Ronald M Fairman

Hospital of the University of Pennsylvania, Filadelfia, Pennsylvania, United States

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Publications (210)600.76 Total impact

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    ABSTRACT: Background.—Although endovascular interventions for peripheral artery disease (PAD) have become increasingly common, they are associated with a significant rate of restenosis. An improved understanding of the risk factors for restenosis is needed to guide the management of patients with PAD.Methods.—We performed a cross-sectional analysis of 101 patients with PAD, to determine the association between clinical predictors, novel imaging measures of vascular function of the femoral artery [intima-media thickness, diameter, and intima-media cross-sectional area, change in diameter (delta diameter), average expansion and average contraction], and risk of reintervention. Univariable and multivariable associations between clinical and imaging measures and the need for reintervention were assessed using logistic regression. The predictive accuracy of the selected regression model and added predictive value of imaging measures were assessed using the area under the Receiver operating characteristic curve (AUC). The added predictive value of ultrasound was assessed by comparing AUC of the selected model with clinical parameters alone with that of the same model with additional ultrasound parameters.Results.—Of the 101 patients with PAD, 20 underwent recent multiple reinterventions. Vessel diameter was statistically significantly smaller in the group who underwent multiple reinterventions, p = 0.0170. Univariate logistic regression revealed that smoking status, hypertension, hypercholesterolemia, and chronic renal insufficiency were clinical parameters that met the statistical cut point of p ≤ 0.20. In the multivariable model, chronic renal insufficiency status (odds ratio (OR) = 8.27, 1.17–58.25), hypertension (OR = 0.145, 0.020–1.062), and femoral artery diameter (OR = 0.375, 0.136–1.031) remained important predictors for reintervention. The AUC for the clinical multivariable logistic regression model was 0.7481 while that for the model additionally including the ultrasound parameters was 0.8325 (p = 0.044).Conclusions.—Including ultrasound parameters in the risk prediction model for restenosis improved the ability to predict restenosis in this group of patients with known PAD. Further study is needed to define its utility in preoperative assessment and risk stratification before revascularization.
    09/2015; 39(3).
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    ABSTRACT: Length of stay is used as a quality metric to reduce cost and improve value of delivery of care. We sought to analyze trends in endovascular aortic aneurysm repair (EVAR) length of stay (LOS) at a tertiary academic institution over the last decade. A retrospective review of prospectively collected data was performed. Infrarenal EVARs from 2001-2013 were divided into 3 groups: Group I (2001-2004): EVARs were performed as part of clinical trials, Group II (2005-2008): EVARs were referred to a tertiary referral center with the most experience with EVAR, Group III (2009-2013):EVARs were referred to academic institutions in the the presence of severe patient comorbidities. Trends in LOS and correlation with severity of illness (SOI) as based on APR-DRG, as well as admission/disposition status were analyzed. LOS index at our institution was then compared to University Health Consortium (UHC) Hospitals over the past 3 years. 1265 EVARs were performed during this time period: 325-Group I, 547-Group II and 393-Group III. The median LOS was 4days (IQR 2, 6) vs 3 days (IQR 2, 5) ±0.28 vs 4 days (IQR 3, 7) respectively (p<0.01). While moderate SOI was fairly constant over time (p=0.66), major/extreme SOI constituted a greater proportion of patients in Group I, was reduced in Group II, and was again increased in Group III, p<0.01. The complication rate paralleled this pattern (Group I-15.2%, Group II-8.6%, Group III-10.4%, p=0.02). The percentage of patients discharged to nursing home/rehab was 5.7%-Group I, 8.2%-Group II, 11.5%-Group III (p=0.03). Cases that were performed urgently/emergently increased over time: 11.6%-Group I, 14.9%- Group II, 21.6%-Group III (p=0.01). The risk-adjusted LOS index at our institution was significantly greater (1.25) when compared to UHC hospitals (0.75). Our study suggests a relationship between time period of EVAR, SOI, complications, admission status and LOS. Attention to these trends could be used to decrease LOS in an increasingly complex patient population. Copyright © 2015 Elsevier Inc. All rights reserved.
