19 results on '"Calligaro, Keith D."'
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2. Systematic Review of the Influence of Anatomy and Aneurysm Type on Treatment Choice and Outcomes in Extracranial Carotid Artery Aneurysms.
- Author
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Hoffman ME, Squiers JJ, Hamandi M, Lanfear AT, Calligaro KD, and Shutze WP
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- Carotid Arteries, Female, Humans, Male, Retrospective Studies, Treatment Outcome, Aneurysm diagnostic imaging, Aneurysm surgery, Aneurysm, False etiology, Carotid Artery Diseases diagnostic imaging, Carotid Artery Diseases surgery, Cranial Nerve Injuries etiology, Endovascular Procedures, Stroke etiology
- Abstract
Background: Extracranial carotid artery aneurysms (ECAA) are rare. Open surgery has traditionally been the treatment of choice, and endovascular management has recently been increasingly described. However, operative guidelines have not been defined., Methods: A systematic review following PRISMA guidelines was performed to identify articles related to the symptoms, treatments, and outcomes of ECAAs. Included studies were further evaluated to identify distribution of treatment strategy based on anatomical location by Attigah classification (Type I-V) and aneurysmal type (true versus pseudoaneurysm)., Results: Twenty-eight retrospective reviews were included. A total of 906 patients (63% male) with 959 ECAAS were identified. The most common presenting symptoms included neck mass (45%) and neurological deficits (26%), while 218 (23%) were asymptomatic. True aneurysms accounted for 52% and pseudoaneurysms for 45% of cases. Of the 959 ECAAs, 750 were treated with open surgery, 85 with an endovascular procedure, and 124 conservatively. Perioperative complications of open surgery included cranial nerve injuries (CNI) in 9% (68), strokes in 4% (27), and death in 2% (18) of cases. There were no CNI, perioperative stroke, or perioperative mortality associated with 85 endovascular procedures; however, there was 1 case of restenosis (1%). Of the 124 patients treated conservatively, 3% (4) died as a result of the aneurysm. Twenty-two of 28 studies (688 ECAAs) reported anatomical location according to Attigah classification. The distribution of ECAAs were Type I (296/688; 43%), Type II (19/688; 3%), Type III (195/688; 28%), Type IV (76/688: 11%), and Type V (102/688; 15%). Eleven of 28 studies (241 ECAAs) reported treatment choice according to Attigah classification and revealed that the majority of Type I (82%), Type II (81%), Type III (91%), and Type IV (100%) ECAAs were treated via open surgery, while Type V ECAAs were evenly treated by open surgery and endovascular surgery. Twenty-three of 28 studies (780 ECAAs) reported treatment choice stratified by aneurysmal type. Of 417 true ECAAs, 88% were treated open surgically, 4% were treated endovascularly, and 8% were treated conservatively. Of 357 pseudoaneurysms, 67% were treated open surgically, 14% were treated endovascularly, and 19% were treated conservatively., Conclusions: Most reported patients with ECAAs are symptomatic. Type I and III account for more than two-thirds of ECAAs, while true aneurysms account for roughly half. The vast majority of ECAAs have been treated surgically with results comparable to reoperative carotid endarterectomy. In selected patients, endovascular treatment has been very successful with no reported morbidity or mortality., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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3. Duplex Ultrasound for Diagnosis of Failing Stents Placed for Lower Extremity Arterial Occlusive Disease.
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Zheng H, Calligaro KD, Jang J, Tyagi S, Madden N, Troutman DA, and Dougherty MJ
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- Blood Flow Velocity, Endovascular Procedures adverse effects, Femoral Artery physiopathology, Humans, Iliac Artery physiopathology, Peripheral Arterial Disease physiopathology, Popliteal Artery physiopathology, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Risk Factors, Time Factors, Treatment Failure, Vascular Patency, Endovascular Procedures instrumentation, Femoral Artery diagnostic imaging, Iliac Artery diagnostic imaging, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease therapy, Popliteal Artery diagnostic imaging, Stents, Ultrasonography, Doppler, Duplex
- Abstract
Background: Noninvasive diagnostic testing may be beneficial to identify stenotic (failing) stents placed for occlusive lower extremity peripheral arterial disease (LEPAD), especially if subsequent intervention proves useful in maintaining prolonged stent patency. We previously documented the benefit of surveillance duplex ultrasound (DU) for peripheral covered stents (stent grafts). The purpose of this study was to evaluate whether DU can reliably diagnose failing bare metal stents placed in iliac, femoral, and popliteal arteries for LEPAD., Methods: Between January 1, 2013, and December 31, 2016, 172 stents were placed for LEPAD in 119 arterial segments (1.4 stents/stenotic artery) in 110 patients who underwent one or more DU surveillance study documenting stent patency. Poststent DU surveillance was performed in our Intersocietal Accreditation Commission accredited noninvasive vascular lab at 1 week and then every 6 months. DU measured peak systolic velocities (PSVs) and ratio of adjacent PSVs (Vr) every 2.0 cm within the stent(s) and adjacent arteries. We retrospectively classified the following factors as "abnormal DU findings": focal PSVs >300 cm/s, uniform PSVs <45 cm/s, and Vr > 3.0., Results: During average follow-up of 22 months (range, 1 week-48 months), all three of these DU criteria were "normal" in 62 (52%) of the 119 stented segments. Of the other 57 (48%) stented arterial segments that had one or more abnormal DU findings, 40 underwent prophylactic intervention, 12 patients did not undergo intervention and subsequently occluded (5 patient refusal, 4 surgeon-decision, 3 shortened surveillance interval), and 5 remained patent after mean follow-up of 7.2 months. Of the 12 arterial segments that occluded, 6 patients chose not to have further intervention, 4 failed additional endovascular intervention and required an arterial bypass, and 2 required amputation. Therefore, of the 17 stented arterial segments with one or more abnormal DU findings that did not undergo intervention, 12 (70%) went on to occlude versus 2 of 62 (3%) with normal DU findings demonstrating an odds ratio of 72.0 (95% CI 12.5-415.6, P < 0.0001). Of these 12 stented arterial segments with abnormal DU findings that occluded, 7 had uniform low PSVs alone, 3 had both abnormal PSV and Vr's, and 2 had abnormal Vr's alone., Conclusions: DU surveillance can predict LEPAD stent occlusion. While PSV >300 cm/sec alone is not a statistically significant predictor of stent failure, Vr > 3.0, and most importantly, uniform PSVs <45 cm/s throughout the stent were statistically reliable markers for predicting stent thrombosis, while the absence of any of these abnormalities strongly predicted stent patency., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
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4. Peripheral Arterial Endovascular Procedures Performed in a Non-Hospital-Based Facility by First-Year Vascular Surgery Fellows.
