39 results on '"J. Veith"'
Search Results
2. Non-reversed and Reversed Great Saphenous Vein Graft Configurations Offer Comparable Early Outcomes in Patients Undergoing Infrainguinal Bypass
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Heepeel Chang, Frank J. Veith, Caron B. Rockman, Neal S. Cayne, Glenn R. Jacobowitz, and Karan Garg
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Treatment Outcome ,Ischemia ,Risk Factors ,Graft Occlusion, Vascular ,Humans ,Saphenous Vein ,Surgery ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Vascular Patency ,Retrospective Studies - Abstract
Data on the efficacy of non-reversed and reversed great saphenous vein bypass (NRGSV and RGSV) techniques are lacking. The aim of the study was to compare the outcomes of patients undergoing open infrainguinal revascularisation using NRGSV and RGSV from a multi-institutional database.The Vascular Quality Initiative database was queried for patients undergoing infrainguinal bypasses using NRGSV and RGSV for symptomatic occlusive disease from January 2003 to February 2021. The primary outcome measures included primary and secondary patency at discharge and one year. Secondary outcomes were re-interventions at discharge and one year. Cox proportional hazards models were used to evaluate the impact of graft configuration on outcomes of interest.Of 7 123 patients, 4 662 and 2 461 patients underwent RGSV and NRGSV, respectively. At one year, the rates of primary patency (78% vs. 78%; p = .83), secondary patency (90% vs. 89%; p = .26), and re-intervention (16% vs. 16%; p = .95) were similar between the RGSV and NRGSV cohorts, respectively. Subgroup analysis based on outflow bypass target and indication for revascularisation did not show differences in primary and secondary outcomes between the two groups. Multivariable analysis confirmed that RGSV (NRGSV as the reference) configuration was not independently associated with increased risk of primary patency loss (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.91 - 1.13; p = .80), secondary patency loss (HR 0.94; 95% CI 0.81 - 1.10; p = .44), and re-intervention (HR 1.03; 95% CI 0.91 - 1.16; p = .67) at follow up.The study shows that RGSV and NRGSV grafting techniques have comparable peri-operative and one year primary and secondary patency and re-intervention rates. This effect persisted when stratified by outflow targets and indication for revascularisation. Therefore, optimal selection of vein grafting technique should be guided by the patient's anatomy, vein conduit availability, and surgeon's experience.
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- 2022
3. Proper technique of lower extremity pulse examination: a lost art
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Keith D. Calligaro, Frank J. Veith, George Berdejo, and Jorge H. Ulloa
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. Outcomes of translumbar embolization of type II endoleaks following endovascular abdominal aortic aneurysm repair
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John F. Charitable, Thomas S. Maldonado, Frank J. Veith, Neal S. Cayne, Caron B. Rockman, Glenn R. Jacobowitz, Karan Garg, and Peter Patalano
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Male ,medicine.medical_specialty ,Time Factors ,Endoleak ,medicine.medical_treatment ,Embolization procedure ,Risk Assessment ,Coronary artery disease ,Blood Vessel Prosthesis Implantation ,Lumbar ,Aneurysm ,Risk Factors ,medicine ,Humans ,Cyanoacrylates ,Embolization ,Aged ,Retrospective Studies ,business.industry ,Endovascular Procedures ,medicine.disease ,Embolization, Therapeutic ,Confidence interval ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,Retreatment ,Female ,Cardiology and Cardiovascular Medicine ,Ligation ,business ,Platelet Aggregation Inhibitors ,Aortic Aneurysm, Abdominal - Abstract
Presence of an endoleak can compromise aneurysm exclusion after endovascular abdominal aortic aneurysm repair (EVAR). Type II endoleaks (T2Es) are most common and may cause sac expansion. We report outcomes of translumbar embolization (TLE) of T2Es following EVAR.We conducted a retrospective chart review of patients with T2E after EVAR treated with TLE from 2011 to 2018 at a single academic institution. Treatment indications were the presence of persistent T2E and aneurysm growth ≥5 mm. Sac stabilization was defined as growth ≤5 mm throughout the follow-up period.Thirty consecutive patients were identified. The majority were men (n = 24), with a mean age of 74.3 years (95% confidence interval [CI], 70.9-77.6 years). The most common comorbidities were hypertension (83.3%) and coronary artery disease (54.0%). The mean maximal sac diameter at T2E discovery was 5.8 cm (95% CI, 5.4-6.2 cm). The mean time to intervention from endoleak discovery was 33.7 ± 28 months with a mean growth of 0.84 cm (95% CI, 0.48-1.2 cm) during that time period. The mean follow-up time after TLE was 19.1 months (95% CI, 11.1-27.2 months). Twenty-eight patients were treated with cyanoacrylate glue (CyG) alone, and two were treated with CyG plus coil embolization (CE). There was immediate complete endoleak resolution as assessed intraoperatively, and sac stabilization in 15 cases (50.0%). Eleven patients (36.7%) had evidence of persistent T2E on initial imaging after the embolization procedure; additional follow-up revealed eventual sac stabilization at a mean of 21.3 ± 7.2 months, and therefore, these patients did not require further intervention. In the remaining four cases (13.3%), there was persistent T2E after the initial TLE, requiring a second intervention. Repeat TLE stabilized growth in three of these four patients after a mean of 17.6 ± 12.9 months. One patient required open sacotomy and ligation of lumbar vessels due to continued persistence of the T2E and continued aneurysm growth. There were no ischemic complications related to the embolization procedures. Factors associated with persistent endoleak after initial embolization were larger aneurysm diameter at the time of initial endoleak identification (P .001) and the use of antiplatelet agents (P .02). The use of anticoagulation was not a significant risk factor for endoleak recurrence or aneurysm growth after TLE.TLE of T2E is a safe and effective treatment option for T2E with aneurysm growth following EVAR. Patients taking antiplatelet medication and those with larger aneurysms at the time of endoleak identification appear to be at increased risk for persistent endoleak and need for subsequent procedures following initial TLE. These patients may require more intensive monitoring and follow-up.
