108 results on '"Robert B. McLafferty"'
Search Results
2. List of contributors
- Author
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Jose Almeida, Lisa Amatangelo, Pier Luigi Antignani, Juliet Blakeslee-Carter, John Blebea, David A. Brown, Ruth L. Bush, Alberto Caggiati, Mabel Chan, Luca Costanzo, Michael C. Dalsing, Grant R. Darner, Ellen D. Dillavou, Yana Etkin, Giacomo Failla, Samuel Anthony Galea, Raudel Garcia, Monika L. Gloviczki, Peter Gloviczki, Manjit Gohel, Mark D. Iafrati, Enjae Jung, Raouf A. Khalil, Neil Khilnani, Nicos Labropoulos, John C. Lantis, Peter F. Lawrence, Byung-Boong Lee, Jani Lee, Sujin Lee, Marzia Lugli, Fedor Lurie, John G. Maijub, Oscar Maleti, Jovan N. Markovic, Rick Mathews, Robert B. McLafferty, Gregory L. Moneta, Giovanni Mosti, Olle Nelzén, Khanh P. Nguyen, Thomas F. O'Donnell, Michael Palmer, Francesco Paolo Palumbo, Hugo Partsch, Marc A. Passman, Michel Perrin, Joseph D. Raffetto, Seshadri Raju, Stanley G. Rockson, Taimur Saleem, Kimberly Scherer, Richard Simman, Julianne Stoughton, Matthew Sussman, Martin V. Taormina, Vibhor Wadhwa, Gregory G. Westin, Emma Wilton, and Jimmy Xia ScB
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- 2023
3. Surgical thrombectomy and percutaneous mechanical thrombectomy for treatment of acute iliofemoral deep venous thrombosis
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Robert B. McLafferty and Bo Eklof
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Mechanical thrombectomy ,medicine.medical_specialty ,Venous thrombosis ,Percutaneous ,business.industry ,medicine ,medicine.disease ,business ,Surgery - Published
- 2021
4. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep vein thrombosis
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Susan R. Kahn, Jim A. Julian, Clive Kearon, Chu-Shu Gu, David J. Cohen, Elizabeth A. Magnuson, Anthony J. Comerota, Samuel Z. Goldhaber, Michael R. Jaff, Mahmood K. Razavi, Andrei L. Kindzelski, Joseph R. Schneider, Paul Kim, Rabih Chaer, Akhilesh K. Sista, Robert B. McLafferty, John A. Kaufman, Brandt C. Wible, Morey Blinder, Suresh Vedantham, Michael Sichlau, Athanasios Vlahos, Steven Smith, Quinn Thalheimer, Nisha Singh, Rekha Harting, John Gocke, Scott Guth, Neel Shah, Paul Brady, Marvin Schatz, Mindy Horrow, Peyman Markazi, Leli Forouzan, Terence A.S. Matalon, David Hertzog, Swapna Goday, Margaret Kennedy, Robert Kaplan, Thomas Campbell, Jamie Hartman, Elmer Nahum, Arvind Venkat, Venkataramu Krishnamurthy, John Rectenwald, Peter Henke, Jonathan Eliason, Jonathon Willatt, Guillermo Escobar, Shaun Samuels, Barry Katzen, James Benenati, Alex Powell, Constantino Pena, Howard Wallach, Ripal Gandhi, Joseph Schneider, Stanley Kim, Farrah Hashemi, Joseph Boyle, Nilesh Patel, Michael Verta, Daniel Leung, Marc Garcia, Phillip Blatt, Jamil Khatri, Dave Epstein, Randall Ryan, Tom Sweeny, Michael Stillabower, George Kimbiris, Tuhina Raman, Paul Sierzenski, Lelia Getto, Michael Dignazio, Mark Horvath, Heather Gornik, John Bartholomew, Mehdi Shishehbor, Frank Peacock, Douglas Joseph, Soo Hyum Kim, Natalia Fendrikova Mahlay, Daniel Clair, Sean Lyden, Baljendra Kapoor, Gordon McLennon, Gregory Pierce, James Newman, James Spain, Amanjiit Gill, Aaron Hamilton, Anthony Rizzo, Woosup Park, Alan Dietzek, Ira Galin, Dahlia Plummer, Richard Hsu, Patrick Broderick, Andrew Keller, Sameer Sayeed, Dennis Slater, Herb Lustberg, Jan Akus, Robert Sidman, Mandeep Dhami, Phillip Kohanski, Anca Bulgaru, Renuka Dulala, James Burch, Dinesh Kapur, Jie Yang, Mark Ranson, Alan Wladis, David Varnagy, Tarek Mekhail, Robert Winter, Manuel Perez-Izquierdo, Stephen Motew, Robin Royd-Kranis, Raymond Workman, Scott Kribbs, Gerald Hogsette, Phillip Moore, Bradley Thomason, William Means, Richard Bonsall, John Stewart, Daniel Golwya, Ezana Azene, Wayne Bottner, William Bishop, Dave Clayton, Lincoln Gundersen, Jody Riherd, Irina Shakhnovich, Kurt Ziegelbein, Thomas Chang, Karun Sharma, Sandra Allison, Fil Banovac, Emil Cohen, Brendan Furlong, Craig Kessler, Mike McCullough, Jim Spies, Judith Lin, Scott Kaatz, Todd Getzen, Joseph Miller, Scott Schwartz, Loay Kabbani, David McVinnie, John Rundback, Joseph Manno, Richard Schwab, Randolph Cole, Kevin Herman, David Singh, Ravit Barkama, Amish Patel, Anthony Comerota, John Pigott, Andrew Seiwert, Ralph Whalen, Todd Russell, Zakaria Assi, Sahira Kazanjian, Jonathan Yobbagy, Brian Kaminski, Allan Kaufman, Garett Begeman, Robert DiSalle, Subash Thakur, Marc Jacquet, Thomas Dykes, Joseph Gerding, Christopher Baker, Mark Debiasto, Derek Mittleider, George Higgins, Steven Amberson, Roger Pezzuti, Thomas Gallagher, Robert Schainfeld, Stephan Wicky, Sanjeeva Kalva, Gregory Walker, Gloria Salazar, Benjamin Pomerantz, Virenda Patel, Christopher Kabrhel, Shams Iqbal, Suvranu Gangull, Rahmi Oklu, Scott Brannan, Sanjay Misra, Haraldur Bjarnason, Aneel Ashrani, Michael Caccavale, Chad Fleming, Jeremy Friese, John Heit, Manju Kalra, Thanila Macedo, Robert McBane, Michael McKusick, Andrew Stockland, David Woodrum, Waldemar Wysokinski, Adarsh Verma, Andrew Davis, Jerry Chung, David Nicker, Brian Anderson, Robert Stein, Michael Weiss, Parag Patel, William Rilling, Sean Tutton, Robert Hieb, Eric Hohenwalter, M. Riccardo Colella, James Gosset, Sarah White, Brian Lewis, Kellie Brown, Peter Rossi, Gary Seabrook, Marcelo Guimaraes, J. Bayne Selby, William McGary, Christopher Hannegan, Jacob Robison, Thomas Brothers, Bruce Elliott, Nitin Garg, M. Bret Anderson, Renan Uflacker, Claudio Schonholz, Laurence Raney, Charles Greenberg, John Kaufman, Frederick Keller, Kenneth Kolbeck, Gregory Landry, Erica Mitchell, Robert Barton, Thomas DeLoughery, Norman Kalbfleisch, Renee Minjarez, Paul Lakin, Timothy Liem, Gregory Moneta, Khashayar Farsad, Ross Fleischman, Loren French, Vasco Marques, Yasir Al−Hassani, Asad Sawar, Frank Taylor, Rajul Patel, Rahul Malhotra, Farah Hashemi, Marvin Padnick, Melissa Gurley, Fred Cucher, Ronald Sterrenberg, G. Reshmaal Deepthi, Gomes Cumaranatunge, Sumit Bhatla, Darick Jacobs, Eric Dolen, Pablo Gamboa, L. Mark Dean, Thomas Davis, John Lippert, Sanjeev Khanna, Brian Schirf, Jeffrey Silber, Donald Wood, J. Kevin McGraw, Lucy LaPerna, Paul Willette, Timothy Murphy, Joselyn Cerezo, Rajoo Dhangana, Sun Ho Ahn, Gregory Dubel, Richard Haas, Bryan Jay, Ethan Prince, Gregory Soares, James Klinger, Robert Lambiase, Gregory Jay, Robert Tubbs, Michael Beland, Chris Hampson, Ryan O'Hara, Chad Thompson, Aaron Frodsham, Fenwick Gardiner, Abdel Jaffan, Lawrence Keating, Abdul Zafar, Radica Alicic, Rodney Raabe, Jayson Brower, David McClellan, Thomas Pellow, Christopher Zylak, Joseph Davis, M. Kathleen Reilly, Kenneth Symington, Camerson Seibold, Ryan Nachreiner, Daniel Murray, Stephen Murray, Sandeep Saha, Gregory Luna, Kim Hodgson, Robert McLafferty, Douglas Hood, Colleen Moore, David Griffen, Darren Hurst, David Lubbers, Daniel Kim, Brent Warren, Jeremy Engel, D.P. Suresh, Eric VanderWoude, Rahul Razdan, Mark Hutchins, Terry Rounsborg, Madhu Midathada, Daniel Moravec, Joni Tilford, Joni Beckman, Mahmood Razavi, Kurt Openshaw, D. Preston Flanigan, Christopher Loh, Howard Dorne, Michael Chan, Jamie Thomas, Justin Psaila, Michael Ringold, Jay Fisher, Any Lipcomb, Timothy Oskin, Brandt Wible, Brendan Coleman, David Elliott, Gary Gaddis, C. Doug Cochran, Kannan Natarajan, Stewart Bick, Jeffrey Cooke, Ann Hedderman, Anne Greist, Lorrie Miller, Brandon Martinez, Vincent Flanders, Mark Underhill, Lawrence Hofmann, Daniel Sze, William Kuo, John Louie, Gloria Hwang, David Hovsepian, Nishita Kothary, Caroline Berube, Donald Schreiber, Brooke Jeffrey, Jonathan Schor, Jonathan Deitch, Kuldeep Singh, Barry Hahn, Brahim Ardolic, Shilip Gupta, Riyaz Bashir, Angara Koneti Rao, Manish Garg, Pravin Patil, Chad Zack, Gary Cohen, Frank Schmieder, Valdimir Lakhter, David Sacks, Robert Guay, Mark Scott, Karekin Cunningham, Adam Sigal, Terrence Cescon, Nick Leasure, Thiruvenkatasamy Dhurairaj, Patrick Muck, Kurt Knochel, Joann Lohr, Jose Barreau, Matthew Recht, Jayapandia Bhaskaran, Ranga Brahmamdam, David Draper, Apurva Mehta, James Maher, Melhem Sharafuddin, Steven Lentz, Andrew Nugent, William Sharp, Timothy Kresowik, Rachel Nicholson, Shiliang Sun, Fadi Youness, Luigi Pascarella, Charles Ray, Martha-Gracia Knuttinen, James Bui, Ron Gaba, Valerie Dobiesz, Ejaz Shamim, Sangeetha Nimmagadda, David Peace, Aarti Zain, Alison Palumto, Ziv Haskal, Jon Mark Hirshon, Howard Richard, Avelino Verceles, Jade Wong-You-Chong, Bertrand Othee, Rahul Patel, Bogdan Iliescu, David Williams, Joseph Gemmete, Wojciech Cwikiel, Kyung Cho, James Schields, Ranjith Vellody, Paula Novelli, Narasimham Dasika, Thomas Wakefield, Jeffrey Desmond, James Froehlich, Minhajuddin Khaja, David Hunter, Jafar Golzarian, Erik Cressman, Yvonne Dotta, Nate Schmiechen, John Marek, David Garcia, Isaac Tawil, Mark Langsfeld, Stephan Moll, Matthew Mauro, Joseph Stavas, Charles Burke, Robert Dixon, Hyeon Yu, Blair Keagy, Kyuny Kim, Raj Kasthuri, Nigel Key, Michael Makaroun, Robert Rhee, Jae−Sung Cho, Donald Baril, Luke Marone, Margaret Hseih, Kristian Feterik, Roy Smith, Geetha Jeyabalan, Jennifer Rogers, Russel Vinik, Dan Kinikini, Larry Kraiss, Michelle Mueller, Robert Pendleton, Matthew Rondina, Mark Sarfati, Nathan Wanner, Stacy Johnson, Christy Hopkins, Daniel Ihnat, John Angle, Alan Matsumoto, Nancy Harthun, Ulku Turba, Wael Saad, Brian Uthlaut, Srikant Nannapaneni, David Ling, Saher Sabri, John Kern, B. Gail Macik, George Hoke, Auh Wahn Park, James Stone, Benjamin Sneed, Scott Syverud, Kelly Davidson, Aditya Sharma, Luke Wilkins, Carl Black, Mark Asay, Daniel Hatch, Robert Smilanich, Craig Patten, S. Douglas Brown, Ryan Nielsen, William Alward, John Collins, Matthew Nokes, Randolph Geary, Matthew Edwards, Christopher Godshall, Pavel Levy, Ronald Winokur, Akhilesh Sista, David Madoff, Kyungmouk Lee, Bradley Pua, Maria DeSancho, Raffaele Milizia, Jing Gao, Gordon McLean, Sanualah Khalid, Larry Lewis, Nael Saad, Mark Thoelke, Robert Pallow, Seth Klein, Gregorio Sicard, Heather L. Gornik, Jim Julian, Stephen Kee, Lawrence Lewis, Elizabeth Magnuson, and Timothy P. Murphy
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Mechanical Thrombolysis ,medicine.medical_treatment ,Catheter directed thrombolysis ,030204 cardiovascular system & hematology ,Iliac Vein ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Quality of life ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Internal medicine ,Epidemiology ,Medicine ,Humans ,In patient ,Thrombolytic Therapy ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,Venous Thrombosis ,business.industry ,Thrombolysis ,Femoral Vein ,Middle Aged ,medicine.disease ,United States ,humanities ,3. Good health ,Venous thrombosis ,Treatment Outcome ,Quality of Life ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.
