38 results on '"Michael Yacoub"'
Search Results
2. Trends and Outcomes in the Operative Management of Traumatic Vascular Injuries: A Comparison of Open versus Endovascular Approaches
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Rudy Judhan, Julton Tomanguillo Chumbe, Michael Yacoub, Damayanti Samanta, Ali F. AbuRahma, Kimball Knackstedt, Bryan K. Richmond, William Charles Sherrill, and Stephanie Thompson
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Univariate analysis ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,Trauma center ,030208 emergency & critical care medicine ,General Medicine ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,medicine.anatomical_structure ,Medicine ,Abdomen ,Injury Severity Score ,business ,Adverse effect ,Prospective cohort study - Abstract
Controversy exists in vascular trauma regarding the best method of treatment—open versus endovascular techniques. Little has been published on this complex topic. Patients from 2005 to 2013 at a Level I trauma center with vascular injuries were identified via a prospectively trauma registry. Patient data, injury type/severity, treatment, and 30-day outcomes were obtained from the trauma registry and the chart review. Adverse events (limb loss, major disability, and death) were outcomes of interest. Univariate analysis and multivariate logistic regression were used to identify predictors of adverse events. In all, 346 patients were included (median age 34, range 1–93 years). Median Injury Severity Score (ISS) was 10(1–59). Endovascular repairs (n = 52) increased from 0 per cent (2005) to 32 per cent (2013), and demonstrated equivalent outcomes to open approaches (P = 0.24). On multi-variate analysis, higher ISS (P = 0.001), increasing age (P = 0.01), and lower extremity injuries (P = 0.001) were associated with adverse outcomes across the entire series. Endovascular approaches were most commonly used in vascular injuries of the chest/abdomen (39 of 52, 75% of all endovascular procedures in the series, P < 0.001), older patients(P = 0.003), blunt injury mechanism (P < 0.001), and patients with a higher ISS at presentation (P < 0.001). In conclusion, this large series, the use of endovascular procedures increased over time, and was associated with equivalent outcomes to open approaches, despite their higher usage in older patients, those with chest/abdominal injuries, and those with a higher ISS at presentation. Although these retrospective results are encouraging, further prospective study into the role of endovascular therapies in the treatment of vascular injuries.
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- 2017
3. Chronic urticaria and common variable immunodeficiency (CVID): an association to remember
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Claudia Villatoro Santos and Michael Yacoub
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0301 basic medicine ,medicine.medical_specialty ,Case Report ,Dapsone ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Chronic Urticaria ,Medical history ,business.industry ,Common variable immunodeficiency ,Primary care physician ,Immunoglobulins, Intravenous ,General Medicine ,Middle Aged ,Diverticulitis ,medicine.disease ,Dermatology ,Diverticulosis ,Common Variable Immunodeficiency ,030104 developmental biology ,030228 respiratory system ,Pneumococcal vaccine ,Female ,business ,Kidney disease ,medicine.drug - Abstract
The patient is a 64-year-old Caucasian woman with idiopathic chronic urticaria who presented to her primary care physician’s office with mucoid otitis media. Medical history was significant for hypertension, hyperlipidaemia, allergic rhinitis, pre-diabetes, gastro-oesophageal reflux, paroxysmal atrial fibrillation, chronic kidney disease, diverticulosis with prior diverticulitis and history of recurrent infections. Her chronic urticaria was initially treated with antibiotics, antihistamines and oral steroids, but later she developed refractory urticaria requiring dapsone with modest improvement. When she presented with mucoid otitis media, immunoglobulin levels were found to be decreased. The pneumococcal vaccine antibody challenge confirmed the diagnosis of common variable immunodeficiency (CVID). Her HIV test was negative. She was started on intravenous immunoglobulin infusions and her chronic urticaria stabilised.In patients with chronic urticaria refractory to treatment, especially with a history of recurrent infections, a diagnosis of CVID should be considered, regardless of HIV status.
