peripheral Vascular Interventions
- Author
-
Patel, Rohini J, Zarrintan, Sina, Vootukuru, Nishita R, Allah, Shatha H, Gaffey, Ann, and Malas, Mahmoud B
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Tobacco ,Tobacco Smoke and Health ,Prevention ,Clinical Research ,6.4 Surgery ,Evaluation of treatments and therapeutic interventions ,Cancer ,Respiratory ,Cardiovascular ,Good Health and Well Being ,Amputation ,Claudicant ,Peripheral Vascular Intervention ,Smoking ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesEmphasis on tobacco cessation given the urgent and emergent nature of vascular surgery is less prevalent than standard elective cases such as hernia repairs, cosmetic surgery, and bariatric procedures. The goal of this study is to determine the effect of active smoking on claudicating individuals undergoing peripheral vascular interventions (PVI). Our goal is to determine if a greater emphasis on education should be placed on smoking cessation in non-urgent cases scheduled through clinic visits and not the Emergency Department.MethodsThis study was performed using the multi-institution de-identified Vascular Quality Initiative-Medicare-Linked database (VISION). Claudicants who underwent PVI for peripheral arterial occlusive disease between 2004-2019 were included in our study. Our final sample consisted of a total of 18,726 patients: 3,617 (19.3%) nonsmokers (NS), 9,975 (53.3%) former smokers (FS) and 5,134 (27.4%) current smokers (CS). We performed propensity score matching (PSM) on 29 variables [age, gender, race, ethnicity, treatment setting (outpatient or inpatient), obesity, insurance, hypertension, diabetes, CAD, CHF, COPD, CKD, previous CABG, CEA, major amputation, inflow treatment, prior bypass or PVI, preop medications, level of treatment, concomitant endarterectomy, and treatment type (atherectomy, angioplasty, stent)] between NS versus FS and FS versus CS. Outcomes were long-term (five-year) overall survival (OS), limb salvage (LS), freedom from reintervention (FR) and amputation free survival (AFS).ResultsPSM resulted with 3,160 well matched pairs of NS and FS and 3,750 well matched pairs of FS and CS. There was no difference between FS and NS in terms of OS [HR = 0.94, 95% CI 0.82-1.09, p=0.43], FR [HR = 0.96, 95% CI 0.89-1.04, p=0.35], or AFS [HR = 0.90, 95% CI 0.79-1.03, p=0.12]. However, when compared to CS, we found FS to have a higher OS [HR = 1.18, 95% CI 1.04-1.33, p =0.01], less FR [HR = 0.89, 95% CI 0.83-0.96, p=0.003] and greater AFS [HR = 1.16, 95% CI 1.03-1.31, p=0.01].ConclusionThis multi-institutional Medicare-linked study looking at elective PVI cases in PAD patients presenting with claudication found that former smokers have similar 5-year outcomes in comparison to non-smokers in terms of OS, FTR and AFS. Additionally, current smokers have lower overall survival and amputation free survival when compared to former-smokers. Overall, this suggests that smoking claudicants should be highly encouraged and referred to structured smoking cessation programs or even required to stop smoking prior to elective PVI due to the perceived 5-year benefit.
- Published
- 2024
15. Multi-Institution Analysis Demonstrates that Augmented Intelligent Maps Improve Intra-Operative Safety During Physician Modified Endograft Repairs
- Author
-
Malas, Mahmoud, Arnaoutakis, Dean, Patel, Rohini, Barleben, Andrew, Bailey, Charles, Pavlock, Samantha, and Shames, Murray
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2024
16. Single or Dual Antiplatelet Therapy Improves One-Year Arteriovenous Graft Patency and Overall Survival
- Author
-
Ebertz, David P, Bose, Saideep, De Valle, Armando, Locham, Satinderjit, Malas, Mahmoud B Malas, and Smeds, Matthew R
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Published
- 2024
17. Association Between Conduit Type and Outcomes After Open Repair of Popliteal Artery Aneurysms
- Author
-
Naazie, Isaac N, Willie-Permor, Daniel, Haykal, Tony, Harris, Linda M, Hughes, Kakra, and Malas, Mahmoud B
- Subjects
Clinical Research ,Rehabilitation ,Cardiovascular ,Amputation free survival ,Bypass conduit ,Popliteal artery aneurysm ,Clinical Sciences ,Surgery - Abstract
IntroductionPrior studies have demonstrated acceptable midterm outcomes with prosthetic conduits for above-knee bypass for occlusive disease in patients with inadequate segment great saphenous vein (GSV). In this study we aimed to investigate whether this holds true for open repair of popliteal artery aneurysms (PAA).MethodsWe queried the Vascular Quality Initiative data for patients who underwent open PAA repair (OPAR). We divided the cohort into three groups based on the conduit used: GSV, other autologous veins, or prosthetic graft. Study outcomes included primary patency, freedom from major amputation, amputation-free survival, and overall survival at 1 y. Kaplan-Meier survival estimates, log-rank tests and multivariable Cox regression were used to compare outcomes between study groups.ResultsA total of 4016 patients underwent bypass for PAA from January 2010 to October 2021. The three cohorts were significantly different in many demographic and clinical characteristics. The adjusted odds of postoperative amputation among symptomatic patients were 3-fold higher for prosthetic conduits compared to the GSV (odds ratio, 3.20; 95% CI, 1.72-5.92; P
- Published
- 2023
18. A Single Institution Case Series of Total Endovascular Relining for Type 3 Endoleaks in Traditional EVAR Grafts with Raised Bifurcations
- Author
-
Patel, Rohini J, Sibona, Agustin, Malas, Mahmoud B, Al-Nouri, Omar, Lane, John S, and Barleben, Andrew R
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Bioengineering ,Cardiovascular ,Assistive Technology ,Good Health and Well Being ,EVAR ,Endoleak ,Endovascular ,Technique ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
BackgroundThe endovascular repair of infrarenal abdominal aortic aneurysms (AAA) can be performed with a wide variety of devices. Many of these grafts elevate the aortic bifurcation which can limit future repairs if the graft material fails thereby creating a type III endoleak to aorto-uniliac (AUI) grafts. Many manufacturers have grafts susceptible to this, but we have seen this in the Medtronic AneuRx graft. Our goal is to provide technical details and outcomes regarding a novel technique to re-line these grafts while maintaining inline flow to the iliac arteries.MethodsThis was a single institution review of patients who had endoleaks requiring intervention after a previously placed graft with an elevated aortic bifurcation. Primary outcomes included technical success defined as placement of all planned devices, resolution of type III endoleak, aneurysm size at follow-up, and requirement of reintervention. Secondary outcomes included 30-day complications, aneurysm-related mortality (ARM), and all-cause mortality (ACM). Technical details of the operation include back table deployment of an Ovation device, modification of the deployment system tether and preemptive placement of an up and over 0.014" wire. The wire is placed up and over and hung outside the contralateral gate. Once the main body is introduced above the old graft, the 0.014" is snared from the contralateral side and externalized. The main body is then able to be seated at the bifurcation as the limb is not fully deployed and then device deployment is completed per IFU.ResultsOur study consists of four individuals, three of which had an AAA initially managed with an AneuRx EVAR and one with a combination of Gore and Cook grafts. All four patients were male with an average age of 84.5 years at time of re-line. All patients had at least 10 years between initial surgery and re-line at our institution. Primary outcomes revealed no type 1 or 3 endoleaks at follow-up, technical success was 100% and one patient required reintervention for aneurysm growth and type 2 endoleak. In terms of our secondary outcomes, there was one postoperative complication which was cardiac dysfunction secondary to demand ischemia, ARM was 0% and ACM was 25% at average follow up of 2.44 years.ConclusionAs individuals continue to age, there are more patients who would benefit from less invasive reinterventions following EVAR. Whether this is due to aortic degeneration, stent migration, or stent material damage is not always known. In this study we present an endovascular approach to treating type III endoleak patients with a previous graft and elevated aortic bifurcation using Ovation stent grafts and found no evidence of type 1 or 3 endoleaks on follow-up imaging. This approach may allow patients with type III endoleak the option of a minimally invasive, percutaneous approach where they previously would not have had one.