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Pineda DM, Calligaro KD, Tyagi S, Troutman DA, Domenico L Jr, and Dougherty MJ
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- Aged, Ambulatory Surgical Procedures adverse effects, Ambulatory Surgical Procedures instrumentation, Clinical Competence, Curriculum, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Female, Humans, Male, Patient Safety, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease physiopathology, Program Evaluation, Retrospective Studies, Risk Factors, Stents, Treatment Outcome, Ambulatory Care Facilities, Ambulatory Surgical Procedures education, Education, Medical, Graduate methods, Endovascular Procedures education, Internship and Residency, Peripheral Arterial Disease surgery
- Abstract
Objective: Traditionally, vascular surgery fellows (VSFs) have learned to perform peripheral arterial endovascular procedures in a hospital setting. Many vascular surgeons currently perform these procedures in an "outpatient" non-hospital-based setting. Loss of these cases from the hospital setting may impact vascular surgery fellowship endovascular volume. We assessed the safety of first-year VSFs performing peripheral endovascular procedures under the supervision of vascular surgery attending surgeons in a non-hospital-based facility., Methods: Between January 1, 2012, and December 31, 2016, 166 patients underwent 193 endovascular procedures in a non-hospital-based ambulatory facility: 136 interventions (65 femoral, 40 iliac, 13 popliteal, and 9 infrapopliteal arteries) and 31 diagnostic arteriograms for claudication (57.8%; 85), rest pain (11.6%; 17), tissue loss (12.9%; 19), and failing grafts (17.7%; 26). Interventions included balloon angioplasty alone in 8.8% (12/136) of cases, stents in 16.9% (23/136), covered stents in 14% (19/136), atherectomy in 60.3% (82/136), and mechanical thrombolysis in 0.7% (1/136)., Results: First-year VSFs performed an increasing percentage of these procedures during this interval: academic year 2012 to 2013 = 0% (0/49), 2013 to 2014 = 31% (17/54), 2014 to 2015 = 93% (56/60), and 2015 to 2016 = 82% (57/70). All but 5 (3%) patients having 167 procedures were discharged home after 2 to 6 hours of bed rest without any 30-day adverse outcomes. Four patients were immediately transferred to our hospital after the intervention: 2 for respiratory issues (hypoxia), 1 for groin hematoma (observation only), and 1 for arterial occlusion (required tibial stent not available at outpatient center). One patient returned to our hospital with rest pain due to treatment site occlusion the following day., Conclusion: Our results demonstrate that complex peripheral arterial endovascular procedures can be performed safely by first-year VSFs under vascular attending supervision in an outpatient, non-hospital-based setting.
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- 2019
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5. Patient satisfaction and chronic illness are predictors of postendovascular aneurysm repair surveillance compliance.
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Tyagi SC, Calligaro KD, Fukuhara S, Greenberg J, Pineda DM, Zheng H, Dougherty MJ, and Troutman DA
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- Aneurysm diagnostic imaging, Aneurysm mortality, Aneurysm psychology, Chronic Disease, Comorbidity, Health Status, Humans, Postoperative Complications mortality, Predictive Value of Tests, Registries, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aneurysm surgery, Aortography methods, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Computed Tomography Angiography, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Patient Compliance, Patient Satisfaction, Postoperative Complications diagnostic imaging, Ultrasonography, Doppler, Duplex
- Abstract
Objective: Although lifelong surveillance is recommended by the Society for Vascular Surgery for patients undergoing endovascular aneurysm repair (EVAR) reported that compliance with long-term follow-up has been poor. We sought to identify factors that predict compliance with EVAR surveillance through analysis of patient variables and post-EVAR questionnaire results., Methods: We analyzed 28 patient variables gathered from our computerized registry, patient charts, and phone questionnaires of patients who underwent EVAR between January 1, 2010, and December 31, 2014. These factors included patient demographics, education, postoperative complications, satisfaction with vascular surgery care, transportation mode, distance to our medical center, and living situation. Compliance was defined as a patient who underwent the most recent recommended follow-up surveillance study within the prescribed timeframe. Post-EVAR surveillance protocol consisted of office evaluation and duplex ultrasound examination performed in our accredited noninvasive vascular laboratory at 1 week, 6 months, then annually. Computed tomography angiography was obtained only if duplex ultrasound examination suggested endoleak, sac enlargement of more than 5 mm, or a failing limb., Results: Of 144 patients who underwent EVAR during this time period, 89 patients (62%) were compliant with the most recent recommended follow-up study. One hundred two patients completed the questionnaire or their families did if patients died or were incapacitated. Of those, 80 were compliant with follow-up and 22 were not. Based on the questionnaires of these 102 patients, estimated compliance at 3 years after EVAR was 69.6 ± 6.0% based on Kaplan-Meier analysis. In the compliant vs noncompliant groups, the estimated 3-year survival rate was 93.2 ± 3.4% vs 52.4 ± 12.7%, respectively (P < .001), and the estimated 5-year survival rate was 83.1 ± 6.4% vs 34.4 ± 13.4%, respectively (P < .001), respectively. However, none of the mortalities observed in the noncompliant group were aneurysm related. Adverse neurologic events after EVAR demonstrated a trend predicting noncompliance after 5 years based on multivariate Cox regression analysis (hazard ratio [HR], 2.57; 95% confidence interval [CI], 0.95-6.90; P = .062). Patient dissatisfaction with their vascular surgeon and hospital care predicted noncompliance with recommended postoperative surveillance (HR, 5.0; 95% CI, 1.52-16.7; P = .008). College education or higher was associated with compliance (HR, 0.28; 95% CI, 0.06-1.23; P = .092). No other variables, including postoperative complications or distance from the hospital, predicted follow-up noncompliance., Conclusions: Patient satisfaction with their vascular surgeon and hospital experience predicted compliance with post-EVAR surveillance regardless of postoperative complications. Noncompliant patients had decreased survival, but mortality and surveillance noncompliance were likely due to disabling chronic disease., (Published by Elsevier Inc.)