- Published
- 2021
4. Novel Risk Score Model for Prediction of Survival Following Elective Endovascular Abdominal Aortic Aneurysm Repair
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Michael Yacoub, Aravinda Najundappa, Mark C. Bates, Mike Broce, Albeir Y. Mousa, Patrick A. Stone, Joseph D. Bozzay, and Ali F. AbuRahma
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,Decision Support Techniques ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Aneurysm ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,National data ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Chi-Square Distribution ,Framingham Risk Score ,business.industry ,Unstable angina ,Endovascular Procedures ,Hazard ratio ,General Medicine ,Middle Aged ,Vascular surgery ,medicine.disease ,United States ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,Multivariate Analysis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Objective: The purpose of this study was to identify significant predictors of long-term mortality after elective endovascular abdominal aortic aneurysm repair (EVAR). Methods: We included all cases with elective EVAR based on a national data set from the Society for Vascular Surgery Patient Safety Organization. Clinical and anatomic variables were analyzed with a Kaplan-Meier and Cox-regression model to determine predictors of mortality and develop a score equation to categorize patients into low, medium, and high long-term mortality risk. Results: A total of 5678 patients with EVAR were included with an average age of 73.6 ± 8.2 years. The majority were male (81.6%) with a history of smoking (86.1%). There were 3 deaths within 30 days (0.1%). Several factors were associated with poor survival: unstable angina (hazard ratio [HR], 2.8; P = .008), dialysis (HR, 3.7; P < .001), estimated glomerular filtration rate (eGFR) 80 (HR, 3.2; P < .001), age 75 to 79 (HR, 2.2; P < .001), chronic obstructive pulmonary disease on oxygen (HR, 3.3; P < .001), aortic diameter >5.8 cm (HR, 1.2; P = .043), and high risk for surgery (HR, 1.4; P = .043). Preoperative aspirin use and body mass index 25 to 35 were both found to be protective (HR, 0.78; P = .017 and HR, 0.8; P = .024, respectively). With our scoring model, 5- and 10-year survival rates for patients with low, medium, and high risk were 89.2%, 80.7%, and 64.1% and 77.2%, 60.1%, and 40.1%, respectively ( P < .001). Conclusion: Ten-year survival following EVAR in patients with a high-risk score utilizing the model provided was 40.1%. Patients with multiple comorbidities at risk for decreased long-term survival can be identified with our model, which is more applicable for high-volume contemporary institutions.
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- 2016
5. Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use
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Mohit Srivastava, Shadi Abu-Halimah, Michael Yacoub, Zachary AbuRahma, Stephen M. Hass, Patrick A. Stone, Ali F. AbuRahma, Jenna Kazil, Albeir Y. Mousa, and L. Scott Dean
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Male ,medicine.medical_specialty ,Endoleak ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Article ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Blood vessel prosthesis ,Odds Ratio ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Patient Selection ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,Perioperative ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,Female ,Radiology ,Complication ,business ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes.We performed a retrospective analysis of prospectively collected data on EVAR patients. Neck features outside IFU were analyzed. Kaplan-Meier and multivariate analyses were used to predict their effect as single features, or in combination, on outcomes.Fifty-two percent of 526 patients had 1 or more features outside the IFU. The overall technical success rate was 99%, and perioperative complication rates were 7% and 12% for IFU vs outside IFU use, respectively (p = 0.04). Type I early endoleak and early intervention rates were 7% and 10% for IFU vs 18% and 24% for outside IFU (p = 0.0002 and p0.0001). At a mean follow-up of 30 months, freedom from late type I endoleak and late reintervention at 1, 2, and 3 years for IFU were 99.5%, 99.5%, and 98.4%, and 99.4%, 98%, and 96.8%; vs 98.9%, 98.1%, and 98.1%, and 97.5%, 96.2%, and 95.2% for outside IFU (p = 0.049 and 0.799), respectively. Survival rates at 1, 2, and 3 years for IFU were 97%, 93.5%, and 89.8%; vs 93.7%, 88.8%, and 86.3% for outside IFU (p = 0.035). Multivariate analysis showed that a neck angle60 degrees had odds ratios for death, sac expansion, and early intervention of 6, 2.6, and 3.3, respectively; neck length10 mm had odds ratios of 2.8 for deaths, 3.4 for early intervention, 4.6 for late reintervention, and 4.3 for late type I endoleak.Patients with neck features outside IFU can be treated with EVAR; however, they have higher rates of early and late type I endoleak, early intervention, and late death.
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- 2016
6. Compliance of postendovascular aortic aneurysm repair imaging surveillance
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Patrick A. Stone, Ravi Viradia, Michael Yacoub, L. Scott Dean, Joseph AbuRahma, Ali F. AbuRahma, Stephen M. Hass, and Albeir Y. Mousa
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Male ,medicine.medical_specialty ,Time Factors ,Aortography ,Endoleak ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Odds Ratio ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,Ultrasonography, Doppler, Duplex ,Chi-Square Distribution ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Aortic Aneurysm ,Surgery ,Logistic Models ,Treatment Outcome ,Predictive value of tests ,Multivariate Analysis ,Retreatment ,Patient Compliance ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Chi-squared distribution - Abstract
Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes.Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities.Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P.0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endoleak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance.Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.