- Published
- 2023
19. Long-term outcomes after lower extremity bypass in the actively smoking claudicant.
- Author
-
Zarrintan, Sina, Jagadeesh, Vasan, Vootukuru, Nishita, Gaffey, Ann, Malas, Mahmoud, and Patel, Rohini
- Subjects
Amputation ,Claudication ,Lower extremity bypass ,Smoking ,Humans ,Risk Factors ,Smoking ,Intermittent Claudication ,Limb Salvage ,Lower Extremity ,Treatment Outcome ,Peripheral Arterial Disease ,Retrospective Studies ,Ischemia - Abstract
OBJECTIVE: Smoking is known to increase complications, including poor wound healing, coagulation abnormalities, and cardiac and pulmonary ramifications. Across specialties, elective surgical procedures are commonly denied to active smokers. Given the base population of active smokers with vascular disease, smoking cessation is encouraged but is not required the way it is for elective general surgery procedures. We aim to study the outcomes of elective lower extremity bypass (LEB) in actively smoking claudicants. METHODS: We queried the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network LEB database from 2003 to 2019. In this database we found 609 (10.0%) never smokers (NS), 3388 (55.3%) former smokers (FS), and 2123 (34.7%) current smokers (CS) who underwent LEB for claudication. We performed two separate propensity score matches without replacement on 36 clinical variables (age, gender, race, ethnicity, obesity, insurance, hypertension, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, previous coronary artery bypass graft, carotid endarterectomy, major amputation, inflow treatment, preoperative medications and treatment type), one of FS to NS and a second analysis of CS to FS. Primary outcomes included 5-year overall survival (OS), limb salvage (LS), freedom from reintervention (FR), and amputation-free survival (AFS). RESULTS: Propensity score matches resulted in 497 well-matched pairs of NS and FS. In this analysis we found no difference in terms of OS (HR, 0.93; 95% CI, 0.70-1.24; P = .61), LS (HR, 1.07; 95% CI, 0.63-1.82; P = .80), FR (HR, 0.9; 95% CI,0.71-1.21; P = .59), or AFS (HR, 0.93; 95% CI,0.71-1.22; P = .62). In the second analysis, we had 1451 well-matched pairs of CS and FS. There was no difference in LS (HR, 1.36; 95% CI,0.94-1.97; P = .11) or FR (HR, 1.02; 95% CI,0.88-1.19; P = .76). However, we did find a significant increase in OS (HR, 1.37; 95% CI,1.15-1.64, P
- Published
- 2023
20. Long-term outcomes after lower extremity bypass in the actively smoking claudicant Presented at the 2023 Vascular Annual Meeting of the Society for Vascular Surgery, National Harbor, Maryland, June 14-17, 2023.
- Author
-
Patel, Rohini J, Zarrintan, Sina, Jagadeesh, Vasan, Vootukuru, Nishita R, Gaffey, Ann, and Malas, Mahmoud B
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2023
21. Two-Stage Offers No Advantages over Single-Stage Arteriovenous Creation: An Analysis of Multicenter National Data.
- Author
-
Zarrintan, Sina, Elsayed, Nadin, Al-Nouri, Omar, Malas, Mahmoud, Patel, Rohini, and Willie-Permor, Daniel
- Subjects
Humans ,Arteriovenous Shunt ,Surgical ,Upper Extremity ,Vascular Patency ,Risk Factors ,Treatment Outcome ,Renal Dialysis ,Postoperative Complications ,Retrospective Studies - Abstract
BACKGROUND: Traditionally, arteriovenous fistulas (AVF) involving the basilic vein (BV) have been created in 1 or 2 stages to allow time for the vein to enlarge before superficialization for potential better fistula maturation. Previous single institution studies and meta-analyses have found conflicting outcomes between single-stage and 2-stage procedures. Our study aims to use a large national database to assess the difference in outcomes between single-stage and 2-stage procedures for dialysis access. METHODS: We studied all patients undergoing BV AVF creation in the Vascular Quality Initiative (VQI) from 2011 to 2021. Patients were split into single-stage or a planned 2-stage procedure for dialysis access. Primary outcomes included dialysis use with index fistula, maturity rate, and number of days from surgery to fistula use. Secondary outcomes included patency (defined by physical exam or imaging on follow-up), 30-day mortality, and postoperative complications (bleeding, steal syndrome, thrombosis, or neuropathy). Logistic regression models were used to assess the association between staged dialysis access procedures and primary outcomes of interest. RESULTS: The cohort consisted of 22,910 individuals of which 7,077 (30.9%) had a 2-staged dialysis access procedure and 15,833 (69.1%) had a single-staged procedure. Average follow-up was 345 days in the single stage and 420 days for 2-stage. Baseline characteristics were significantly different between the 2 groups in terms of medical comorbidities. Primary outcomes were significant for more patients in the 2-stage group undergoing dialysis with the index fistula compared to single stage (31.5% vs. 22.2%, P
- Published
- 2023
22. Modality-Specific Outcomes of Patients Undergoing Carotid Revascularization in the Setting of Recent Myocardial Infarction
- Author
-
Straus, Sabrina, Moghaddam, Marjan, Zarrintan, Sina, Willie-Permor, Daniel, Jagadeesh, CPH Vasan, and Malas, Mahmoud
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Neurosciences ,Clinical Research ,Stroke ,Brain Disorders ,Good Health and Well Being ,Carotid Artery Stenting ,Carotid Endarterectomy ,Cerebrovascular Disease/Stroke ,MI ,Myocardial Infarction ,Quality and Outcomes ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
IntroductionRecent myocardial infarction (MI) represents a real challenge in patients requiring any vascular procedure. There is currently a lack of data on the effect of preoperative MI on the outcomes of carotid revascularization methodology (carotid enterectomy (CEA), transfemoral carotid artery stenting (TFCAS), or transcarotid artery revascularization (TCAR)). This study looks to identify modality-specific outcomes for patients with recent MI undergoing carotid revascularization.MethodsData was collected from VQI (2016-2022) for patients with carotid stenosis in the United States and Canada with recent MI (2 days), and 30-day mortality.ResultsThe final cohort included 1,217 (54.2%) CEA, 445 (19.8%) TFCAS, and 584 (26.0%) TCAR cases. Patients undergoing CEA were more likely to have prior CABG/PCI and to use anticoagulant. Patients undergoing TFCAS were more likely to be symptomatic, have prior CHF, COPD, CKD, and undergo urgent operations. Patients undergoing TCAR were more likely to have higher rates of ASA class IV-V, P2Y12 inhibitor, and protamine use. In the univariate analysis, CEA was associated with a lower rate of ipsilateral stroke (P=0.079), death (P=0.002), and 30-day mortality (P=0.007). After adjusting for confounders, TFCAS was associated with increased risk of stroke/death (aOR= 2.69 [95% CI: 1.36-5.35] P=0.005) and stroke/death/MI (aOR=1.67, [95% CI: 1.07-2.60], P=0.025) compared to CEA. However, TCAR had similar outcomes compared to CEA. Both TFCAS and TCAR were associated with increased risk of post-operative hypotension (aOR= 1.62 [95% CI: 1.18-2.23] P=0.003 and aOR= 1.74 [95% CI: 1.31-2.32] P=
- Published
- 2023
23. Changes in Treatment Patterns of Thoracoabdominal Aortic Aneurysms in the United States
- Author
-
Mohnot, Joy, Wang, Yunda, Yin, Kanhua, Malas, Mahmoud B, Edwards, Niloo M, Dobrilovic, Nikola, and Zhan, Yong
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Clinical Research ,Cardiovascular ,Good Health and Well Being - Published
- 2023
24. Regional variation in patient selection, practice patterns, and outcomes based on techniques for carotid artery revascularization in the Vascular Quality Initiative Presented at the Forty-sixth Annual Meeting of the Midwestern Vascular Surgical Society, Grand Rapids, Mich, September 15, 2022.