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- 2019
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6. Outcomes of Brachial Artery Access for Endovascular Interventions.
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Madden NJ, Calligaro KD, Zheng H, Troutman DA, and Dougherty MJ
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- Aged, Catheterization, Peripheral adverse effects, Catheterization, Peripheral mortality, Databases, Factual, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Female, Humans, Male, Middle Aged, Postoperative Complications etiology, Punctures, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Vascular Diseases diagnostic imaging, Vascular Diseases mortality, Brachial Artery diagnostic imaging, Catheterization, Peripheral methods, Endovascular Procedures methods, Vascular Diseases surgery
- Abstract
Background: A percutaneous brachial artery (BA) approach is a suitable or even favorable alternative to femoral artery access when performing certain endovascular interventions. However, this approach may have a higher complication rate compared to femoral artery access. We analyzed our results using percutaneous BA approach for noncardiac endovascular interventions., Methods: Between January 1, 2003 and December 31, 2017, BA access was used in 157 cases performed on 136 patients. The procedures included 102 (65%) therapeutic interventions and 55 (35%) diagnostic studies. The vessels studied or treated included lower extremity arteries (48), the aorta and iliac arteries (45), mesenteric arteries (45), failing arterial revascularizations (24), renal arteries (9), subclavian arteries (8), carotid arteries (2), and visceral aneurysms (2), or in conjunction with endovascular aneurysm repair (EVAR), fenestrated EVAR, or thoracic EVAR (8). More than 1 vessel was studied or treated in 34 cases. Sheath sizes included 5F in 38 (24%) cases, 6F in 93 (59%) cases, and 7F in 26 (17%) cases. Percutaneous puncture was utilized in 142 (90.4%) cases and planned surgical exposure with primary closure of the BA in 15 (9.6%) cases (10, 7F; 4, 6F; 1, 5F). Manual compression was used for hemostasis at the conclusion of all percutaneous cases., Results: There were 2 (1.3%; 2/157 cases) deaths in the perioperative period, one due to myocardial infarction and the other from mesenteric ischemia. Access site complications occurred in 10.6% (15/142) of percutaneous cases, which required open surgical repair for bleeding (8) and BA thrombosis (7). There was an increased risk of complications with increasing sheath size in the percutaneous approach: 5.4% (2/37), 12.4% (11/89), and 12.5% (2/16) for 5F, 6F, and 7F sheaths, respectively (P = 0.49). None of the 15 patients who underwent surgical treatment suffered long-term vascular or neuropathic complications., Conclusions: In our experience, percutaneous BA access was associated with a 10% complication rate with an increased risk of complications associated with increasing sheath size. There was approximately the same incidence of bleeding as thrombosis. For patients who require 6 or 7F sheaths via a BA approach, we recommend more liberal use of open surgical exposure and primary BA repair., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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7. Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.
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Calligaro KD, Amankwah KS, D'Ayala M, Brown OW, Collins PS, Eslami MH, Jain KM, Kassavin DS, Propper B, Sarac TP, Shutze WP, and Webb TH
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- Certification standards, Clinical Competence standards, Education, Medical, Continuing standards, Education, Medical, Graduate standards, Endovascular Procedures education, Humans, Surgeons education, Vascular Surgical Procedures education, Endovascular Procedures standards, Medical Staff Privileges standards, Medical Staff, Hospital standards, Societies, Medical standards, Surgeons standards, Vascular Surgical Procedures standards
- Abstract
The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training. Second, applicants for new hospital privileges wishing to perform vascular surgery should have completed an Accreditation Council for Graduate Medical Education-accredited vascular surgery residency or fellowship or American Osteopathic Association-accredited training program before 2020 and should obtain American Board of Surgery certification in vascular surgery or American Osteopathic Association certification within 7 years of completion of their training. Third, we recommend that applicants for renewal of hospital privileges in vascular surgery include physicians who are board certified in vascular surgery, general surgery, or cardiothoracic surgery. These physicians with an established practice in vascular surgery should participate in Maintenance of Certification programs as established by the American Board of Surgery and maintain their respective board certification. Fourth, we provide recommendations concerning guidelines for endovascular procedures for vascular surgeons and other vascular interventionalists who are applying for new or renewed hospital privileges. All physicians performing open or endovascular procedures should track outcomes using nationally validated registries, ideally by the Vascular Quality Initiative. Fifth, we endorse the Intersocietal Accreditation Commission recommendations for noninvasive vascular laboratory interpretations and examinations to become a Registered Physician in Vascular Interpretation, which is included in the requirements for board eligibility in vascular surgery, but recommend that only physicians with demonstrated clinical experience in the diagnosis and management of vascular disease be allowed to interpret these studies., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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8. Late type II endoleaks after endovascular aneurysm repair require intervention more frequently than early type II endoleaks.