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- 2020
5. If you build it…Why won't they come?
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Robert B. McLafferty
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Health Knowledge, Attitudes, Practice ,business.industry ,Mentors ,Health Promotion ,Awareness ,Public relations ,United States ,Leadership ,Peripheral Arterial Disease ,Health promotion ,Patient Education as Topic ,Nursing ,Risk Factors ,Specialization (functional) ,Humans ,Medicine ,Surgery ,Voluntary Health Agencies ,Cardiology and Cardiovascular Medicine ,business ,Risk Reduction Behavior ,Vascular Surgical Procedures ,Societies, Medical ,Specialization - Published
- 2015
6. Advances in Operative Thrombectomy for Lower Extremity Venous Thrombosis
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Matthew C. Koopmann and Robert B. McLafferty
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medicine.medical_specialty ,030204 cardiovascular system & hematology ,030230 surgery ,Perioperative Care ,Postthrombotic Syndrome ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Thrombolytic Agent ,Humans ,In patient ,Thrombus ,Vein ,Contraindication ,Thrombectomy ,Venous Thrombosis ,business.industry ,medicine.disease ,Thrombosis ,Surgery ,Venous thrombosis ,medicine.anatomical_structure ,Lower Extremity ,Stents ,business ,Complication - Abstract
Lower extremity deep venous thrombosis is a leading cause of morbidity and mortality. The mainstay of therapy is medical. However, anticoagulation does not remove the thrombus and restore venous patency. In select patients, early thrombus removal and anticoagulation can restore venous patency, preserve venous valve function, and may reduce the incidence of postthrombotic syndrome. Catheter-directed therapies are minimally invasive with low complication rates. However, in patients with a contraindication to thrombolytic agents who can receive anticoagulation, open thrombectomy should be considered if indications for thrombus removal are met and patients are good operative risks.
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- 2018
7. Wound Care Management for Venous Ulcers
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Sheena K. Harris, Dale G. Wilson, and Robert B. McLafferty
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medicine.medical_specialty ,Wound care ,Calf muscle pump ,business.industry ,medicine ,Venous reflux ,Arterial perfusion ,Intensive care medicine ,business ,Venous Obstruction - Abstract
This chapter discusses the evaluation and management of venous ulcers. Successful treatment of venous ulcers depends upon following essential steps as based on current evidence in order to maximize success. These steps include confirming adequate arterial perfusion, eliminating edema, treating infection and biofilm, addressing venous reflux, alleviating venous obstruction, and reducing the impact of host risk factors and comorbidities. Such factors as reduction in obesity, improvement in calf muscle pump dysfunction, elimination of smoking, reduction of standing, and maximizing nutrition remain paramount to healing. Comprehensive wound centers may be better poised to offer this care in a coordinated fashion that helps incorporate a more patient-centric approach.
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- 2017
8. Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit
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Bryant J. McLafferty, Gregory L. Moneta, Enjae Jung, Robert B. McLafferty, Daniel S. Ahn, Amir F. Azarbal, Cherrie Z. Abraham, Gregory J. Landry, Courtney J. Mostul, Timothy K. Liem, and Erica L. Mitchell
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Adult ,Male ,Time Factors ,medicine.medical_treatment ,Critical Illness ,Ischemia ,030204 cardiovascular system & hematology ,Amputation, Surgical ,law.invention ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,Patient Admission ,law ,Risk Factors ,Catheterization, Peripheral ,Medicine ,Humans ,Vasoconstrictor Agents ,030212 general & internal medicine ,Photoplethysmography ,Dialysis ,Aged ,Retrospective Studies ,Aspirin ,business.industry ,Hazard ratio ,Anticoagulants ,Vasospasm ,Middle Aged ,medicine.disease ,Intensive care unit ,Intensive Care Units ,Treatment Outcome ,Amputation ,Regional Blood Flow ,Anesthesia ,Arterial line ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Objective Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. Methods All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded. ICU patients were compared with concurrently evaluated non-ICU inpatients with finger ischemia. Results There were 98 ICU patients (55 male, 43 female) identified. The mean age was 57.1 ± 16.8 years. Of these patients, 42 (43%) were in the surgical ICU and 56 (57%) in the medical ICU. Seventy (72%) had abnormal findings on finger photoplethysmography, 40 (69%) unilateral and 30 (31%) bilateral. Thirty-six (37%) had ischemia associated with an arterial line. Twelve (13%) had concomitant toe ischemia. Eighty (82%) were receiving vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (31%), epinephrine (26%), and vasopressin (24%). Treatment was with anticoagulation in 88 (90%; therapeutic, 48%; prophylactic, 42%) and antiplatelet agents in 59 (60%; aspirin, 51%; clopidogrel, 15%). Other frequently associated conditions included mechanical ventilation at time of diagnosis (37%), diabetes (34%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Only five patients (5%) ultimately required finger amputation. The 30-day, 1-year, and 3-year survival was 84%, 69%, and 59%. By Cox proportional hazards modeling, cancer (hazard ratio, 2.4; 95% confidence interval, 1.1-5.6; P = .035) was an independent predictor of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P = .05) and hyperlipidemia (42% vs 24%; P = .03) and to undergo finger amputations (16% vs 5%; P = .03). Conclusions Finger ischemia in the ICU is frequently associated with the presence of arterial lines and the use of vasopressor medications, of which phenylephrine and norepinephrine are most frequent. Anticoagulation or antiplatelet therapy is appropriate treatment. Whereas progression to amputation is rare, patients with finger ischemia in the ICU have a high rate of mortality, particularly in the presence of cancer. Non-ICU patients hospitalized with finger ischemia more frequently require finger amputations, probably because of more frequent connective tissue disorders.
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- 2017
9. Diagnostic algorithm for telangiectasia, varicose veins, and venous ulcers: Current guidelines
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Robert B. Mclafferty
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business.industry ,Varicose veins ,Valvular incompetence ,medicine ,Signs and symptoms ,medicine.symptom ,Venous disease ,Telangiectasia ,business ,Algorithm ,Venous Obstruction ,Strain gauge plethysmography - Abstract
This chapter describes an orderly process of making a diagnosis for a patient with chronic venous disease (CVD). It focuses on telangiectasia, varicose veins, and venous ulcers. CVD is a common affliction, with telangiectasia being found in the large majority of people who are over 60 years old. Patients presenting with venous ulcers should be questioned in a similar manner. Other pertinent questions relevant to a venous ulcer include location, size, appearance, and whether there are signs and symptoms of infection present. Clusters of telangiectasias can appear as skin blemishes or venous lakes. Varicose veins that continue to be visualized or are slow to dissipate may also suggest the presence of significant venous obstruction. Venous outflow is typically measured with impedance and strain gauge plethysmography. Increased resistance to venous outflow in combination with valvular incompetence can be responsible for the more recalcitrant ulcer. The chapter discusses the algorithm emphasizes diagnostic options in a logical order.
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- 2017
10. A Comparison Between the HeRO Graft and Conventional Arteriovenous Grafts in Hemodialysis Patients
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Marc H. Glickman, Lisa Thackeray, Eric K. Peden, George M. Nassar, Jeffrey H. Lawson, J. Kevin Croston, Howard E. Katzman, Robert B. McLafferty, Joseph I. Zarge, and Jeffrey M. Martinez
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Prosthesis Design ,Upper Extremity ,Young Adult ,Arteriovenous Shunt, Surgical ,Blood vessel prosthesis ,Occlusion ,medicine ,Humans ,HERO ,Vascular Patency ,Dialysis ,Aged ,business.industry ,Graft Occlusion, Vascular ,Middle Aged ,Vascular surgery ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Stenosis ,surgical procedures, operative ,Nephrology ,Cohort ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business - Abstract
Venous stenosis and occlusion are a major cause of vascular access dysfunction and failure. The HeRO Graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. A randomized, multicenter study was conducted to evaluate the efficacy and safety of the HeRO Graft relative to conventional AV grafts. The design was to enroll 143 patients in a 2:1 randomization ratio between HeRO and conventional AV control groups. Data on 72 subjects (52 HeRO Graft and 20 AV graft controls) were obtained. The HeRO Graft and control cohorts were comparable in baseline characteristics. Adequacy of dialysis, bacteremia rates, and adverse events were consistent between groups. Twelve month Kaplan-Meier estimates for primary and secondary patency rates were 34.8% and 67.6% in the HeRO Graft cohort, and 30.6% and 58.4% in the control cohort. There was no statistical difference in terms of patency between groups. The rates of intervention were 2.2/year for HeRO Graft and 1.6/year for the control (p = 0.100). Median days to loss of secondary patency was 238 for HeRO Graft versus 102 for the control (p = 0.032). The HeRO Graft appears to provide similar patency, adequacy of dialysis, and bacteremia rates to those of conventional AV grafts.
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- 2014
11. In with the old, out with the new: The American Venous Forum leads the way
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Robert B. McLafferty
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business.industry ,media_common.quotation_subject ,Media studies ,Residency program ,Patience ,Mentorship ,Honor ,Wife ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Venous disease ,business ,media_common ,Front (military) - Abstract
American Venous Forum members, distinguished guests, and representatives from industry, welcome to the 25th Silver Anniversary Annual Meeting of the American Venous Forum (AVF) here in Phoenix, Arizona. What an honor it has been to serve as your President over the past year. I am extremely humbled by this opportunity and have often felt that the only reason for my own success is that I have truly stood on the shoulders of giants in the field of venous disease. So many, both here and away, past and present, have had a profound influence on me and have ever so shaped who I am. First and foremost, I could not have made it through this year were it not for all the sacrifices put forth by my lovely wife, Erica. This past year marks 20 years of marriage for us and it has been a wonderful journey. It takes an even more special person to let someone else’s career be front and center, yet Erica’s own success as Professor of Obstetrics and Gynecology, university division chair, residency program director, accomplished clinician, devoted mother, supportive wife, and dear friend, keeps me in awe each and every day. I would not be here if it were not for you. To our son Bryant, and our daughter Lesley, thanks for all your support and patience e although I think you enjoyed watching me fumble through preparing dinners while trying to coordinate the many AVF conference calls. Both of you mean the world to your mother and I. A career in medicine, and particularly surgery, is privileged along every stage with the special opportunity of mentorship. It is part of our culture and we thrive on it. I have said to many that my abilities in academic surgery
- Published
- 2014
12. Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing
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Gregory L. Moneta, Amir F. Azarbal, Younes Jahangiri, Robert B. McLafferty, Nabil J. Alkayed, Gregory J. Landry, and Nasibeh Vatankhah
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medicine.medical_specialty ,Multivariate analysis ,business.industry ,Surrogate endpoint ,medicine.medical_treatment ,fungi ,Odds ratio ,030204 cardiovascular system & hematology ,Systemic inflammation ,medicine.disease ,Diabetic foot ,Article ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Amputation ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,medicine.symptom ,Neutrophil to lymphocyte ratio ,Cardiology and Cardiovascular Medicine ,Wound healing ,business - Abstract
Objective The neutrophil-to-lymphocyte ratio (NLR) has been used as a surrogate marker of systemic inflammation. We sought to investigate the association between NLR and wound healing in diabetic wounds. Methods The outcomes of 120 diabetic foot ulcers in 101 patients referred from August 2011 to December 2014 were examined retrospectively. Demographic, patient-specific, and wound-specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing, minor amputation, major amputation, and chronic ulcer. Results The subjects' mean age was 59.4 ± 13.0 years, and 67 (66%) were male. Final outcome was complete healing in 24 ulcers (20%), minor amputation in 58 (48%) and major amputation in 16 (13%), and 22 chronic ulcers (18%) at the last follow-up (median follow-up time, 6.8 months). In multivariate analysis, higher NLR (odds ratio, 13.61; P = .01) was associated with higher odds of nonhealing. Conclusions NLR can predict odds of complete healing in diabetic foot ulcers independent of wound infection and other factors.