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- 2021
5. Smaller Superficial Femoral Artery is Associated with Worse Outcomes after Percutaneous Transluminal Angioplasty for De Novo Atherosclerotic Disease
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Karan Garg, Glenn R. Jacobowitz, Anvar Babaev, Bhama Ramkhelawon, Heepeel Chang, Neal S. Cayne, Caron B. Rockman, Virendra I. Patel, and Frank J. Veith
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Male ,medicine.medical_specialty ,Time Factors ,Percutaneous ,Databases, Factual ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Balloon ,Transluminal Angioplasty ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Angioplasty ,medicine ,Humans ,Vascular Patency ,Aged ,Retrospective Studies ,Superficial femoral artery ,business.industry ,Atherosclerotic disease ,General Medicine ,Middle Aged ,Plaque, Atherosclerotic ,Surgery ,Angioplasty balloon ,Femoral Artery ,Treatment Outcome ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Claudication ,Angioplasty, Balloon ,Vascular Access Devices - Abstract
With the exponential increase in the use of endovascular techniques in the treatment of peripheral artery disease, our understanding of factors that affect intervention failures continues to grow. We sought to assess the outcomes of percutaneous transluminal angioplasty for isolated de novo superficial femoral artery (SFA) disease based on balloon diameter.The Vascular Quality Initiative database was queried for patients undergoing percutaneous balloon angioplasty for isolated de novo atherosclerotic SFA disease. Based on the diameter of the angioplasty balloon as a surrogate measure of arterial diameter, patients were stratified into 2 groups: group 1, balloon diameter5 mm (354 patients) and group 2, balloon diameter ≥5 mm (1,550 patients). The primary patency and major adverse limb event (MALE) were estimated by the Kaplan-Meier method and compared with the log-rank test, based on vessel diameter. Multivariable Cox regression analysis was used to determine factors associated with the primary patency.From January 2010 through December 2018, a total of 1,904 patients met criteria for analysis, with a mean follow-up of 13.3 ± 4.5 months. The mean balloon diameters were 3.92 ± 0.26 mm and 5.47 ± 0.55 mm in group 1 and 2, respectively (P0.001). The mean length of treatment and distribution of TASC lesions were not statistically different between the groups. Primary patency at 18 months was significantly lower in group 1, compared with group 2 (55% vs. 67%; log-rank P0.001). The MALE rate was higher in group 1 than group 2 (33% vs. 26%; log-rank P0.001). Among patients with claudication, there was no significant difference in the primary patency (61% vs 68%; log-rank P = 0.073) and MALE (27% vs. 22%; log-rank P = 0.176) at 18 months between groups 1 and 2, respectively. However, in patients with CLTI, group 1 had significantly lower 18-month primary patency (47% vs. 64%; log-rank P0.014) and higher MALE rates (41% vs. 35%; log-rank P = 0.012) than group 2. Cox proportional hazard analysis confirmed that balloon diameter5 mm was independently associated with increased risks of primary patency loss (HR 1.35; 95% CI, 1.04-1.72; P = 0.021) and MALE (HR 1.29; 95% CI, 1-1.67; P = 0.048) at 18-months.In patients undergoing isolated SFA balloon angioplasty for CLTI, smaller SFA (5 mm) was associated with worse primary patency and MALE. Using balloon size as a surrogate, our findings suggest that patients with a smaller SFA diameter appear to be at increased risk for treatment failure and warrant closer surveillance. Furthermore, these patients may also be considered for alternative approaches, including open revascularization.
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- 2021
6. Renal transplant recipients undergoing endovascular abdominal aortic aneurysm repair have increased risk of perioperative acute kidney injury but no difference in late mortality
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Heepeel Chang, Frank J. Veith, Igor Laskowski, Thomas S. Maldonado, Jonathan R. Butler, Glenn R. Jacobowitz, Caron B. Rockman, Muhammad Zeeshan, Daniel J. Ventarola, Neal S. Cayne, Aiden Lui, Romeo Mateo, Sateesh Babu, Arun Goyal, and Karan Garg
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
7. Regarding Comparison of Recent Practice Guidelines for the Management of Patients with Asymptomatic Carotid Stenosis
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Anne L. Abbott, Alejandro Brunser, Oliseneku D. Uyagu, Hrvoje Budincevic, Konstantinos Spanos, and Frank J. Veith
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Cardiology and Cardiovascular Medicine - Published
- 2022
8. Neuroprotective association of preoperative renin-angiotensin system blocking agents use in patients undergoing carotid interventions
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Chong Li, Caron Rockman, Heepeel Chang, Virendra I Patel, Jeffrey J Siracuse, Neal Cayne, Frank J Veith, Jose L Torres, Thomas S Maldonado, Anjali A Nigalaye, Glenn Jacobowitz, and Karan Garg
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Radiology, Nuclear Medicine and imaging ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Objective The optimal medical management strategy in the periprocedural period for patients undergoing carotid artery interventions is not well described. Renin-angiotensin-system blocking (RASB) agents are considered to be among the first line anti-hypertensive agents; however, their role in the perioperative period is unclear. The objective of this study was to examine the relationship between the use of RASB agents on periprocedural outcomes in patients undergoing carotid interventions—carotid endarterectomy (CEA), transfemoral carotid artery stenting (CAS), and transcervical carotid artery revascularization (TCAR). Method The Society for Vascular Surgery Quality Initiative database was queried for all patients undergoing CAS, CEA, and TCAR between 2003 and 2020. Patients were stratified into two groups based upon their use of RASB agents in the periprocedural period. The primary endpoint was periprocedural neurologic events (including both strokes and transient ischemic attacks (TIAs)). The secondary endpoints were peri-procedural mortality and significant cardiac events, including myocardial infarction, dysrhythmia, and congestive heart failure. Results Over 150,000 patients were included in the analysis: 13,666 patients underwent TCAR, 13,811 underwent CAS, and 125,429 underwent CEA for carotid artery stenosis. Overall, 52.2% of patients were maintained on RASB agents. Among patients undergoing CEA, patients on RASB agents had a significantly lower rate of periprocedural neurologic events (1.7% versus 2.0%, p =0.001). The peri-procedural neurological event rate in the TCAR cohort was similarly reduced in those treated with RASB agents, but did not reach statistical significance (2.0% vs 2.4%, p = 0.162). Among patients undergoing CAS, there was no difference in perioperative neurologic events between the RASB treated and untreated cohorts (3.4% vs 3.2%, p = 0.234); however, the use of RASB agents was significantly associated with lower mortality (1.2% vs 1.7%, p =0.001) with CAS. The use of preoperative RAS-blocking agents did not appear to affect the overall rates of adverse cardiac events with any of the three carotid intervention types, or periprocedural mortality following CEA or TCAR. On multivariable analysis, the use of RAS-blocking agents was independently associated with lower rates of post-procedural neurologic events in patients undergoing CEA (OR 0.819, CI 0.747–0.898; p = 0.01) and TCAR (OR 0.869, CI 0.768–0.984; p = 0.026), but not in those undergoing CAS (OR 0.967, CI 0.884–1.057; p = 0.461). Conclusion The use of peri-procedural RASB agents was associated with a significantly decreased rate of neurologic events in patients undergoing both CEA and TCAR. This effect was not observed in patients undergoing CAS. As carotid interventions warrant absolute minimization of perioperative complications in order to provide maximum efficacy with regard to stroke protection, the potential neuro-protective effect associated with RASB agents use following CEA and TCAR warrants further examination.
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- 2022
9. Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease
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Kosmas I. Paraskevas, Peter Gloviczki, Pier Luigi Antignani, Anthony J. Comerota, Alan Dardik, Alun H. Davies, Hans-Henning Eckstein, Gianluca Faggioli, Jose Fernandes e Fernandes, Gustav Fraedrich, George Geroulakos, Jonathan Golledge, Ajay Gupta, Victor S. Gurevich, Arkadiusz Jawien, Mateja K. Jezovnik, Stavros K. Kakkos, Michael Knoflach, Gaetano Lanza, Christos D. Liapis, Ian M. Loftus, Armando Mansilha, Andrew N. Nicolaides, Rodolfo Pini, Pavel Poredos, Robert M. Proczka, Jean-Baptiste Ricco, Tatjana Rundek, Luca Saba, Felix Schlachetzki, Mauro Silvestrini, Francesco Spinelli, Francesco Stilo, Jasjit S. Suri, Alexei V. Svetlikov, Clark J. Zeebregts, Seemant Chaturvedi, Frank J. Veith, and Dimitri P. Mikhailidis
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Carotid Artery Diseases ,Anticholesteremic Agents ,Statins ,Fibric Acids ,Cholesterol, LDL ,Ezetimibe ,Best medical treatment ,Stroke ,Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors ,Carotid endarterectomy ,Cardiovascular Diseases ,Humans ,Carotid artery stenosis ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Proprotein Convertase 9 ,Cardiology and Cardiovascular Medicine ,Carotid artery stenting ,Hypolipidemic Agents - Abstract
International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. The cerebrovascular and CV beneficial effects associated with statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and other non-statin lipid-lowering agents (e.g. fibrates, ezetimibe) are reviewed. The use of statins and PCSK9 inhibitors is associated with several beneficial effects for Asx/SCS patients, including carotid plaque stabilization and reduction of stroke rates. Ezetimibe and fibrates are associated with smaller reductions in stroke rates. The side-effects resulting from statin and PCSK9 inhibitor use are also highlighted. The benefits associated with lowering LDL-C with statins or non-statin lipid lowering agents (e.g. PCSK9 inhibitors) outweigh the risks and potential side-effects. Irrespective of their LDL-C levels, all Asx/SCS patients should receive high-dose statin treatment±ezetimibe or PCSK9 inhibitors for reduction not only of LDL-C levels, but also of stroke, cardiovascular mortality and coronary event rates.