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Pineda DM, Calligaro KD, Tyagi S, Troutman DA, and Dougherty MJ
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- Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Rupture epidemiology, Aortic Rupture therapy, Aortography methods, Computed Tomography Angiography, Endoleak diagnostic imaging, Endoleak epidemiology, Humans, Ligation, Philadelphia epidemiology, Prevalence, Registries, Reoperation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Duplex, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Embolization, Therapeutic adverse effects, Endoleak therapy, Endovascular Procedures adverse effects
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Objective: Type II endoleaks (T2ELs) are commonly observed after endovascular aneurysm repair (EVAR). We sought to determine whether time at onset of T2ELs correlated with the need to intervene based on sac expansion or rupture., Methods: Between 1998 and 2015, 462 EVARs performed at our institution had duplex ultrasound surveillance in our accredited noninvasive vascular laboratory. Computed tomography and arteriography were reserved for abnormal duplex ultrasound findings. The need for intervention for T2ELs was classified according to time at onset after EVAR. Interventions for T2ELs were performed only for sac expansion >5 mm or rupture. We defined early-onset T2ELs as <1 year after EVAR and delayed or late onset as >1 year of follow-up., Results: Of the 462 EVARs, 96 patients (21%) developed T2ELs after implantation. Of these, 65 (68%) had early and 31 (32%) had late onset (mean, 12 months; range, 1-112 months). Early T2ELs resolved without treatment in 75% (49/65) of cases compared with only 29% (9/31) of late T2ELs (P < .0001). Intervention was required for only 8% (5/65) of patients with early T2ELs (5 sac expansions, 0 ruptures) compared with 55% (17/31) for late T2ELs (16 sac expansions, 1 rupture; P < .0001). The remaining patients were observed for persistent T2ELs with no sac growth (17% [11/65] early vs 16% [5/31] late; P = .922)., Conclusions: Less than one-third (29%) of T2ELs that develop after 1 year will resolve spontaneously and about half (55%) will require intervention for sac growth or rupture. T2ELs that develop >1 year after EVAR should be followed up with a more frequent surveillance protocol and perhaps with a lower threshold to intervene., (Copyright © 2017. Published by Elsevier Inc.)
- Published
- 2018
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9. The fate of endovascular aortic aneurysm repair after 5 years monitored with duplex ultrasound imaging.
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Pineda DM, Phillips ZM, Calligaro KD, Krol E, Dougherty MJ, Troutman DA, and Dietzek A
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- Aged, Aged, 80 and over, Aorta, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal mortality, Aortic Rupture diagnostic imaging, Aortic Rupture etiology, Aortic Rupture therapy, Aortography methods, Computed Tomography Angiography, Connecticut, Endoleak diagnostic imaging, Endoleak etiology, Endoleak therapy, Female, Humans, Male, Middle Aged, Philadelphia, Predictive Value of Tests, Registries, Retrospective Studies, Time Factors, Treatment Outcome, Aorta, Abdominal surgery, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Ultrasonography, Doppler, Duplex
- Abstract
Background: Interventions for aortic aneurysm sac growth have been reported across multiple time points after endovascular aortic aneurysm repair (EVAR). We report the long-term outcomes of patients after EVAR monitored with duplex ultrasound (DUS) imaging with respect to the need for and type of intervention after 5 years., Methods: We report a series of patients who were monitored with DUS imaging for a minimum of 5 years after EVAR. DUS imaging was performed in an accredited noninvasive vascular laboratory, and computed tomography angiography was only performed for abnormal DUS findings., Results: There were 156 patients who underwent EVAR with follow-up >5 years (mean, 7.5 years; range, 5.1-14.5 years). Interventions for endoleak, graft limb stenosis, or thrombosis were performed in 44 patients (28%) at some time during follow-up. Of the 156 patients, 34 (22%) underwent their first intervention during the first 5 years (25 endoleaks, 9 limb stenoses, or occlusions). Four ruptures occurred, all in patients with their first intervention before 5 years. The remaining 10 patients (6%) underwent a first intervention >5 years after implantation: 3 for type I endoleak, 2 for type II endoleak with sac expansion, 2 for combined type I and II endoleaks 2 for type III endoleak, and 1 unknown type., Conclusions: Long-term follow-up of EVAR (mean, 7.5 years) revealed that approximately one in four patients will require intervention at some point during follow-up. First-time interventions were necessary in 22% of all patients in the first 5 years and in 6% of patients after 5 years, highlighting the need for continued graft surveillance beyond 5 years. All patients who had a first-time intervention after 5 years underwent an endoleak repair; none of these patients had a thrombosed limb or a rupture as a result of the endoleak., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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10. Variability in 2-year training programs in vascular surgery based on results of an Association of Program Directors in Vascular Surgery survey.