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- 2016
13. Multicenter assessment of the repeatability and reproducibility of the revised Venous Clinical Severity Score (rVCSS)
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William A. Marston, Eberhard Rabe, Michael Vasquez, Cynthia K. Shortell, Fedor Lurie, Robert B. McLafferty, Joanne M. Lohr, Thomas W. Wakefield, and Marc A. Passman
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medicine.medical_specialty ,Pathology ,Reproducibility ,business.industry ,Repeatability ,Disease severity ,Physical therapy ,medicine ,Surgery ,In patient ,Clinical severity ,Cardiology and Cardiovascular Medicine ,Venous disease ,business ,Clinical evaluation ,Kappa - Abstract
The Venous Clinical Severity Score (VCSS) was designed and validated as an objective measure of disease severity in patients with chronic venous disease (CVD). Recently, a revision of the VCSS (rVCSS) was performed to resolve ambiguity in the clinical descriptors and improve clarity and ease of use. This new revised VCSS requires validation to determine its repeatability and reproducibility in clinical evaluation of patients with varying levels of CVD.A prospective multicenter protocol was designed to enroll patients undergoing evaluation for CVD at venous practices with experience using the original VCSS. At the time of initial evaluation, two clinicians independently assessed both lower extremities to determine the rVCSS and the CEAP clinical score. Between 1 and 6 weeks, patients returned and received repeat assessment of the rVCSS by the same two clinicians independently. Patients were excluded if any venous intervention occurred between the two separate evaluation visits. Scores were compared to determine inter- and intra-observer variability overall and within each CEAP clinical class.Seven centers enrolled a total of 136 limbs yielding 248 paired evaluations for interobserver variability and 258 paired evaluations for intraobserver variability. The mean interobserver rVCSS difference was 1.4 ± 1.7 and the mean intraobserver variability was 1.3 ± 1.6. Statistical assessment with weighted kappa yielded good repeatability (κ = 0.68; P .0001) and good reproducibility (κ = 0.72; P .000001) for the rVCSS. The rVCSS correlated well with the CEAP clinical class with significant differences between rVCSS in increasing classes. (P .0001).In this multicenter evaluation, the rVCSS was demonstrated to be a reliable and reproducible instrument for documentation of the severity of symptoms in patients with lower extremity venous insufficiency.
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- 2013
14. American Venous Registry - The First National Registry for the Treatment of Varicose Veins
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John Blebea, Lowell S. Kabnick, Jose I. Almeida, R. Kinsman, U. Onyeachom, Sesadri Raju, Michael C. Dalsing, Peter J. Pappas, Joseph D. Raffetto, Thomas W. Wakefield, Mark H. Meissner, Brajesh K. Lal, Robert B. McLafferty, J. Rectenwald, and David L. Gillespie
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Disease specific ,medicine.medical_specialty ,business.industry ,Gold standard ,Hemodynamics ,macromolecular substances ,Text mining ,Internal medicine ,Varicose veins ,Medicine ,Surgery ,National registry ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
VS between the patients’ symptoms and their clinical signs (P 1⁄4 .175 and r 1⁄4 .219). Conclusions: These results indicate that the VCSS and the C of CEAP may also be useful in the assessment of PTS severity, and that the VFI may provide a clinically meaningful hemodynamic evaluation. These results also confirm that the VS remains the gold standard disease specific assessment in the evaluation of PTS.
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- 2016
15. Use of Compression Therapy in Patients with Chronic Venous Insufficiency Undergoing Ablation Therapy: A Report from the American Venous Registry
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Jose I. Almeida, Brajesh K. Lal, Joseph D. Raffetto, J. Rectenwald, R. Kinsman, Thomas W. Wakefield, U. Onyeachom, David L. Gillespie, John Blebea, Robert B. McLafferty, Peter J. Pappas, and Lowell S. Kabnick
- Subjects
medicine.medical_specialty ,Text mining ,business.industry ,Chronic venous insufficiency ,Ablation Therapy ,Medicine ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Compression therapy ,medicine.disease - Published
- 2016
16. The Role of Intravascular Ultrasound in Venous Thromboembolism
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Robert B. McLafferty
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Venography ,equipment and supplies ,medicine.disease ,Venous Obstruction ,Inferior vena cava ,Article ,Catheter ,medicine.anatomical_structure ,Embolism ,medicine.vein ,Intravascular ultrasound ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Radiology ,Thrombus ,Cardiology and Cardiovascular Medicine ,Vein ,business - Abstract
Venous thromboembolism (VTE) remains a serious problem, and treatments surrounding this potentially life-threatening disease continue to evolve. Evidence-based guidelines purport the need for minimally invasive catheter-based procedures as part of the armamentarium to prevent and treat VTE. When the appropriate clinical scenarios arise, intravascular ultrasound (IVUS) becomes a necessary part of those procedures to provide alternative imaging that complements traditional venography. IVUS of the major axial veins provides a 360-degree two-dimensional gray scale ultrasound image of lumen and vessel wall structures. IVUS remains the criterion standard for venous imaging when contemplating catheter-based procedures from the common femoral vein to the inferior vena cava. Not only can precise location and size of these veins be determined by the IVUS probe from key landmarks and venous branches, but other important abnormalities can be visualized. These include external compression, acute and chronic thrombus, fibrosis, mural wall thickening, spurs, and trabeculations. Specific procedures that use IVUS include the treatment of venous obstruction and the placement of vena cava filters at the bedside. IVUS remains a vital part of accurately imaging the major axial veins when contemplating catheter-based procedures to prevent or treat VTE-related disorders.
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- 2012
17. Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program
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W. Todd Bohannon, Colleen M. Moore, Joann M. Lohr, Marc A. Passman, Robert B. McLafferty, Joseph A. Caprini, Jennifer A. Heller, Shardul B. Nagre, Mark D. Iafrati, Joseph R. Schneider, and Michelle F. Lentz
- Subjects
Male ,medicine.medical_specialty ,Chronic venous insufficiency ,Subgroup analysis ,Severity of Illness Index ,Veins ,Quality of life ,Internal medicine ,Severity of illness ,Varicose veins ,medicine ,Humans ,Vascular Diseases ,Stage (cooking) ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Cohort ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Lower limbs venous ultrasonography - Abstract
BackgroundSeveral standard venous assessment tools have been used as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of Venous Clinical Severity Scoring (VCSS) and its integration with other venous assessment tools as a global venous screening instrument.MethodsThe American Venous Forum (AVF), National Venous Screening Program (NVSP) data registry from 2007 to 2009 was queried for participants with complete datasets, including CEAP clinical staging, VCSS, modified Chronic Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound results. Statistical correlation trends were analyzed using Spearman's rank coefficient as related to VCSS.ResultsFive thousand eight hundred fourteen limbs in 2,907 participants were screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4: 7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range, 0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ± 0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33, induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112, ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation between CEAP and VCSS was moderately strong (rs = 0.49; P < .0001), with highest correlation for attributes reflecting more advanced disease, including varicose vein (rs = 0.51; P < .0001), pigmentation (rs = 0.39; P < .0001), inflammation (rs = 0.28; P < .0001), induration (rs = 0.22; P < .0001), and edema (rs = 0.21; P < .0001). Based on the modified CIVIQ assessment, overall mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ± 3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social 5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was moderately strong (rs = 0.43; P < .0001), with the highest correlation noted for pain (rs = 0.55; P < .0001) and edema (rs = 0.30; P < .0001). Based on screening venous ultrasound results, 38.1% of limbs had reflux and 1.5% obstruction in the femoral, saphenous, or popliteal vein segments. Correlation between overall venous ultrasound findings (reflux + obstruction) and VCSS was slightly positive (rs = 0.23; P < .0001) but was highest for varicose vein (rs = 0.32; P < .0001) and showed no correlation to swelling (rs = 0.06; P < .0001) and pain (rs = 0.003; P = .7947).ConclusionsWhile there is correlation between VCSS, CEAP, modified CIVIQ, and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. This observation may reflect that VCSS has more global application in determining overall severity of venous disease, while at the same time highlighting the strengths of the other venous assessment tools.
- Published
- 2011
18. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum
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Monika L. Gloviczki, Frank T. Padberg, Thomas W. Wakefield, Robert B. McLafferty, Marc A. Passman, Michael C. Dalsing, Anthony J. Comerota, Joann M. Lohr, Peter Gloviczki, M. Hassan Murad, David L. Gillespie, Peter J. Pappas, Mark H. Meissner, Joseph D. Raffetto, Michael Vasquez, and Bo Eklof
- Subjects
medicine.medical_specialty ,Chronic venous insufficiency ,medicine.medical_treatment ,Anterior accessory saphenous vein ,Risk Assessment ,Severity of Illness Index ,Varicose Veins ,Small saphenous vein ,Predictive Value of Tests ,Recurrence ,Compression Bandages ,Sclerotherapy ,Varicose veins ,Humans ,Medicine ,Vein ,Societies, Medical ,Evidence-Based Medicine ,business.industry ,Patient Selection ,Endovascular Procedures ,Great saphenous vein ,Cardiovascular Agents ,Pelvic congestion syndrome ,medicine.disease ,United States ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Venous Insufficiency ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C2; GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration >500 ms, vein diameter >3.5 mm) located underneath healed or active ulcers (CEAP class C5-C6; GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B). (J Vasc Surg 2011;53:2S-48S.)