- Author
-
Dakour-Aridi, Hanaa, Vyas, Punit K, Schermerhorn, Marc, Malas, Mahmoud, Eldrup-Jorgensen, Jens, Cronenwett, Jack, Wang, Grace, Kashyap, Vikram S, and Motaganahalli, Raghu L
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2023
25. What Is the Role of Transcarotid Artery Revascularization?
- Author
-
Zarrintan, Sina and Malas, Mahmoud B
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Neurosciences ,Stroke ,Brain Disorders ,Clinical Research ,Patient Safety ,Cardiovascular ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Humans ,Carotid Stenosis ,Endovascular Procedures ,Risk Factors ,Risk Assessment ,Stents ,Treatment Outcome ,Time Factors ,Endarterectomy ,Carotid ,Arteries ,Retrospective Studies ,Carotid artery stenosis ,Carotid artery stenting ,Carotid endarterectomy ,Ischemic stroke ,Surgery - Abstract
Carotid endarterectomy (CEA) is the gold-standard method of carotid revascularization in symptomatic patients with ≥50% and in asymptomatic patients with ≥70% stenosis. Transfemoral carotid artery stenting (TFCAS) has been associated with higher perioperative stroke rates compared to CEA in several studies. On the other hand, transcarotid artery revascularization (TCAR) has outperformed TFCAS in patients who are considered high risk for surgery. There is increasing data that supports TCAR as a safe and efficient technique with outcomes similar to those of CEA, but additional level-one studies are necessary to evaluate the long-term outcomes of TCAR in high- and standard-risk patients.
- Published
- 2023
26. Vascular Surgery in Low-Income and Middle-Income Countries: A State-of-the-Art Review
- Author
-
Bencheikh, Nissma, Zarrintan, Sina, Quatramoni, Jon G, Al-Nouri, Omar, Malas, Mahmoud, and Gaffey, Ann C
- Subjects
Clinical Research ,Cardiovascular ,Good Health and Well Being ,Humans ,Developing Countries ,Treatment Outcome ,Cardiovascular Diseases ,Vascular Surgical Procedures ,Iran ,Quality-Adjusted Life Years ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
BackgroundCardiovascular disease (CVD) represents 32% of all global deaths. Studies have shown an increase in CVD prevalence and mortality with the most substantial increase in low-income and middle-income countries (LMICs). Within LMICs, we sought to 1) measure the burden of CVD with respect to aortic aneurysm (AA), ischemic stroke (IS), and peripheral arterial disease (PAD); 2) quantify surgical access to vascular surgery services; and 3) identify challenges and solutions to addressing disparities.MethodsThe Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool was used to assess the global burden of CVD (AA, PAD, IS). Population data were extracted from the World Bank & Workforce data. A literature review was completed through PubMed.ResultsThe number of deaths attributable to AA, PAD, and IS in LMICs increased by up to 102% between 1990 and 2019. Disability-adjusted life-years (DALYs) lost to AA, PAD, and IS in LMICs also increased by up to 67%. High-income countries (HIC) had a less considerable increase in deaths and DALYs during this time period. There are 101 and 72.7 vascular surgeons per 10 million people in the United States and United Kingdom, respectively. LMICs, such as Morocco, Iran, and South Africa have 10 times less this number. Ethiopia has 0.25 vascular surgeons per 10 million people, 400 times less than the United States. Interventions addressing these global disparities should address infrastructure and financing, data collection and sharing, patient knowledge and beliefs, and workforce development.ConclusionsExtreme regional discrepancies are evidence at a global scale. Identifying mechanisms to expand the vascular surgical workforce to meet the increasing need for vascular surgical access is imminent.
- Published
- 2023
27. Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers are Associated With Improved Amputation Free Survival in Chronic Limb-threatening Ischemia
- Author
-
Elsayed, Nadin, Clouse, Darrin, Motaganahalli, Raghu L, and Malas, Mahmoud
- Subjects
Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2023
28. Regional variation in patient selection, practice patterns, and outcomes based on techniques for carotid artery revascularization in the Vascular Quality Initiative
- Author
-
Dakour-Aridi, Hanaa, Vyas, Punit K, Schermerhorn, Marc, Malas, Mahmoud, Eldrup-Jorgensen, Jens, Cronenwett, Jack, Wang, Grace, Kashyap, Vikram S, and Motaganahalli, Raghu L
- Subjects
Neurosciences ,Stroke ,Cardiovascular ,Clinical Research ,Brain Disorders ,Good Health and Well Being ,Humans ,Carotid Stenosis ,Constriction ,Pathologic ,Patient Selection ,Risk Assessment ,Stents ,Endarterectomy ,Carotid ,Risk Factors ,Carotid Arteries ,Treatment Outcome ,Retrospective Studies ,Carotid revascularization ,Death ,Endarterectomy ,Regional variation ,Stenting ,TCAR ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectiveSignificant regional variation is known with multiple surgical procedures. This study describes regional variation in carotid revascularization within the Vascular Quality Initiative (VQI).MethodsData from the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) databases from 2016 to 2021 were used. Nineteen geographic VQI regions were divided into three tertiles based on the average annual volume of carotid procedures performed per region (low-volume: 956 cases [range, 144-1382]; medium-volume: 1533 cases [range, 1432-1589]; and high-volume: 1845 cases [range, 1642-2059]). Patients' characteristics, indications for carotid revascularization, practice patterns, and outcomes (perioperative and 1-year stroke/death) of different revascularization techniques were compared between these regional groups. Regression models that adjust for known risk factors and allow for random effects at the center level were used.ResultsCEA was the most common revascularization procedure (>60%) across all regional groups. Significant regional variation was observed in the practice of CEA such as variability in the use of shunting, drain placement, stump pressure and electroencephalogram monitoring, intraoperative protamine, and patch angioplasty. For transfemoral CAS, high-volume regions had a higher proportion of asymptomatic patients with
- Published
- 2023
29. Contemporary Outcomes of Thoracic Endovascular Aortic Repair in Patients With Connective Tissue Disorders: A Multi-Centre National Study
- Author
-
Willie-Permor, Daniel, Straus, Sabrina, Rahgozar, Shima, Wellington, Hannah, Shalhub, Sherene, and Malas, Mahmoud
- Subjects
Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Published
- 2023
30. Endovascular Therapy Versus Bypass for Chronic Limb-Threatening Ischemia in the Real-World Practice: Propensity-Score Matched Analyses of A Medicare-Linked Database
- Author
-
Zarrintan, Sina, Ross, Elsie G, Farber, Alik, Menard, Matthew T, Conte, Michael S, and Malas, Mahmoud B
- Subjects
Medical and Health Sciences ,Cardiovascular System & Hematology - Published
- 2023
31. Novel Risk Score Calculator for Perioperative Mortality after EVAR with Incorporation of Anatomical Factors
- Author
-
Mathlouthi, Asma, Abdelkarim, Ahmed, Elsayed, Nadin, Ramakrishnan, Ganesh, Naazie, Isaac, and Malas, Mahmoud B
- Subjects
Clinical Research ,Cardiovascular ,Good Health and Well Being ,Humans ,Female ,Aortic Aneurysm ,Abdominal ,Blood Vessel Prosthesis Implantation ,Endovascular Procedures ,Treatment Outcome ,Retrospective Studies ,Time Factors ,Risk Factors ,Risk Assessment ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
