Kelly L. Killeen

Cedars-Sinai Medical Center, Los Angeles, CA, United States

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Publications (5)6.23 Total impact

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    ABSTRACT: Because of limited longevity and perceived increased perioperative risk, the optimal treatment of significant carotid stenosis in nonagenarians is controversial. This study was conducted to evaluate our results in this demographic group. A retrospective review was performed of carotid endarterectomies (CEAs) done in nonagenarians at Cedars-Sinai Medical Center between 1996 and 2006. During this period, a total of 2,038 CEAs were performed on patients of all ages. Data abstracted included demographics, patient risk factors, indications for surgery, perioperative complications, and survival. Fifty-three (2.8%) CEAs were performed as the primary procedure on 49 patients aged 90 or greater during the study period. Of these patients, 11 (22.4%) had diabetes, 38 (77.5%) had hypertension, and 31 (63.3%) had coronary artery disease. Eleven patients (22.4%) had a history of smoking, and there were no current smokers. Renal disease was present in three (6.1%) patients, one of whom was dialysis-dependent. The median length of stay was 2 days with a range of 1 to 24 days. Five patients (10.2%) required the intensive care unit following surgery. There were no postoperative strokes, and none of the patients had suffered ipsilateral stroke during follow-up. One patient (1.8%) had a perioperative myocardial infarction. One patient died in the perioperative period (1.8%). The 1-month stroke and mortality results did not differ significantly from those in patients under the age of 90, 0.3% and 0.4%, respectively (p = nonsignificant by Fisher's exact test). Using Kaplan-Meier life-table analysis, the 1- and 5-year survival rates were 84 +/- 5% and 33 +/- 9%, respectively. Our study demonstrates that in a group of well-selected nonagenarians, CEA is a safe procedure with acceptable perioperative morbidity.
    Annals of Vascular Surgery 04/2008; 22(2):190-4. · 0.99 Impact Factor
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    ABSTRACT: Based on the evolution that the management of colonic trauma has undergone since the early 1990s, we hypothesized that the use of diversion has decreased at our institution over the last decade. A retrospective review was performed of all patients who presented to our trauma center with colon injuries between 1995 and 2006. A total of 81 patients were analyzed. Twenty-five patients (31%) were treated with diversion and 56 patients (69%) underwent primary repair or resection with anastomosis. The rate of diversion in the first half of the study period as well as the second half of the study period was 31%. There was no difference in the complication rates. The usage of diversion remains higher than current literature would indicate. As a result, we are implementing a program that will actively encourage our trauma surgeons to improve the quality of patient care by incorporating evidence-based medicine into clinical practice.
    American journal of surgery 01/2008; 194(6):746-9; discussion 750. · 2.36 Impact Factor
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    ABSTRACT: En raison d'une longévité limitée et de la perception d'une augmentation du risque péri-opératoire, le traitement optimal des sténoses carotidiennes significatives chez le nonagénaire reste controversé. Cette étude a été réalisée pour évaluer nos résultats dans ce groupe démographique. Une étude rétrospective a été réalisée des endartériectomies carotidiennes (EC) réalisées chez des nonagénaires au Cedars-Sinai Medical Center entre 1996 et 2006. Au cours de cette période, 2.038 EC ont été réalisées chez des malades de tous âges. Les données étudiées concernaient la démographie, les facteurs de risque des malades, les indications opératoires, les complications péri-opératoires et la survie. Cinquante trois EC (2,8%) ont été réalisées comme intervention principale chez 49 malades âgés de 90 ans ou plus au cours de la période d'étude. Parmi ces malades, 11 (22,4%) étaient diabétiques, 38 (77,5%) étaient hypertendus et 31 (63,3%) étaient coronariens. Onze malades (22,4%) avaient des antécédents de tabagisme et il n'y avait aucun fumeur actif. Une insuffisance rénale chronique était présente chez trois malades (6,1%) dont un était dialysé. La durée médiane de séjour a été de deux jours avec des extrêmes de 1 et 24 jours. Cinq malades (10,2%) ont nécessité un séjour en unité de soins intensifs après l'intervention. Il n'y a eu aucun accident vasculaire cérébral post-opératoire et aucun malade n'a eu d'accident vasculaire cérébral homolatéral au cours du suivi. Un malade (1,8%) a fait un infarctus du myocarde post-opératoire. Un malade est décédé au cours de la période post-opératoire (1,8%). Les taux d'accident vasculaire cérébral et de mortalité à un mois ne différaient pas significativement par rapport à ceux des malades âgés de moins de 90 ans (0,3% et 0,4% respectivement, p = non significatif par le test exact de Fisher). En utilisant l'analyse actuarielle de Kaplan-Meier, les taux de survie à un et 5 ans étaient respectivement de 84 ± 5% et 33 ± 9%. Notre travail démontre que dans un groupe de nonagénaires, l'EC est une intervention sûre avec une morbidité péri-opératoire acceptable.
    Annales De Chirurgie Vasculaire. 01/2008; 22(2):203-207.
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    ABSTRACT: Although autogenous brachial-basilic upper arm transpositions (BVT) have been extensively utilized, there has been significant disparity in published patency rates. Very little is known about the efficacy of autogenous brachial-cephalic upper arm transpositions (CVT). We evaluated our experience with transposed upper arm arteriovenous fistulas (tAVF) in order to assess patency and identify factors that affect efficacy. We then compared our tAVF patients with a cohort of upper arm arteriovenous grafts (AVG). A retrospective review was conducted of tAVF performed at our institution from 1998 to 2004. The tAVF group consisted of 119 BVT and 71 CVT procedures. We compared these with 164 AVG. tAVF were placed only for veins >/=2.5 mm in diameter by duplex ultrasonography. Mean follow-up was 28 months. With the exception of mean vein diameter, the patients in the BVT and CVT groups had similar demographic parameters and complication rates. Primary and secondary patency rates were 52% and 62% at 5 years for BVT and 40% and 46% at 5 years for CVT, respectively (P = NS). Multivariate analysis revealed that hemodialysis dependence at the time of fistula placement and history of previous upper arm access independently affected primary patency. History of upper torso dialysis catheters independently affected secondary patency. Comparison of the tAVF and AVG groups revealed that tAVF patients were significantly younger, more likely to be male, less likely to be African American (AA) and less likely to have a history of previous AV access. The primary patency rate for tAVF was significantly higher than for AVG: 48% vs 14% at 5 years (P < .001). The secondary patency rate for tAVF was also significantly higher than for AVG: 57% vs 17% at 5 years (P < .001). Among the tAVF procedures, 9% required one or more revisions to maintain secondary patency, compared to 51% with the AVG group (P < .001). Multivariate analysis revealed that presence of AVG and a history of previous upper arm access negatively affected primary and secondary patency. Autogenous BVT and CVT have similar, high patency rates. Transposed upper arm arteriovenous fistulas have higher patency rates than upper arm AVG and require significantly fewer revisions. Our data strongly support the contention that as long as the patient is a candidate for an upper arm tAVF, based on anatomical criteria, a tAVF should always be considered before an AVG.
    Journal of Vascular Surgery 08/2007; 46(1):94-99; discussion 100. · 2.88 Impact Factor