- Published
- 2011
19. Evidence of prevention and treatment of postthrombotic syndrome
- Author
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Robert B. McLafferty
- Subjects
medicine.medical_specialty ,Treatment outcome ,Risk Assessment ,Postthrombotic Syndrome ,Varicose Ulcer ,Text mining ,Predictive Value of Tests ,Risk Factors ,Compression Bandages ,Preventive Health Services ,medicine ,Humans ,Thrombolytic Therapy ,Intensive care medicine ,Venous Thrombosis ,Evidence-Based Medicine ,business.industry ,Postthrombotic syndrome ,Evidence-based medicine ,medicine.disease ,Venous thrombosis ,Treatment Outcome ,Predictive value of tests ,Surgery ,business ,Risk assessment ,Cardiology and Cardiovascular Medicine - Published
- 2010
- Full Text
- View/download PDF
20. Tenth Meeting of the European Venous Forum: Copenhagen, Denmark, 5–7 June 2009
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K V Lyadov, M S Makaroun, D C Bogdanovic, M J Metcalfe, U Filizcan, B Lawaetz, J Alm, Ö Karabay, F J Casals, A L Sokolov, L. Leon, A Vaalasti, Bo Eklof, G Jones, A C Shepherd, L H Rasmussen, E A Alayunt, R Darcey, R A Wesley, Vinita Bahl, S. Gianesini, M Gohel, P Casoni, L Bjoern, O Iqbal, R Chang, M Mihmanlý, S S Gale, L V Philips, N Eren, M Ceviz, N Shadid, Evi Kalodiki, J. Roelens, E A Chen, Robert B. McLafferty, J Makanjuola, M. Vuylsteke, S V Lavrenko, Darrell A. Campbell, Nicos Labropoulos, M Kurtoǧlu, A Sommer, L K Marone, T H Shawker, T Hussain, Th De Bo, J A Reise, J J Franklin, M Jørgensen, P. Pittaluga, L Moro, K J Hodgson, C S Lim, Hugo Partsch, Apostolos K. Tassiopoulos, S. Chastanet, J-F Uhl, E A Mao, V. Mattaliano, M M Loutsenko, M Venermo, Sesadri Raju, D. J. Milic, D Bernaudo, Anthony J. Comerota, P Lebda, M Mobasheri, C Daniel, T Locret, J N Lee, S S Zivic, S Rao, Joseph A. Caprini, Antonios P. Gasparis, A W Kam, O Pichot, L P Jensen, S. Kakkos, D A Wyrick, M E Walsh, H S Huhtala, D Madut, M Wüst, M Lawaetz, Thomas W. Wakefield, N Görmüþ, A.M. van Rij, R A Chaer, M Vandendriessche, N Lozano, A Blemings, A. Cornu-Thenard, E Bateman, R Antonelli-Incalzi, H Ekim, S Papadoulas, Jean-François Uhl, M S Gohel, Peter K. Henke, P. Zamboni, G. Tacconi, B Partsch, C Lebard, Patrick H. Carpentier, Serge Mordon, C Moore, P Neglén, M K Horne, F Zuccarelli, J Saarinen, G Konig, T Kleffmann, D L Wojnarowski, R Y Rhee, M. Hamish, A Hjerppe, J Van Dorpe, M Chahim, A Liboni, I Ntouvas, A Dolgun, G Lampropoulos, P Muck, E Aslým, S Just, S A Leers, Alun H. Davies, D Saba, O Nelzén, Peter J. Pappas, S Ricci, P. D. Coleridge Smith, N Bækgaard, D Hood, A Palazzo, M Borge, S Kodati, J Lozier, C Adiguzel, P A Gatenby, A Thors, Y Akçalý, Georgios Spentzouris, V M Patel, C Köksoy, I Tsolakis, G. Mosti, J S Cho, R Broholm, H M Hu, George Geroulakos, and E. Menegatti
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Family medicine ,Medicine ,General Medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,030218 nuclear medicine & medical imaging - Published
- 2009
21. Techniques to Enhance Arteriovenous Fistula Maturation
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Robert B. McLafferty
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medicine.medical_specialty ,Fistula ,Treatment outcome ,Arteriovenous fistula ,Veins ,End stage renal disease ,Upper Extremity ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,medicine ,Humans ,Intensive care medicine ,Ligation ,Hemodialysis access ,Ultrasonography, Doppler, Duplex ,Intervention program ,business.industry ,Patient Selection ,medicine.disease ,Clinical Practice ,Treatment Outcome ,Education, Medical, Graduate ,Practice Guidelines as Topic ,Kidney Failure, Chronic ,Surgery ,Clinical Competence ,Clinical competence ,Cardiology and Cardiovascular Medicine ,business - Abstract
Maturation of an arteriovenous fistula remains an elusive step in obtaining a good functional hemodialysis access outcome. Considerable variability in the performance of access procedures exists between surgical practices that are not necessarily well justified. Herein, a brief overview of techniques is presented to help in maximize the potential for maturing an arteriovenous fistula. These include arm vein preservation, arm vein duplex mapping, branch ligation, staged transposition/ superficialization, and comprehensive follow-up and intervention program. Although definitive data may be lacking to show effectiveness in all areas reviewed, recommendations are made to help surgeons in working toward higher maturation rates. Further opportunities avail to developing clinical practice guidelines so as to give all end stage renal disease patients the best clinical experience.
- Published
- 2009
22. Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program
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Joanne M. Lohr, Thom W. Rooke, Michael C. Dalsing, Thomas W. Wakefield, Marc A. Passman, Joseph A. Caprini, Mark H. Meissner, Steven A. Markwell, Robert B. McLafferty, and Bo Eklof
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Population ,MEDLINE ,Pilot Projects ,Risk Assessment ,Severity of Illness Index ,Age Distribution ,Internal medicine ,Severity of illness ,Ethnicity ,medicine ,Humans ,Mass Screening ,Sex Distribution ,education ,Societies, Medical ,Aged ,Probability ,Aged, 80 and over ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,education.field_of_study ,business.industry ,Vascular disease ,Incidence ,Warfarin ,Reflux ,Awareness ,Middle Aged ,medicine.disease ,United States ,Surgery ,Venous Insufficiency ,Population Surveillance ,Chronic Disease ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Report card ,medicine.drug - Abstract
Objective To evaluate the results of the expanded National Venous Screening Program (NVSP) as administered by the American Venous Forum. Methods Eighty-three physicians across 40 states participated in screening Americans for venous disease. The NVSP instrument included demographics, venous thromboembolism (VTE) risk assessment, quality-of-life (QOL) assessment, duplex ultrasound scan for reflux and obstruction, and clinical inspection. Participants received educational materials and a report card to give their physician. Results A total of 2234 individuals underwent screening (mean, 26 people/site; range, 4-42). Demographic data observed included mean age of 60 years (range, 17-93 years); 77% female; 80% Caucasian; mean BMI of 29 (range, 11-68); 40% current or previous smoker; and 24% taking antiplatelet therapy and 4% taking warfarin. If placed in a situation conducive for VTE, 40% of participants were low risk, 22% were moderate risk, 21% were high risk, and 17% were very high risk. On a venous QOL assessment, 17% had a combined total score for all 11 questions of "very limited" or "impossible to do." Reflux or obstruction was noted in 37% and 5% of participants, respectively. CEAP class 0 to 6 was 29%, 29%, 23%, 10%, 9%, 1.5%, 0.5%, respectively. Discussion Despite a dramatic expansion in the second annual NSVP (from 17 to 83 centers), the presence of venous disease observed in a larger screened population continues to be high. The NVSP represents one pathway to increasing public awareness about venous disease.
- Published
- 2008
23. Endovascular Management of Deep Venous Thrombosis
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Robert B. McLafferty
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Catheterization ,Fibrinolytic Agents ,Intravascular ultrasound ,medicine ,Humans ,Thrombolytic Therapy ,cardiovascular diseases ,Thrombus ,Venous anatomy ,Ultrasonography, Interventional ,Thrombectomy ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Postthrombotic syndrome ,Ultrasound ,Equipment Design ,Thrombolysis ,medicine.disease ,Venous thrombosis ,Ultrasound guidance ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The past decade has witnessed new developments for the treatment of deep venous thrombosis (DVT) as well as more information about the virulent nature of DVT over the long term. Symptoms of pain, edema, skin changes, and/or ulceration can affect upwards of 70% of individuals to some degree. Studies have determined that early intervention of thrombus removal may help prevent postthrombotic syndrome in a significant number of patients. Several devices now specifically combine mechanical or ultrasound energy with chemical thrombolysis. These devices include the Trellis-8, Angiojet Power Pulse System, and the Ekos Endowave. Other important aspects central to successful endovascular removal of DVT include using ultrasound guidance for access, understanding venous anatomy and physiology in relation to endovascular techniques, knowing when to perform venous interventions, and using intravascular ultrasound. Endovascular removal of DVT is increasingly becoming the standard of care, particularly that affecting the iliofemoral segments.
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- 2008
24. Acute venous disease: Venous thrombosis and venous trauma
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Enrico Ascher, Aiwu Ruth He, Lazar J. Greenfield, Joseph A. Caprini, Thomas W. Wakefield, Robert B. McLafferty, Anil Hingorani, Mark H. Meissner, Peter K. Henke, Bo Eklof, Craig M. Kessler, Russell D. Hull, Robert D. McBane, David L. Gillespie, and Anthony J. Comerota
- Subjects
medicine.medical_specialty ,Population ,Thrombophlebitis ,Veins ,Risk Factors ,medicine ,Humans ,Thrombolytic Therapy ,cardiovascular diseases ,Thrombus ,Vein ,education ,Venous Thrombosis ,education.field_of_study ,business.industry ,Thromboembolism Prophylaxis ,medicine.disease ,Thrombosis ,Surgery ,Pulmonary embolism ,Venous thrombosis ,medicine.anatomical_structure ,Acute Disease ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Acute venous disorders include deep venous thrombosis, superficial venous thrombophlebitis, and venous trauma. Deep venous thrombosis (DVT) most often arises from the convergence of multiple genetic and acquired risk factors, with a variable estimated incidence of 56 to 160 cases per 100,000 population per year. Acute thrombosis is followed by an inflammatory response in the thrombus and vein wall leading to thrombus amplification, organization, and recanalization. Clinically, there is an exponential decrease in thrombus load over the first 6 months, with most recanalization occurring over the first 6 weeks after thrombosis. Pulmonary embolism (PE) and the post-thrombotic syndrome (PTS) are the most important acute and chronic complications of DVT. Despite the effectiveness of thromboembolism prophylaxis, appropriate measures are utilized in as few as one-third of at-risk patients. Once established, the treatment of venous thromboembolism (VTE) has been defined by randomized clinical trials, with appropriate anticoagulation constituting the mainstay of management. Despite its effectiveness in preventing recurrent VTE, anticoagulation alone imperfectly protects against PTS. Although randomized trials are currently lacking, at least some data suggests that catheter-directed thrombolysis or combined pharmaco-mechanical thrombectomy can reduce post-thrombotic symptoms and improve quality of life after acute ileofemoral DVT. Inferior vena caval filters continue to have a role among patients with contra-indications to, complications of, or failure of anticoagulation. However, an expanded role for retrievable filters for relative indications has yet to be clearly established. The incidence of superficial venous thrombophlebitis is likely under-reported, but it occurs in approximately 125,000 patients per year in the United States. Although the appropriate treatment remains controversial, recent investigations suggest that anticoagulation may be more effective than ligation in preventing DVT and PE. Venous injuries are similarly under-reported and the true incidence is unknown. Current recommendations include repair of injuries to the major proximal veins. If repair not safe or possible, ligation should be performed.
- Published
- 2007
25. Endovenous Laser Ablation of Varicose Veins: Review of Current Technologies and Clinical Outcome
- Author
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Colleen M. Johnson and Robert B. McLafferty
- Subjects
medicine.medical_specialty ,Chronic venous insufficiency ,Adult population ,030204 cardiovascular system & hematology ,Varicose Veins ,03 medical and health sciences ,0302 clinical medicine ,Varicose veins ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Saphenous Vein ,Radiology, Nuclear Medicine and imaging ,Venous Thrombosis ,business.industry ,General Medicine ,medicine.disease ,Surgery ,Laser Therapy ,Radiology ,medicine.symptom ,Burns ,Cardiology and Cardiovascular Medicine ,business ,Lower limbs venous ultrasonography ,Femoral Nerve ,030217 neurology & neurosurgery - Abstract
Symptomatic lower extremity varicose veins represent one of the most common vascular conditions in the adult population. Associated symptoms ranged from mild conditions such as fatigue, heaviness, and itching to more serious conditions such as skin discoloration and leg ulceration. The predominant causative factor of this condition is reflux of the great saphenous vein (GSV), which is traditionally treated with surgical saphenofemoral ligation and stripping of the incompetent saphenous vein. In recent years, there have been significant advances in saphenous vein ablation using percutaneous techniques, including the endovenous laser therapy (EVLT). In this article, the authors discuss the therapeutic evolution of this technology, theoretical basis of laser energy in GSV ablation, and procedural techniques of EVLT using duplex ultrasonography. Additional discussion of procedural-related complications, such as deep vein thrombosis, skin burn, saphenous nerve injury, and phletibis, and ecchymosis, are provided. Lastly, clinical results of EVLT in GSV ablation are discussed. Current literatures support EVLT as a safe and effective treatment option for varicosities caused by GSV incompetence.