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- 2022
10. Introduction
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Enrico Ascher and Frank J. Veith
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. Beta-blocker use after thoracic endovascular aortic repair in patients with type B aortic dissection is associated with improved early aortic remodeling
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Heepeel Chang, Caron B. Rockman, Bhama Ramkhelawon, Thomas S. Maldonado, Neal S. Cayne, Frank J. Veith, Glenn R. Jacobowitz, Virendra I. Patel, Igor Laskowski, and Karan Garg
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Male ,Time Factors ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Adrenergic beta-Antagonists ,Thrombosis ,Middle Aged ,Blood Vessel Prosthesis Implantation ,Aortic Dissection ,Treatment Outcome ,Risk Factors ,Humans ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
Beta-blockers (BBs) are first-line anti-impulse therapy for patients presenting with acute type B aortic dissection (TBAD). However, little is understood about their effects after aortic repair. The aim of the present study was to evaluate the role of postoperative BB use on the outcomes of thoracic endovascular aortic repair (TEVAR) in TBAD.The Vascular Quality Initiative database was queried for all patients who had undergone TEVAR for TBAD from 2012 to 2020. Aortic-related reintervention, all-cause mortality, and the effects of TEVAR on false lumen thrombosis of the treated aortic segment were assessed and compared between patients treated with and without BBs postoperatively. Cox proportional hazards models were used to estimate the effect of BB therapy on the outcomes.A total of 1114 patients who had undergone TEVAR for TBAD with a mean follow-up of 18 ± 12 months were identified. The mean age was 61.1 ± 11.9 years, and 791 (71%) were men. Of the 1114 patients, 935 (84%) continued BB therapy at discharge and follow-up. The patients taking BBs were more likely to have had an entry tear originating in zones 1 to 2 (22% vs 13%; P = .022). The prevalence of acute, elective, and symptomatic aortic dissection, prevalence of concurrent aneurysms, number of endografts used, distribution of proximal and distal zones of dissection, and operative times were comparable between the two cohorts. At 18 months, significantly more complete false lumen thrombosis (58% vs 47%; log-rank P = .018) was observed for patients taking BBs, and the rates of aortic-related reinterventions (13% vs 9%; log-rank P = .396) and mortality (0.2% vs 0.7%; log-rank P = .401) were similar for patients taking and not taking BBs, respectively. Even after adjusting for clinical and anatomic factors, postoperative BB use was associated with increased complete false lumen thrombosis (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P = .012) but did not affect mortality or aortic-related reintervention. A secondary analysis of BB use for those with acute vs chronic TBAD showed a higher rate of complete false lumen thrombosis for patients with chronic TBAD and taking BBs (59% vs 38%; log-rank P = .038). In contrast, no difference was found in the rate of complete false lumen thrombosis for those with acute TBAD between the two cohorts (58% vs 51%; log-rank P = .158). When analyzed separately, postoperative angiotensin-converting enzyme inhibitor use did not affect the rates of complete false lumen thrombosis, mortality, and aortic-related reintervention.BB use was associated with promotion of complete false lumen thrombosis for patients who had undergone TEVAR for TBAD. In addition to its role in the acute setting, anti-impulse control with BBs appears to confer favorable aortic remodeling and might improve patient outcomes after TEVAR, especially for those with chronic TBAD.
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- 2022
12. Multicenter Mid-Term Outcomes of the Chimney Technique in the Elective Treatment of Degenerative Pararenal Aortic Aneurysms
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Georgios A. Pitoulias, Stefano Fazzini, Konstantinos P. Donas, Giovanni Torsello, Salvatore T. Scali, Frank J. Veith, Stefan Puchner, Mario D'Oria, Pitoulias, Ga, Fazzini, S, Donas, Kp, Scali, St, D'Oria, M, Torsello, G, Veith, F, and Puchner, Sb
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medicine.medical_specialty ,pararenal ,medicine.medical_treatment ,Technical success ,aneurysm ,aortic ,chimney ,degenerative ,elective ,Prosthesis Design ,Asymptomatic ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Risk Factors ,Occlusion ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dialysis ,Retrospective Studies ,business.industry ,Endovascular Procedures ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Stenosis ,Treatment Outcome ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Splanchnic ,Aortic Aneurysm, Abdominal - Abstract
Purpose Chimney endovascular abdominal aortic aneurysm repair (CHEVAR) has predominantly been described as an alternative technique for the management of urgent presentations of degenerative pararenal aortic aneurysms (dPAAs). However, the role of CHEVAR in the treatment of asymptomatic patients remains unknown. The aim of current multinational study was to evaluate the outcomes of elective CHEVAR of dPAAs. Material and Methods Retrospective analysis of 267 consecutive dPAA patients treated with elective CHEVAR at 13 European and US centers from 2008 to 2014. Primary endpoints were 30 days and out of hospital CHEVAR-related mortality. Secondary endpoints included persistent type Ia endoleak or endotension, angiographically confirmed occlusion and/or high-grade chimney graft (CG) or involved splanchnic vessel stenosis identified at index procedure and/or during follow-up, as well as CHEVAR-related re-intervention. Results Mean follow-up time was 25.5±13.3 months. The 442 visceral vessels were involved and mean number of CGs per patient was 1.63±0.7. 436 targeted vessels were successfully cannulated. The aortic graft intentionally covered 6 renal arteries and immediate technical success was 98.6%. The 30 days mortality was 1.9% (n=5), while the in-hospital complication rate was 10.1% (n=27) including 3 strokes, 1 permanent dialysis, and 1 intestinal ischemia. No 30 day type Ia endoleaks were detected and 3.2% of CGs (n=14, including the intentionally covered) had evidence of occlusion and/or stenosis. The overall CHEVAR-related mortality was 2.2% (n=6). Freedom from primary and secondary type Ia endoleak/endotension rates at 3 years was 93.0% and 98.0%, respectively. Primary and secondary CG patency was 87.0% and 89.0%. Primary and secondary endovascular freedom from any endpoint at 3 years was 81.0% and 94.0% respectively. Conclusion Elective use of CHEVAR in the management of dPAAs seems to be durable. These results are comparable to published outcomes with other total endovascular strategies, which justifies an expanded role for CHEVAR in the treatment of asymptomatic patients presenting with dPAAs.
