Sachin V Phade

University of Tennessee at Chattanooga, Chattanooga, Tennessee, United States

Are you Sachin V Phade?

Claim your profile

Publications (10)19.88 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe acute stroke patients with critical carotid stenosis or occlusion without intracranial thrombus typically do not undergo emergent carotid thromboendarterectomy (CEA) because of the risk of reperfusion-related intracranial hemorrhage. Past studies have not consistently demonstrated benefit of early operative intervention. Cerebral computed tomography (CT), cervical and cerebral CT angiography (CTA), and cerebral CT perfusion (CTP) imaging may identify a subset of acute stroke patients without intracranial thrombus who may benefit from emergent CEA. Acute stroke patients underwent unenhanced brain CT imaging to exclude pathology that would contraindicate emergent therapy. Emergent CTAs of the intracranial and extracranial vessels were utilized to identify patients that presented with stroke symptoms based on the presence of isolated extracranial carotid disease in the absence of intracranial thromboembolism. CTP was then utilized to assess the extent of potentially reversible cerebral ischemia (penumbral tissue). Patients with isolated extracranial carotid lesions with significant reversible ischemia in the absence of large areas of irreversible cerebral damage underwent emergent CEA to salvage ischemic penumbra. In one year, three patients presented with large acute strokes in which CTA disclosed symptomatic extracranial internal carotid artery (ICA) pre-occlusive or occlusive lesions without intracranial thromboembolic occlusions. CTP indicated a large area of ischemic penumbra with limited permanent injury. Mean age, time to presentation, and National Institutes of Health stroke score (NIHSS) were 66 years, 4.2 hours, and 19.3. All underwent emergent CEA with cervical carotid thrombectomy. Average time from stroke symptom onset to revascularization was 10.5 (range 5.8-19.0) hours. There were no perioperative deaths. At day 5, the mean NIHSS decreased to 7.6 and at day 30 was 4.7. The modified Rankin scale score dropped from a post-stroke, pre-op level of 5 to 2.3 by day 30. Emergent CEA should be considered in patients presenting with large acute strokes based on favorable CT, CTA, and CTP findings. Emergent clot localization and physiological assessment of brain “tissue at risk” relative to irreversible cerebral infarction utilizing CT, CTA, and CTP is now available. Utilization of this information by an experienced stroke team of neurologists, radiologists, and surgeons may aid in the recognition of a select group of patients in which emergent CEA may drive to improved outcomes.
    No preview · Article · Sep 2014 · Annals of Vascular Surgery
  • Source

    Preview · Article · May 2013 · Journal of Vascular Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be difficult and, because the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms. Methods: In this study we performed a retrospective, multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery. Results: Between January 2000 and January 2011, 7 patients, aged 12-56 years, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or another hereditary disorder, including Ehler-Danlos syndrome (n=3), Marfan's disease (n=2), neurofibromatosis (n=1), and an unspecified connective tissue abnormality (n=1). Eight of 9 aneurysms were managed operatively, including an attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos syndrome. Although endovascular exclusion was not performed in isolation, 2 hybrid procedures were performed. There were no instances of perioperative stroke or death. Conclusions: Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality.
    No preview · Article · Mar 2013 · Annals of Vascular Surgery
  • Source