- Published
- 2007
26. Characterization of tibial velocities by duplex ultrasound in severe peripheral arterial disease and controls
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Dale G. Wilson, Nicholas G. Robbins, Gregory L. Moneta, Robert B. McLafferty, Gregory J. Landry, Jeffrey D. Crawford, Lauren A. Harry, and Erica L. Mitchell
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Illness ,Ischemia ,030204 cardiovascular system & hematology ,Revascularization ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Predictive Value of Tests ,medicine.artery ,Internal medicine ,Medicine ,Humans ,Ankle Brachial Index ,Aged ,Retrospective Studies ,Gangrene ,Ultrasonography, Doppler, Duplex ,business.industry ,Critical limb ischemia ,Intermittent Claudication ,Middle Aged ,medicine.disease ,Popliteal artery ,Intermittent claudication ,Surgery ,Tibial Arteries ,medicine.anatomical_structure ,Regional Blood Flow ,Cardiology ,Female ,Ankle ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity ,Artery - Abstract
The relationship between tibiopopliteal velocities and peripheral arterial disease (PAD) severity is not well understood. We sought to characterize tibiopopliteal velocities in severe PAD and non-PAD control patients.Patients with an arterial duplex ultrasound (DUS) examination with PAD evaluated during a 5-year period were retrospectively compared with non-PAD controls. Control DUS examinations were collected sequentially during a 6-month period, retrospectively. PAD patients included those with lifestyle-limiting intermittent claudication warranting revascularization and patients with critical limb ischemia, defined as ischemic rest pain, gangrene, or a nonhealing ischemic ulcer. For each, tibial and popliteal artery peak systolic velocity (PSV) was measured at the proximal, mid, and distal segment of each artery, and a mean PSV for each artery was calculated. Mean PSV, ankle-brachial indices, peak ankle velocity (PAV), average ankle velocity (AAV), mean tibial velocity (MTV), and ankle-profunda index (API) were compared between the two groups using independent t-tests. PAV is the maximum PSV of the distal peroneal, posterior tibial (PT), or anterior tibial (AT) artery; AAV is the average PSV of the distal peroneal, PT, and AT arteries; MTV is calculated by first averaging the proximal, mid, and distal PSV for each tibial artery and then averaging the three means together; API is the AAV divided by proximal PSV of the profunda.DUS was available in 103 patients with PAD (68 patients with critical limb ischemia and 35 patients with intermittent claudication) and 68 controls. Mean ankle-brachial index in the PAD group was 0.64 ± 0.25 compared with 1.08 ± 0.09 in controls (P = .006). Mean PSVs were significantly lower in PAD patients than in controls at the popliteal (64.6 ± 42.2 vs 76.2 ± 29.6; P = .037), peroneal (34.3 ± 26.4 vs 53.8 ± 23.3; P.001), AT (43.7 ± 31.4 vs 65.4 ± 25.0; P.001), and PT (43.4 ± 42.3 vs 74.1 ± 30.6; P.001) and higher at the profunda (131.5 ± 88.0 vs 96.2 ± 44.8; P = .001). Tibial parameters including PAV (52.6 ± 45.0 vs 86.9 ± 35.7; P.001), AAV (37.4 ± 26.4 vs 64.5 ± 21.7; P.001), MTV (41.7 ± 30.4 vs 65.4 ± 21.7; P.001), and API (0.43 ± 0.45 vs 0.75 ± 0.30; P.001) were significantly lower in the PAD group than in controls. Nonoverlapping 95% confidence interval reference ranges were established for severe PAD and non-PAD controls.This study aims to characterize lower extremity arterial PSVs and ankle parameters in severe PAD and non-PAD controls. These early criteria establish reference ranges to guide vascular laboratory interpretation and clinical decision-making.
- Published
- 2015
27. Office-Based Treatment of Venous Disease
- Author
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Robert B. McLafferty
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Varicose Veins ,Ambulatory care ,Sclerotherapy ,Varicose veins ,Ambulatory Care ,medicine ,Humans ,Vein ,Ambulatory phlebectomy ,business.industry ,Vascular surgery ,Physicians' Offices ,Surgery ,medicine.anatomical_structure ,Chronic Disease ,Catheter Ablation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Varices ,business ,Vascular Surgical Procedures - Abstract
Many recent developments in the care of venous disease have dramatically changed the options for office-based treatments. Traditionally relegated to patient education, compression, and wound care, office-based care is witnessing a dramatic change in treatment of patients particularly diagnosed with the full spectrum of chronic venous disease. These treatments primarily involve sclerotherapy, ambulatory phlebectomy, and percutaneous venous ablation. Although these procedures can be delivered in a general vascular surgery clinic, more effective and streamlined care may be best provided by forming a specialty vein clinic created specifically for patients with varicose veins or all stages of chronic venous disease. An overview about sclerotherapy, ambulatory phlebectomy, and percutaneous venous ablation treatments that can be safely performed in the office and the benefits of forming a clinic dedicated only to venous treatment are present.
- Published
- 2006
28. Surgeon communication behaviors that lead patients to not recommend the surgeon to family members or friends: Analysis and impact
- Author
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Gary L. Dunnington, Andrew D. Lambert, Reed G. Williams, and Robert B. McLafferty
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Adult ,Male ,Physician-Patient Relations ,Pediatrics ,medicine.medical_specialty ,Adolescent ,business.industry ,Communication ,MEDLINE ,Surgery clinic ,Friends ,Middle Aged ,Patient Acceptance of Health Care ,Patient satisfaction ,Patient Satisfaction ,General Surgery ,Surveys and Questionnaires ,Family medicine ,Humans ,Medicine ,Family ,Female ,Surgery ,In patient ,business - Abstract
Background This study analyzes specific elements of physician communication that lead patients to not recommend surgeons to family members or friends (FMoFs). Methods Patients completed questionnaires after surgery clinic encounters. Questionnaires addressed whether surgeons used optimal communication behaviors and whether patients would recommend the surgeon. Results A total of 1,514 questionnaires were completed for 39 surgeons. Patients reported the following communication lapses: failure to ask whether the patient had questions (6.9% of occasions), failure to sit down (6.5%), use of words patients could not understand (5%), failure to educate patients about their condition (4.3%), failure to introduce themselves (4%), lack of interest in patients as persons (2.4%), and inadequacies in answering questions (2%). Surgeons omitted at least one of these optimal behaviors in 16.3% of encounters. Surgeons were not recommended in 1.7% of encounters. Twelve surgeons (31%) were not recommended on at least 1 occasion. Behaviors omitted most commonly in encounters where patients wouldn’t recommend surgeons included failure to show interest in the patient (52%), explain their medical condition (52%), invite questions (40%), and answer questions (36%). Conclusions Extrapolating these results to 1,618 patient visits/surgeon/year, results in the following number of patients annually who do not recommend their surgeons: 15 for failure to adequately explain their medical condition, 15 for failure to show interest in them, 11 for failure to ask if the patient had questions, and 10 for failure to answer questions. Considering the ripple effect due to the number of a patient’s FMoFs, surgeons should be aware of the significant impact of even occasional lapses in optimal communication behaviors.
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- 2006
29. Closure of a Surgically Created Arteriovenous Fistula with a Covered Stent-Graft in a Patient with Venous Ambulatory Hypertension
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Don E. Ramsey, Robert B. McLafferty, Zachary C. Schmittling, and Kim J. Hodgson
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Fistula ,Arteriovenous fistula ,Femoral artery ,Iliac Vein ,030204 cardiovascular system & hematology ,Catheterization ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Arteriovenous Shunt, Surgical ,Postoperative Complications ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Venous Thrombosis ,Leg ,Vascular disease ,business.industry ,Stent ,Arteriovenous malformation ,General Medicine ,Femoral Vein ,medicine.disease ,Surgery ,Femoral Artery ,surgical procedures, operative ,Ambulatory ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Venous Pressure ,Common iliac vein - Abstract
The purpose of this paper is to report the use of a covered stent-graft in the endovascular treatment of a surgically created arteriovenous fistula. A 37-year-old woman with symptomatic venous ambulatory hypertension underwent a left common femoral vein-to-right common iliac vein bypass using 10 mm ringed polytetrafluoroethylene (PTFE) with creation of an arteriovenous (AV) fistula from the superficial femoral artery to the PTFE graft. At 1 year postoperatively, recurrent symptoms thought to be due to the arteriovenous fistula were treated by placement of an 8 mm x 10 cm Viabahn covered stent-graft. Placement was via crossover technique from the right common femoral artery using a 9 French sheath. At 2 months' follow-up symptoms had resolved, the AV fistula was occluded, and venous bypass remained patent. Focal arteriovenous fistulas of the proximal superficial femoral artery can be treated safely with a covered stent-graft via an endovascular approach.
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- 2005
30. Anesthesia Technique and Outcomes of Endovascular Aneurysm Repair
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Laura A. Gruneiro, Robert B. McLafferty, Tami Crabtree, Juan Ayerdi, Don E. Ramsey, Kim J. Hodgson, and Jose R. Parra
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Anesthesia, General ,Endovascular aneurysm repair ,Cohort Studies ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Postoperative Complications ,Sex Factors ,Anesthesia, Conduction ,Risk Factors ,Humans ,Medicine ,Local anesthesia ,Prospective Studies ,Retrospective Studies ,business.industry ,Age Factors ,Retrospective cohort study ,General Medicine ,medicine.disease ,Prosthesis Failure ,Surgery ,Survival Rate ,Clinical trial ,Treatment Outcome ,Anesthesia ,Anesthesia Recovery Period ,Anesthetic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anesthesia, Local ,Aortic Aneurysm, Abdominal ,Follow-Up Studies ,Abdominal surgery ,medicine.drug - Abstract
Anesthetic techniques vary widely in the endovascular repair of abdominal aortic aneurysms (EVAR). Previous studies have demonstrated the feasibility of using local anesthesia. However, the ideal anesthetic technique has not been determined. This study examines whether anesthetic technique influences the outcomes of EVAR. Data regarding demographics, risk factors, procedural characteristics, recovery characteristics, treatment complications, acute (30 day) medical complications, mortality, and anesthetic type were prospectively collected during the AneuRx phase II aortic endograft trial. Patient cohorts receiving general, regional, or local anesthesia were compared. From 1997 to 1998, 424 patients underwent EVAR at 13 sites using the AneuRx Bifurcated endograft. There were 279 patients in the general anesthesia group, 95 patients in the regional group, and 50 patients in the local group. Risk factors were similar. There were no significant differences in age, gender, American Society of Anesthesiologists grade, length of anesthesia, branch artery occlusions, proximal endoleaks, failed implants, or open surgical conversions. Cardiac, renal, and wound-healing complications were all lower in the local group. Mortality was equivalent among the three groups. (p0.05, ANOVA). From these results we concluded that EVAR with local anesthesia is a safe and efficacious method that may reduce recovery times and postoperative medical morbidity compared to use of general or spinal/epidural anesthesia.
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- 2005
31. Predictors of complications after a prospective evaluation of diagnostic and therapeutic endovascular procedures
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Steven J. Markwell, Christopher H. Lee, Jeffrey S. Danetz, Don E. Ramsey, Kim J. Hodgson, Zachary C. Schmittling, Juan Ayerdi, and Robert B. McLafferty
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Adult ,Male ,medicine.medical_specialty ,Demographics ,Adolescent ,Prospective evaluation ,Catheterization ,Postoperative Complications ,Predictive Value of Tests ,Risk Factors ,Medicine ,Humans ,Complication rate ,In patient ,Prospective Studies ,Vascular Diseases ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,Surgery ,Predictive value of tests ,Female ,Complication ,business ,Cardiology and Cardiovascular Medicine - Abstract
ObjectiveTo prospectively evaluate complications after diagnostic and therapeutic endovascular procedures (DTEPs) and determine what factors are predictive.MethodsFrom December 2002 to December 2003, all patients undergoing DTEPs performed by university vascular surgeons in a catheterization laboratory were prospectively evaluated. Medical demographics, procedure-related details, and type and severity of complications were recorded at the time of the procedure, during the first 24 hours, and at 2 to 4 weeks. Complications were classified as local vascular (LV), local nonvascular (LNV), systemic remote (SR), and major, minor, and nonsignificant.ResultsThree hundred-three DTEPs were performed (54.5% DEPs, 45.5% TEPs). At the time of DTEP, 28 complications occurred in 23 patients: 10 LV (3.3%), 15 LNV (5.0%), and 3 SR (1.0%). At 24 hours, 26 complications occurred in 25 patients: 5 LV (1.7%), 7 LNV (2.3%), and 14 SR (4.7%). At 2 to 4 weeks, 26 complications occurred 25 patients: 5 LV (1.7%), 7 LNV (2.3%), and 14 SR (4.7%). The combined major (7.3%) and minor (4.3%) complication rate attributed to DTEPs was 11.6%. Significant predictors (P < .05) by multivariate analysis included thrombolysis, prior stroke, an additional procedure during the study period, and diabetes mellitus (odds ratios: 9.1, 3.2, 2.7, and 2.4, respectively).ConclusionAccording to newly applied reporting standards, the prospective evaluation of DTEPs reveals that complications are uniformly distributed by type and follow-up period. Just over 1 in 10 patients will suffer either a major or minor complication. Potential predictors have been identified that may assist in patient selection and treatment plans to lower complications resulting from DTEPs.
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- 2004
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32. Characterization and Probability of Upper Extremity Deep Venous Thrombosis
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Kim J. Hodgson, Robert B. McLafferty, Don E. Ramsey, W. Todd Bohannon, and Zachary C. Schmittling
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Male ,medicine.medical_specialty ,Malignancy ,Duplex scanning ,Risk Factors ,medicine ,Edema ,Humans ,Retrospective Studies ,Ultrasonography ,Venous Thrombosis ,business.industry ,Retrospective cohort study ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Multivariate Analysis ,Arm ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Subclavian vein ,Abdominal surgery - Abstract
The objective of this study was to characterize patient demographics, risk factors, and anatomic distribution of upper extremity deep venous thrombosis (UEDVT) to develop a probability model for diagnosis. A retrospective review of all patients who underwent color-flow duplex scanning (CDS) for clinically suspected acute UEDVT over a 5-year period was performed. Patient risk factors and clinical symptoms were evaluated as predictors. Technically adequate complete CDS of 177 upper extremities (UEs) of arms were reviewed. CDS scanning identified acute UE venous thrombosis in 53 (30%) of the arms examined with deep system involvement in 40 (23%). Of the UEs affected, the subclavian was involved in 64%, the axillary in 25%, the internal jugular in 32%, the brachial in 36%, the cephalic in 32%, and the basilic in 47%. Multivariate analysis identified limb tenderness (odds ratio 9.3), history of central venous catheterization (odds ratio 7.0), and malignancy (odds ratio 2.9) as positive predictors for UEDVT. Erythema (odds ratio 0.12) and suspected pulmonary embolism (odds ration 0.06) were identified as negative predictors. A predictive model was designed from these variables. The anatomic distribution of UEDVT obtained from this study is consistent with previous reviews. Potential positive and negative risk factors can be identified from which a predictive model can be designed. Use of this model can help focus clinical suspicion, improve color-flow duplex utilization, and provide timely treatment with anticoagulation.