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- 2022
13. Foreword
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Frank J. Veith
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- 2022
14. Severity of stenosis in symptomatic patients undergoing carotid interventions might influence perioperative neurologic events
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Karan Garg, Heepeel Chang, Jeffrey J. Siracuse, Glenn R. Jacobowitz, Jose Torres, Frank J. Veith, Virendra I. Patel, Thomas S. Maldonado, Mikel Sadek, Neal S. Cayne, and Caron B. Rockman
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Endarterectomy, Carotid ,Time Factors ,Endovascular Procedures ,Myocardial Infarction ,Constriction, Pathologic ,Risk Assessment ,Stroke ,Carotid Arteries ,Treatment Outcome ,Ischemic Attack, Transient ,Risk Factors ,Humans ,Surgery ,Carotid Stenosis ,Stents ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
The carotid artery plaque burden, indirectly measured by the degree of stenosis, quantifies a patient's future embolic risk. In natural history studies, patients with moderate degrees of stenosis have had a lower stroke risk than those with severe stenosis. However, patients with symptomatic carotid stenosis who have experienced transient ischemic attack (TIA) or stroke were found to have both moderate and severe degrees of stenosis. We examined the association of carotid artery stenosis severity with the outcomes for symptomatic patients who had undergone carotid intervention, including carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcervical carotid artery revascularization (TCAR).The Society for Vascular Surgery Vascular Quality Initiative database was queried for all patients who had undergone TFCAS, CEA, or TCAR between 2003 and 2020. The patients were stratified into two groups according to stenosis severity-nonsevere (0%-69%) and severe (≥70%). The primary end point was periprocedural neurologic events (stroke and TIA). The secondary end points were periprocedural death, myocardial infarction (MI), and the composite outcomes of stroke/death and stroke/death/MI in accordance with the reporting standards for carotid intervention.Of the 29,614 included symptomatic patients, 5296 (17.9%) had undergone TCAR, 7844 (26.5%) TFCAS, and 16,474 (55.6%) CEA for symptomatic carotid artery stenosis. In the CEA cohort, the neurologic event rate was significantly lower for the patients with severe stenosis than for those with nonsevere stenosis (2.6% vs 3.2%; P = .024). In the TCAR cohort, the periprocedural neurologic even rate was lower for those with severe stenosis than for those with nonsevere stenosis (3% vs 4.3%; P = .033). No similar difference was noted for the TFCAS cohort, with a periprocedural neurologic event rate of 3.8% in the severe group vs 3.5% in the nonsevere group (P = .518). On multivariable analysis, severe stenosis was associated with significantly decreased odds of postprocedural neurologic events after CEA (odds ratio, 0.75; 95% confidence interval, 0.6-0.92; P = .007) and TCAR (odds ratio, 0.83; 95% confidence interval, 0.69-0.99; P = .039) but not after TFCAS.Severe carotid stenosis, in contrast to more moderate stenosis degrees, was associated with decreased rates of periprocedural stroke and TIA in symptomatic patients undergoing TCAR and CEA but not TFCAS. The finding of increased rates of periprocedural neurologic events in symptomatic patients with lesser degrees of stenosis undergoing TCAR and CEA warrants further evaluation with a particular focus on plaque morphology and brain physiology and their inherent risks with carotid revascularization procedures.
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- 2021
15. Statin Use Reduces Mortality in Patients Who Develop Major Complications After Transcarotid Artery Revascularization
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Heepeel Chang, Muhammad Zeeshan, Caron B. Rockman, Frank J. Veith, Igor Laskowski, Vikram S. Kashyap, Glenn R. Jacobowitz, Karan Garg, Mikel Sadek, and Thomas S. Maldonado
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
16. Statin use and renal function after aortic aneurysm repair procedures
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Frank J. Veith, Kosmas I. Paraskevas, and Dimitri P. Mikhailidis
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medicine.medical_specialty ,Aortic aneurysm repair ,business.industry ,Internal medicine ,medicine ,Cardiology ,Renal function ,Surgery ,Statin treatment ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
17. The spinning of randomized controlled trials
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Frank J. Veith and Kosmas I. Paraskevas
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
18. Comparative analysis of patients undergoing lower extremity bypass using in-situ and reversed great saphenous vein graft techniques
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Heepeel Chang, Frank J Veith, Caron B Rockman, Thomas S Maldonado, Glenn R Jacobowitz, Neal S Cayne, and Karan Garg
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Radiology, Nuclear Medicine and imaging ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
ObjectiveAutologous great saphenous vein (GSV) is considered the conduit of choice for lower extremity bypass (LEB). However, the optimal configuration remains the source of debate. We compared outcomes of patients undergoing LEB using in-situ and reversed techniques.MethodsThe Vascular Quality Initiative database was queried for patients undergoing LEB with a single-segment GSV in in-situ (ISGSV) and reversed (RGSV) configurations for symptomatic occlusive disease from 2003 to 2021. Patient demographics, procedural detail, and in-hospital and follow-up outcomes were collected. The primary outcome measures included primary patency at discharge or 30 days and one year. Secondary outcomes were secondary patency, and reinterventions at discharge or 30 days and one year. Cox proportional hazards models were created to determine the association between bypass techniques and outcomes of interest.ResultsOf 8234 patients undergoing LEBs, in-situ and reversed techniques were used in 3546 and 4688 patients, respectively. The indication for LEBs was similar between the two cohorts. ISGSV was performed more frequently from the common femoral artery and to more distal targets. RGSV bypass was associated with higher intraoperative blood loss and longer operative time. Perioperatively, ISGSV cohort had higher rates of reinterventions (13.2 vs 11.1%; p = 0.004), surgical site infection (4.2 vs 3%; p = 0.003), and lower primary patency (93.5 vs 95%; p = 0.004) but a comparable rate of secondary patency (99 vs 99.1%; p = 0.675). At 1 year, in-situ bypasses had a lower rate of reinterventions (19.4% vs 21.6%; p=0.02), with similar rates of primary (82.6 vs 81.8%; p = 0.237) and secondary patency (88.7 vs 88.9%; p = 0.625). After adjusting for significant baseline differences and potential confounders, in-situ bypass was independently associated with decreased risks of primary patency loss (HR 0.9; 95% CI, 0.82–0.98; p = 0.016) and reinterventions (HR 0.88; 95% CI, 0.8–0.97; p = 0.014) but a similar risk of secondary patency loss (HR 0.99; 95% CI, 0.86–1.16; p = 0.985) at follow-up, compared to reversed bypass. A subgroup analysis of bypasses to crural targets showed that in-situ and reversed bypasses had similar rates of primary patency loss and reinterventions at 1 year. Among patients with chronic limb-threatening ischemia, in-situ bypass was associated with a decreased risk of reinterventions but similar rates of primary and secondary patency and major amputations at 1 year.ConclusionsIn patients undergoing LEBs using the GSV, in-situ configuration was associated with more perioperative reinterventions and lower primary patency rate. However, this was offset by decreased risks of loss of primary patency and reinterventions at 1 year. A thorough intraoperative graft assessment with adjunctive imaging may be performed to detect abnormalities in patients undergoing in-situ bypasses to prevent early failures. Furthermore, closer surveillance of reversed bypass grafts is warranted given the higher rates of reinterventions.
