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Cassius I Ochoa Chaar, Fatma Shebl, Bauer Sumpio, Alan Dardik, Jeffrey Indes, Timur Sarac
OBJECTIVE: Distal embolization (DE) during peripheral arterial endovascular interventions is a well-known complication that is poorly studied. The goal of this study was to determine the incidence, risk factors, and effect of DE on the outcomes of lower extremity endovascular interventions (LEIs). METHODS: All LEIs between 2010 and 2014 in the Vascular Study Group of New England (VSGNE) database were reviewed. Patient characteristics were analyzed to determine predictors of DE...
July 2017: Journal of Vascular Surgery
Dejah R Judelson, Jessica P Simons, Julie M Flahive, Virendra I Patel, Christopher T Healey, Brian W Nolan, Daniel J Bertges, Andres Schanzer
BACKGROUND: The Vascular Study Group of New England (VSGNE) requires documentation of follow-up for >80% of patients at least 9 months postprocedure. However, many participating groups fall short of this goal. We sought to identify factors independently associated with loss to long-term follow-up (LTF). METHODS: The VSGNE was queried from 2008 to 2012, for all carotid endarterectomy (CEA), endovascular aneurysm repair (EVAR), open abdominal aortic aneurysm repair (OPEN), infrainguinal bypass (INFRA), and suprainguinal bypass (SUPRA) procedures in patients who survived greater than 9 months postprocedure...
November 27, 2016: Annals of Vascular Surgery
Christopher T Healey, Michael Neilson, David Clark, Andres Schanzer, William Robinson
BACKGROUND: Previous risk prediction models of mortality after ruptured abdominal aortic aneurysm (rAAA) repair have been limited by imprecision, complexity, or inclusion of variables not available in the preoperative setting. Most importantly, these prediction models have been derived and validated before the adoption of endovascular aneurysm repair (EVAR) as a treatment for rAAA. We sought to derive and validate a new risk-prediction tool using only easily obtainable preoperative variables in patients with rAAA who are being considered for repair in the endovascular era...
January 2017: Annals of Vascular Surgery
Peter A Soden, Sara L Zettervall, Katie E Shean, Sarah E Deery, Jeffrey A Kalish, Christopher T Healey, Nikhil Kansal, Marc L Schermerhorn
BACKGROUND: Isolated common femoral endarterectomy was recently reported to have a 30-day mortality of 3.4%. The effect of adjunctive femoral endarterectomy at the time of lower extremity bypass is not well described, and therefore, the purpose of this study was to determine its associated perioperative and long-term risk. METHODS: Vascular Study Group of New England registry data were used to identify patients undergoing initial lower extremity bypass from 2003 to 2015...
March 2017: Journal of Vascular Surgery
Amit Bardia, Akshay Sood, Feroze Mahmood, Vwaire Orhurhu, Ariel Mueller, Mario Montealegre-Gallegos, Marc R Shnider, Klaas H J Ultee, Marc L Schermerhorn, Robina Matyal
Importance: Epidural analgesia (EA) is used as an adjunct procedure for postoperative pain control during elective abdominal aortic aneurysm (AAA) surgery. In addition to analgesia, modulatory effects of EA on spinal sympathetic outflow result in improved organ perfusion with reduced complications. Reductions in postoperative complications lead to shorter convalescence and possibly improved 30-day survival. However, the effect of EA on long-term survival when used as an adjunct to general anesthesia (GA) during elective AAA surgery is unknown...
December 1, 2016: JAMA Surgery
Klaas H J Ultee, Sara L Zettervall, Peter A Soden, Jeremy Darling, Daniel J Bertges, Hence J M Verhagen, Marc L Schermerhorn
BACKGROUND: Bowel ischemia is a rare but devastating complication after abdominal aortic aneurysm (AAA) repair. Its rarity has prohibited extensive risk-factor analysis, particularly since the widespread adoption of endovascular AAA repair (EVAR); therefore, this study assessed the incidence of postoperative bowel ischemia after AAA repair in the endovascular era and identified risk factors for its occurrence. METHODS: All patients undergoing intact or ruptured AAA repair in the Vascular Study Group of New England (VSGNE) between January 2003 and November 2014 were included...