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Calligaro KD, Pineda DM, Tyagi S, Zheng H, Troutman DA, and Dougherty MJ
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- Biomedical Research, Clinical Competence, Curriculum, Humans, Outpatient Clinics, Hospital, Personnel Staffing and Scheduling, Surveys and Questionnaires, Time Factors, United States, Workload, Education, Medical, Graduate methods, Endovascular Procedures education, Vascular Surgical Procedures education
- Abstract
Objective: Although a great deal of attention has recently focused on 5-year integrated (0+5) training programs in vascular surgery, a paucity of data exists concerning variability of daily assignments in 2-year (5+2) vascular fellowships., Methods: We polled Association of Program Directors in Vascular Surgery members with 2-year vascular fellowships to determine the number of days in a 5-day work week that first- and second-year fellows were assigned to open vascular operations, endovascular procedures (hospital vs nonhospital facility), arterial clinic, venous clinic, noninvasive vascular laboratory (NIVL), and research., Results: Of the 103 program directors from 5+2 vascular training programs, 102 (99%) responded. The most common schedule for both first- and second-year fellows was performing both open and endovascular procedures in the hospital on the same day 4 days of the week and spending time in combined artery and vein clinic 1 day of the week. Program directors developed different schedules for each year of the 2-year fellowship in about half (55% [56]) of the programs. A small minority of programs devoted days to only open surgical cases (13% [13]), a separate venous clinic (17% [17]), or a separate arterial clinic (11% [11]) and performed endovascular procedures in a nonhospital facility (15% [15]). All but three programs had mandatory time in clinic both years. Approximately one-third (30% [31]) of programs designated time devoted to research, whereas the others expected fellows to find time on their own. Although passing the Registered Physician in Vascular Interpretation examination is required, there was devoted time in the NIVL in only 60% (61) of programs., Conclusions: Training assignments in terms of time spent performing open and endovascular procedures and participating in clinic, the NIVL, and research varied widely among Accreditation Council for Graduate Medical Education-accredited 5+2 vascular fellowships and did not always fulfill Accreditation Council for Graduate Medical Education guidelines. In the current era of emphasis on endovascular-based interventions, few programs devoted days to purely open surgical procedures. Endovascular experience in a nonhospital facility (where these procedures will likely become more common in the future), outpatient venous procedures, and designated time devoted to the NIVL and research were lacking in many programs. These results provide a valid data set for the Association of Program Directors in Vascular Surgery to consider establishing guidelines for training assignments in 5+2 vascular training programs., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2017
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11. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease: Executive summary.
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Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, and Yamaguchi DJ
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- Chronic Disease, Clinical Trials as Topic standards, Consensus, Endovascular Procedures adverse effects, Humans, Ischemia diagnosis, Ischemia physiopathology, Peer Review, Research standards, Periodicals as Topic standards, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease physiopathology, Treatment Outcome, Data Collection standards, Endovascular Procedures standards, Ischemia therapy, Lower Extremity blood supply, Peripheral Arterial Disease therapy, Research Design standards
- Abstract
Recommended reporting standards for lower extremity ischemia were last published by the Society for Vascular Surgery in 1997. Since that time, there has been a proliferation of endovascular therapies for the treatment of chronic peripheral arterial disease. The purpose of this document is to clarify and update these standards, specifically for reports on endovascular treatment. The document is divided into sections: Claudication Reporting, Critical Limb Ischemia Reporting, Preintervention Assessment and Nonanatomic Treatment, Intervention, Outcome Measures - Procedural, Outcome Measures - Disease Specific, and Complications., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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12. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease.
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Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, and Yamaguchi DJ
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- Chronic Disease, Clinical Trials as Topic standards, Consensus, Endovascular Procedures adverse effects, Humans, Ischemia diagnosis, Ischemia physiopathology, Peer Review, Research standards, Periodicals as Topic standards, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease physiopathology, Treatment Outcome, Data Collection standards, Endovascular Procedures standards, Ischemia therapy, Lower Extremity blood supply, Peripheral Arterial Disease therapy, Research Design standards
- Abstract
Peripheral arterial disease (PAD) represents a spectrum from asymptomatic stenosis to limb-threatening ischemia. The last decade has seen a tremendous increase in the variety of endovascular devices and techniques to treat occlusive disease. Like many evolving technologies, the literature surrounding therapy for endovascular arterial disease consists of mixed-quality manuscripts without clear standardization. Accordingly, critical evaluation of the reported results may be problematic. As such, providers and their patients make treatment decisions without the full benefit of a comparative effectiveness framework. The purpose of this document is to provide a summary for the reporting of endovascular revascularization techniques in the setting of chronic disease. Much of the work in this document is based on prior publications and standards proposed by the Society for Vascular Surgery. We have also made recommendations based on current literature and have attempted to acknowledge shortcomings and areas for future research. The various sections contain summaries of required reporting standards and should serve as a guide for the design of clinical trials and as reference for journal editors and reviewers when considering scientific work pertaining to endovascular therapy for chronic lower extremity arterial disease. An Appendix is provided with commonly used abbreviations in this document., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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13. Surveillance Duplex Ultrasonography of Stent Grafts for Popliteal Aneurysms.