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- 2022
19. Prior infrarenal aortic surgery is not associated with increased risk of spinal cord ischemia after thoracic endovascular aortic repair and complex endovascular aortic repair
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Stacey Chen, Thomas S. Maldonado, Deane E. Smith, Neal S. Cayne, Virendra I. Patel, Frank J. Veith, Caron B. Rockman, Aubrey C. Galloway, Glenn R. Jacobowitz, Rae S. Rokosh, and Karan Garg
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Aortic repair ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Ischemia ,Risk Factors ,medicine ,Humans ,Renal Insufficiency, Chronic ,Risk factor ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,Renal ischemia ,Spinal Cord Ischemia ,business.industry ,Endovascular Procedures ,Spinal cord ischemia ,Vascular surgery ,medicine.disease ,Aortic surgery ,Surgery ,Treatment Outcome ,Mesenteric Ischemia ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Patients with prior infrarenal aortic intervention represent an increasing demographic of patients undergoing thoracic endovascular aortic repair (TEVAR) and/or complex EVAR. Studies have suggested that prior abdominal aortic surgery is a risk factor for spinal cord ischemia (SCI). However, these results were largely based on single-center experiences with limited multi-institutional and national data that had assessed the clinical outcomes for these patients. The objective of the present study was to evaluate the effect of prior infrarenal aortic surgery on the occurrence of SCI.The Society for Vascular Surgery Vascular Quality Initiative database was retrospectively reviewed to identify all patients aged ≥18 years who had undergone TEVAR and/or complex EVAR from January 2012 to June 2020. Patients with previous thoracic or suprarenal aortic repair were excluded. The baseline and procedural characteristics and postoperative outcomes were compared between TEVAR and/or complex EVAR with and without previous infrarenal aortic repair. The primary outcome was postoperative SCI. The secondary outcomes included postoperative hospital length of stay, bowel ischemia, renal ischemia, and 30-day mortality. Multivariate regression was used to determine the independent predictors of postoperative SCI. Additional analysis was performed of the patients who had undergone isolated TEVAR.A total of 9506 patients met the inclusion criteria: 8691 (91.4%) had not undergone prior infrarenal aortic repair and 815 (8.6%) had undergone previous infrarenal aortic repair. Patients with previous infrarenal repair were older with an increased prevalence of chronic kidney disease (P = .001) and cardiovascular risk factors, including hypertension, chronic obstructive pulmonary disease, and positive smoking history (P .001). These patients also presented with a larger maximal aortic diameter (6.06 ± 1.47 cm vs 5.15 ± 1.76 cm; P .001) and required more stent-grafts (P .001) with increased intraoperative blood transfusion requirements (P .001), and longer procedure times (P .001). Univariate analysis demonstrated no differences in postoperative SCI, postoperative hospital length of stay, bowel ischemia, or renal ischemia between the two groups. The 30-day mortality was significantly higher in patients with prior infrarenal repair (P = .001). On multivariate regression, prior infrarenal aortic repair was not a predictor of postoperative SCI. In contrast, aortic dissection (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.26-2.16; P .001), number of stent-grafts deployed (OR, 1.45; 95% CI, 1.30-1.62; P .001), and units of packed red blood cells transfused intraoperatively (OR, 1.33; 95% CI, 1.03-1.73; P = .032) were independent predictors of postoperative SCI.Although the patients in the TEVAR and/or complex EVAR group with prior infrarenal aortic repair constituted a sicker cohort with higher 30-day mortality, the rate of SCI was comparable to that of the patients without prior repair. Previous infrarenal repair was not associated with the risk of SCI.
- Published
- 2022
20. Outcomes of transfemoral carotid artery stenting and transcarotid artery revascularization for restenosis after prior ipsilateral carotid endarterectomy
- Author
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Frank J. Veith, Heepeel Chang, Vikram S. Kashyap, Mikel Sadek, Karan Garg, Thomas S. Maldonado, Glenn R. Jacobowitz, and Caron B. Rockman
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Carotid endarterectomy ,Revascularization ,Risk Assessment ,Restenosis ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Carotid Stenosis ,Hospital Mortality ,Registries ,cardiovascular diseases ,Myocardial infarction ,Stroke ,Aged ,Retrospective Studies ,Endarterectomy, Carotid ,business.industry ,Endovascular Procedures ,Graft Occlusion, Vascular ,Perioperative ,medicine.disease ,Femoral Artery ,Stenosis ,medicine.anatomical_structure ,Cardiology ,Female ,Stents ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Artery - Abstract
Restenosis after carotid endarterectomy (CEA) poses unique therapeutic challenges, with no specific guidelines available on the operative approach. Traditionally, transfemoral carotid artery stenting (TfCAS) has been regarded as the preferred approach to treating restenosis after CEA. Recently, transcarotid artery revascularization with a flow-reversal neuroprotection system (TCAR) has gained popularity as an effective alternative treatment modality for de novo carotid artery stenosis. The aim of the present study was to compare the contemporary perioperative outcomes of TfCAS and TCAR in patients with prior ipsilateral CEA.The Vascular Quality Initiative database was reviewed for patients who had undergone TfCAS and TCAR for restenosis after prior ipsilateral CEA between January 2016 and August 2020. The primary outcome was the 30-day composite outcome of stroke and death. The secondary outcomes included 30-day stroke, transient ischemic attack (TIA), myocardial infarction (MI), death, and composite 30-day outcomes of stroke, death, and TIA, stroke and TIA, and stroke, death, and MI. Multivariable logistic regression models were used to evaluate the outcomes of interest after adjustment for potential confounders and baseline differences between cohorts.Of 3508 patients, 1834 and 1674 had undergone TfCAS and TCAR, respectively. The TCAR cohort was older (mean age, 71.6 years vs 70.2 years; P .001) and less likely to be symptomatic (27% vs 46%; P .001), with a greater proportion taking aspirin (92% vs 88%; P = .001), a P2Y12 inhibitor (89% vs 80%; P .001), and a statin (91% vs 87%; P = .002) compared with the TfCAS cohort. Perioperatively, the TCAR cohort had had lower 30-day composite outcomes of stroke/death (1.6% vs 2.7%; P = .025), stroke/death/TIA (1.8% vs 3.3%; P = .004), and stroke/death/MI (2.1% vs 3.2%; P = .048), primarily driven by lower rates of stroke (1.3% vs 2.3%; P = .031) and TIA (0.2% vs 0.7%; P = .031). Among asymptomatic patients, the incidence of stroke (0.6% vs 1.4%; P = .042) and the composite of stroke/TIA (0.8% vs 1.8%; P = .036) was significantly lower after TCAR than TfCAS, and TCAR was associated with a lower incidence of TIA (0% vs 1%; P = .038) among symptomatic patients. On adjusted analysis, the TCAR cohort had lower odds of TIA (adjusted odds ratio, 0.17; 95% confidence interval, 0.04-0.74; P = .019).Among patients undergoing carotid revascularization for restenosis after prior ipsilateral CEA, TCAR was associated with decreased odds of 30-day TIA compared with TfCAS. However, the two treatment approaches were similarly safe in terms of the remaining perioperative outcomes, including stroke and death and stroke, death, and MI. Our results support the safety and efficacy of TCAR in this subset of patients deemed at high risk of reintervention.
