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Jonathan P Rehfuss, Kenneth M DeSart, Jared M Rozowsky, Kerri A O'Malley, Lyle L Moldawer, Henry V Baker, Yaqun Wang, Rongling Wu, Peter R Nelson, Scott A Berceli
BACKGROUND: Despite being the definitive treatment for lower extremity peripheral arterial disease, vein bypass grafts fail in half of all cases. Early repair mechanisms after implantation, governed largely by the immune environment, contribute significantly to long-term outcomes. The current study investigates the early response patterns of circulating monocytes as a determinant of graft outcome. METHODS: In 48 patients undergoing infrainguinal vein bypass grafting, the transcriptomes of circulating monocytes were analyzed preoperatively and at 1, 7, and 28 days post-operation...
March 2018: Circ Genom Precis Med
Douglas W Jones, Philip P Goodney, Jens Eldrup-Jorgensen, Marc L Schermerhorn, Jeffrey J Siracuse, Jeanwan Kang, Jesse A Columbo, Bjoern D Suckow, David H Stone
OBJECTIVE: Performing lower extremity bypass (LEB) in actively smoking claudicants remains controversial. Whereas some surgeons advocate a strict nonoperative approach to active smokers, citing perceived inferior outcomes, others will proceed with surgical bypass if the patient is anatomically suited and medical management has failed. The purpose of this study was to determine the impact of active smoking on LEB outcomes among claudicants. METHODS: All patients undergoing infrainguinal LEB for claudication in the Vascular Study Group of New England from 2003 to 2016 were analyzed...
March 6, 2018: Journal of Vascular Surgery
Mazlum Sahin, Helin El
AIM: To evaluate the accuracy of the FARP2 scoring system in predicting early graft failure after infrainguinal bypass surgery (IBS). METHODS: Patient charts which underwent IBS between January 2014 and January 2017 , in two tertiary academic centers were evaluated retrospectively. In follow ups, one week after operation, detailed physical examination was done and doppler ultrasonography was performed one month after operation and integrity of the graft was evaluated...
March 6, 2018: Annals of Vascular Surgery
Corey A Kalbaugh, Nicole Jadue Gonzalez, Daniel J Luckett, Jason Fine, Thomas E Brothers, Mark A Farber, Adam W Beck, John W Hallett, William A Marston, Raghuveer Vallabhaneni
OBJECTIVE: Although smoking cessation is a benchmark of medical management of intermittent claudication, many patients require further revascularization. Currently, revascularization among smokers is a controversial topic, and practice patterns differ institutionally, regionally, and nationally. Patients who smoke at the time of revascularization are thought to have a poor prognosis, but data on this topic are limited. The purpose of this study was to evaluate the impact of smoking on outcomes after infrainguinal bypass for claudication...
March 2, 2018: Journal of Vascular Surgery
Nassiri N, Huntress LA
Endovascular salvage of failed surgical bypasses has been scantly reported for treatment of infrainguinal occlusive disease. While catheter-directed thrombolysis and/or mechanical thromboembolectomy have been the mainstay of endovascular salvage of previous bypass grafts, native vessel recanalization remains seldom attempted. Herein, we present a unique approach to native vessel recanalization of a chronically thrombosed popliteal artery aneurysm for non-healing distal ulceration.
March 1, 2018: Annals of Vascular Surgery
Kuniyasu Ikeoka, Shiro Hoshida, Tetsuya Watanabe, Yukinori Shinoda, Tomoko Minamisaka, Hidetada Fukuoka, Hirooki Inui, Keisuke Ueno, Yasushi Sakata
AIM: Maximal hyperemic response, leading to examination of microvascular resistance in lower-limb lesions is not well understood. This study aimed to investigate the infrainguinal arterial physiological response through a hyperemic condition and the pathophysiological significance of microvascular resistance in peripheral artery disease. METHODS: Sixteen limbs with focal stenosis of the superficial femoral artery (SFA) and 16 control limbs were analyzed. We assessed the fractional flow reserve (FFR), vascular flow reserve (VFR), and hyperemic microvascular resistance (h-MR) of the SFA with a pressure/Doppler flow sensor-tipped combination guidewire before and after endovascular therapy (EVT)...
February 28, 2018: Journal of Atherosclerosis and Thrombosis
Juliet J Ray, Sarah A Eidelson, Charles A Karcutskie, Jonathan P Meizoso, Hilene DeAmorim, Lee J Goldstein, John Karwowski, Arash Bornak
INTRODUCTION: This study examines the outcome of hybrid revascularization combining iliofemoral endartectomy and iliac artery stenting using covered stents in TASC C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). METHODS: A retrospective review was conducted of patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length-of-stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, as well as patency were assessed...