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- 2004
33. Pancreatitis Caused by Rheolytic Thrombolysis: An Unexpected Complication
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Kim J. Hodgson, Don E. Ramsey, Juan Ayerdi, Robert B. McLafferty, Zachary C. Schmittling, Lori A. Rolando, and Jeffrey S. Danetz
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Male ,Superior Vena Cava Syndrome ,medicine.medical_specialty ,Abdominal pain ,medicine.medical_treatment ,Revascularization ,Fibrinolytic Agents ,Mechanical Thrombolysis ,Ischemia ,Superior vena cava ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Radiology, Nuclear Medicine and imaging ,Renal Insufficiency, Chronic ,business.industry ,Thrombolysis ,Middle Aged ,medicine.disease ,Thrombosis ,Recombinant Proteins ,Surgery ,Lower Extremity ,Pancreatitis ,Tissue Plasminogen Activator ,Acute Disease ,Cardiology ,Acute pancreatitis ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Two patients developed acute pancreatitis after mechanical thrombolysis with use of the AngioJet system. Patient 1 had undergone a remote complex revascularization of the lower extremities and presented with acute ischemia after thrombosis of his composite distal bypass. Patient 2 presented with superior vena cava (SVC) syndrome and had thrombosis of the SVC and innominate veins. Despite dissimilar presentations, both patients had renal insufficiency, were treated with mechanical and chemical thrombolysis, and had extensive thrombus burden. The pathophysiology of acute pancreatitis in this setting is believed to be secondary to massive hemolysis in the presence of chronic renal insufficiency. This phenomenon should be considered in patients whom develop abdominal pain after mechanical thrombolysis.
- Published
- 2004
34. Selective venography versus nonselective venography before vena cava filter placement: evidence for more, not less
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Jeffrey S. Danetz, Robert B. McLafferty, Juan Ayerdi, Don E. Ramsey, Kim J. Hodgson, and Laura A. Gruneiro
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Male ,medicine.medical_specialty ,Vena Cava Filters ,Adolescent ,Venography ,Inferior vena cava ,Preoperative care ,Veins ,Thromboembolism ,Preoperative Care ,medicine ,Humans ,Vascular Diseases ,Thrombus ,Vein ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Phlebography ,medicine.disease ,medicine.anatomical_structure ,medicine.vein ,cardiovascular system ,Female ,Surgery ,Radiology ,Gonadal vein ,Renal vein ,business ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Subclavian vein - Abstract
ObjectiveWe undertook this study to determine whether additional use of selective venography, compared with nonselective venography alone, reveals more abnormal anatomic venous findings that lead to changes in vena cava filter (VCF) position.MethodsFrom January 1998 to June 2002, 94 patients underwent VCF placement by vascular surgeons at a university tertiary care center. Indications, techniques, decision analysis, and complications were reviewed. Nonselective venography and selective venography of the inferior vena cava (IVC) were evaluated for image quality, abnormal findings, aberrant anatomy, and the anatomic relationship of vertebral bodies to major venous tributaries.ResultsAbsolute and relative indications for VCF placement were 44% and 56%, respectively. Jugular, femoral, and subclavian vein approach was used in 47%, 47%, and 6% of patients, respectively. Seventy-three percent of VCFs were placed in the catheterization laboratory, 21% in the operating room, and 5% at the bedside. Nonselective venography was performed in 80 patients (85%), of whom 44% had undergone selective venography. At nonselective venography plus selective venography 7.5% of patients had an abnormal finding (IVC compression, n = 3; IVC thrombus, n = 2; tortuosity, n = 1). Similarly, 17.5% of patients had aberrant anatomy (accessory renal vein, n = 8; IVC duplication, n = 3; large low right gonadal vein, n = 2; megacava, n = 2). Nonselective venography plus selective venography demonstrated that 16% of VCFs required a major change in position, 10% of which were placed above the renal veins. Compared with nonselective venography alone, selective venography enabled detection of significantly more abnormal and aberrant findings (9% vs 49%; P < .001). Changes in VCF placement were necessary significantly more often in patients undergoing additional selective venography compared with nonselective venography alone (31% vs 4%; P = .003). In one patient in the series, a VCF was malpositioned in the iliac vein with intravascular ultrasound visualization.ConclusionWhen nonselective venography plus selective venography were performed, 23% of patients had either an abnormal finding or aberrant anatomy, and most of these required a major change in VCF position. Nonselective venography plus selective venography redefines the criterion standard and, because of limitations of other methods of vena cava visualization for VCF deployment, should be performed in most patients.
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- 2003
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35. Retrograde Endovascular Hypogastric Artery Preservation (REHAP) and Aortouniiliac (AUI) Endografting in the Management of Complex Aortoiliac Aneurysms
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Robert B. McLafferty, Laura A. Gruneiro, Juan Ayerdi, Don E. Ramsey, Jeffrey S. Danetz, Jose R. Parra, Theodore H. Teruya, Maurice M. Solis, and Kim J. Hodgson
- Subjects
medicine.medical_specialty ,Iliac Artery ,Pelvis ,Blood Vessel Prosthesis Implantation ,Ischemia ,Ectasia ,medicine.artery ,Humans ,Medicine ,cardiovascular diseases ,business.industry ,Arterial perfusion ,General Medicine ,Common iliac artery ,Internal iliac artery ,Aortic Aneurysm ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,cardiovascular system ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Aortic neck ,Artery ,Abdominal surgery - Abstract
The preservation of internal iliac artery (IIA) flow during endovascular repair of abdominal aortic aneurysms (er-AAA) remains a controversial area. Ectasia and aneurysmal disease of the iliac arteries represent a formidable challenge to the endovascular surgeon, particularly when aortic neck length and diameter are suitable for er-AAA. We describe a procedure to maintain arterial perfusion to the pelvis during er-AAA called retrograde endovascular hypogastric artery preservation (REHAP). This technique is particularly useful in the presence of common iliac artery (CIA) and internal iliac artery (IIA) aneurysms when pelvic perfusion to one IIA needs to be maintained. A Wallgraft is first placed from the IIA to the ipsilateral EIA followed by er-AAA using an aortouniiliac graft (AUI) and a femorofemoral bypass graft (BPG). This procedure represents one alternative to maintaining pelvic perfusion using standard endovascular and surgical techniques.
- Published
- 2003
36. Indications and outcomes of AneuRx Phase III trial versus use of commercial AneuRx stent graft
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Don E. Ramsey, Jose R. Parra, Steve Markwell, Maurice M. Solis, Kim J. Hodgson, Laura A. Gruneiro, Robert B. McLafferty, and Juan Ayerdi
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Aneurysm ,Multicenter trial ,medicine.artery ,medicine ,Humans ,Multicenter Studies as Topic ,Prospective Studies ,Aged ,Aged, 80 and over ,business.industry ,Patient Selection ,Stent ,Middle Aged ,Left Common Iliac Artery ,medicine.disease ,Common iliac artery ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Clinical Trials, Phase III as Topic ,Iliac Aneurysm ,Inclusion and exclusion criteria ,Female ,Stents ,Radiology ,business ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal - Abstract
Objective: Approval by the United States Food and Drug Administration of endoluminal repair of abdominal aortic aneurysm (AAA) with the AneuRx stent graft was based on the outcome of a multicenter trial in which patients met strict inclusion and exclusion criteria. Since widespread use of the commercially available graft, little information is available as to whether indications and outcomes have evolved. We examined this important issue at our institution. Methods: Data concerning indications, repair, and follow-up for all patients undergoing endoluminal repair of AAA was prospectively entered into a patient registry. Group 1 comprised consecutive patients enrolled in the AneuRx Phase III clinical trial between November 1998 and September 2000. Group 2 consisted of consecutive patients who underwent implantation of the commercially available AneuRx graft between May 1999 and June 2001. Results: Group 1 included 42 patients (mean age, 72 years), and group 2 included 54 patients (mean age, 73 years). Patient demographics and risk factors were similar between the two groups. Maximum aortic aneurysm diameter was significantly greater ( P =.021) in group 1 (55 mm ± 10.9 [SD] mm) compared with group 2 (52 ± 15.6 mm). Maximum infrarenal aortic neck length was significantly longer ( P =.022) in group 1 (30 ± 11.7 mm) than in group 2 (23 ± 12.0 mm). Maximum left common iliac artery diameter in group 1 (13.0 ± 3.2 mm) was significantly smaller ( P =.032) than that in group 2 (14 ± 6.5 mm). During follow-up, no differences were observed for number of endoleaks, subsequent interventions, or graft explantation between the two groups. Conclusions: In group 2 patients AAAs were significantly smaller, infrarenal aortic neck length was shorter, and left common iliac arteries were larger. Common iliac artery ectasia and aneurysmal disease has become another indication for use of the AneuRx commercial graft at our institution, with no significant differences in intermediate outcome. Given the possibility for evolving indications compared with trial inclusion and exclusion criteria, institutions that use the AneuRx commercial graft should prospectively monitor outcomes for quality assurance. (J Vasc Surg 2003;37:739-43.)
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- 2003
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37. Conformational changes associated with proximal seal zone failure in abdominal aortic endografts
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Maurice M. Solis, Don E. Ramsey, Laura A. Gruneiro, Jose R. Parra, Kim J. Hodgson, Robert B. McLafferty, and Juan Ayerdi
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Infrarenal aorta ,Endovascular aneurysm repair ,Aneurysm ,medicine.artery ,Medicine ,Humans ,Aorta, Abdominal ,Aged ,business.industry ,Vascular disease ,Abdominal aorta ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Blood Vessel Prosthesis ,Prosthesis Failure ,Concomitant ,cardiovascular system ,Female ,Radiology ,business ,Aortic body ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal - Abstract
Objective: Endovascular aneurysm repair (EVAR) has become a popular treatment for abdominal aortic aneurysm (AAA). This study examines conformational changes in the infrarenal aortas of patients in whom proximal seal zone failures (PSF) developed after EVAR. Methods: All 189 patients with aortic endograft underwent routine post-EVAR computed tomographic scan surveillance. Patients identified with proximal type I endoleaks, type III endoleaks, or proximal component separation without demonstrable endoleak underwent three-dimensional reconstruction of the computed tomographic scans from which measurements of the migration, length, volume, and angulation of the infrarenal aorta were made. Results: Five patients (3%) had PSF develop, four of whom had aortic extender cuffs. Although changes in the AAA volume and aortic neck angle were slight or variable, the mean AAA length increased 34 mm and the mean aortic body angulation increased 17 degrees ( P =.03 and.01, respectively). Lengthening and migration caused proximal component separation in four patients, with concomitant migration in two patients. Two patients underwent endovascular repair, two patients needed explantation of the endograft, and one patient awaits endovascular repair. Proximal component separation and type III endoleak recurred in one patient and were repaired with a custom-fitted graft. Conclusion: PSF of aortic endografts is associated with proximal angulation and lengthening of the infrarenal aorta. These findings reinforce the importance of proper initial deployment to minimize the need for aortic extender cuffs, which pose a risk of late endoleak development. (J Vasc Surg 2003;37:106-11.)
