Benjamin J Pearce

The University of Chicago Medical Center, Chicago, Illinois, United States

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Publications (6)11.28 Total impact

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    ABSTRACT: Brachial artery pseudoaneurysms secondary to intravenous drug abuse represent a limb-threatening problem to patients and a technical challenge to the vascular surgeon. Here information is reported about a patient with metachronous bilateral giant brachial artery pseudoaneurysms secondary to intravenous drug use that were successfully treated with excision of the aneurysm and ligation of the brachial artery. Furthermore, a review of the current literature on the treatment of brachial artery aneurysm is presented.
    Vascular and Endovascular Surgery 01/2007; 41(5):467-72. · 0.88 Impact Factor
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    ABSTRACT: Vascular remodeling in response to injury or low shear stress (or both) is characterized by neointimal hyperplasia and luminal contraction. When profound, the response leads to restenosis after percutaneous endovascular intervention as well as to de novo stenosis in vein grafts. It has recently been reported that exposure of vein patches to neurovirulence-attenuated Herpes simplex virus-1 (HSV-1) decreases neointimal hyperplasia and increases luminal area. This experiment tested the hypothesis that R7020, a more highly attenuated mutant of HSV-1, would modulate the vascular remodeling response of experimental vein grafts chronically exposed to low shear stress. The external jugular veins of 31 New Zealand white rabbits were clamped and intraluminally exposed to vehicle (phospate-buffered saline solution, n = 11), R7020 2.5 x 10(8) plaque forming units [PFU]/mL (n = 8), or R7020 2.5 x 10(9) PFU/mL (n = 12) for 10 or 30 minutes at an average pressure of 80 mm Hg. After exposure, an end-to-side distal external jugular-to-common carotid artery anastomosis was created, resulting in a widely patent arteriovenous fistula. The external jugular was suture-ligated just proximal to the thoracic inlet, distal to a small 10- to 50-microm venous tributary, creating a reversed vein "graft" segment immediately and abruptly exposed to arterial pressure (48 +/- 3 mm Hg) and low shear stress (0.12 +/- .02 dyne/cm(2)). In the 29 animals (N = 31) that survived to harvest, 26 grafts were found to be patent and were analyzed further. Nine grafts were harvested within the first week after operation, snap frozen in liquid nitrogen, and assayed for the presence of the Herpes viral immediate-response protein ICP0 by Western blot analysis. The 17 remaining grafts were perfusion-fixed, excised, stained, and analyzed morphometrically by digital planimetry. In patent grafts, the hemodynamic environment of low shear stress was maintained (shear stress at harvest, 0.26 +/- .06 dyne/cm(2)). Western blot analysis revealed the presence of ICP0 in R7020-exposed vein grafts after 2, 3, 7, and 14 days; ICP0 was not detected in unexposed vein grafts or adjacent carotid arteries. After 4 weeks, vein grafts exposed to R7020 exhibited a statistically significantly increased ratio of luminal radius to wall thickness, indicating altered remodeling (vehicle, 6.7 +/- 1.3; R7020 2.5 x 10(8), 9.1 +/- 1.3; R7020 2.5 x 10(9) ratio, 11.3 +/- 1.4; P < .05 for high dose compared with vehicle). A brief exposure of the neurovirulence-attenuated HSV-1 strain R7020 results in an increased ratio of luminal radius to wall thickness in experimental vein grafts chronically exposed to low shear stress.
    Journal of Vascular Surgery 01/2005; 41(1):115-21. · 2.88 Impact Factor
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    ABSTRACT: Open repair of abdominal aortic aneurysms (AAAs) or occlusive disease can be complicated by pseudoaneurysm formation and aneurysmal dilatation of native vessels. Reports of reoperation for these new lesions have a mortality rate of 5-17% electively, and 24-88% if ruptured. These complications are commonly several years after initial repair, and progression of other comorbidities can further complicate a repeat exploration. The authors reviewed 5 cases of late complications of open aortic bypass surgery treated with endovascular stent grafting as an alternative to reexploration in patients with increased risk for morbidity and mortality. Over a 6-year experience, 5 patients underwent endovascular stent grafting to repair paraanastomotic aneurysms. Patient records were reviewed and clinical cardiac risk evaluation was performed. Follow-up clinic notes and computed tomography (CT) scans were evaluated. Between October 1996 and February 2002, 5 patients underwent 6 endovascular procedures to repair paraanastomotic aneurysms. Mean period between interventions was 16.6 +/-6.27 years (range 10-25); mean age at endovascular procedure 74.2 +/-6.37 years (range 67-84). Cardiac clinical risk index increased in 80% of patients by Goldman Risk Index and in 40% by the Modified Cardiac Risk Index. On completion angiography, there was complete exclusion of the paraanastomotic aneurysms in all cases (100%). Length of postoperative stay was 1.5 +/-0.547 days. Mean estimated blood loss at conclusion of endovascular procedure was 577 +/-546.504 cc (range, 60 cc-1,500 cc). Mean follow-up was 24.4 +/-24.593 months (range, 5-67 months). On repeat imaging, all stent grafts remain patent without rupture or endoleak. Endovascular stent grafting to repair late complications of open AAA repair is a viable alternative to reexploration in patients with significant comorbidities. These procedures can be performed without violating the previous surgical planes of sites. The operations can be performed under local anesthesia and with reduced hospitalizations. In patients with increased risk factors, endovascular stent grafting is a less morbid alternative to open surgical techniques.