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Pineda DM, Troutman DA, Dougherty MJ, and Calligaro KD
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- Aged, Aged, 80 and over, Aneurysm diagnostic imaging, Aneurysm physiopathology, Blood Flow Velocity, Blood Vessel Prosthesis Implantation adverse effects, Databases, Factual, Endovascular Procedures adverse effects, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Popliteal Artery diagnostic imaging, Popliteal Artery physiopathology, Predictive Value of Tests, Retrospective Studies, Risk Factors, Thrombosis etiology, Thrombosis physiopathology, Time Factors, Treatment Outcome, Vascular Patency, Aneurysm surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Graft Occlusion, Vascular diagnostic imaging, Popliteal Artery surgery, Stents, Thrombosis diagnostic imaging, Ultrasonography, Doppler, Duplex
- Abstract
Objective: Stent grafts, also known as covered stents, have become an increasingly acceptable treatment for popliteal artery aneurysms. However, endovascular exclusion confers lower primary patency compared to traditional open bypass and exclusion. The purpose of this study was to evaluate whether duplex ultrasonography (DU) can reliably diagnose failing stent grafts placed for popliteal artery aneurysms prior to occlusion., Methods: Between June 5, 2007, and March 11, 2014, 21 stent grafts (Viabahn; Gore, Flagstaff, Arizona) were placed in 19 patients for popliteal artery aneurysms. All patients had at least 1 follow-up duplex scan postoperatively. Mean follow-up was 28.9 months (9-93 months). Postoperative DU surveillance was performed in our Intersocietal Accreditation Commission noninvasive vascular laboratory at 1 week postprocedure and every 6 months thereafter. Duplex ultrasonography measured peak systolic velocities (PSVs) and ratio of adjacent PSVs (Vr) every 5 cm within the stent graft and adjacent arteries., Results: We retrospectively classified the following factors as "abnormal DU findings": focal PSV > 300 cm/s, uniform PSVs < 50 cm/s throughout the graft, and Vr > 3.0. These DU criteria were derived from laboratory-specific data that we previously published on failing stent grafts placed for lower extremity occlusive disease. Four of the 21 stent grafts presented with symptomatic graft thrombosis within 6 months of a normal DU. Three of these 4 patients presented with rest pain and underwent thrombectomy (2) or vein bypass (1), and 1 elected for nonintervention for claudication., Conclusion: Our results suggest that surveillance DU using criteria established for grafts placed for occlusive disease may not be useful for predicting stent graft failure in popliteal artery aneurysms., (© The Author(s) 2016.)
- Published
- 2016
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14. Duplex ultrasound diagnosis of failing stent grafts placed for occlusive disease.
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Troutman DA, Madden NJ, Dougherty MJ, and Calligaro KD
- Subjects
- Arterial Occlusive Diseases diagnostic imaging, Blood Flow Velocity, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects, Graft Occlusion, Vascular physiopathology, Humans, Predictive Value of Tests, Prosthesis Design, Regional Blood Flow, Reproducibility of Results, Retrospective Studies, Risk Factors, Thrombosis physiopathology, Time Factors, Treatment Outcome, Vascular Patency, Arterial Occlusive Diseases surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Graft Occlusion, Vascular diagnostic imaging, Lower Extremity blood supply, Prosthesis Failure, Stents, Thrombosis diagnostic imaging, Ultrasonography, Doppler, Duplex
- Abstract
Objective: We previously showed that duplex ultrasound (DU) imaging is beneficial in the diagnosis of failing vein and prosthetic grafts performed for arterial occlusive disease. The purpose of this study was to evaluate whether DU imaging can reliably diagnose failing stent grafts (ie, covered stents) placed for arterial occlusive disease., Methods: Between July 1, 2005, and June 30, 2013, we placed 142 stent grafts in 92 arterial segments (1.5 stent grafts/stenotic artery) for lower extremity occlusive disease in patients who also underwent at least one DU surveillance study documenting a patent stent graft. Stent grafts were placed in 29 iliac and 52 femoropopliteal arteries and in 11 failing infrainguinal bypass grafts. Stent grafts used were Viabahn (W. L. Gore and Associates Inc, Flagstaff, Ariz) in 116 (82%), Wallgraft (Boston Scientific, Natick, Mass) in 23 (16%), Fluency (C. R. Bard Inc, Tempe, Ariz) in 2 (1%), and iCast (Atrium, Hudson, NH) in 1 (1%). Mean follow-up was 16 months (range, 1 week-86 months). Postoperative DU surveillance was performed in our Intersocietal Accreditation Commission accredited noninvasive vascular laboratory at 1 week, then every 3 months the first year, and every 6 months thereafter. DU measured peak systolic velocities (PSVs) and velocity ratio of adjacent PSVs (Vr) every 5 cm within the stent graft and adjacent arteries., Results: We retrospectively classified the following factors as "abnormal DU findings:" focal PSVs >300 cm/s, uniform PSVs <50 cm/s throughout the graft, and a Vr >3.0. Fifteen of 20 patients with one or more of these abnormal DU findings underwent prophylactic intervention (n = 8) or occluded without intervention (n = 7), whereas only two of 72 with normal DU findings occluded (P = .0001). Excluding the eight patients who underwent prophylactic intervention, seven of 12 patients with abnormal DU findings occluded without intervention vs two of 72 with normal DU findings (P = .0001)., Conclusions: These findings suggest that follow-up DU surveillance can predict failure of stent grafts placed for lower extremity occlusive disease. Focal PSVs >300 cm/s, Vr >3.0, and most importantly, uniform PSVs <50 cm/s throughout the stent graft were statistically reliable markers for predicting stent graft thrombosis., (Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
15. Endovascular aortic aneurysm repair surveillance may not be necessary for the first 3 years after an initially normal duplex postoperative study.