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- 2003
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38. Outcome of Venous Stasis Ulceration when Complicated by Arterial Occlusive Disease
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Kim J. Hodgson, Mark A. Mattos, S.T. Chaney, Don E. Ramsey, Robert B. McLafferty, William T. Bohannon, and Laura A. Gruneiro
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Male ,Arterial inflow ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Limb salvage ,Occlusive disease ,Arterial Occlusive Diseases ,Severity of Illness Index ,Varicose Ulcer ,Venous stasis ,Outcome Assessment, Health Care ,Humans ,Medicine ,Venous stasis ulcer, Arterial occlusive disease, Outcome ,Aged ,Retrospective Studies ,Aged, 80 and over ,Medicine(all) ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Wound area ,Amputation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Major amputation - Abstract
Objective: to report the outcome of patients with venous stasis ulceration (VSU) and severe arterial occlusive disease (AOD). Design: retrospective study. Methods: using the International Classification of Diseases (ICD-9), codes for VSU and AOD were cross-matched to identify patients from 1989 to 1999 at two tertiary hospitals. Entry into the study required the presence of a VSU and an ipsilateral procedure to improve AOD or major amputation during the same hospitalisation. Results: fourteen patients (15 extremities) with a mean age of 80 years (range: 47–93) were identified as having VSU and AOD. Mean duration of VSU up to the time of revascularisation or amputation was 6.4 years (range: 4 months–21 years). The mean number of VSUs per extremity was 2.1 and mean wound area was 71cm 2 . Mean ankle–brachial index was 0.46 (range: 0.10–0.78). Nine extremities (60%) had a bypass procedure, 3 (20%) had an interventional procedure, 1 (0.6%) had a lumbar sympathectomy, and 2 (13%) had an amputation. Over a mean follow-up of 2.8 years, 3 extremities (23%) healed of which 2 recurred. On last review, 11 patients with 12 afflicted extremities had expired. Nine of the remaining 10 extremities were not healed at the time of death. Eight of nine bypass grafts remained patent in follow-up or at death and subsequent limb salvage was 100%. Conclusions: combined VSU and AOD represents a rare condition predominantly found in elderly patients with multiple comorbidities. Few patients had complete healing despite an arterial inflow procedure and mortality was high over the short term.
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- 2002
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39. Pitfalls in Achieving the Dialysis Outcome Quality Initiative (DOQI) Guidelines for Hemodialysis Access
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Robert B. McLafferty, Kim J. Hodgson, Don E. Ramsey, Maurice S. Solis, Laura A. Gruneiro, and James K. Fullerton
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Adult ,Male ,medicine.medical_specialty ,Quality Assurance, Health Care ,Basilic Vein ,medicine.medical_treatment ,Physical examination ,Diabetes Complications ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Diabetes Mellitus ,medicine ,Humans ,Vein ,Dialysis ,Hemodialysis access ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Arteriovenous Fistula ,Practice Guidelines as Topic ,Female ,Illinois ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Abdominal surgery - Abstract
The Dialysis Outcome Quality Initiative (DOQI) mandates that 50% of permanent hemodialysis (HD) access be native arteriovenous fistulae (AVFs). Recent reports have shown that when these guidelines are followed, the percentage of new AVFs can exceed DOQI guidelines. From July 1998 to July 2001, 330 HD access procedures were performed in an academic tertiary care center. Patients were categorized into two groups. Group I followed DOQI guidelines and underwent history and physical examination; duplex vein mapping; use of basilic vein transposition; and a postoperative protocol to determine maturation and start needle access in a stepwise progression. Group II had history and physical examination and basilic vein transposition was not used. Patient data were retrospectively reviewed. Overall, 100 (31%) HD shunts were AVFs. Group I (42/183, 23%) had significantly less AVFs (p = 0.005) than group II (58/147, 39%). For first-time placement of HD access, there was no significant difference (p = 0.95) in the percentage of AVFs in group I (26/62, 42%) and group II (29/68, 43%). For patients with prior history of HD access, significantly less AVFs (p0.001) were placed in group I (16/121, 13%) than in group II (29/79, 37%). Group I had significantly less first-time HDS (P = 0.03) than group II, 34% VS. 46%, respectively. AVF maturation for hemodialysis occurred in 79% of group I and 71% of group II (P = 0.52). There were no significant differences (P0.05) when comparing age, gender, and incidence of diabetes between the two groups. AVF formation based largely on duplex vein mapping in group I and lack of basilic vein transposition in group II contributed to the inability to achieve DOQI guidelines. Integration of knowledge and practice among vascular surgeons may help to avoid these pitfalls.
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- 2002
40. The use of color-flow duplex scan for the detection of endoleaks
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Laura A. Karch, Don E. Ramsey, Bradford S. McCrary, Mark A. Mattos, Maurice M. Solis, Robert B. McLafferty, and Kim J. Hodgson
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Ultrasonography, Doppler, Duplex ,Duplex ultrasonography ,medicine.medical_specialty ,business.industry ,Abdominal aorta ,medicine.disease ,Sensitivity and Specificity ,Aortic aneurysm ,Aneurysm ,Predictive Value of Tests ,Predictive value of tests ,medicine.artery ,medicine ,Humans ,Duplex scan ,False Positive Reactions ,Surgery ,Color flow ,Tomography ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Objective: Computed tomographic (CT) scan represents the criterion standard for surveillance of endoleaks after endoluminal repair of abdominal aortic aneurysms (erAAAs). Given need for surveillance, risks, and expense of CT scan, the accuracy of color-flow duplex (CFD) scan after erAAA was determined. Methods: During a 43-month period, patients enrolled in phase II and III of the AneuRx Multicenter Clinical Trial at our institution underwent CFD scan 1 month after erAAA. Patients with CFD scan results that were positive for endoleak underwent CT scanning at 3 months after erAAA, and those with CFD scan results that were negative for endoleak underwent CT scanning at 6 months after erAAA. Results: Seven of 79 patients (9%) who underwent CFD and CT scanning had the diagnosis of endoleak. All endoleaks that were diagnosed with CT scan were detected with CFD scan. One patient had positive results for endoleak with CFD scan at 1 month and then negative results with CT scan at 3 months. Although this may represent resolution of endoleak, this case was counted as a false-positive result. When compared with CT scan, CFD scan had a sensitivity of 100%, specificity of 99%, positive predictive value of 88%, negative predictive value of 100%, and accuracy of 99%. Conclusion: CFD scan is an accurate test for the detection of endoleak after erAAA. In addition, most endoleaks diagnosed with CFD scan at 1 month continued to be present at 6 months. This important finding increases the emphasis on the use of this noninvasive test and may initiate earlier intervention of endoleak. (J Vasc Surg 2002;36:100-4.)
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- 2002
41. Endovascular management of iliac limb occlusion of bifurcated aortic endografts
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Laura A. Karch, Maurice M. Solis, Mark A. Mattos, Kim J. Hodgson, Robert B. McLafferty, W. Todd Bohannon, Jose R. Parra, and Don E. Ramsey
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Male ,Reoperation ,medicine.medical_specialty ,Arterial disease ,Arterial Occlusive Diseases ,Iliac Artery ,Postoperative Complications ,Occlusion ,Humans ,Medicine ,Endovascular treatment ,Aorta ,Aged ,Iliac artery ,Femorofemoral bypass ,business.industry ,Vascular disease ,Extremities ,Middle Aged ,medicine.disease ,Component separation ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Vascular Surgical Procedures ,Aortic Aneurysm, Abdominal - Abstract
Although aortic endograft iliac limb occlusion is an uncommon event, its treatment is problematic because standard surgical thrombectomy risks graft dislodgment or component separation. Although femorofemoral bypass grafting can restore perfusion to the affected limb, its longevity may be inferior to reestablishing patency of the endograft itself and represents a failure of the endograft procedure. With aortic endografts now commercially available, implanting surgeons must be aware of this important complication and well versed in all of the endovascular treatment options. We report three cases of endoluminal management of unilateral iliac limb occlusion of bifurcated aortic endografts.
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- 2002
42. Nasal methicillin-resistant Staphylococcus aureus colonization is associated with increased wound occurrence after major lower extremity amputation
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Greg Moneta, Robert B. McLafferty, Gregory J. Landry, Amir F. Azarbal, James M. Edwards, Timothy K. Liem, Erica L. Mitchell, and Sheena K. Harris
- Subjects
Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,medicine.medical_treatment ,Dehiscence ,Nose ,medicine.disease_cause ,Gastroenterology ,Amputation, Surgical ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Surgical Wound Dehiscence ,medicine ,Humans ,Surgical Wound Infection ,Dialysis ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Vascular disease ,Retrospective cohort study ,Staphylococcal Infections ,medicine.disease ,Methicillin-resistant Staphylococcus aureus ,Surgery ,Staphylococcus aureus ,Cardiology and Cardiovascular Medicine ,business - Abstract
Wound occurrence (WO) after major lower extremity amputation (MLEA) can be due to wound infection or sterile dehiscence. We sought to determine the association of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and other patient factors with overall WO, WO due to wound infection, and WO due to sterile dehiscence.The medical records of all patients undergoing MLEA from August 1, 2011, to November 1, 2013, were reviewed. Demographic data, hemoglobin A1c level, albumin concentration, dialysis dependence, peripheral vascular disease (PVD), nasal MRSA colonization, and diabetes mellitus (DM) were examined as variables. The overall WO rate was determined, and the cause of WO was categorized as either a sterile dehiscence or a wound infection.Eighty-three patients underwent 96 MLEAs during a 27-month period. The rates of overall WO, WO due to infection, and WO due to sterile dehiscence were 39%, 19%, and 19%, respectively (1% developed a traumatic wound). On univariate analysis, PVD, MRSA colonization, DM, and dialysis dependence were all associated with higher rates of overall WO (P.05). On multivariate analysis, MRSA colonization was associated with higher rates of overall WO (P = .03) and WO due to wound infection (11% vs 45%; P.01). DM and PVD were associated with higher rates of overall WO and WO due to sterile dehiscence on both univariate and multivariate analysis (P.05).Nasal MRSA colonization is associated with higher rates of overall WO and WO due to wound infection. DM and PVD are associated with higher rates of overall WO and WO due to sterile dehiscence but are not associated with WO due to wound infection. Further studies addressing the effect of nasal MRSA eradication on postoperative wound outcomes after MLEA are warranted.
- Published
- 2014
43. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum
- Author
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Thomas F. O'Donnell, Thomas W. Wakefield, William A. Marston, William J. Ennis, Mohammad Hassan Murad, David L. Gillespie, Peter Gloviczki, Joseph D. Raffetto, Monika L. Gloviczki, Mary E. Cummings, Robert B. McLafferty, Lori C. Pounds, Peter K. Henke, Cynthia K. Shortell, Fedor Lurie, Hugo Partsch, Sesadri Raju, Michael C. Dalsing, Robert L. Kistner, Bo Eklof, Julianne Stoughton, and Marc A. Passman
- Subjects
medicine.medical_specialty ,Wound Healing ,Evidence-Based Medicine ,business.industry ,General surgery ,Treatment outcome ,Endovascular Procedures ,Diagnostic Techniques, Cardiovascular ,Cardiovascular Agents ,Vascular surgery ,Varicose Ulcer ,Clinical Practice ,Treatment Outcome ,Predictive Value of Tests ,Compression Bandages ,medicine ,Physical therapy ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Societies, Medical - Abstract
Thomas F. O’Donnell Jr, MD, Marc A. Passman, MD, William A. Marston, MD, William J. Ennis, DO, Michael Dalsing, MD, Robert L. Kistner, MD, Fedor Lurie, MD, PhD, Peter K. Henke, MD, Monika L. Gloviczki, MD, PhD, Bo G. Eklof, MD, PhD, Julianne Stoughton, MD, Sesadri Raju, MD, Cynthia K. Shortell, MD, Joseph D. Raffetto, MD, Hugo Partsch, MD, Lori C. Pounds, MD, Mary E. Cummings, MD, David L. Gillespie, MD, Robert B. McLafferty, MD, Mohammad Hassan Murad, MD, Thomas W. Wakefield, MD, and Peter Gloviczki, MD
- Published
- 2014
44. Carotid Endarterectomy in Women
- Author
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Kim J. Hodgson, David S. Sumner, Jose R. Parra, Don E. Ramsey, Robert B. McLafferty, W. Todd Bohannon, Mark A. Mattos, and Laura A. Karch
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Carotid endarterectomy ,Risk Assessment ,Severity of Illness Index ,law.invention ,Age Distribution ,Postoperative Complications ,Randomized controlled trial ,law ,Internal medicine ,Carotid artery disease ,medicine ,Humans ,Carotid Stenosis ,Prospective Studies ,Registries ,Sex Distribution ,Risk factor ,Prospective cohort study ,Stroke ,Aged ,Probability ,Retrospective Studies ,Endarterectomy ,Aged, 80 and over ,Endarterectomy, Carotid ,business.industry ,Scientific Papers of the American Surgical Association ,Ultrasonography, Doppler ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Analysis ,digestive system diseases ,Surgery ,Treatment Outcome ,Female ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
Randomized carotid trials have clearly shown the importance of carotid endarterectomy (CEA) in reducing the risk of stroke for specific symptomatic and asymptomatic patients. 1–5 Public acknowledgment of the results from these trials has led to an apparent change in the practice patterns of surgeons performing this procedure, resulting in a dramatic increase in the number of CEAs being performed in the United States. 6,7 Unfortunately, the randomized trials have not remained free from criticism. Male patients represented the majority of the trial populations, making it difficult to evaluate the outcome of surgery for certain patient subgroups, such as women and minorities. As a result, the short- and long-term benefits of CEA in women appear to be less clear, and the role of CEA surgery among women with carotid disease remains uncertain. 5,8 A review of the more recent literature has provided conflicting information regarding the effect of female gender on the outcome after CEA. Several multicenter reviews, reviews of state-based hospital discharge databases, collective reviews, and large single-center studies have suggested that female gender may be a predictor of complications after CEA and have questioned the value of surgery in women. 6,9–13 Meanwhile, other reports have shown no evidence of gender-based differences in terms of outcome after CEA. 14,15 Various single-institution reviews have specifically addressed the stroke and death rates between women and men after CEA. 16–20 The authors of these reviews concluded that CEA can be performed safely in women, with success rates similar to those observed in men. The present report highlights our experience with CEA during a 21-year period. The purpose of this review was to evaluate and compare the short- and long-term outcomes in women and men after CEA. By doing so, we sought to provide answers to the following questions: Can CEA be performed safely in women with symptomatic and asymptomatic carotid artery disease? Are the early results in women after CEA comparable to the results in men? Is female gender a risk factor for nonneurologic complications after CEA? Does female gender adversely affect late stroke and death rates after CEA compared with the rates in men? Are the results from our study comparable to the early and late results reported in the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET)? Should the indications for CEA in women remain the same as for men?