November 2016: Journal of Vascular Surgery
Mohammad H Eslami, Clara K Zhu, Denis Rybin, Gheorghe Doros, Jeffrey J Siracuse, Alik Farber
BACKGROUND: Native arteriovenous fistulas (AVFs) have a high 1 year failure rate leading to a need for secondary procedures. We set out to create a predictive model of early failure in patients undergoing first-time AVF creation, to identify failure-associated factors and stratify initial failure risk. METHODS: The Vascular Study Group of New England (VSGNE) (2010-2014) was queried to identify patients undergoing first-time AVF creation. Patients with early (within 3 months postoperation) AVF failure (EF) or no failure (NF) were compared, failure being defined as any AVF that could not be used for dialysis...
August 2016: Annals of Vascular Surgery
Klaas H J Ultee, Peter A Soden, Sara L Zettervall, John C McCallum, Jeffrey J Siracuse, Matthew J Alef, Hence J M Verhagen, Marc L Schermerhorn
BACKGROUND: Open repair of abdominal aortic aneurysms (AAAs) is occasionally performed in conjunction with additional procedures; however, how these concomitant procedures affect outcome is unclear. This study determined the frequency of additional procedures during elective open AAA repair and the effect on perioperative outcomes. METHODS: All elective infrarenal open AAA repairs between January 2003 and November 2014 in the Vascular Study Group of New England (VSGNE) were identified...
October 2016: Journal of Vascular Surgery
Mohammad H Eslami, Denis Rybin, Gheorghe Doros, Alik Farber
BACKGROUND: The goal of this study was to construct and externally validate a risk prediction model for patients who undergo carotid endarterectomy (CEA). METHODS: The Vascular Study Group of New England (VSGNE) and Vascular Quality Initiative (VQI) databases were queried for patients who underwent CEA. Data on perioperative variables, comorbidities, and medications were entered into a logistic regression model as predictors of the composite adverse outcomes in the VSGNE sample...
February 2016: Journal of Vascular Surgery
F Krenzien, G Wiltberger, H-M Hau, I Matia, C Benzing, G Atanasov, M Schmelzle, P T Fellmer
OBJECTIVE: The present study tested scoring models for ruptured abdominal aortic aneurysms (rAAAs) in patients treated by open surgical repair (OSR). Scores were tested in a European population to validate their applicability for predicting outcome. METHODS: Between 2002 and 2013, 92 patients with rAAAs underwent OSR and medical records were reviewed retrospectively. The Edinburgh Rupture Aneurysm Score (ERAS), Vascular Study Group of New England (VSGNE) rAAA risk score, Hardman Index, and Glasgow Aneurysm Score (GAS) were calculated and analyzed according to in hospital mortality...
January 2016: European Journal of Vascular and Endovascular Surgery
Luke Vierthaler, Peter W Callas, Philip P Goodney, Andres Schanzer, Virenda I Patel, Jack Cronenwett, Daniel J Bertges
OBJECTIVE: Our objective was to analyze periprocedural and 1-year outcomes of peripheral endovascular intervention (PVI) for critical limb ischemia (CLI). METHODS: We reviewed 1244 patients undergoing 1414 PVIs for CLI (rest pain, 29%; tissue loss, 71%) within the Vascular Study Group of New England (VSGNE) from January 2010 to December 2011. Overall survival (OS), amputation-free survival (AFS), and freedom from major amputation at 1 year were analyzed using the Kaplan-Meier method...
September 2015: Journal of Vascular Surgery
Mohammad H Eslami, Denis Rybin, Gheorghe Doros, Jeffrey A Kalish, Alik Farber
BACKGROUND: A certain number of deaths may result from elective abdominal aortic aneurysm (AAA) repair due to inherent risks of operation; however, no agreement exists about which predictive model for in-hospital mortality is most accurate in predicting these events. This study developed a risk prediction model using Vascular Study Group of New England (VSGNE) data and compared it with established models. METHODS: VSGNE data (2003-2013) were queried for patients undergoing elective AAA repair by open or endovascular techniques...
November 2015: Journal of Vascular Surgery
Lindsay Gates, Robert Botta, Felix Schlosser, Philip Goodney, Margriet Fokkema, Marc Schermerhorn, Timur Sarac, Jeffrey Indes
OBJECTIVE: The Stenting with Angioplasty and Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial compared carotid endarterectomy (CEA) to carotid artery stenting (CAS) among high-risk patients using a model of risk that has not been validated by previous publications. The objective of our study was to determine the accuracy of this high-risk model and to determine the true risk factors that result in patients being at high risk for CEA. METHODS: Prospectively collected data for 3098 CEAs between 2003 and 2011 at 20 Vascular Surgery Group of New England (VSGNE) centers were used...