    Annals of Vascular Surgery 08/2015; DOI:10.1016/j.avsg.2015.07.003 · 1.17 Impact Factor
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    ABSTRACT: Objective Retrievable inferior vena cava filters (IVCFs) left in place for a prolonged period can lead to complications including filter migration, fracture, and caval thrombosis. "Fall-back" techniques for IVCF retrieval that can be used when standard snaring is unsuccessful have been recently described. The purpose of this study was to analyze how incorporation of these new techniques affected the outcomes of IVCF retrievals at our institution during the past 5 years. Methods Data were collected of all patients undergoing IVCF removal by vascular surgeons at a tertiary academic medical center between 2009 and 2013, including demographics and procedural and filter characteristics. A standard technique of snaring the retrieval hook was attempted first in all cases; if this was unsuccessful, a number of fall-back techniques were employed, including the use of endoscopic graspers, 18F sheaths, and snaring a second wire below the collar of the filter to collapse it into the sheath. Results IVCF retrieval was attempted in 275 patients; 3 were excluded intraoperatively because of thrombus in the filter. Most filters (97%) were Günther Tulips (Cook Medical, Bloomington, Ind); 70% had been placed prophylactically before bariatric surgery. A total of 268 filters (98.5%) were retrieved successfully, 213 (79%) by standard snaring and 55 (21%) with fall-back techniques. In patients undergoing fall-back techniques, technical success was achieved 100% of the time. The median time since insertion was significantly longer in the fall-back group (173 days vs 83 days; P <.0001). Four intraoperative complications occurred; fractured wires embolized to the right atrium or pulmonary artery and were successfully removed endovascularly. The majority of the procedures (80%) were performed under sedation in both groups. Conclusions Incorporation of fall-back techniques may allow 100% technically successful and safe removal of retrievable IVCFs and is especially useful in removing filters with prolonged dwell time. Copyright © 2015 by the Society for Vascular Surgery. Published by Elsevier Inc.
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    ABSTRACT: Venous thromboembolism (VTE) is a potentially preventable complication following surgery. There is variation with regard to the most effective mode of prophylaxis. We sought to determine if an aggressive approach to VTE prophylaxis would reduce VTE rates on the inpatient vascular surgical service. Vascular inpatients from a single institution from July 2010 to March 2013 were included in the analysis. A protocol for VTE prophylaxis was implemented on the inpatient vascular surgical service in November 2011. This included subcutaneous (SQ) heparin initiation within 24 h of admission unless deemed inappropriate by the attending, as well as intermittent compression devices (ICD) and compression stockings (CS). The rate of VTE was compared prior to and following the intervention. Patients were compared using AHRQ comorbidity categories, APR-DRG severity of illness, insurance status, and principle procedure. T-tests were used to compare continuous variables and chi-square analysis used to compare categorical variables. There were 1483 vascular patients in the pre-intervention group and 1652 patients in the post-intervention group. The rate of pharmacologic prophylaxis was 52.57% pre-intervention compared to 69.33% post-intervention (p < 0.001). The rate of pharmacologic or mechanical prophylaxis was 91.76% pre-intervention compared to 93.10% post-intervention (p = 0.54). The overall rate of VTE prior to the intervention was 1.49% compared to after intervention which was 0.38% (p = 0.033). The DVT rate prior to intervention was 1.09% vs 0.189% after intervention (p = 0.0214). The rate of pulmonary embolism trended towards a significant reduction with the intervention (0.681% vs 0.189%, p = 0.095). There were no statistically significant differences in patient groups based on gender, comorbidity category, severity of illness, or insurance type. The overall rate of VTE was reduced by 75% after the initiation of a standard protocol for pharmacologic VTE prophylaxis. These findings justify an aggressive approach to VTE prophylaxis in vascular surgery patients. © The Author(s) 2015.
    Vascular 06/2015; DOI:10.1177/1708538115594094 · 0.80 Impact Factor