- Published
- 2001
45. A prospective study of discharge disposition after vascular surgery
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D. Scott Crouch, Laura A. Karch, John P. Henretta, Robert B. McLafferty, Don E. Ramsey, Mark A. Mattos, David S. Sumner, and Kim J. Hodgson
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic Diseases ,Medicine ,Humans ,Postoperative Period ,Prospective Studies ,Prospective cohort study ,Aged ,Aged, 80 and over ,Peripheral Vascular Diseases ,Endarterectomy, Carotid ,business.industry ,Discharge disposition ,Vascular surgery ,Length of Stay ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Logistic Models ,Amputation ,Emergency medicine ,Extended care ,Quality of Life ,Female ,business ,Complication ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Independent living ,Artery - Abstract
The purpose of this study was to determine what factors are predictive of a decline in independent living after vascular surgery during recovery.Demographics, risk factors, operations, complications, wound status, and discharge disposition for all patients admitted to a tertiary vascular surgery service for any surgical procedure were prospectively recorded at the time of discharge. The declining order of dispositions at discharge were home (no professional assistance), home (professional assistance), rehabilitation facility, and skilled nursing facility.Over a 15-month period, 380 patients underwent 442 primary operations. Primary operations included 74 (17%) carotid procedures, 38 (8%) aortic procedures, 186 (42%) extremity revascularizations, 29 (7%) major amputations, 45 (10%) minor amputations, and 70 (16%) other. There were 148 (33%) complications and 85 (20%) subsequent operations (same hospitalization); 159 (36%) open wounds occurred. Forty-six percent of the patients were discharged to home (no professional assistance), 28% to home (professional assistance), 3% to a rehabilitation facility, and 18% to a skilled nursing facility; 5% died. At discharge, 51% of patients required professional assistance, 39% had a decline in disposition, and 12% went from home (+/- professional assistance) to a facility. By multivariate regression analysis, a hospital stay more than 6 days, emergency operation, open operative wound, systemic complications, and minor amputation were significantly associated (P.001) with a decline in disposition at discharge (odds ratios: 5.5, 3.7, 3.6, 3.6, and 2.8, respectively).Prospective study reveals that a large proportion of patients (39%) had a decline in disposition after vascular surgery. A hospital stay more than 6 days, emergency operation, open operative wound, systemic complications, and minor amputation were strong independent predictors of decline. This information suggests modifications in treatment strategies may improve independent living status after vascular surgery and decrease the intense use of extended care resources required for this patient population during recovery.
- Published
- 2001
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46. Management of ectatic, nonaneurysmal iliac arteries during endoluminal aortic aneurysm repair
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Laura A. Karch, Mark A. Mattos, Don E. Ramsey, Robert B. McLafferty, William T. Bohannon, and Kim J. Hodgson
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Male ,medicine.medical_specialty ,Iliac Artery ,Blood Vessel Prosthesis Implantation ,Aneurysm ,medicine.artery ,medicine ,Humans ,Aged ,Aorta ,medicine.diagnostic_test ,business.industry ,Incidence ,Angioplasty ,Angiography ,External iliac artery ,musculoskeletal system ,medicine.disease ,Internal iliac artery ,Common iliac artery ,Abdominal aortic aneurysm ,Aortic Aneurysm ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Cuff ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Dilatation, Pathologic ,Follow-Up Studies - Abstract
Purpose: Most endografts for an endoluminal AAA repair cannot achieve an adequate hemostatic seal in ectatic common iliac arteries larger than 14 mm. The extension of the endograft into the external iliac artery can alleviate this problem but requires sacrifice of the internal iliac artery. We have used the larger diameter aortic extension cuff to obtain adequate endograft to arterial wall apposition in patients with ectatic, nonaneurysmal common iliac arteries. Because of the resultant flared configuration of the iliac limb, the technique is termed bell-bottom. However, it is unknown whether subsequent enlargement of these ectatic common iliac arteries that will lead to endoleaks or endograft migration will occur. Methods: The records of all 96 patients who have undergone endoluminal abdominal aortic aneurysm repair at our institution were reviewed. Fourteen patients were identified in whom aortic extension cuffs were placed into 18 ectatic (>14 mm, but
- Published
- 2001
47. Classification of anatomic involvement of the iliocaval venous outflow tract and its relationship to outcomes after iliocaval venous stenting
- Author
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Jose I. Almeida, Jason R. Crowner, William A. Marston, Marc A. Passman, and Robert B. McLafferty
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Venography ,Venous Segment ,Venous Obstruction ,Inferior vena cava ,Surgery ,medicine.anatomical_structure ,medicine.vein ,medicine ,External iliac vein ,Radiology ,Cardiology and Cardiovascular Medicine ,Vein ,business ,Lower limbs venous ultrasonography ,Common iliac vein - Abstract
Objective Iliocaval venous obstruction (ICVO) includes a wide spectrum of iliac vein and vena cava obstructive patterns but anatomic classification is lacking, making comparisons of treatment modalities difficult. The purpose of this study was to propose an anatomic classification for ICVO based on patterns of venous obstruction and to correlate severity to clinically relevant outcomes. Methods A multi-institutional retrospective evaluation of patients with ICVO who underwent venous stenting procedures was performed to identify anatomic patterns of iliocaval obstruction. The sites of venous disease were categorized on the basis of computed tomography or magnetic resonance venography supplemented by contrast venography or intravascular ultrasound. Proposed anatomic classification was defined as follows: type I, stenosis of a single venous segment; type II, stenosis of multiple venous segments; type III, occlusion of a single venous segment; and type IV, occlusion of multiple venous segments. Anatomic segments included in the classification scheme were defined as inferior vena cava, common iliac vein, external iliac vein, and common femoral vein. All patients underwent attempted stenting to re-establish normal iliocaval outflow. Outcomes, including initial procedural success and rethrombosis rates within 6 months, were determined for each type of ICVO. Results A consecutive 120 patients with ICVO underwent venography and attempted intervention. The type of ICVO was well distributed across all categories, with type I involvement identified in 42.5% of cases, type II in 19.2%, type III in 13.3%, and type IV in 25%. Procedural success was achieved significantly more often in types I and II ICVO ( P = .02). Stent reocclusion was more frequent in type IV ICVO (26.7%) than in type I (7.8%) or type II ICVO (4.3%) ( P = .009). Conclusions On the basis of a proposed anatomic classification, the diversity of ICVO may be stratified according to the severity of venous involvement. The anatomic classification was found to correlate to the technical success and short-term patency of venous intervention. Prospective evaluation is required to further validate the utility of this new anatomic classification system.
- Published
- 2013
48. Venous Leg Ulcers
- Author
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Robert B. McLafferty
- Subjects
medicine.medical_specialty ,Systemic disease ,medicine.diagnostic_test ,business.industry ,Physical examination ,medicine.disease ,digestive system diseases ,Surgery ,Controlling pain ,Edema ,Diabetes mellitus ,medicine ,medicine.symptom ,Differential diagnosis ,Wound healing ,business ,Pyoderma gangrenosum - Abstract
Venous leg ulcers are the most common form of leg ulcer. While there are many rare causes of ulcerations that can occur from knee to the toes, the overview provided herein gives the practitioner guidance on how to evaluate a patient presenting with a leg ulcer and care for and heal the venous ulcer and information about other more common types of ulcers that are in the differential diagnosis. Fortunately, history and physical examination can help determine, with some confirmatory tests, the type of ulcer. Nevertheless, the essentials of wound healing remain the same for the large majority of ulcers on the lower extremities. Healing will hasten if treatment of all leg ulcers includes assuring adequate perfusion; removing nonviable tissue; reducing inflammation and eliminating infection, relieving edema; optimizing tissue growth; off-loading or providing pressure relief; controlling pain; and treating host systemic disease or conditions such as diabetes and nutrition.
- Published
- 2013
49. Algorithm for the diagnosis and treatment of endoleaks
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David S. Sumner, Mark A. Mattos, Laura A. Karch, Kim J. Hodgson, John P. Henretta, Robert B. McLafferty, and Don E. Ramsey
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medicine.medical_specialty ,Time Factors ,Collateral Circulation ,Inferior mesenteric artery ,Duplex scanning ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Postoperative Complications ,Aneurysm ,medicine.artery ,Image Processing, Computer-Assisted ,medicine ,Humans ,Prospective Studies ,Ultrasonography, Doppler, Color ,Postoperative Care ,business.industry ,Abdominal aorta ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Common iliac artery ,Spiral computed tomography ,Surgery ,Stents ,Radiology ,Tomography, X-Ray Computed ,business ,Algorithm ,Algorithms ,Angioplasty, Balloon ,Lumbar arteries ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Background: Endoluminal grafting of abdominal aortic aneurysms (AAA) has shown promising early results. However, endoleaks present a new and challenging obstacle to successful aneurysm exclusion. We report our experience with primary, persistent endoleaks and provide an algorithm for their diagnosis and management. Methods: Over a 19-month period, 73 patients underwent endoluminal repair of their AAAs using a modular bifurcated endograft as part of a US FDA Investigational Device Exemption trial. Spiral computed tomography (CT) scanning was performed prior to discharge after repair to evaluate for complete aneurysm exclusion. If no endoleak was present on that initial CT scan, color-flow duplex scanning was performed at 1 month, with repeat CT scanning at 6 months and 1 year. If the initial CT scan revealed the presence of an endoleak, repeat CT scanning was performed at 2 weeks, 1 month, and 3 months, or until the endoleak resolved. Any patient with an endoleak that persisted beyond 3 months underwent angiographic evaluation to localize the source of the leak. Results: At 1 month, 62 patients (85%) had successful aneurysm exclusion. The remaining 11 patients (15%) had primary endoleaks, 8 (11%) of which persisted beyond 3 months, prompting angiographic evaluation. In 2 patients the endoleak was related to a graft-graft or graft-arterial junction. One was from the endograft terminus in the common iliac artery and was successfully embolized, along with its outflow lumbar artery. The other required placement of an additional endograft component across a leaking graft-graft junction to successfully exclude the aneurysm. The remaining six endoleaks were due to collateral flow through the aneurysm sac. In 4 cases this was lumbar to lumbar flow fed by hypogastric artery collaterals to the inflow lumbar artery. In the remaining 2 patients the endoleak was found to be due to flow between a lumbar and inferior mesenteric artery. Resolution of the endoleak by coil embolization of the feeding hypogastric artery branch in 1 patient was unsuccessful due to rapid recruitment of another hypogastric branch. Two of the six collateral flow endoleaks have resolved spontaneously without treatment, while the remaining cases have been followed up without evidence of aneurysm expansion. Conclusion: Systematic postoperative surveillance facilitates proper diagnosis and treatment of endoleaks. This involves serial CT scans to detect the presence of endoleaks, followed by angiography to determine their etiology and guide treatment, if clinically indicated.
- Published
- 1999
50. RR9. Characterization of Tibial Velocities by Duplex Ultrasound in Severe Peripheral Arterial Disease and Healthy Controls
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Jeff D. Crawford, Nicholas G. Robbins, Lauren A. Harry, Dale G. Wilson, Vincent J. Santo, Robert B. McLafferty, Erica L. Mitchell, Gregory J. Landry, and Gregory L. Moneta
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2015
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