October 2015: Journal of Vascular Surgery
Julia T Saraidaridis, Emel Ergul, Virendra I Patel, David H Stone, Richard P Cambria, Mark F Conrad
OBJECTIVE: In 2009, the Society for Vascular Surgery (SVS) established objective performance goals (OPG) for lower extremity bypass (LEB) in patients with critical limb ischemia (CLI) based on pooled data from previously performed prospective studies in an effort to provide a benchmark and historical control for future trials. However, patients with a prosthetic conduit and end-stage renal disease were excluded from this cohort. In contemporary practice, many patients do not meet the criteria for SVS OPG inclusion, making generalization of the SVS OPG difficult...
August 2015: Journal of Vascular Surgery
Ruby C Lo, Bing Lu, Margriet T M Fokkema, Mark Conrad, Virendra I Patel, Mark Fillinger, Robina Matyal, Marc L Schermerhorn
OBJECTIVE: Women have been shown to have up to a fourfold higher risk of abdominal aortic aneurysm (AAA) rupture at any given aneurysm diameter compared with men, leading to recommendations to offer repair to women at lower diameter thresholds. Although this higher risk of rupture may simply reflect greater relative aortic dilatation in women who have smaller aortas to begin with, this has never been quantified. Our objective was therefore to quantify the relationship between rupture and aneurysm diameter relative to body size and determine whether a differential association between aneurysm diameter, body size, and rupture risk exists for men and women...
May 2014: Journal of Vascular Surgery
M Fokkema, G J de Borst, B W Nolan, J Indes, D B Buck, R C Lo, F L Moll, M L Schermerhorn
OBJECTIVES: The benefit of carotid endarterectomy (CEA) may be diminished by cranial nerve injury (CNI). Using a quality improvement registry, we aimed to identify the nerves affected, duration of symptoms (transient vs. persistent), and clinical predictors of CNI. METHODS: We identified all patients undergoing CEA in the Vascular Study Group of New England (VSGNE) between 2003 and 2011. Surgeon-observed CNI rate was determined at discharge (postoperative CNI) and at follow-up to determine persistent CNI (CNIs that persisted at routine follow-up visit)...
January 2014: European Journal of Vascular and Endovascular Surgery
Reshma B Patel, Peter Beaulieu, Karen Homa, Philip P Goodney, Andrew C Stanley, Jack L Cronenwett, David H Stone, Daniel J Bertges
OBJECTIVE: The goal of this study was to evaluate whether protamine usage after carotid endarterectomy (CEA) increased within the Vascular Study Group of New England (VSGNE) in response to studies indicating that protamine reduces bleeding complications associated with CEA without increasing the risk of stroke. METHODS: We reviewed 10,059 CEAs, excluding concomitant coronary bypass, performed within the VSGNE from January 2003 to July 2012. Protamine use and reoperation for bleeding were evaluated monthly using statistical process control...
December 2013: Journal of Vascular Surgery
Tze-Woei Tan, Mohammad H Eslami, Jeffrey A Kalish, Robert T Eberhardt, Gheorghe Doros, Philip P Goodney, Jack L Cronenwett, Alik Farber
OBJECTIVE: The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED). METHODS: We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not...
January 2014: Journal of Vascular Surgery
Margriet Fokkema, Gert Jan de Borst, Brian W Nolan, Ruby C Lo, Robert A Cambria, Richard J Powell, Frans L Moll, Marc L Schermerhorn
BACKGROUND: Outcomes for patients undergoing intervention for restenosis after prior ipsilateral carotid endarterectomy (CEA) in the era of carotid angioplasty and stenting (CAS) are unclear. We compared perioperative results and durability of CAS vs CEA in patients with symptomatic or asymptomatic restenosis after prior CEA and investigated the risk of reintervention compared with primary procedures. METHODS: Patients undergoing CAS and CEA for restenosis between January 2003 and March 2012 were identified within the Vascular Study Group of New England (VSGNE) database...
January 2014: Journal of Vascular Surgery
William P Robinson, Andres Schanzer, Youfu Li, Philip P Goodney, Brian W Nolan, Mohammad H Eslami, Jack L Cronenwett, Louis M Messina
OBJECTIVE: Scoring systems for predicting mortality after repair of ruptured abdominal aortic aneurysms (RAAAs) have not been developed or tested in a United States population and may not be accurate in the endovascular era. Using prospectively collected data from the Vascular Study Group of New England (VSGNE), we developed a practical risk score for in-hospital mortality after open repair of RAAAs and compared its performance to that of the Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score...
February 2013: Journal of Vascular Surgery
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