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- 2022
21. Endovascular treatment of popliteal artery aneurysms has comparable long-term outcomes to open repair with shorter lengths of stay
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Thomas S. Maldonado, Noor G. Shah, Michael E. Barfield, Glenn R. Jacobowitz, Frank J. Veith, Rae S. Rokosh, Brent Safran, Neal S. Cayne, Patrick J. Lamparello, Karan Garg, Caron B. Rockman, and Mikel Sadek
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Risk Assessment ,Tertiary care ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Long term outcomes ,medicine ,Humans ,Popliteal Artery ,030212 general & internal medicine ,Endovascular treatment ,Vascular Patency ,Aged ,Retrospective Studies ,Aged, 80 and over ,Surgical repair ,business.industry ,Medical record ,Endovascular Procedures ,Length of Stay ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,Aneurysm ,Popliteal artery ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Cohort ,Open repair ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
During the past two decades, the treatment of popliteal artery aneurysms (PAAs) has undergone a transformation. Although open surgical repair (OR) has remained the reference standard for treatment, endovascular repair (ER) has become an attractive alternative for select patient populations. The objective of the present study was to compare the outcomes of OR vs ER of PAAs at a single institution.We performed a retrospective review of the medical records for all patients who had undergone repair for PAAs from 1998 to 2017. The baseline patient, anatomic, and operative characteristics and outcomes were compared between the OR and ER cohorts. Intervention and treatment were at the discretion of the surgeon.From 1998 to 2017, 64 patients had undergone repair of 73 PAAs at our tertiary care center. Of the 69 patients (73 PAAs), 29 (33 PAAs) had undergone OR and 35 (40 PAAs) had undergone ER. When comparing the two cohorts, no statistically significant differences were found in the demographic characteristics such as age, gender, or number of runoff vessels. Significantly more patients in the ER group (n = 21; 53%) than in the OR group (n = 7; 21%) had had hyperlipidemia (P = .008) and a previous carotid intervention (6% vs 0%; P = .029). Overall, the presence of symptoms was similar between the two groups. However, the OR group had a significantly higher number of patients who had presented with acute ischemia (P = .01). The length of stay was significantly shorter for the ER cohort (mean, 1.8 days; range, 1-11 days) than for the OR group (mean, 5.4 days; range, 2-13 days; P .0001). No significant difference was found in the primary or secondary patency rates between the two groups. In the ER group, good runoff (two or more vessels) was a positive predictor for primary patency at 1 year (odds ratio, 3.36; 95% confidence interval, 1.0-11.25). However, it was not in the OR group. Postoperative single and/or dual antiplatelet therapy did not affect primary patency in either cohort.The results of our study have demonstrated that ER of PAAs is a safe and durable option with patency rates comparable to those with OR and a decreased length of stay, with good runoff a positive predictor for primary patency in the ER cohort.
- Published
- 2021
22. Polytetrafluoroethylene Bypasses to Tibial Arteries Are a Worthwhile Limb Salvage Procedure: An 18-Year Experience
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Enrico Ascher, Jeffrey Silpe, Gregg S. Landis, Richard F. Neville, Yana Etkin, and Frank J. Veith
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medicine.medical_specialty ,chemistry.chemical_compound ,Polytetrafluoroethylene ,chemistry ,business.industry ,medicine ,Surgery ,Tibial artery ,Cardiology and Cardiovascular Medicine ,business ,Limb Salvage Procedure - Published
- 2021
23. Neuroprotective Benefit of Renin-Angiotensin System Blocking Agents in Carotid Artery Surgery
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Chong Li, Virendra I. Patel, Glenn R. Jacobowitz, Neal S. Cayne, Caron B. Rockman, Karan Garg, Heepeel Chang, Frank J. Veith, Thomas S. Maldonado, Anjali A. Nigalaye, and Jeffrey J. Siracuse
- Subjects
Blocking (radio) ,business.industry ,Carotid arteries ,Renin–angiotensin system ,Medicine ,Surgery ,Pharmacology ,Cardiology and Cardiovascular Medicine ,business ,Neuroprotection - Published
- 2021
24. Comparative Analysis of Lower Extremity Bypass Using in Situ and Reversed Great Saphenous Vein
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Frank J. Veith, Virendra I. Patel, Heepeel Chang, Glenn R. Jacobowitz, Karan Garg, Neal S. Cayne, and Caron B. Rockman
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medicine.medical_specialty ,business.industry ,Great saphenous vein ,medicine ,Surgery ,Lower extremity bypass ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
25. The mechanism for directional hearing in fish.
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Veith J, Chaigne T, Svanidze A, Dressler LE, Hoffmann M, Gerhardt B, and Judkewitz B
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- Animals, Female, Male, Algorithms, Pressure, Sound, Vibration, X-Ray Microtomography, Motion, Reflex, Startle, Particulate Matter, Cues, Hearing physiology, Sound Localization physiology, Cyprinidae physiology
- Abstract
Locating sound sources such as prey or predators is critical for survival in many vertebrates. Terrestrial vertebrates locate sources by measuring the time delay and intensity difference of sound pressure at each ear
1-5 . Underwater, however, the physics of sound makes interaural cues very small, suggesting that directional hearing in fish should be nearly impossible6 . Yet, directional hearing has been confirmed behaviourally, although the mechanisms have remained unknown for decades. Several hypotheses have been proposed to explain this remarkable ability, including the possibility that fish evolved an extreme sensitivity to minute interaural differences or that fish might compare sound pressure with particle motion signals7,8 . However, experimental challenges have long hindered a definitive explanation. Here we empirically test these models in the transparent teleost Danionella cerebrum, one of the smallest vertebrates9,10 . By selectively controlling pressure and particle motion, we dissect the sensory algorithm underlying directional acoustic startles. We find that both cues are indispensable for this behaviour and that their relative phase controls its direction. Using micro-computed tomography and optical vibrometry, we further show that D. cerebrum has the sensory structures to implement this mechanism. D. cerebrum shares these structures with more than 15% of living vertebrate species, suggesting a widespread mechanism for inferring sound direction., (© 2024. The Author(s).)- Published
- 2024
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26. Ultrafast sound production mechanism in one of the smallest vertebrates.
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Cook VANO, Groneberg AH, Hoffmann M, Kadobianskyi M, Veith J, Schulze L, Henninger J, Britz R, and Judkewitz B
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- Animals, X-Ray Microtomography, Sound, Acoustics, Animal Communication, Cyprinidae genetics
- Abstract
Motion is the basis of nearly all animal behavior. Evolution has led to some extraordinary specializations of propulsion mechanisms among invertebrates, including the mandibles of the dracula ant and the claw of the pistol shrimp. In contrast, vertebrate skeletal movement is considered to be limited by the speed of muscle, saturating around 250 Hz. Here, we describe the unique propulsion mechanism by which Danionella cerebrum , a miniature cyprinid fish of only 12 mm length, produces high amplitude sounds exceeding 140 dB (re. 1 µPa, at a distance of one body length). Using a combination of high-speed video, micro-computed tomography (micro-CT), RNA profiling, and finite difference simulations, we found that D. cerebrum employ a unique sound production mechanism that involves a drumming cartilage, a specialized rib, and a dedicated muscle adapted for low fatigue. This apparatus accelerates the drumming cartilage at over 2,000 g, shooting it at the swim bladder to generate a rapid, loud pulse. These pulses are chained together to make calls with either bilaterally alternating or unilateral muscle contractions. D. cerebrum use this remarkable mechanism for acoustic communication with conspecifics., Competing Interests: Competing interests statement:The authors declare no competing interest.
- Published
- 2024
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27. Society resources can provide unmet need for real-world data.
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Jacobowitz GR
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- Humans, Needs Assessment, Health Services Needs and Demand
- Abstract
Competing Interests: Disclosures None.
- Published
- 2024
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28. Forecasting disease trajectories in critical illness: comparison of probabilistic dynamic systems to static models to predict patient status in the intensive care unit.
