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Publications (83)
Objectives
We aim to evaluate the safety and effectiveness of the Zenith Dissection Endovascular System (ZDES; Zenith TX2 Dissection Endovascular Graft with Pro-Form and Zenith Dissection Endovascular Stent), which uses a proximal stent graft along with a distal bare metal stent compared to traditional stent grafts in the repair of acute, complicat...
Aortic dissection (AD) involves a tear in the intimal layer of the aorta that creates a false lumen within the aortic wall and can result in malperfusion of distal branch vessels. Herein, a comprehensive examination of malperfusion in the context of acute AD is provided, with a focus on the mechanisms underlying dynamic and static obstructions, the...
Introduction
Arteriovenous fistulas (AVFs) and grafts are essential for long‐term hemodialysis access in patients with end‐stage renal disease. However, complications and access failure often necessitate re‐intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revisi...
Loeys Dietz Syndrome (LDS) is an autosomal dominant connective tissue disorder resulting from a mutation in the transforming growth factor beta receptor (TGFBR) family of genes. It is commonly associated with the development of aortic aneurysms and dissections. We report the successful open surgical management of thoracoabdominal aneurysms in a fat...
Background
We evaluated the impact of completion intraoperative venography on clinical outcomes for axillosubclavian vein (AxSCV) thrombosis owing to venous thoracic outlet syndrome (vTOS).
Methods
We performed a retrospective, single-center review of all patients with vTOS treated with first rib resection (FRR) and intraoperative venography from...
We describe the workup and successful surgical management of a patient with a right-sided aortic arch complicated by chronic type B aortic dissection, tracheal injury, and an unexpected aortoesophageal fistula.
Optimal Medical Therapy (OMT) has been the accepted mode of treatment for uncomplicated Type B Aortic Dissection (uTBAD). There is growing evidence that despite the short-term benefits of OMT, patients suffer deleterious consequences in the long-term with OMT alone. Thoracic Endovascular Aortic Repair (TEVAR) along with OMT has emerged as an altern...
Isolated external iliac vein aneurysm is exceedingly rare, not well-described in the literature, and presents several potential surgical approaches. Herein we describe the case of a 72-year-old woman who presented with incidentally found 4.3cm x 3.4cm x 5.6cm right external iliac vein aneurysm after undergoing MRI for orthopedic workup. She was tre...
Objectives
Endovascular procedures for lower extremity revascularization are becoming more commonplace due to low morbidity, mortality, and shorter length of stay. The role of open bypass must be reconsidered. Aortobifemoral bypass is the gold standard for extensive aortoiliac occlusive disease (AIOD); however, thoracodistal bypass holds a niche po...
Renal artery pseudoaneurysms are infrequently reported in the literature. We present a case of ruptured renal artery pseudoaneurysm requiring coil embolization. A 49-year-old male presented to our institution with hypertensive emergency. CT scan revealed a 3.4 cm right renal artery pseudoaneurysm. Nonemergent coil embolization was planned for the f...
Placement of extracorporeal membrane oxygenation (ECMO) in obese patients has been challenging; however, cannulation risk in obese patients has not been clearly investigated. We therefore explored ECMO cannulation complications in this obese population. Data were reviewed from adult ECMO database from 2010 to 2019. Patients were stratified by body...
Giant abdominal aortic aneurysms (AAAs) are defined in literature as greater than 10-13 cm in maximum transverse diameter. We describe a Case of a patient presenting for open repair of a 18cm AAA and review the literature of giant AAAs greater than 10 cm in maximum transverse diameter. Forty patients were compiled. Average AAA maximum diameter was...
Objective: Proper follow-up after diagnosis and treatment of aortic dissection (AD) is important. Secondary problems like aneurysmal degeneration leading to rupture, stenosis, evolution of the dissection flap, and aortic remodeling can develop after treatment. Patients often have various barriers that hinder them from following up with their vascul...
Axillary artery injury is a rare complication of blunt upper extremity trauma and is reported in the literature on only a few cases. The usual treatment is an open operation with the exclusion of the aneurysm and interposition grafting. Vascular injury in the elderly population after trauma is especially “dangerous” owing to a large cohort of these...