  • Journal of Vascular Surgery 06/2015; 61(6):174S-175S. DOI:10.1016/j.jvs.2015.04.331 · 3.02 Impact Factor

  • Journal of Vascular Surgery 06/2015; 61(6):187S-188S. DOI:10.1016/j.jvs.2015.04.354 · 3.02 Impact Factor

  • Journal of Vascular Surgery 06/2015; 61(6):70S. DOI:10.1016/j.jvs.2015.04.133 · 3.02 Impact Factor

  • Journal of Vascular Surgery 06/2015; 61(6):52S. DOI:10.1016/j.jvs.2015.04.092 · 3.02 Impact Factor
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    ABSTRACT: Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. The Medtronic Thoracic Endovascular Registry (MOTHER; Medtronic, Santa Rosa, Calif), consists of data from five sponsored trials and one institutional series incorporating 1010 patients undergoing TEVAR from 2002 to 2010. Perioperative stroke and spinal cord injury (SCI) rates were described according to the management of the LSA and presenting pathology. Multivariate analysis was performed to determine factors associated with perioperative neurologic complications. Of 1002 patients included in the analysis, stroke occurred in 48 (4.8%), and SCI developed in 42 (4.2%) ≤30 days of surgery. The stroke rate was 2.2% in patients with no coverage of the LSA vs 9.1% with coverage alone and 5.1% in patients who underwent LSA revascularization before coverage (P < .001). This relationship was strongest in the aneurysm group. Coverage of the LSA without revascularization was independently associated with stroke (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.1), specifically in the posterior territory (OR, 11.7; 95% CI, 2.5-54.6), as was previous cerebrovascular accident (OR, 7.1; 95% CI, 2.2-23.1; P = .001), whereas a covered LSA was not associated with an increased risk of SCI. Coverage of the LSA without revascularization is an important modifiable risk factor for stroke in patients undergoing TEVAR for a thoracic aortic aneurysm. Prior revascularization appears to protect against posterior circulation territory stroke. Copyright © 2014 Society for Vascular Surgery. All rights reserved.
    Journal of Vascular Surgery 12/2014; 60(6):1491-1498.e1. DOI:10.1016/j.jvs.2014.08.114 · 3.02 Impact Factor
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    ABSTRACT: Thoracic endovascular aortic repair (TEVAR) has been shown to have survival benefit in patients with complicated type B dissection compared with open surgery or medical therapy. We analyze the impact of timing of intervention from the onset of symptoms to TEVAR, and its relation to complications. Between 2005 and 2012, we performed 132 TEVARs for acute and subacute (<6 weeks) type B dissection; 186 other patients were managed with medical therapy only. Patients were followed in a clinical registry. Standard univariate and survival methods were used. Of the 132 TEVARs for type B dissection, 70 were performed within 48 hours of presentation (Acute-Early); 44 between 48 hours and 14 days from presentation (Acute-Delayed); and 18 between 14 days and 6 weeks of presentation (Subacute). Demographic characteristics were similar among groups. Severe complications were more common in the Early-Acute and Delayed-Acute patients than in the Subacute patients (P = .04) Retrograde type A dissection tended to be more common in the Acute-Early group. Overall survival was similar among groups. Delayed intervention appears to lower the risk of complications of TEVAR for aortic dissection in patients who are stable enough to wait. Among patients initially managed medically, new TEVAR indications were not uncommon, and such patients must be followed closely. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Thoracic and Cardiovascular Surgery 11/2014; 149(2). DOI:10.1016/j.jtcvs.2014.10.105 · 4.17 Impact Factor
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    ABSTRACT: Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs.
    Journal of Vascular Surgery 09/2014; 61(1). DOI:10.1016/j.jvs.2014.08.003 · 3.02 Impact Factor
  • Scott M. Damrauer · Ann C. Gaffey · Ann D. Smith · Ronald M. Fairman · Louis L. Nguyen ·