- Author
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Troutman DA, Chaudry M, Dougherty MJ, and Calligaro KD
- Subjects
- Aortic Aneurysm diagnostic imaging, Constriction, Pathologic, Endoleak etiology, Endoleak therapy, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular therapy, Humans, Postoperative Care, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Aortic Aneurysm surgery, Blood Vessel Prosthesis Implantation adverse effects, Endoleak diagnostic imaging, Endovascular Procedures adverse effects, Graft Occlusion, Vascular diagnostic imaging, Ultrasonography, Doppler, Duplex
- Abstract
Objective: We have previously shown that duplex ultrasonography (DU) may replace computed tomography angiography (CTA) as the primary surveillance tool for endovascular aortic aneurysm repair (EVAR). Current Society for Vascular Surgery practice guidelines suggest that if CTA does not document endoleak, aneurysm sac enlargement, or limb stenosis by 12 months after EVAR, surveillance studies may be performed annually. The purpose of this study was to determine whether the time to the second surveillance DU study can be safely postponed to 3 years after EVAR if the initial study finding is normal., Methods: Between 1998 and 2013, DU surveillance was performed in our accredited noninvasive vascular laboratory at 1 week, 6 months, and annually after 410 EVARs (follow-up: mean, 35 months; range, 0.5-151 months). DU was used to measure sac diameter, intrasac endoleak peak systolic velocities (PSVs), and PSVs within endograft limbs. If an endoleak, limb stenosis, or increase in sac size was documented, DU surveillance was performed more frequently or CTA was performed, followed by intervention if appropriate., Results: On the basis of DU surveillance, 113 patients (28%) were diagnosed with either endoleak or graft limb stenosis during the follow-up period. There were 95 patients (23%) with 118 endoleaks (15 [13%] type I, 90 [76%] type II, 11 [9%] type III, 2 [2%] type IV). There were 18 (4%) patients with limb stenosis defined as PSV >300 cm/s. Intervention was performed in 32 (28%) of the 113 patients with endoleak or limb stenosis, or in 8% of the total group (32 of 410), during the follow-up period of 0.5 to 151 months. Only 2.2% of the patients (7 of 325) with an initially normal finding on post-EVAR DU went on to develop endoleak or limb stenosis that required intervention during 3-year follow-up compared with 25% of patients (21 of 85) with an initially abnormal finding on post-EVAR DU (P = .0001)., Conclusions: These findings suggest that follow-up DU surveillance can be postponed until 3 years after EVAR if the initial result of surveillance DU is normal (no endoleak, sac enlargement, stenosis), with minimal risk of an adverse clinical event., (Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
16. Stent graft placement for a tracheoinnominate artery fistula.
- Author
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Troutman DA, Dougherty MJ, Spivack AI, and Calligaro KD
- Subjects
- Aged, Aneurysm, False diagnosis, Aneurysm, False etiology, Blood Vessel Prosthesis, Brachiocephalic Trunk diagnostic imaging, Carotid Artery, Common surgery, Fatal Outcome, Female, Heart Arrest, Hemoptysis etiology, Humans, Ligation, Prosthesis Design, Radiography, Recurrence, Respiratory Tract Fistula diagnosis, Respiratory Tract Fistula etiology, Stents, Subclavian Artery surgery, Tracheal Diseases diagnosis, Tracheal Diseases etiology, Treatment Outcome, Vascular Fistula diagnosis, Vascular Fistula etiology, Aneurysm, False surgery, Blood Vessel Prosthesis Implantation instrumentation, Brachiocephalic Trunk surgery, Endovascular Procedures instrumentation, Respiratory Tract Fistula surgery, Tracheal Diseases surgery, Tracheostomy adverse effects, Vascular Fistula surgery
- Abstract
A 68-year-old woman with ventilator-dependent respiratory failure and multiple comorbidities developed acute massive hemoptysis. Computed tomographic angiogram revealed a 3.9-cm pseudoaneurysm arising from the innominate artery abutting the trachea. The patient was successfully treated with stent graft insertion via the right common carotid artery, with exclusion of the aneurysm from the proximal innominate to the right common carotid artery, with ligation of the proximal right subclavian artery and right common carotid to subclavian artery bypass. The patient remained medically stable for 3 months after the procedure with no evidence of endoleak or infection. She then developed recurrent hemoptysis with fatal cardiac arrest. Open surgical repair has been the treatment of choice for tracheoinnominate artery fistula. However, direct repair confers a high mortality risk. Endovascular exclusion offers a less invasive treatment option for tracheoinnominate artery fistula and can serve as a bridge for patients with potential for becoming better surgical candidates., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
17. Updated strategies to treat acute arterial complications associated with total knee and hip arthroplasty.
- Author
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Troutman DA, Dougherty MJ, Spivack AI, and Calligaro KD
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Arteries injuries, Arteries surgery, Chi-Square Distribution, Female, Hospitals, High-Volume, Humans, Limb Salvage, Male, Middle Aged, Registries, Risk Factors, Time Factors, Treatment Outcome, Vascular System Injuries diagnosis, Vascular System Injuries etiology, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Knee adverse effects, Endovascular Procedures adverse effects, Endovascular Procedures trends, Vascular System Injuries therapy
- Abstract
Objective: Traditional treatment of acute arterial complications associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) has generally included arteriography followed by open surgery. The purpose of this study was to describe our evolution from open surgery to preferential endovascular treatment for acute arterial complications of TKA and THA., Methods: We analyzed our computerized database registry and patient charts for vascular interventions associated with TKA and THA at a hospital with a large volume of orthopedic surgery to determine changing trends in endovascular intervention for these complications., Results: Between 1989 and 2012, 39,196 TKA (26,374 total: 23,205 primary; 3169 revisions) and THA (12,822 total: 10,293 primary; 2529 revisions) were performed. Vascular surgery consultation was provided for the treatment of acute ischemia, hemorrhage, ischemia with hemorrhage, and pseudoaneurysm formation. All interventions were performed within 30 days of joint replacement. A total of 49 (0.13%) acute arterial complications occurred over the 23-year period: 37 (76%) associated with TKA and 12 (24%) with THA. Arterial injury was detected on the same day as the orthopedic procedure in 28 patients, between postoperative days 1 and 5 in 18 patients, and between postoperative days 5 and 30 in three patients. The arterial complications caused ischemia in 28 patients (58%), hemorrhage in six (12%), ischemia with hemorrhage in six (12%), and pseudoaneurysm in nine (18%). Treatment included solely endovascular intervention in 12 (25%), failed endovascular treatment converted to open surgery in one (2%), and open surgery alone in 36 (73%) patients. Before 2002, only 6% (2/32; 2 TKA) of patients were successfully treated with endovascular intervention compared with 59% (10/17; 9 TKA, 1 THA) after June 2002 (P = .0004). There was no mortality, and limb salvage was achieved in all patients., Conclusions: Although the majority of acute arterial complications after TKA and THA are diagnosed on the day of surgery, a high clinical awareness for acute arterial injury should also be present in the postoperative period. Although not always feasible, endovascular management is now our preferred treatment for injuries associated with TKA or THA. This offers substantially shorter time to vascular restoration, with less morbidity than open repair, and equivalent satisfactory outcomes., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
- Full Text
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18. Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device.