Introduction
In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program creating a two tiered system of training for vascular surgeons. The question remains if the new paradigm is equivalent to the traditional training. The true test of this may be looking at data from...
Complicated type B aortic dissection (TBAD) is a life-threatening condition requiring surgical intervention. One such complication in the acute or chronic setting is aneurysmal degeneration. The dissected aortic wall is weakened, and the pressures in the false lumen are often high. In the past decade, thoracic endovascular aortic repair (TEVAR) has...
Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and trea...
Wound management is an important component of the care for neurosurgical patients. Improper wound management can lead to patient suffering, morbidity, increased length of stay, readmission, increased cost of care, and, in some cases, infection, sepsis, and mortality. The neurosurgeons manage the neurosurgical wounds. In contrast, pressure wounds ar...
Background:
Type IIIB endoleak from material failure can lead to aneurysmal sac enlargement and latent rupture after endovascular repair of abdominal aortic aneurysm. Long-term durability of the endovascular stent graft is largely unknown, and the complication rate from device failure due to material fatigue may be underappreciated. In addition, e...
Modern management of neurosurgical patients requires close cooperation between neurosurgeons and other specialists. The latter include internists, nurse practitioners, and physician assistants. This textbook aims to provide for these professionals a guide to the challenges associated with the medical management of these patients. It gives an overvi...
Background
Functional popliteal artery entrapment syndrome (FPAES) results from hypertrophied gastrocnemius, soleus, and/or plantaris muscles, without an identifiable anatomic abnormality. Historically, FPAES has been managed with surgical myotomy or myomectomy. Herein, we review the literature to evaluate the results of surgery along with a newer...
The authors aimed to improve the rate of pre-dialysis arteriovenous (AV) access placement for hospitalized patients with advanced chronic kidney disease. The authors developed and implemented a protocol for hospitalized adult patients with an estimated glomerular filtration rate <20 mL/min to streamline the workflow for obtaining AV access. The pro...
Objective:
Vascular groin incision complications contribute significantly to patients' morbidity and rising health care costs. Negative pressure therapy over the closed incision decreases the infection rate in cardiac and orthopedic procedures. This study prospectively evaluated negative pressure therapy as a means to decrease wound complications...
Clostridium septicum aortitis is a rare, highly morbid condition typically accompanied by malignant disease, such as hematologic cancer or colon adenocarcinoma. Presenting symptoms commonly described include acute onset of abdominal pain, nausea, and fevers. Prompt diagnosis of infectious aortitis is critical to prevent deadly complications, such a...
Right lower extremity edema can be a presenting symptom of iliocaval compression syndrome, even in the absence of deep vein thrombosis. It has been reported in idiopathic and rarely, iatrogenic, cases secondary to variant anatomy, arterial stents, and bony hardware. Classically seen in the more confined left common iliac vein as May-Thurner syndrom...
Objective:
Mycotic rupture of the arteries is a rare but deadly disorder. Current management typically involves open surgical repair. However, endovascular repair is a potential treatment that can be used to delay open repair, especially in acutely unstable patients. A case report and review of the literature was conducted to determine whether end...
Mycotic aortic aneurysms are rare occurrences and such aneurysms associated with Streptococcal pneumoniae are seldom seen in the current antibiotic era. We present the unusual case of a 68 year old healthy female with a Streptococcal mycotic abdominal aortic aneurysm of unknown etiology treated with antibiotics and open surgical intervention. Post-...
Lumbar sympathectomy is a procedure that has been used in the past century for various disease processes. Its role has evolved as treatment modalities for the aforementioned pathologies have advanced. It is currently reserved for patients with complex regional pain syndromes, hyperhidrosis, and vascular disease not amenable to revascularization or...
Patients with a uretero-iliac artery fistula (UIAF) are at an elevated risk of life-threatening hemorrhage. Identification and treatment of the fistula may be challenging, and requires the combined expertise of a urologist and endovascular specialist. This manuscript provides a list of equipment needed and describes our technique for diagnosing and...