February 23, 2018: Annals of Vascular Surgery
Thomas F X O'Donnell, Chloe Powell, Sarah E Deery, Jeremy D Darling, Kakra Hughes, Kristina A Giles, Grace J Wang, Marc L Schermerhorn
OBJECTIVE: Prior studies identified significant racial disparities as well as regional variation in outcomes of patients with peripheral artery disease (PAD). We aimed to determine whether regional variation contributes to these racial disparities. METHODS: We identified all white or black patients who underwent infrainguinal revascularization or amputation in 15 deidentified regions of the Vascular Quality Initiative between 2003 and 2017. We excluded three regions with <100 procedures...
February 16, 2018: Journal of Vascular Surgery
Shinsuke Mii, Atsushi Guntani, Eisuke Kawakubo, Kiyoshi Tanaka, Ryoichi Kyuragi
BACKGROUND: Few reports have described the effects of medication on the wound healing of ischemic ulcers after revascularization. This study was conducted to investigate the effects of cilostazol on wound healing in patients who underwent infrainguinal bypass for ischemic tissue loss. METHODS: Two hundred and sixty-three limbs undergoing de novo infrainguinal bypass for tissue loss from January 2004 to December 2015 were divided into two groups based on whether or not cilostazol was administered after surgery...
February 15, 2018: Annals of Vascular Surgery
S Keisin Wang, Ashley R Gutwein, Natalie A Drucker, Michael P Murphy, Andres Fajardo, Michael C Dalsing, Raghu L Motaganahalli, Gary W Lemmon
OBJECTIVE: Single-length saphenous vein continues to be the conduit of choice in infected-field critical limb ischemia (CLI). However, half of these individuals have inadequate vein secondary to previous use or chronic venous disease. We reviewed our outcomes of infected-field infrainguinal bypasses performed with cryopreserved homografts (CH), a widely-accepted alternative to autogenous vein in this setting. METHODS: This is a retrospective, institutional descriptive analysis of infected-field infrainguinal revascularizations between 2012-2015...
February 5, 2018: Annals of Vascular Surgery
Akihiko Seo, Kota Yamamoto, Atsushi Akai, Daisuke Akagi, Toshio Takayama, Katsuyuki Hoshina
The main objective is to examine whether the severity of peripheral arterial disease (PAD) affects the expenses and hospital stay of the patients who undergo bypass surgery below the inguinal ligament for PAD. Eighty consecutive patients who underwent infrainguinal bypass surgery for PAD between January 2012 and December 2014 were included in the study. Patients were divided into groups according to their critical limb ischemia (CLI) symptoms and the Wound, Ischemia, and Foot Infection (WIfI) classification...
February 2, 2018: Heart and Vessels
Stefan Stojkovic, Magdalena Jurisic, Christoph W Kopp, Renate Koppensteiner, Kurt Huber, Johann Wojta, Thomas Gremmel
BACKGROUND AND AIMS: Target lesion restenosis is the most frequent complication after angioplasty and stenting for peripheral artery disease (PAD). MicroRNAs (miRs) regulate crucial pathophysiological processes leading to in-stent restenosis and thrombosis. The aim of this study was to investigate the predictive value of 11 miRs for the composite endpoint of target lesion restenosis and atherothrombotic events (primary endpoint), and target vessel revascularization (TVR, secondary endpoint) in 62 consecutive PAD patients after infrainguinal angioplasty with stent implantation...
January 16, 2018: Atherosclerosis
Nicola Troisi, Filippo Turini, Emiliano Chisci, Leonardo Ercolini, Pierfrancesco Frosini, Renzo Lombardi, Francesca Falciani, Cristiana Baggiore, Roberto Anichini, Stefano Michelagnoli
Objective: To retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Materials and Methods: Between January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA)...
January 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Katriina Heikkila, David C Mitchell, Ian M Loftus, Amundeep S Johal, Sam Waton, David A Cromwell
Background -The availability and diversity of lower limb revascularisation procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. Methods -Individual-patient records from Hospital Episode Statistics (HES) were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty or bypass) lower limb revascularisation for infrainguinal peripheral artery disease (PAD) in England between January 2006 and December 2015...