BackgroundHostile proximal aortic neck anatomy has been associated with an increased risk of perioperative mortality after endovascular aneurysm repair (EVAR). However, all available mortality risk prediction models after EVAR lack neck anatomic associations. The aim of this study is to develop a preoperative prediction model for perioperative mortality after EVAR incorporating important anatomic factors.MethodsData were obtained from the Vascular Quality Initiative database on all patients who underwent elective EVAR between January 2015 and December 2018. A stepwise multivariable logistic regression analysis was implemented to identify independent predictors and develop a risk calculator for perioperative mortality after EVAR. Internal validation was done using bootstrap of 1,000 reps.ResultsA total of 25,133 patients were included, of whom 1.1% (N = 271) died within 30 days or before discharge. Significant preoperative predictors of perioperative mortality were age (odds ratio [OR], 1.053; 95% confidence interval [CI], 1.050-1.056; P < 0.001), female sex (OR, 1.46; 95% CI, 1.38-1.54; P < 0.001), chronic kidney disease (OR, 1.65; 95% CI, 1.57-1.73; P < 0.001), chronic obstructive pulmonary disease (OR, 1.86; 95% CI, 1.77-1.94; P < 0.001), congestive heart failure (OR, 2.02; 95% CI, 1.91-2.13, P < 0.001), aneurysm diameter ≥ 6.5 cm (OR, 2.35; 95% CI, 2.24-2.47, P < 0.001), proximal neck length < 10 mm (OR, 1.96; 95% CI, 1.81-2.12; P < 0.001), proximal neck diameter ≥ 30 mm (OR, 1.41; 95% CI, 1.32-1.5; P < 0.001), infrarenal neck angulation ≥ 60° (OR, 1.27; 95% CI, 1.18-1.26; P < 0.001), and suprarenal neck angulation ≥ 60° (OR, 1.26; 95% CI, 1.16-1.37; P < 0.001). Significant protective factors included aspirin use (OR, 0.89; 95% CI, 0.85-0.93; P < 0.001) and statin intake (OR, 0.77; 95% CI, 0.73-0.81; P < 0.001). These predictors were incorporated to build an interactive risk calculator of perioperative mortality after EVAR (C-statistic = 0.749).ConclusionsThis study provides a prediction model for mortality following EVAR that incorporates aortic neck features. The risk calculator can be used to weigh risk/benefit ratio when counseling patients preoperatively. Prospective use of this risk calculator may show its benefit in long-term prediction of adverse outcomes.
- Published
- 2023
32. Upper Extremity Access Has Worse Outcomes in F/BEVAR using the VQI Dataset
- Author
-
Patel, Rohini J, Sibona, Agustin, Malas, Mahmoud B, Lane, John S, Al-Nouri, Omar, and Barleben, Andrew R
- Subjects
Stroke ,Clinical Research ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
ObjectivePhysician modified endografts (PMEG) and custom manufactured devices (CMD) use branched and fenestrated techniques (F/BEVAR) to repair complex aneurysms. Traditionally many of these are deployed through a combination of upper and lower extremity access. However, with newer steerable sheaths, you can now simulate upper extremity access from a transfemoral approach. Single institution studies have demonstrated increased risks of access site complications and stroke when upper extremity access is used. This study compares outcomes after F/BEVAR in a national database between total transfemoral (TTF) access and mixed upper extremity (UEM) access.MethodsThis study is an analysis of the Vascular Quality Initiate for all patients who underwent F/BEVAR from 2014-2021. Patients were stratified based on a TTF delivery of all devices versus any UEM access for deployment of target vessel stents. Primary outcomes included stroke, myocardial infarction and perioperative death. Secondary outcomes included access site hematoma, occlusion, or embolization, operative time, fluoroscopy time, and technical success. Multivariable linear and logistic regression analyses were performed.Results3146 patients underwent a F/BEVAR; 2309 (73.4%) TTF and 837 (26.6%) UEM. Logistic regression analysis indicated a two-fold increased risk of death and MI and a three-fold increased risk of stroke in the UEM group. Furthermore, there is decreased operative time (221 versus 297 minutes, p
- Published
- 2023
33. Long-Term Outcomes of Carotid Endarterectomy vs. Transfemoral Carotid Stenting in a Medicare-Matched Database
- Author
-
Yei, Kevin S, Janssen, Claire, Elsayed, Nadin, Naazie, Isaac, Sedrakyan, Art, and Malas, Mahmoud B
- Subjects
Brain Disorders ,Clinical Research ,Neurosciences ,Aging ,Health Services ,Stroke ,Cardiovascular ,Good Health and Well Being ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ImportanceCarotid endarterectomy is associated with lower risk of perioperative stroke compared to transfemoral carotid artery stenting in the treatment of carotid artery stenosis. However, there is discrepancy in data regarding long-term outcomes. We aimed to compare long-term outcomes of carotid endarterectomy vs transfemoral carotid artery stenting using the Medicare-matched Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database.MethodsWe assessed patients undergoing first-time carotid endarterectomy or transfemoral carotid artery stenting in VQI-VISION from January 2003 to December 2018. Patients with prior history of carotid revascularization, non-transfemoral stenting, stenting performed without distal embolic protection, multiple or non-atherosclerotic lesions, or concomitant procedures were excluded. The primary outcome of interest was all-cause mortality, any stroke, and combined endpoint of death or stroke. We additionally performed propensity score matching and stratification based on symptomatic status.ResultsA total of 80,146 carotid revascularizations were performed of which 72,615 were carotid endarterectomy and 7,531 were transfemoral carotid artery stenting. CEA was associated with significantly lower risk of death (57.8% vs. 70.4%, aHR 0.46, 95%CI 0.41-0.52, p
- Published
- 2023
34. Hemodynamic instability predicts in-hospital and 1-year mortality after transcarotid artery revascularization and transfemoral carotid stenting
- Author
-
Elsayed, Nadin, Chow, Christopher, Ramachandran, Mokhshan, Al-Nouri, Omar, Motaganahalli, Raghu L, and Malas, Mahmoud B
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Stroke ,Hypertension ,Cardiovascular ,Clinical Research ,Patient Safety ,Neurosciences ,Brain Disorders ,Prevention ,Humans ,Carotid Stenosis ,Treatment Outcome ,Stents ,Risk Factors ,Myocardial Infarction ,Hypotension ,Femoral Artery ,Hemodynamics ,Retrospective Studies ,Risk Assessment ,Endovascular Procedures ,Carotid artery stenting ,Carotid outcomes ,Hemodynamic instability ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectiveBlood pressure fluctuations are a common hemodynamic alteration following carotid artery stenting either with transfemoral (TFCAS) or transcarotid (TCAR) approach and are thought to be related to alteration in baroreceptor function due to angioplasty and stent expansion. These fluctuations are particularly worrisome in the high-risk patient population referred for CAS. This study aims to evaluate the outcomes of patients who required the administration of intravenous blood pressure medication (IVBPmed) for hypotension or hypertension after CAS.MethodsAll patients undergoing carotid revascularization in the Vascular Quality Initiative (VQI) database between 2016 and 2021 were included. We compared outcomes of patients who required postoperative IVBPmed to treat hyper- or hypotension with normotensive patients. In-hospital outcomes were compared using multivariable logistic regression. One-year outcomes were assessed using Kaplan-Meier survival and multivariable Cox proportional hazard regression analyses.ResultsWe identified 38,510 patients undergoing CAS (57.7% TCAR and 42.3% TFCAS), of which, 30% received IVBPmed for treatment of either postoperative hypertension (12.6%) or hypotension (16.4%). In multivariable analysis, postoperative hypotension was associated with a higher risk of stroke, death, or myocardial infarction (MI) (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.6-3.6; P < .001), stroke or death (OR, 2.9; 95% CI, 2.4-3.5; P < .001), stroke (OR, 2.6; 95% CI, 2.1-3.2; P < .001), death (OR, 3.5; 95% CI, 2.6-4.8; P < .001), MI (OR, 4.7; 95% CI, 3.3-6.7; P < .001), and bleeding (OR, 1.96; 95% CI, 1.4-2.7; P < .001) compared with normotensive patients. Postoperative hypertension was associated with a higher risk of stroke, death, or MI (OR, 3.6; 95% CI, 3-4.4; P < .001), stroke or death (OR, 3.3; 95% CI, 2.7-4.1; P < .001), stroke (OR, 3.7; 95% CI, 3-4.7; P < .001), death (OR, 2.7; 95% CI, 1.9-3.9; P < .001), MI (OR, 5.7; 95% CI, 3.9-8.3; P < .001), and bleeding (OR, 1.9; 95% CI, 1.4-2.7; P < .001) compared with normotensive patients.ConclusionsPostoperative hypertension or hypotension requiring IVBPmed after CAS is associated with an increased risk of in-hospital stroke, death, MI, and bleeding. Postoperative hypertension is associated with worse survival at 1 year. This study indicates that the need for IVBPmed after CAS is not benign; therefore, these patients necessitate aggressive perioperative medical management and safe techniques to avoid hypo and hypertension. Close follow-up and continue medical management are needed to maximize these patients' survival.