- Author
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Blom AS, Troutman D, Beeman B, Yarchoan M, Dougherty MJ, and Calligaro KD
- Subjects
- Blood Flow Velocity, Blood Vessel Prosthesis Implantation adverse effects, Chi-Square Distribution, Constriction, Pathologic, Endovascular Procedures adverse effects, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Philadelphia, Predictive Value of Tests, Prosthesis Design, Regional Blood Flow, Registries, Retrospective Studies, Sensitivity and Specificity, Time Factors, Treatment Outcome, Vascular Patency, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Graft Occlusion, Vascular diagnostic imaging, Prosthesis Failure, Ultrasonography, Doppler, Duplex
- Abstract
Objective: We attempted to correlate duplex ultrasound (DU) findings with the clinical outcome of graft limb stenosis or kinking after endovascular aneurysm repair (EVAR)., Methods: Between 1998 and 2010, 248 patients underwent EVAR and postoperative DU surveillance of 496 graft limbs in our accredited noninvasive vascular laboratory by one of three experienced technologists. Routine DU surveillance was performed 1 week, 6 months, and annually after EVAR. Peak systolic velocities (PSVs) were measured in the body and midportion and distal attachment site of both limbs of the graft, and adjacent PSV ratios were calculated., Results: None of 479 graft limbs with a PSV of <300 cm/s occluded during long-term follow-up (mean, 22.3 months; range, 1-123 months). Of 17 graft limbs with a PSV >300 cm/s, seven occluded (0 of 479 vs 7 of 17, P < .01; sensitivity, 100%; specificity, 98%), five underwent prophylactic intervention (mean adjacent PSV ratio, 7.3), and five (30%) remained patent without intervention (mean PSV ratio, 3.2)., Conclusions: This large series of DU surveillance for failing EVARs grafts suggests that graft limbs with PSVs <300 cm/s can be safely monitored. However, limbs with more elevated PSVs may benefit from prophylactic intervention or more frequent surveillance to prevent limb occlusion., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
- Full Text
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19. Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR.
- Author
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Beeman BR, Murtha K, Doerr K, McAfee-Bennett S, Dougherty MJ, and Calligaro KD
- Subjects
- Aortic Aneurysm, Abdominal physiopathology, Blood Vessel Prosthesis Implantation adverse effects, Endoleak etiology, Endoleak therapy, Endovascular Procedures adverse effects, Hemodynamics, Humans, Pennsylvania, Predictive Value of Tests, Prosthesis Design, Registries, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Color, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endoleak diagnostic imaging, Endovascular Procedures instrumentation, Prosthesis Failure, Ultrasonography, Doppler, Duplex
- Abstract
Objective: While the significance of type II endoleaks (T2ELs) on the long-term outcome of endovascular abdominal aneurysm repair (EVAR) to repair abdominal aortic aneurysms (AAAs) is debatable, duplex ultrasonography (DU) parameters have been suggested to be predictive of their closure or persistence. The purpose of this study was to determine which, if any, of these variables was associated with persistent T2EL or increased AAA sac diameter., Methods: Between 1998 and 2009, 278 patients underwent EVAR and post-operative DU surveillance during long-term follow-up (1-11 years) in our accredited non-invasive vascular laboratory by one of three experienced technologists. DU measured intra-sac flow velocity (IFV), spectral doppler waveform (SDW) patterns, post-EVAR sac diameter, and number of T2ELs., Results: T2ELs developed in 14% (38/278) of patients post-EVAR. Fourteen patients had T2ELs that resolved, and sac diameter decreased or remained the same: the average IFV was 42 cm/second; SDW patterns were monophasic in five, biphasic in seven and bidirectional in two; and multiple T2ELs were not present (0%) in any patient. Twelve patients had T2ELs that persisted, but sac diameter decreased or remained the same: the average IFV was 47 cm/second; SDW patterns were monophasic in one, biphasic in five, bidirectional in five, and undetermined in one; and multiple T2ELs were found in 17% (2) of patients. Twelve patients had T2ELs that persisted and were associated with increased sac diameter: the average IFV was 43 cm/second, SDW patterns were monophasic in one, biphasic in two, and bidirectional in nine; and multiple T2ELs were identified in 75% (9) of patients. None of the 38 patients with T2ELs treated with selective surgical or endovascular intervention for enlarging sac diameters (11/12) experienced a ruptured aneurysm., Conclusion: Contrary to previous smaller reports of T2ELs and DU surveillance, parameters such as IFV did not correlate with increased post-EVAR sac diameter. The presence of multiple T2ELs and bidirectional SDW may be the strongest factors predictive of increased sac diameter., (Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
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