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Duggal A, Scheraga R, Sacha GL, Wang X, Huang S, Krishnan S, Siuba MT, Torbic H, Dugar S, Mucha S, Veith J, Mireles-Cabodevila E, Bauer SR, Kethireddy S, Vachharajani V, and Dalton JE
- Subjects
- Humans, Retrospective Studies, Intensive Care Units, Hospitalization, Critical Care, Critical Illness therapy, COVID-19 epidemiology
- Abstract
Objective: Conventional prediction models fail to integrate the constantly evolving nature of critical illness. Alternative modelling approaches to study dynamic changes in critical illness progression are needed. We compare static risk prediction models to dynamic probabilistic models in early critical illness., Design: We developed models to simulate disease trajectories of critically ill COVID-19 patients across different disease states. Eighty per cent of cases were randomly assigned to a training and 20% of the cases were used as a validation cohort. Conventional risk prediction models were developed to analyse different disease states for critically ill patients for the first 7 days of intensive care unit (ICU) stay. Daily disease state transitions were modelled using a series of multivariable, multinomial logistic regression models. A probabilistic dynamic systems modelling approach was used to predict disease trajectory over the first 7 days of an ICU admission. Forecast accuracy was assessed and simulated patient clinical trajectories were developed through our algorithm., Setting and Participants: We retrospectively studied patients admitted to a Cleveland Clinic Healthcare System in Ohio, for the treatment of COVID-19 from March 2020 to December 2022., Results: 5241 patients were included in the analysis. For ICU days 2-7, the static (conventional) modelling approach, the accuracy of the models steadily decreased as a function of time, with area under the curve (AUC) for each health state below 0.8. But the dynamic forecasting approach improved its ability to predict as a function of time. AUC for the dynamic forecasting approach were all above 0.90 for ICU days 4-7 for all states., Conclusion: We demonstrated that modelling critical care outcomes as a dynamic system improved the forecasting accuracy of the disease state. Our model accurately identified different disease conditions and trajectories, with a <10% misclassification rate over the first week of critical illness., Competing Interests: Competing interests: No conflicts of interest or competing interests reported by any authors related to this work. Dr. Duggal is on the Advisory Board for ALung technologies, but that relationship has no impact on this work., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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29. Associations with Discharge to Post-Acute Care Facilities Among Patients Undergoing Open Reduction Internal Fixation of Distal Radius Fractures.
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Donato DP, Simpson AM, Willcockson J, Veith J, King BW, and Agarwal JP
- Abstract
Introduction: Distal radius fractures are a common injury of the hand and wrist that often require intensive rehabilitation. We sought to identify risk factors associated with discharge to a post-acute care facility following distal radius fracture repair. Methods: The 2011 to 2016 National Surgical Quality Improvement Program® (NSQIP) database was queried for all Current Procedural Terminology (CPT) codes that corresponded with open distal radius fracture repair. Patients with concomitant traumatic injuries were excluded. Patient demographics, comorbidities, perioperative factors, laboratory data, and surgical details were collected. Our primary outcome was to determine postoperative discharge destination: home versus a post-acute care facility, and to identify factors that predict discharge to post-acute care facility. Secondary outcomes included unplanned readmission, reoperation, and complications. Results: Between 2011 and 2016, a total of 12,001 patients underwent open distal radius fracture repair and had complete information for their discharge. Of these analyzed patients, 3.24% (n = 389) were discharged to rehabilitation facilities. The following factors were identified on multivariate analysis to have an association with discharge to a post-acute care facility: 65 years or older, White race, underweight, using steroids preoperatively, American Society of Anesthesiologists (ASA) classification > 2, admitted from a nursing home or already hospitalized, anemic, undergoing bilateral surgery, wound classification other than clean, and complications prior to discharge. Conclusion: Factors identified by our study to have associations with discharge to post-acute care facilities following distal radius fracture repair can help in appropriate patient counseling and triage from the hospital to home versus a post-acute care facility., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 The Author(s).)
- Published
- 2024
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30. Surgical Management of Pachyonychia Congenita in a 3-Year-Old.
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Sudduth JD, Clinker C, Holdaway M, Marquez JL, Veith J, Wright T, and Rockwell WB
- Abstract
Pachyonychia congenita is a rare genetic disorder characterized by hypertrophic nail plates, hyperkeratotic nail beds, and thickened hyponychium of the fingers and toes, impairing manual dexterity and resulting in poor aesthetics. The current body of literature describes various treatment modalities, but no singular approach has been defined as the gold standard. In this case, the authors employed different surgical techniques for treating pachyonychia congenita to evaluate the most effective approach. A 3-year-old boy presented with hypertrophic nail growth involving all digits of both hands and feet. Three surgical procedures were performed on the patient's fingers and toes using germinal matrix excision (GME) alone, GME plus partial sterile matrix excision (pSME), or GME plus complete sterile matrix excision (cSME). The digits treated with GME + cSME exhibited no recurrence of nail growth. Those treated with GME alone exhibited recurrence of hypertrophic nail growth, although their growth slowed. Excision of GME + cSME prevented recurrence of hypertrophic nails, while GME alone or with pSME led to slower-growing hypertrophic nails. Complete excision of the germinal and sterile matrices with skin graft closure may be a definitive treatment for pachyonychia congenita, but further studies are needed to validate these findings., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)
- Published
- 2023
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31. Blazed oblique plane microscopy reveals scale-invariant inference of brain-wide population activity.
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Hoffmann M, Henninger J, Veith J, Richter L, and Judkewitz B
- Subjects
- Brain diagnostic imaging, Brain physiology, Neurons physiology, Microscopy methods, Neurosciences
- Abstract
Due to the size and opacity of vertebrate brains, it has until now been impossible to simultaneously record neuronal activity at cellular resolution across the entire adult brain. As a result, scientists are forced to choose between cellular-resolution microscopy over limited fields-of-view or whole-brain imaging at coarse-grained resolution. Bridging the gap between these spatial scales of understanding remains a major challenge in neuroscience. Here, we introduce blazed oblique plane microscopy to perform brain-wide recording of neuronal activity at cellular resolution in an adult vertebrate. Contrary to common belief, we find that inferences of neuronal population activity are near-independent of spatial scale: a set of randomly sampled neurons has a comparable predictive power as the same number of coarse-grained macrovoxels. Our work thus links cellular resolution with brain-wide scope, challenges the prevailing view that macroscale methods are generally inferior to microscale techniques and underscores the value of multiscale approaches to studying brain-wide activity., (© 2023. The Author(s).)
- Published
- 2023
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32. Smartphone Use for Patient Photography by Plastic Surgery Trainees.
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Veith J, King BW, Moss W, Luo J, Dunklebarger M, Garlick J, and Crombie C
- Subjects
- Humans, United States, Smartphone, Photography, Privacy, Surgery, Plastic, Plastic Surgery Procedures
- Abstract
Medical photography has become essential to patient care, trainee education, and research in highly visual specialties such as plastic surgery. As smartphone technology advances, plastic surgeons and trainees are using their personal smartphones to take medical photographs prompting ethical and legal concerns about patient consent and privacy. This study aims to determine the prevalence of personal smartphone use for patient photography among plastic surgery trainees, evaluate encryption practices, and establish understanding of current guidelines. Through a survey of 71 plastic surgery trainees throughout the United States, we show that 99% use their personal cell phone to take medical photographs while only 65% use HIPAA-compliant photo storage applications, and only 49% are aware of standard guidelines. This highlights that personal smartphone use among plastic surgery trainees is ubiquitous and there is a need for additional education and access to HIPAA-compliant photo storage applications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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33. An effective stent for most.
- Author
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Jacobowitz GR
- Subjects
- Humans, Treatment Outcome, Stents
- Published
- 2023
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34. Improving Communication Between Nursing Staff and Surgery Residents in the age of Electronic Medical Records.