- Published
- 2023
35. Cost-Effectiveness Analysis of Open Versus Endovascular Revascularization for Chronic Mesenteric Ischemia
- Author
-
Patel, Rohini J, Cui, Christina, Khan, Maryam Ali, Willie-Permor, Daniel, and Malas, Mahmoud B
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Dentistry ,Cost Effectiveness Research ,Comparative Effectiveness Research ,Clinical Research ,Health Services ,Good Health and Well Being ,Aged ,Humans ,United States ,Cost-Effectiveness Analysis ,Mesenteric Ischemia ,Cost-Benefit Analysis ,Treatment Outcome ,Medicare ,Ischemia ,Quality-Adjusted Life Years ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
BackgroundRecent studies have shown a trend supporting endovascular revascularization (ER) in the treatment of chronic mesenteric ischemia (CMI). However, few studies have compared the cost effectiveness of ER and open revascularization (OR) for this indication. The purpose of this study is to conduct a cost-effectiveness analysis comparing open versus ER for CMI.MethodsWe built a Markov model with Monte Carlo microsimulation using transition probabilities and utilities from existing literature for CMI patients undergoing OR versus ER. Costs were derived from the hospital perspective using the 2020 Medicare Physician Fee Schedule. The model randomized 20,000 patients to either OR or ER and allowed for 1 subsequent reintervention with 3 other intervening health states: alive, alive with complications, and dead. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) were analyzed over a 5-year period. One-way sensitivity and probabilistic sensitivity analyses were conducted to study the impact of parameter variability on cost effectiveness.ResultsOR cost $4,532 for 1.03 QALYs while ER cost $5,092 for 1.21 QALYs, leading to an ICER of $3,037 per QALY gained in the ER arm. This ICER was less than our willingness to pay threshold of $100,000. Sensitivity analysis demonstrated that our model was most sensitive to costs, mortality, and patency rates after OR and ER. Probabilistic sensitivity analysis demonstrated ER would be considered cost effective 99% of iterations.ConclusionsThis study found that while 5-year costs for ER were greater than OR, ER afforded greater QALYs than OR. Although ER is associated with lower long-term patency and higher rates of reintervention, it appears to be more cost effective than OR for the treatment of CMI.
- Published
- 2023
36. Five Year Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease: a Retrospective Cohort Analysis of Linked Registry Claims Data
- Author
-
Levin, Scott R, Farber, Alik, Goodney, Philip P, King, Elizabeth G, Eslami, Mohammad H, Malas, Mahmoud B, Patel, Virendra I, Kiang, Sharon C, and Siracuse, Jeffrey J
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology - Published
- 2023
37. Renin‐Angiotensin‐Aldosterone System Inhibitors Are Associated With Favorable Outcomes Compared to Beta Blockers in Reducing Mortality Following Abdominal Aneurysm Repair
- Author
-
Elsayed, Nadin, Gaffey, Ann C, Abou‐Zamzam, Ahmed, and Malas, Mahmoud B
- Subjects
Cardiovascular ,Hypertension ,Clinical Research ,Good Health and Well Being ,Humans ,Aged ,United States ,Renin-Angiotensin System ,Retrospective Studies ,Aortic Aneurysm ,Abdominal ,Endovascular Procedures ,Aortic Rupture ,Blood Vessel Prosthesis Implantation ,Medicare ,Treatment Outcome ,Risk Factors ,abdominal aortic aneurysm repair ,aneurysm rupture ,angiotensin-converting enzyme inhibitors ,beta blockers ,angiotensin‐converting enzyme inhibitors ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
Background The best medical therapy to control hypertension following abdominal aortic aneurysm repair is yet to be determined. We therefore examined whether treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs) versus beta blockers influenced postoperative and 1-year clinical end points following abdominal aortic aneurysm repair in a Medicare-linked database. Methods and Results All patients with hypertension undergoing endovascular aneurysm repair and open aneurysm repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database between 2003 and 2018 were included. Patients were divided into 2 groups based on their preoperative and discharge medications, either RAASIs or beta blockers. Our cohort included 8789 patients, of whom 3523 (40.1%) were on RAASIs, and 5266 (59.9%) were on beta blockers. After propensity score matching, there were 3053 matched pairs of patients in each group. After matching, RAASI use was associated with lower risk of postoperative mortality (odds ratio [OR], 0.3 [95% CI, 0.1-0.6]), myocardial infarction (OR, 0.1 [95% CI, 0.03-0.6]), and nonhome discharge (OR, 0.6 [95% CI, 0.5-0.7]). Before propensity score matching, RAASI use was associated with lower 1-year mortality (hazard ratio [HR], 0.4 [95% CI, 0.4-0.5]) and lower risk of aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). These results persisted after propensity score matching for mortality (HR, 0.4 [95% CI, 0.4-0.5]) and aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). Conclusions In this large contemporary retrospective cohort study, RAASI use was associated with favorable postoperative outcomes compared with beta blockers. It was also associated with lower mortality and aneurysmal rupture at 1 year of follow-up.
- Published
- 2023
38. Propensity-Score Matched Analysis of Three Years Survival of TransCarotid Artery Revascularization Versus Carotid Endarterectomy in the Vascular Quality Initiative Medicare Linked Database.