    Journal of the American College of Surgeons 09/2014; 219(3):S156. DOI:10.1016/j.jamcollsurg.2014.07.376 · 5.12 Impact Factor
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    ABSTRACT: Objective: Recent initiatives to improve health care quality have focused attention on length of stay (LOS) and readmission rates for surgical patients, yet these two outcomes may be inversely related. This study was designed to elucidate the risk factors for both outcomes and to clarify the relationship between them in patients undergoing lower extremity bypass (LEB). Methods: Peripheral arterial disease (PAD) patients who underwent LEB were identified from the 2007-2010 California State Inpatient Database. LOS and risk factors were analyzed using Poisson regression. Risk factors for 30-day readmission were analyzed using logistic regression. Results: There were 6307 patients who underwent LEB, and 1291 (20%) were readmitted. The average index LOS was 8.3 days for those who were readmitted and 5.5 days for those who were not (P < .0001) and was an independent risk factor for 30-day readmission. The significant factors with the largest effect estimates for increased LOS reflected disease severity and postoperative complications: emergency department admission; advanced PAD; postoperative pneumonia, respiratory failure, urinary tract infection, wound/graft infection, graft complication, and discharge to a nursing facility. Independent predictors of readmission, other than LOS, reflected underlying patient factors: advanced PAD, chronic lung disease, diabetes, renal failure, postoperative congestive heart failure, and discharge status. Age, Medicaid or private insurance, and low income were protective. Of the 1291 readmissions, 453 (35%) were for definitive complications. Conclusions: In patients undergoing LEB, LOS is primarily associated with the occurrence of postoperative complications, whereas 30-day readmission is largely explained by underlying patient illness. Additionally, increased LOS is an independent risk factor for readmission. These findings suggest that efforts to reduce both LOS and readmission will be complementary. Furthermore, they support the notion that both LOS and 30-day readmission rates should be risk-adjusted.
    Joint Annual Meeting of the New-England-Society-for-Vascular-Surgery; 09/2014

  • Joint Annual Meeting of the New-England-Society-for-Vascular-Surgery; 09/2014

  • Joint Annual Meeting of the New-England-Society-for-Vascular-Surgery; 09/2014
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    ABSTRACT: Objective: Endovascular treatment of abdominal aortic aneurysm (AAA) is associated with benefits over open surgery, yet limitations remain with current endovascular devices. This study was performed to assess outcomes of AAA repair with the Aptus endograft and EndoAnchors (Aptus Endosystems, Sunnyvale, Calif). Methods: This prospective, multicenter, single-arm investigational device exemption trial was conducted at 25 sites in the United States. A total of 155 patients were enrolled in the trial (mean age, 73 ± 8 years; male, 93.5%; mean AAA diameter, 53.6 ± 7.9 mm). The Aptus endograft is a two-component system: a multilumen, modular endograft with two docking limbs (Aptus Endograft System) and the Heli-FX Aortic Securement System comprising an electronically controlled applier (Heli-FX Applier) with helical EndoAnchors provided in a cassette and a deflectable sheath (Heli-FX Guide) designed for delivery of the applier to the target location for EndoAnchor implantation. The main eligibility criteria included proximal neck length of ≥12 mm, diameter of 19 to 29 mm, and infrarenal angulation of ≤60 degrees. The primary safety end point was freedom from major adverse events at 30 days, and the primary effectiveness end point was successful aneurysm treatment at 12 months. Thrombus-related events (TRE) were defined as limb occlusion or thromboembolism from the endograft. Subjects were observed for a median of 4.2 years, with imaging end points analyzed by a core laboratory and adverse events adjudicated by a clinical events committee. Results: Among 155 enrolled subjects, 153 (98.7%) underwent successful implantation of the Aptus endograft and a median of five EndoAnchors; two subjects were converted to open surgical repair during the initial procedure. Overall, the primary safety and effectiveness end points were met in 98.1% and 97.4% of the subjects, respectively. Aneurysm-related mortality was 0.6%, with one postdischarge cardiac death 18 days after implantation. There were no AAA ruptures. There were no fractures of stents or EndoAnchors. There was one type I endoleak and one type III endoleak. Stent graft migration was noted in five subjects, none associated with sac enlargement, type I endoleak, or EndoAnchor dislocation from the endograft. AAA sac shrinkage of ≥5 mm at 1, 2, and 3 years was observed in 60.3%, 72.9%, and 81.7%, respectively. Sixty-one subjects (39.4%) experienced 113 TRE, associated with 80 reinterventions (in 58 subjects) unassociated with limb loss or death. A root cause analysis of TRE identified small, out-of-specification docking limbs with graft infolding and high local shear, resulting in thrombus formation within the endograft with subsequent distal embolization in some cases. Conclusions: Early results of the Aptus endograft trial met its safety and effectiveness end points; however, a high rate of TRE was observed because of manufacturing discrepancies. The findings confirm a low rate of type I and type III endoleaks, migration, and non-TRE reintervention with a high rate of aneurysm sac regression during midterm follow-up.
    Journal of Vascular Surgery 08/2014; 60(2):275-285. DOI:10.1016/j.jvs.2014.02.017 · 3.02 Impact Factor