    Preview · Article · Dec 2012 · Journal of Vascular Surgery
  • Source
    Sachin V Phade · Manuel Garcia-Toca · Melina R Kibbe
    [Show abstract] [Hide abstract]
    ABSTRACT: Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies.
    Preview · Article · Oct 2011 · International journal of vascular medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite advances in endoluminal salvage for failed endografts, certain circumstances necessitate open endovascular abdominal aneurysm repair (EVAR) conversion. We review the indications for and outcomes after late EVAR explants. Retrospective review of EVAR patients requiring delayed (>30 days) conversion from 1999 to 2009. Demographics, index endovascular procedure, conversion indication/technique, and outcomes were analyzed. Among 16 patients who required late conversion, the mean age was 73 years (range, 41-84 years) and 94% were men. Indications included 9 device failures, 6 endograft infections, and a single type II endoleak with sac enlargement. Explanted prostheses included the following: 7 Cook Zenith(®) endoprosthesis, 3 Gore Excluder(®) grafts, 3 Medtronic AneuRx(®) endograft devices, 2 Endologix Powerlink(®) endografts, and 1 Guidant Ancure(®) graft. Before conversion, 7 patients underwent unsuccessful secondary salvage procedures. Transperitoneal (81%) and left retroperitoneal approaches (19%) were used, with 75% requiring supraceliac control. Reconstructions depended on clinical manifestations and included 10 in situ prosthetic repairs, 4 extra-anatomic bypasses, and 2 in situ cryopreserved human allograft repairs. Two patients died during their hospitalization, resulting in a 13% mortality rate. Mean hospitalization for survivors was 18 days (range, 6-78 days), and 7 (50%) of the patients were discharged directly home. Most delayed EVAR conversions are because of device failure or infection and can be successfully converted to open surgical reconstruction. Supraceliac control is often required, and the perioperative complications are greater than primary elective open or endovascular repair. This study addresses how best to manage failed abdominal aortic endografts and what can be done to improve patient outcomes with this difficult clinical problem.
    No preview · Article · Oct 2011 · Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vascular Ehlers-Danlos (VED) represents a rare disorder in which a defect in collagen synthesis renders vessels to be extremely fragile. We report the successful repair of a subclavian artery pseudoaneurysm via a hybrid technique employing delivery of a covered stent along with video-assisted thoracoscopic ligation of the internal mammary artery in a patient with VED.
    Full-text · Article · Sep 2011 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
  • [Show abstract] [Hide abstract]
    ABSTRACT: Late stent fatigue is a known complication after carotid artery stenting (CAS) for cervical carotid occlusive disease. The purpose of this study was to determine the prevalence and clinical significance of carotid stent fractures. A single-center retrospective review of 253 carotid bifurcation lesions treated with CAS and mechanical embolic protection from April 2001 to December 2009 was performed. Stent integrity was analyzed by two independent observers using multiplanar cervical plain radiographs with fractures classified into the following types: type I = single strut fracture; type II = multiple strut fractures; type III = transverse fracture; and type IV = transverse fracture with dislocation. Mean follow-up was 32 months. Follow-up imaging was completed on 106 self-expanding nitinol stents (26 closed-cell and 80 open-cell stents). Eight fractures (7.5%) were detected (type I n = 1, type II n = 6, and type III n = 1). Seven fractures were found in open-cell stents (Precise n = 3, ViVEXX n = 2, and Acculink n = 2), and 1 fracture was found in a closed-cell stent (Xact n = 1) (p = 0.67). Only a previous history of external beam neck irradiation was associated with fractures (p = 0.048). No associated clinical sequelae were observed among the patients with fractures, and only 1 patient had an associated significant restenosis (≥ 80%) requiring reintervention. Late stent fatigue after CAS is an uncommon event and rarely clinically relevant. Although cell design does not appear to influence the occurrence of fractures, lesion characteristics may be associated risk factors.
    No preview · Article · Mar 2011 · CardioVascular and Interventional Radiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Intimal angiosarcomas are rare and difficult to diagnose preoperatively. Complete surgical resection is essential, but long-term survival is unlikely. We report a patient who presented with a contained ruptured infrarenal aorta with clinical and radiologic findings suggestive of infectious aortitis. Surgical resection, regional debridement, and reconstruction were completed using a cadaveric arterial homograft. However, pathologic evaluation revealed a high-grade intimal sarcoma. (J Vase Surg 2011;53:818-21.)
    Preview · Article · Mar 2011 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
  • Mark L Keldahl · Sachin V Phade · Mark K Eskandari
    [Show abstract] [Hide abstract]
    ABSTRACT: Carotid artery stenting has rapidly grown as an alternative to carotid endarterectomy for stroke prevention among selected patients with extracranial carotid artery stenosis. Development of mechanical embolic protection devices (EPDs) has been associated with improved clinical outcomes and is now a strongly advocated adjunct to the procedure. Characteristically, EPDs have been broadly defined into 3 primary categories, of which the distal filter elements have largely been the most developed and used. Improvements among the class of proximal balloon occlusion devices with flow reversal have a number of theoretic advantages and are the focus of this review article.
    No preview · Article · Sep 2010 · Perspectives in Vascular Surgery