- Author
-
Zarrintan, Sina, Elsayed, Nadin, Patel, Rohini J, Clary, Bryan, Goodney, Philip P, and Malas, Mahmoud B
- Subjects
Patient Safety ,Aging ,Brain Disorders ,Neurosciences ,Clinical Research ,Stroke ,Cardiovascular ,Medical and Health Sciences ,Surgery ,Clinical sciences - Abstract
ObjectiveCarotid endarterectomy (CEA) remains the gold standard procedure for carotid revascularization. Transfemoral carotid artery stenting (TFCAS) was introduced as a minimally invasive alternative procedure in patients who are at high risk for surgery. However, TFCAS was associated with increased risk of stroke and death compared to CEA.Summary background dataTranscarotid artery revascularization (TCAR) has outperformed TFCAS in several prior studies and has shown similar perioperative and one-year outcomes compared to CEA. We aimed to compare the one-year and three-year outcomes of TCAR vs. CEA in the Vascular Quality Initiative (VQI)-Medicare-Linked (Vascular Implant Surveillance & Interventional Outcomes Network [VISION]) database.MethodsThe VISION Database was queried for all patients undergoing CEA and TCAR between September 2016 to December 2019. The primary outcome was one-year and three-years survival. One-to-one propensity-score matching (PSM) without replacement was used to produce two well-matched cohorts. Kaplan-Meier estimates, and Cox regression were used for analyses. Exploratory analyses compared stroke rates using claims-based algorithms for comparison.ResultsA total of 43,714 patients underwent CEA and 8,089 patients underwent TCAR during the study period. Patients in the TCAR cohort were older and were more likely to have severe comorbidities. PSM produced two well-matched cohorts of 7,351 pairs of TCAR and CEA. In the matched cohorts, there were no differences in one-year death (HR=1.13, 95% CI: 0.99-1.30; P=0.065). At three-years, TCAR was associated with slight increased risk of death (HR=1.16, 95% CI: 1.04-1.30; P=0.008). When stratifying by initial symptomatic presentation, the increased three-year death associated with TCAR persisted only in symptomatic patients (HR=1.33, 95% CI: 1.08-1.63; P=0.008). Exploratory analyses of post-operative stroke rates using administrative sources suggested that validated measures of claims-based stroke ascertainment are necessary.ConclusionsIn this large multi-institutional PSM analysis with robust Medicare-linked follow-up for survival analysis, the rate of death at one-year was similar in TCAR and CEA regardless of symptomatic status. The slight increase in the risk of three-year death in symptomatic patients undergoing TCAR is likely confounded by more severe comorbidities despite matching. A randomized controlled trial comparing TCAR to CEA is necessary to further determine the role of TCAR in standard risk patients requiring carotid revascularization.
- Published
- 2023
39. Comparing Outcomes of Transfemoral Versus Transbrachial or Transradial Approach in Carotid Artery Stenting (CAS)
- Author
-
Khan, Maryam Ali, Dodo-Williams, Taiwo S, Janssen, Claire, Patel, Rohini J, Mahmud, Ehtisham, and Malas, Mahmoud B
- Subjects
Neurosciences ,Clinical Research ,Cardiovascular ,Patient Safety ,Stroke ,Brain Disorders ,Good Health and Well Being ,Male ,Humans ,Carotid Stenosis ,Risk Factors ,Risk Assessment ,Constriction ,Pathologic ,Stents ,Time Factors ,Treatment Outcome ,Endarterectomy ,Carotid ,Femoral Artery ,Carotid Arteries ,Retrospective Studies ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
BackgroundWhile Transfemoral Carotid Artery Stenting (TFCAS) is a valid minimally invasive option for patients who also might be suitable for carotid endarterectomy (CEA) or transcarotid artery revascularization (TCAR), alternative access sites such as transbrachial (TB) or transradial (TR) are only utilized when anatomic factors preclude direct carotid or transfemoral access. In this study, we aimed to evaluate the outcomes of TR/TB access in comparison to TF for percutaneous carotid artery revascularization.MethodsAll patients undergoing non-TCAR carotid artery stenting (CAS) from January 2012 to June 2021 in the Vascular Quality Initiative (VQI) Database were included. Patients were divided into 2 groups based on the access site for CAS: TF or TR/TB. Primary outcomes included stroke/death, technical failure and access site complications (hematoma, stenosis, infection, pseudoaneurysm and AV fistula). Secondary outcomes included stroke, TIA, MI, death, non-home discharge, extended length of postoperative stay (LOS) (>1 day), and composite endpoints of stroke/MI and stroke/death/MI. Univariable and multivariable logistic regression models were used to assess postoperative outcomes, and results were adjusted for relevant potential confounders including age, gender, race, degree of stenosis, symptomatic status, anesthesia, comorbidities, and preoperative medications.ResultsOut of the 23,965 patients, TR/TB approach was employed in 819 (3.4%) while TF was used in 23,146 (96.6%). Baseline characteristics found men were more likely to undergo revascularization using TR/TB approach (69.4% vs. 64.9%, P = 0.009). Patients undergoing TR/TB approach were also more likely to be symptomatic (49.9% vs. 28.6%, P
- Published
- 2023
40. Prophylactic Perigraft Arterial Sac Embolization During EVAR: Minimizing Type II Endoleaks and Improving Sac Regression
- Author
-
Mathlouthi, Asma, Yei, Kevin, Guajardo, Isabella, Al-Nouri, Omar, Malas, Mahmoud B, and Barleben, Andrew
- Subjects
Prevention ,Cardiovascular ,Good Health and Well Being ,Humans ,Endoleak ,Aortic Aneurysm ,Abdominal ,Blood Vessel Prosthesis Implantation ,Prospective Studies ,Endovascular Procedures ,Treatment Outcome ,Time Factors ,Retrospective Studies ,Embolization ,Therapeutic ,Risk Factors ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Dentistry - Abstract
BackgroundType II endoleaks (ELII) are the most common complication following endovascular aneurysm repair (EVAR). Persistent ELII require continual surveillance and have been shown to increase the risk of Type I and III endoleaks, sac growth, need for intervention, conversion to open or even rupture, directly or indirectly. These are often difficult to treat following EVAR, and there are limited data regarding the effectiveness of prophylactic treatment of ELII. The aim of this study is to report the midterm outcomes of prophylactic perigraft arterial sac embolization (pPASE) performed in patients undergoing EVAR.MethodsThis is a comparison of 2 elective cohorts of those undergoing EVAR using the Ovation stent graft with and without prophylactic branch vessel and sac embolization. Patients who underwent pPASE at our institution had their data collected in a prospective, institutional review board-approved database. These were compared against the core lab-adjudicated data from the Ovation Investigational Device Exemption trial. Prophylactic PASE was performed at the time of EVAR with thrombin, contrast, and Gelfoam if the lumbar or mesenteric arteries were patent. Endpoints included freedom from ELII, reintervention, sac growth, all-cause mortality, and aneurysm-related mortality.ResultsThirty-six patients (13.1%) underwent pPASE, while 238 patients (86.9%) had standard EVAR. Median follow-up was 56 months (33-60 months). The 4-year freedom from ELII estimates were 84% for the pPASE versus 50.7% for the standard EVAR group (P = 0.0002). All aneurysms in the pPASE group remained stable in size or demonstrated regression, whereas aneurysm sac expansion was seen in 10.9% of the standard EVAR group, P = 0.03. At 4 years, mean AAA diameter decreased by 11 mm (95% CI 8-15) in the pPASE group versus 5 mm (95% CI 4-6) for the standard EVAR group, P = 0.0005. There were no differences in the 4-year freedom from all-cause mortality and aneurysm-related mortality. However, the difference in reintervention for ELII trended toward significance (0.0% vs. 10.7%, P = 0.1). On multivariable analysis, pPASE was associated with a 76% reduction in ELII [(95% CI): 0.24 (0.08-0.65), P = 0.005].ConclusionsThese results suggest that pPASE in those undergoing EVAR is safe and effective in the prevention of ELII and significantly improves sac regression over standard EVAR while minimizing the need for reintervention.