  • Journal of Vascular Surgery 06/2014; 59(6):1554-1554. · 3.02 Impact Factor

  • Journal of Vascular Surgery 06/2014; 59(6):96S. DOI:10.1016/j.jvs.2014.03.215 · 3.02 Impact Factor
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    ABSTRACT: Whereas uncomplicated acute type B aortic dissections are often medically managed with good outcomes, a subset develop subacute or chronic aneurysmal dilation. We hypothesized that computational fluid dynamics (CFD) simulations may be useful in identifying patients at risk for this complication. Patients with acute type B dissection complicated by rapidly expanding aortic aneurysms (N = 7) were compared with patients with stable aortic diameters (N = 7). Three-dimensional patient-specific dissection geometries were generated from computed tomography angiography and used in CFD simulations of pulsatile blood flow. Hemodynamic parameters including false lumen flow and wall shear stress were compared. Patients with rapid aneurysmal degeneration had a growth rate of 5.3 ± 2.7 mm/mo compared with those with stable aortic diameters, who had rates of 0.2 ± 0.02 mm/mo. Groups did not differ in initial aortic diameter (36.1 ± 2.9 vs 34.4 ± 3.6 mm; P = .122) or false lumen size (22.6 ± 2.9 vs 20.2 ± 4.5 mm; P = .224). In patients with rapidly expanding aneurysms, a greater percentage of total flow passed through the false lumen (78.3% ± 9.3% vs 56.3% ± 11.8%; P = .016). The time-averaged wall shear stress on the aortic wall was also significantly higher (12.6 ± 3.7 vs 7.4 ± 2.8 Pa; P = .028). Hemodynamic parameters derived from CFD simulations of acute type B aortic dissections were significantly different in dissections complicated by aneurysm formation. Thus, CFD may assist in predicting which patients may benefit from early stent grafting. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Vascular Surgery 06/2014; 59(6):82S-83S. DOI:10.1016/j.jvs.2014.03.185 · 3.02 Impact Factor

Publication Stats

6k Citations
600.76 Total Impact Points


  • 2000-2015
    • Hospital of the University of Pennsylvania
      • • Division of Vascular Surgery
      • • Department of Surgery
      Filadelfia, Pennsylvania, United States
    • University of Pennsylvania
      • • Department of Surgery
      • • Department of Medicine
      • • Division of Vascular Surgery
      • • Department of Radiology
      Filadelfia, Pennsylvania, United States
    • Union Memorial Hospital
      Baltimore, Maryland, United States
  • 2014
    • University of Wisconsin - Platteville
      Platteville, Wisconsin, United States
  • 2006-2013
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2010
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
  • 2007
    • University of Chicago
      • Department of Surgery
      Chicago, Illinois, United States
    • Columbia University
      New York, New York, United States
  • 2003
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2002
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
  • 2001
    • University of Maryland Medical Center
      • Division of Vascular Surgery
      Baltimore, Maryland, United States