Lumbar sympathectomy is a procedure that has been used in the past century for various disease processes. Its role has evolved as treatment modalities for the aforementioned pathologies have advanced. It is currently reserved for patients with complex regional pain syndromes, hyperhidrosis, and vascular disease not amenable to revascularization or...
Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed...
As vascular surgery training paradigms evolve, one measure of success is operative experience. This study assessed the initial operative experience of those graduating from new integrated programs (0+5) vs those from the traditional programs (5+2).
National operative case log data supplied by the Accreditation Council for Graduate Medical Education...
Background:
Thoracic endovascular aortic repair (TEVAR) has emerged as a safe and effective alternative to open surgery for treatment of thoracic aortic aneurysms. It has recently been reported that stent-graft coverage of the celiac artery (CA) during TEVAR is associated with a low risk of acute mesenteric ischemia. However, the long-term effect...
Objective
To report the safe and effective treatment of celiac axis aneurysm (CAA) using a covered stent plus coil embolization of the gastric and splenic arteries, and to assess the results of similar cases treated using endovascular techniques.
Methods
Case report and PUBMED literature review (2000–2013) of cases treated using endovascular techn...
Aberrant right subclavian artery is a rare anatomical finding of abnormal embryologic development of the dorsal aorta and right subclavian artery. An associated aortic outpouching, or Kommerell diverticulum, may develop at the origin of the aberrant right subclavian artery. Given historically high rates of aneurysm rupture and mortality, early repa...
Middle Aortic Coarctation (MAC), a variant of Middle Aortic Syndrome, is a rare entity with only ∼200 cases described in the literature. It classically presents with early onset and refractory hypertension, abdominal angina, and lower extremity claudication. Although endovascular repair has been described for focal stenoses, open bypass remains the...
Carotid endarterectomy (CEA) is the preferred treatment for symptomatic [1–3] and asymptomatic [4, 5] patients with high-grade
extracra-nial carotid stenosis, compared with the best medical therapy. The increase in the number of CEAs done worldwide
has resulted in a number of post-CEA carotid restenosis (CR) cases. Carotid artery stenting (CAS) has...
Endovenous ablation is a newer therapy for treating superficial veins in patients with chronic venous disease. The saphenous veins and their accessory veins can be treated. Radiofrequency and laser energy are used to ablate the veins. Accurate ultrasound mapping is needed to plan and perform these procedures. The length and the number of the veins...
Lymphoceles and lymph fistulas are common complications of femoral exposure for vascular procedures. Three patients who required readmission after their vascular interventions were treated with negative pressure wound therapy. Once adequate control of the drainage was obtained, the patients were discharged home with a portable suction unit. The mea...
The treatment of wounds created after resection of a giant hairy nevus poses a challenge in that large defects are created. To heal these wounds, we have used the Integra dermal regeneration template. We have demonstrated good cosmetic and functional results with no need for tissue expansion.
Reconstruction of cutaneous scalp defects from tumor ablation are currently managed with a wide array of coverage options. These include split- or full-thickness skin grafting, local or regional flaps, tissue expansion, and free tissue transfer with variations and combinations thereof. Many of these options require multiple procedures, significant...
The authors present two cases in which traumatic wounds in patients with Ehlers-Danlos syndrome (EDS) were successfully treated with a bioengineered skin equivalent (BSE) (Apligraf®, Organogenesis, Canton, Massachusetts). Due to defects in collagen metabolism, it has been reported that patients with EDS have poor wound healing and unsightly scarrin...
Traumatic axonal injury (TAI) is one of the most important pathologies associated with closed head injury, and contributes to ensuing morbidity. The authors evaluated the potential role of calpains in TAI using a new model of optic nerve stretch injury in mice. Male C57BL/6 mice were anesthetized, surgically prepared, and subjected to a 2.0-mm opti...
Long-term cultures of brain slices were used to test if the lysosomotropic agent chloroquine induces beta-amyloid-related peptides in hippocampus and if such effects are accompanied by other manifestations of brain aging. Chloroquine administration resulted in the appearance of a carboxyl-terminal fragment of the beta-amyloid precursor protein (APP...