- Published
- 2023
41. Unique presentation of renovascular hypertension due to fibromuscular dysplasia
- Author
-
Doshi, Mitali, Layman, Peter, Justino, Henri, and Malas, Mahmoud
- Subjects
Kidney Disease ,Cardiovascular ,Hypertension - Published
- 2023
42. The impact of completion and follow-up endoleaks on survival, reintervention, and rupture.
- Author
-
Li, Chun, de Guerre, Livia, Dansey, Kirsten, Lu, Jinny, Patel, Priya, Yao, Mengdi, Jones, Douglas, Schermerhorn, Marc, and Malas, Mahmoud
- Subjects
AAA ,Aneurysm ,Completion endoleak ,EVAR ,Follow-up ,Humans ,Aged ,United States ,Treatment Outcome ,Follow-Up Studies ,Blood Vessel Prosthesis Implantation ,Risk Factors ,Aortic Aneurysm ,Abdominal ,Medicare ,Endoleak ,Endovascular Procedures ,Retrospective Studies - Abstract
OBJECTIVE: Endoleaks may be seen at case completion of endovascular abdominal aortic aneurysm repair (EVAR), and the presence of an endoleak may impact outcomes. However, the clinical implications of various endoleaks seen during follow-up is not well-described. Therefore, we studied the impact of endoleaks at completion and at follow-up on mid-term outcomes. METHODS: We reviewed patients who underwent EVAR from 2003 to 2016 within the Vascular Quality Initiative-Medicare database and identified patients with endoleak at procedure completion and during follow-up, excluding those presenting with rupture. We stratified cohorts by presence of completion and follow-up endoleak subtypes. The primary outcome was 5-year survival, and secondary outcomes included 5-year freedom from reintervention and freedom from rupture. We used Kaplan-Meier estimates and log-rank tests to analyze differences in time-to-event endpoints. RESULTS: Of 21,745 patients with completion endoleak data, 5085 (23%) had an endoleak. Compared with those without endoleak, those with type I endoleaks had lower 5-year survival (69% vs 75%; P < .001), type II endoleaks had higher survival (79%; P < .001), and types III, IV, and indeterminate were not statistically different (73%, 73%, and 75%, respectively). Freedom from reintervention for types I and III endoleaks were significantly lower than no endoleak cohort (I: 76%; P < .001; III: 72%; P < .001 vs 83%), but freedom from rupture was higher for those with type II and III endoleak (95% and 97% vs 94%; P < .001). Of 14,479 patients with detailed follow-up endoleak data, 2290 (16%) had an endoleak. Compared with those without endoleak, types I and III had significantly lower 5-year survival (I: 80%; P = .002; III: 66%; P < .001 vs 84%), but there were no differences for types II (82%) and indeterminate (77%). Those with any type of follow-up endoleak had lower 5-year freedom from reintervention (I: 70%; P < .001; II: 76%; P = .006; III: 36%; P < .001; indeterminate: 60%; P = .007 vs 84%), and lower freedom from rupture (I: 92%; P < .001; II: 91%; P = .16; III: 88%; P = .01; indeterminate: 90%; P = .11 vs 94%). CONCLUSIONS: Compared with patients with no endoleak, those with type I completion endoleaks have lower 5-year survival and freedom from reintervention. Patients with types I and III follow-up endoleaks also have lower survival, and any endoleak at follow-up is associated with lower freedom from reintervention and freedom from rupture. These data highlight the importance of careful patient selection and close postoperative follow-up after EVAR, as the presence of endoleaks, specifically type I and III, over time portends worse outcomes.
- Published
- 2023
43. The impact of neighborhood social disadvantage on presentation and management of first-time hemodialysis access surgery patients
- Author
-
Zhu, Max, Mota, Lucas, Farber, Alik, Schermerhorn, Marc L, King, Elizabeth, Alonso, Andrea, Kobzeva-Herzog, Anna, Morrissey, Nicholas, Malas, Mahmoud, and Siracuse, Jeffrey J
- Subjects
Clinical Research ,Good Health and Well Being ,Area Deprivation Index ,Health outcomes ,Hemodialysis access ,Social determinants of health ,Vascular surgery ,Medical and Health Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThe impact of social determinants of health on the presentation, management, and outcomes of patients requiring hemodialysis (HD) arteriovenous (AV) access creation have not been well-characterized. The Area Deprivation Index (ADI) is a validated measure of aggregate community-level social determinants of health disparities experienced by members living within a community. Our goal was to examine the effect of ADI on health outcomes for first-time AV access patients.MethodsWe identified patients who underwent first-time HD access surgery in the Vascular Quality Initiative between July 2011 to May 2022. Patient zip codes were correlated with an ADI quintile, defined as quintile 1 (Q1) to quintile 5 (Q5) from least to most disadvantaged. Patients without ADI were excluded. Preoperative, perioperative, and postoperative outcomes considering ADI were analyzed.ResultsThere were 43,292 patients analyzed. The average age was 63 years, 43% were female, 60% were of White race, 34% were of Black race, 10% were of Hispanic ethnicity, and 85% received autogenous AV access. Patient distribution by ADI quintile was as follows: Q1 (16%), Q2 (18%), Q3 (21%), Q4 (23%), and Q5 (22%). On multivariable analysis, the most disadvantaged quintile (Q5) was associated with lower rates of autogenous AV access creation (OR, 0.82; 95% confidence interval [CI], 0.74-0.90; P < .001), preoperative vein mapping (OR, 0.57; 95% CI, 0.45-0.71; P < .001), access maturation (OR, 0.82; 95% CI, 0.71-0.95; P = .007), and 1-year survival (OR, 0.81; 95% CI, 0.71-0.91; P = .001) compared with Q1. Q5 was associated with higher 1-year intervention rates than Q1 on univariable analysis, but not on multivariable analysis.ConclusionsThe patients undergoing AV access creation who were most socially disadvantaged (Q5) were more likely to experience lower rates of autogenous access creation, obtaining vein mapping, access maturation, and 1-year survival compared with the most socially advantaged (Q1). Improvement in preoperative planning and long-term follow-up may be an opportunity for advancing health equity in this population.
- Published
- 2023
44. Perioperative Outcomes Following Carotid Revascularization for Stroke Stratified by Modified Rankin Scale and Time of Intervention
- Author
-
Conroy, Patrick D, Solomon, Yoel, Rastogi, Vinamr, Summers, Steven P, Wang, Grace J, Schneider, Peter A, Malas, Mahmoud, De Borst, Gert J, and Schermerhorn, Marc L
- Subjects
Medical and Health Sciences ,Cardiovascular System & Hematology - Published
- 2023
45. Open Bypass Is Superior to Endovascular Revascularization in Patients Undergoing Reintervention for Chronic Limb-threatening Ischemia Using a Medicare-linked Database