January 9, 2018: Circulation
Rebecca Craig-Schapiro, Besma Nejim, Isibor Arhuidese, Mahmoud B Malas
While studies demonstrate poor outcomes of lower extremity revascularization in end-stage renal disease patients, little is known about results in renal transplant patients. We analyzed 2-year primary patency and limb salvage outcomes and associated risk factors of transplant (N=202) and non-transplant patients (N=25,274) in the Vascular Quality Initiative database undergoing infrainguinal bypass from 2003-2016. Multivariable Cox regression analysis and coarsened exact matching with many-to-one were employed...
December 29, 2017: American Journal of Transplantation
Isibor Arhuidese, Amber Kernodle, Besma Nejim, Satinderjit Locham, Caitlin Hicks, Mahmoud B Malas
OBJECTIVE: The objective of this study was to compare conduit use and surgical outcomes of hemodialysis-dependent men and women after open lower extremity bypass surgery. METHODS: Using the United States Renal Data System, we studied all hemodialysis patients in the United States who underwent infrainguinal bypass surgery between January 1, 2006, and December 31, 2011. Univariate methods (χ2, analysis of variance) were employed to compare patient and bypass characteristics between men and women...
December 21, 2017: Journal of Vascular Surgery
Cori A Cason, Kyle T Dolan, Gaurav Sharma, Ming Tao, Rohan Kulkarni, Irene B Helenowski, Brendan M Doane, Michael J Avram, Mary M McDermott, Eugene B Chang, C Keith Ozaki, Karen J Ho
OBJECTIVE: Multiple studies have shown that gut microbes contribute to atherosclerosis, and there is mounting evidence that microbial metabolism of dietary nutrients influences pathophysiology. We hypothesized that indole- and phenyl-derived metabolites that originate solely or in part from bacterial sources would differ between patients with advanced atherosclerosis and age- and sex-matched controls without clinically apparent atherosclerosis. METHODS: Plasma from the advanced atherosclerosis cohort (n = 100) was from patients who underwent carotid endarterectomy, open infrainguinal leg revascularization, or major leg amputation for critical limb ischemia...
December 13, 2017: Journal of Vascular Surgery
Achim Neufang, Christine Espinola-Klein, Savvas Savvidis, Walther Schmiedt, Alicia Poplawski, Christian Friedrich Vahl, Bernhard Dorweiler
OBJECTIVE: Use of autologous veins as peripheral bypass graft may become critical in the presence of significant varicose degeneration of the harvested vein. External support of such dilated veins with standard polytetrafluoroethylene (PTFE) prostheses was recommended as an option to use these veins for peripheral bypass. A single-center experience with this technique regarding long-term graft function, secondary reinterventions, and potential graft degeneration is presented. METHODS: Between January 1995 and January 2006, there were 54 patients with varicose veins who underwent 57 consecutive infrainguinal vein bypass operations with PTFE reinforcement in 57 limbs...
December 11, 2017: Journal of Vascular Surgery
Bartosz Olechowski, Vikram Khanna, Mark Mariathas, Alexander Ashby, Richard T Dalton, Ian Nordon, Nicola Englyst, Scott Harris, Zoe Nicholas, Kala Thayalasamy, Michael Mahmoudi, Nick Curzen
The role of platelets in ischaemic events is well established. Aspirin represents the default antiplatelet and blocks the metabolism of arachidonic acid (AA) at the cyclo-oxygenase enzyme (COX). AA is commonly used as a test of response to aspirin, but recent data raise uncertainty about the validity of this approach. Specifically, in some patients AA-induced clotting is not suppressed, but the level of COX-dependent AA metabolite, thromboxane B2 (TXB2 ) is negligible. Furthermore, AA-induced whole blood clotting varies dynamically in individuals, who are aspirin responsive according to TXB2 levels...
December 11, 2017: Platelets
Nathaniel Chiang, Odette A Rodda, Jamie Sleigh, Thodur Vasudevan
BACKGROUND: Perioperative adjuncts are utilized across surgical specialities with the goal of improving patient outcomes. High-dose oxygen and extended warming are shown to increase wound collagen deposition during abdominal surgery. Prostacyclin is shown to improve limb salvage and patency rate in infrainguinal bypass (IIB) surgery. This study evaluated the impact of these adjuncts on healing and perfusion post IIB surgery. METHODS: This randomized controlled study allocated patients undergoing IIB surgery into three treatment arms (perioperative high-dose oxygen, extended warming, and a synthetic prostacyclin) or a control group...
December 2017: Journal of Surgical Research
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