- Author
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Veith J, Spitz K, Luftman K, Long S, Martin J, Bell J, Billingsley S, Ali S, and Uecker J
- Subjects
- Humans, Communication, Electronic Health Records, Nursing Staff
- Abstract
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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35. Local delivery of FK506 to a nerve allograft is comparable to systemic delivery at suppressing allogeneic graft rejection.
- Author
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Davis B, Wojtalewicz S, Erickson S, Veith J, Simpson A, Sant H, Shea J, Gale B, and Agarwal J
- Subjects
- Animals, Mice, Allografts, Drug Delivery Systems, Axons, Nerve Regeneration, Tacrolimus pharmacology, Graft Rejection drug therapy, Graft Rejection prevention & control
- Abstract
The objective of this study was to determine if locally delivered FK506 could prevent allogeneic nerve graft rejection long enough to allow axon regeneration to pass through the nerve graft. An 8mm mouse sciatic nerve gap injury repaired with a nerve allograft was used to assess the effectiveness of local FK506 immunosuppressive therapy. FK506-loaded poly(lactide-co-caprolactone) nerve conduits were used to provide sustained local FK506 delivery to nerve allografts. Continuous and temporary systemic FK506 therapy to nerve allografts, and autograft repair were used as control groups. Serial assessment of inflammatory cell and CD4+ cell infiltration into the nerve graft tissue was performed to characterize the immune response over time. Nerve regeneration and functional recovery was serially assessed by nerve histomorphometry, gastrocnemius muscle mass recovery, and the ladder rung skilled locomotion assay. At the end of the study, week 16, all the groups had similar levels of inflammatory cell infiltration. The local FK506 and continuous systemic FK506 groups had similar levels of CD4+ cell infiltration, however, it was significantly greater than the autograft control. In terms of nerve histmorphometry, the local FK506 and continunous systemic FK506 groups had similar amounts of myelinated axons, although they were significantly lower than the autograft and temporary systemic FK506 group. The autograft had significantly greater muscle mass recovery than all the other groups. In the ladder rung assay, the autograft, local FK506, and continuous systemic FK506 had similar levels of skilled locomotion performance, whereas the temporary systemic FK506 group had significanty better performance than all the other groups. The results of this study suggest that local delivery of FK506 can provide comparable immunosuppression and nerve regeneration outcomes as systemically delivered FK506., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Davis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2023
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36. Associations of discharge destination and length of stay in lower extremity free flap reconstruction.
- Author
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Donato D, Veith J, Holoyda K, Magno-Padron D, Simpson A, King B, and Agarwal J
- Subjects
- Humans, Female, Length of Stay, Risk Factors, Retrospective Studies, Patient Discharge, Free Tissue Flaps
- Abstract
Patients with lower extremity defects requiring free flap reconstruction often have difficult postoperative courses with prolonged length of stay and need for transfer to a post-acute care facility. The primary aim of this study was to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction. The secondary aim was to determine associations of various complications with their discharge destination. The 2011- 2017 NSQIP database was queried for CPT codes for free flap procedures and ICD-9/ICD-10 codes for lower extremities. Univariate and multivariate analyses were used to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction and associations of complications with their discharge destination. A total of 420 patients were identified who underwent lower extremity reconstruction in 2011-2017. Of 79.8% were discharged home and 21.2% were discharged to destinations other than home. On multivariate analysis, female gender, age > 55, ASA class > 2 and dependent functional status were found to have independent associations with discharge to post-acute care facilities. ASA classification greater than 2, active smoking, and discharge to a post-acute care facility all were independently associated with prolonged length of stay. Increased length of stay and discharge to post-acute care facility are closely associated. Understanding variables that influence length of stay and need for discharge to post-acute care facilities can help identify patients that may be triaged through appropriate interventions and expectation management.
- Published
- 2023
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- View/download PDF
37. Current Practices in the Pathologic Assessment of Breast Tissue in Transmasculine Chest Surgery.
- Author
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Goodwin IA, Luo J, Magno-Pardon DA, Veith J, Willcockson J, Carter G, Matsen C, Kwok AC, and Agarwal CA
- Subjects
- Adult, Early Detection of Cancer, Female, Humans, Practice Patterns, Physicians', Surveys and Questionnaires, United States, Breast Neoplasms surgery, Surgeons, Surgery, Plastic
- Abstract
Background: No guidelines exist regarding management of breast tissue for transmasculine and gender-nonconforming individuals. This study aims to investigate the experiences and practices regarding perioperative breast cancer risk management among the American Society of Plastic Surgeons members performing chest masculinization surgery., Methods: An anonymous, online, 19-question survey was sent to 2517 U.S.-based American Society of Plastic Surgeons members in October of 2019., Results: A total of 69 responses were analyzed. High-volume surgeons were more likely from academic centers (OR, 4.88; 95 percent CI, 1.67 to 15.22; p = 0.005). Age older than 40 years [ n = 59 (85.5 percent)] and family history of breast cancer in first-degree relatives [ n = 47 (68.1 percent)] or family with a diagnosis before age 40 [ n = 49 (71.0 percent)] were the most common indications for preoperative imaging. Nineteen of the respondents (27.5 percent) routinely excise all macroscopic breast tissue, with 21 (30.4 percent) routinely leaving breast tissue. Fifty-one respondents (73.9 percent) routinely send specimens for pathologic analysis. There was no significant correlation between surgical volume or type of practice and odds of sending specimens for pathologic analysis. High patient costs and patient reluctance [ n = 27 (39.1 percent) and n = 24 (35.3 percent), respectively] were the most often cited barriers for sending specimens for pathologic analysis. Six respondents (8.7 percent) have found malignant or premalignant lesions in masculinizing breast specimens., Conclusions: Large variation was found among surgeons' perioperative management of chest masculinizing surgery patients regarding preoperative cancer screening, pathologic assessment of resected tissue, and postoperative cancer surveillance. Standardization of care and further studies are needed to document risk, incidence, and prevalence of breast cancer in the transmasculine population before and after surgery., (Copyright © 2022 by the American Society of Plastic Surgeons.)
- Published
- 2022
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38. Frontofacial Reconstruction Technique Modification With Preservation of Blood Supply to the Monobloc Segment.
- Author
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King B, Veith J, Kim E, Kestle J, Siddiqi F, and Gociman B
- Subjects
- Female, Follow-Up Studies, Humans, Acrocephalosyndactylia surgery, Craniofacial Dysostosis surgery, Craniosynostoses surgery, Osteogenesis, Distraction methods
- Abstract
Abstract: Craniosynostosis syndromes, including Apert Syndrome, Pfeiffer Syndrome, and Crouzon Syndrome, share similar phenotypes, including bicoronal craniosynostosis, midface hypoplasia, hypertelorism, and exorbitism. The standard surgical treatment for these craniofacial abnormalities is monobloc osteotomy with distraction osteogenesis. Complications of this technique include the failure of osteogenesis or resorption of the frontal bone. The authors propose an alternative surgical technique with a frontal arch in continuity with the midface segment to ensure vascularization to anterior and posterior borders of distraction. A case report of an 8-year-old female patient with Apert Syndrome is reported using our technique. Our frontal arch monobloc distraction procedure preserves blood supply to a cranial component of the monobloc segment site that becomes the anterior portion of distraction rather than with the traditional devascularized frontal bone flap. This technique modification should improve osteogenesis outcomes by preventing resorption or failure of bone formation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)
- Published
- 2022
- Full Text
- View/download PDF
39. Implementing change is a science.
- Author
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Ibarra-Estrada M, Veith J, and Mireles-Cabodevila E
- Published
- 2022
- Full Text
- View/download PDF
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