- Author
-
Elsayed, Nadin, Alnouri, Omar, Schermerhorn, Marc L, and Malas, Mahmoud
- Subjects
Medical and Health Sciences ,Cardiovascular System & Hematology - Published
- 2023
46. Operative and long-term outcomes of combined and staged carotid endarterectomy and coronary bypass.
- Author
-
Haywood, Nathan, Ratcliffe, Sarah, Zheng, Xinyan, Mao, Jialin, Farivar, Behzad, Tracci, Margaret, Malas, Mahmoud, Goodney, Philip, and Clouse, W
- Subjects
Carotid endarterectomy ,Carotid stenosis ,Coronary artery bypass grafting ,Coronary artery disease ,Humans ,Aged ,United States ,Endarterectomy ,Carotid ,Coronary Artery Disease ,Carotid Stenosis ,Treatment Outcome ,Retrospective Studies ,Medicare ,Coronary Artery Bypass ,Myocardial Infarction ,Stroke ,Risk Factors - Abstract
OBJECTIVE: Optimal temporal surgical management of significant carotid stenosis and coronary artery disease remains unknown. Carotid endarterectomy (CEA) and coronary artery bypass (CABG) are performed concurrently (CCAB) or in a staged (CEA-CABG or CABG-CEA) approach. Using the Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Coordinated Registry Network-Medicare-linked dataset, this study compared operative and long-term outcomes after CCAB and staged approaches. METHODS: The Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Coordinated Registry Network dataset was used to identify CEAs from 2011 to 2018 with combined CABG or CABG within 45 days preceding or after CEA. Patients were stratified based on concurrent or staged approach. Primary outcomes were stroke, myocardial infarction (MI), all-cause mortality, stroke and death as composite (SD) and all as composite within 30 days from the last procedure as well as in the long term. Univariate analysis and risk-adjusted analysis using inverse propensity weighting were performed. Kaplan-Meier curves of stroke, MI, and death were created and compared. RESULTS: There were 1058 patients included: 643 CCAB and 415 staged (309 CEA-CABG and 106 CABG-CEA). Compared with staged patients, those undergoing CCAB had a higher preoperative rate of congestive heart failure (24.8% vs 18.4%; P = .01) and decreased renal function (14.9% vs 8.5%; P < .01), as well as fewer prior neurological events (23.5% vs 31.4%; P
- Published
- 2023
47. Use of surgical augmented intelligence maps can reduce radiation and improve safety in the endovascular treatment of complex aortic aneurysms
- Author
-
Patel, Rohini J, Lee, Arielle M, Hallsten, John, Lane, John S, Barleben, Andrew R, and Malas, Mahmoud B
- Subjects
Pediatric Research Initiative ,Clinical Research ,Patient Safety ,Cardiovascular ,Humans ,Aortic Aneurysm ,Abdominal ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Endovascular Procedures ,Aortic Aneurysm ,Retrospective Studies ,Postoperative Complications ,Aortic aneurysm ,Artificial intelligence ,Radiation ,Medical and Health Sciences ,Cardiovascular System & Hematology - Abstract
ObjectiveThe introduction of endovascular procedures has revolutionized the management of complex aortic aneurysms. Although repair has traditionally required longer operative times and increased radiation exposure compared with simple endovascular aneurysm repair, the recent introduction of three-dimensional technology has become an invaluable operative adjunct. Surgical augmented intelligence (AI) is a rapidly evolving tool initiated at our institution in June 2019. In our study, we sought to determine whether this technology improved patient and operator safety.MethodsA retrospective review of patients who had undergone endovascular repair of complex aortic aneurysms (pararenal, juxtarenal, or thoracoabdominal), type B dissection, or infrarenal (endoleak, coil placement, or renal angiography with or without intervention) at a tertiary care center from August 2015 to November 2021 was performed. Patients were stratified according to the findings from intelligent maps, which are patient-specific AI tools used in the operating room in conjunction with real-time fluoroscopic images. The primary outcomes included operative time, radiation exposure, fluoroscopy time, and contrast use. The secondary outcomes included 30-day postoperative complications and long-term follow-up. Linear regression models were used to evaluate the association between AI use and the main outcomes.ResultsDuring the 6-year period, 116 patients were included in the present study, with no significant differences in the baseline characteristics. Of the 116 patients, 76 (65.5%) had undergone procedures using AI and 40 (34.5%) had undergone procedures without AI software. The intraoperative outcomes revealed a significant decrease in radiation exposure (AI group, 1955 mGy; vs non-AI group, 3755 mGy; P = .004), a significant decrease in the fluoroscopy time (AI group, 55.6 minutes; vs non-AI group, 86.9 minutes; P = .007), a decrease in the operative time (AI group, 255 minutes; vs non-AI group, 284 minutes; P = .294), and a significant decrease in contrast use (AI group, 123 mL; vs non-AI group, 199 mL; P
- Published
- 2023
48. Loss of follow-up after carotid revascularization is associated with worse long-term stroke and death.
- Author
-
Elsayed, Nadin, Patel, Rohini, Naazie, Isaac, Hicks, Caitlin, Siracuse, Jeffrey, and Malas, Mahmoud
- Subjects
Carotid revascularization ,Loss to follow-up ,Humans ,Carotid Stenosis ,Follow-Up Studies ,Risk Factors ,Treatment Outcome ,Stents ,Vascular Surgical Procedures ,Stroke ,Endarterectomy ,Carotid ,Postoperative Complications ,Carotid Arteries ,Retrospective Studies ,Risk Assessment - Abstract
OBJECTIVES: Society for Vascular Surgery practice guidelines recommend surveillance with duplex ultrasound scanning at baseline (within 3 months from discharge), every 6 months for 2 years, and annually afterward following carotid endarterectomy or carotid artery stenting. There is a growing concern regarding the significance of postoperative follow-up after several vascular procedures. We sought to determine whether 1-year loss to follow-up (LTF) after carotid revascularization was associated with worse outcomes in the Vascular Quality Initiative (VQI) linked to Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database. METHODS: All patients who underwent carotid revascularization in the VQI VISION database between 2003 and 2016 were included. LTF was defined as failure to complete 1-year follow-up in the VQI long-term follow-up dataset. Data about stroke and mortality were captured in the VISION dataset using a list of Current Procedural Terminology, International Classification of Diseases (Ninth Revision), and International Classification of Diseases (Tenth Revision) codes linked to index procedures in VQI. Kaplan-Meier life-table methods and Cox proportional hazard modeling were used to compare 5- and 10-year outcomes between patients with no LTF and those who were LTF. RESULTS: A total of 58,840 patients were available for analysis. The 1-year LTF rate was 43.8%. Patients who were LTF were older and more frequently symptomatic, with chronic obstructive pulmonary diseases, chronic kidney diseases, and congestive heart failure. Also, patients who underwent carotid artery stenting were more likely to be LTF compared with carotid endarterectomy patients (54.5% vs 42.3%; P < .001). The incidence of postoperative (30 days) stroke was higher in the LTF group (2.9% vs 1.7%; P < .001). Cox regression analysis revealed that LTF was associated with an increased risk of long-term stroke at 5 years (hazard ratio [HR]: 1.4, 95% confidence interval [CI]: 1.2-1.6; P < .001) and 10 years (HR: 1.3, 95% CI: 1.2-1.5; P < .001). It was also associated with significantly higher mortality at 5 years (HR: 2.5, 95% CI: 2.3-2.8; P < .001) and 10 years (HR: 2.2, 95% CI: 1.9-2.5; P < .001). Stroke or death was significantly worse in the LTF group at 5 years (HR: 2.3, 95% CI: 2.1-2.5; P < .001) and up to 10 years (HR: 2.02, 95% CI: 1.8-2.3; P < .001). CONCLUSIONS: One-year follow-up after carotid revascularization procedures was found to be associated with better stroke- and mortality-free survival. Surgeons should emphasize the importance of follow-up to all patients who undergo carotid revascularization, especially those with multiple comorbidities and postoperative neurological complications.
- Published
- 2023
49. Prolonged Length of Stay after Elective Carotid Revascularization
- Author
-
Aridi, Hanaa, Murphy, Michael P, Malas, Mahmoud, Schermerhorn, Marc L, Kashyap, Vikram S, Wang, Grace J, Eldrup-jorgensen, Jens, and Motaganahalli, Raghunandan L
- Subjects
Clinical Sciences ,Surgery ,Clinical sciences - Published
- 2023
50. Medicare Patients with Symptomatic Carotid Disease Requiring Carotid Revascularization Are Likely to Have Delayed Access: An Analysis of a Multi-Center Surgical Data
- Author
-
Willie-permor, Daniel, Moghaddam, Marjan, Zarrintan, Sina, and Malas, Mahmoud
- Subjects
Clinical Sciences ,Surgery ,Clinical sciences - Published
- 2023
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.