    Vascular and Endovascular Surgery 01/2005; 39(3):221-8. · 0.88 Impact Factor
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    ABSTRACT: The study was performed to evaluate the performance of digital fixed-mounted angiographic C-arm systems in the operating room as used by surgeons, cardiologists, and interventional radiologists. An observational study in the operating room was performed, along with a structured questionnaire and semi-structured interviews. Twenty interventions were observed at 5 sites. Workflow was analyzed. Integration of high-end angiographic imaging equipment in the operating room enables image-guided surgery with high-quality images, on-table quality assessment of surgical procedures, and "one-stop shopping" procedures. Integrated suites were run by surgery as well as radiology departments, and are used for a variety of procedures, including vascular, cardiothoracic, open surgical, percutaneous, and combined procedures. Operation of the angiographic system and its user interface design were not considered ideal for operating room use. Limited patient accessibility was observed, sometimes leading to uncomfortable positions for the operating physicians. Certain procedures, such as tibial artery surgery, were difficult to perform, owing to lack of accessories. Patient transfer was considered inadequate. Cleaning of the system was rated as poor. Operating room use puts an even higher demand on reliability of the system. Integration of digital angiographic systems into operating rooms has produced opportunities for new treatments and offers a superior solution for interdisciplinary work among surgeons, cardiologists, and radiologists. However, the context of use differs radically from that in the traditional radiologic examination room; the environment, users, and procedures are all different. Integration of imaging methods into the operating room can be more successful if special operating room conditions are taken into account by medical systems manufacturers.
    Journal of Vascular Surgery 10/2004; 40(3):494-9. · 2.88 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the outcome of patients in whom an infrainguinal bypass graft failed. This was a retrospective analysis of consecutive patients undergoing infrainguinal bypass grafting in a single institution over 8 years. Six hundred thirty-one infrainguinal bypass grafts were placed in 578 limbs in 503 patients during the study period. The indication for surgery was limb-threatening ischemia in 533 patients (85%); nonautologous conduits were used in 259 patients (41%), and 144 (23%) were repeat operations. After a mean follow-up of 28 +/- 1 months (median, 23 months; range, 0-99 months), 167 grafts (26%) had failed secondarily. The rate of limb salvage in patients with graft failure was poor, only 50% +/- 5% at 2 years after failure. The 2-year limb salvage rate depended on the initial indication for bypass grafting: 100% in patients with claudication (n = 16), 55% +/- 8% in patients with rest pain (n = 49), and 34% +/- 6% in patients with tissue loss (n = 73; P <.001). The prospect for limb salvage also depended on the duration that the graft remained patent. Early graft failure (<30 days; n = 25) carried a poor prognosis, with 2-year limb salvage of only 25% +/- 10%; limb salvage was 53% +/- 5% after intermediate graft failure (<2 years, n = 110) and 79% +/- 10% after late failure (>2 years, n = 15; P =.04). Multivariate analysis revealed shorter patency interval before failure (P =.006), use of warfarin sodium (Coumadin) postoperatively (P =.006), and infrapopliteal distal anastomosis (P =.01) as significant predictors for ultimate limb loss. The overall prognosis for limb salvage in patients with failed infrainguinal bypass grafts is poor, particularly in patients with grafts placed because of tissue loss and those with early graft failure.
    Journal of Vascular Surgery 05/2004; 39(5):951-7. · 2.88 Impact Factor
  • Benjamin J Pearce, James F McKinsey
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    ABSTRACT: The acute technical success of percutaneous transluminal angioplasty (PTA) has been improved with the use of intravascular stents. However, stent placement has led to the development of an increased myointimal hyperplastic response leading to late reduction in vessel lumen. Restenosis (> or =50% reduction in reference lumen diameter) rates for coronary angioplasty and stenting are reported between 20% and 50% at 1 year. Several studies are currently evaluating novel delivery of antiproliferative agents to prevent neointimal hyperplasia. The authors review the mechanism of neointimal hyperplasia as it relates to stent placement and discuss recent and ongoing trials evaluating intravascular brachytherapy and drug-eluting stent technology in the inhibition of restenotic lesions.
    Vascular and Endovascular Surgery 01/2003; 37(4):231-7; discussion 237. · 0.88 Impact Factor