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- 2016
7. Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions
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Mark C. Bates, Patrick A. Stone, Ali F. AbuRahma, Mike Broce, Joseph D. Bozzay, Albeir Y. Mousa, Michael Yacoub, and Maher Kali
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Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Comorbidity ,Kaplan-Meier Estimate ,Carotid endarterectomy ,Revascularization ,Severity of Illness Index ,Asymptomatic ,Tertiary Care Centers ,Peripheral Arterial Disease ,Restenosis ,Recurrence ,Risk Factors ,Angioplasty ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stroke ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Endarterectomy, Carotid ,Ultrasonography, Doppler, Duplex ,business.industry ,Age Factors ,Stent ,Middle Aged ,West Virginia ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Multivariate Analysis ,Cardiology ,Female ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de novo carotid stenosis vs patients treated for restenosis after carotid endarterectomy (CEA). Methods: A retrospective review was conducted of all 385 patients (mean age 68.6±9.6 years; 231 men) who underwent 435 CAS procedures at a large tertiary care center between January 1999 and December 2013. For analysis, patients were stratified based on their lesion type [de novo (dn) vs post-CEA restenosis (res)] and subclassified by symptoms status [symptomatic (Sx) or asymptomatic (Asx)], creating 4 groups: (1) CAS-dn Asx, (2) CAS-dn Sx, (3) CAS-res Asx, and (4) CAS-res Sx. For the CAS-res group, the mean elapsed time from CEA to CAS was 72.4±63.6 months. Outcomes included target vessel reintervention (TVR) and in-stent restenosis (ISR), the latter defined by a carotid duplex ultrasound velocity >275 cm/s. Results: The main indication for initial carotid angiography with possible revascularization was severe carotid stenosis (≥70%-99% on duplex) in both CAS-dn and CAS-res groups (83.6% vs 83.7%, p=0.999). There were no significant differences in the percentage of patients with postintervention residual stenosis (
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- 2015
8. Appropriate Use of d-Dimer Testing Can Minimize Over-Utilization of Venous Duplex Ultrasound in a Contemporary High-Volume Hospital
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Albeir Y. Mousa, Mike Broce, Gurpreet Gill, Michael Yacoub, Ali F. AbuRahma, and Maher Kali
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Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Enzyme-Linked Immunosorbent Assay ,Unnecessary Procedures ,Article ,Fibrin Fibrinogen Degradation Products ,Cost Savings ,Predictive Value of Tests ,D-dimer ,medicine ,False positive paradox ,Electronic Health Records ,Humans ,Hospital Costs ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,business.industry ,Medical record ,Retrospective cohort study ,General Medicine ,Emergency department ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Lower Extremity ,Predictive value of tests ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Hospitals, High-Volume - Abstract
Background The sensitivity of d -dimer (DD) in detecting deep venous thrombosis (DVT) is remarkably high; however, many institutions send patients immediately for a venous duplex ultrasound (VDU). This study was designed to examine the appropriate utilization of DD and VDU in a high-volume hospital. Methods A retrospective study was conducted on consecutive patients who presented to a high-volume emergency department (ED) with lower extremity limb swelling/pain over a 30-day period, who were sent for VDU during an evaluation for DVT. VDU data were merged with electronic DD laboratory results. The enzyme-linked immunosorbent assay method was used to provide DD values and thresholds. Values above 0.60 mg/fibrinogen equivalent unit (FEU) were considered abnormal. Results We reviewed the medical records of 517 ED patients in the month of June 2013. After applying the Wells criteria, 157 patients (30.4%) were excluded because of a history of DVT or pulmonary embolism, having been screened for shortness of breath, or sent for surveillance—leaving 360 for analysis. The average age was 59.3 ± 16.5 years with more women (210, 58.3%) and the majority reported limb pain or swelling (73.9%). DD was performed on 51 patients with an average value of 3.6 ± 5.4 mg/FEU, of which 43 (84.3%) were positive. DD identified all positive and negative DVT patients (100% sensitivity and negative predictive value), but also included 40 false positives (16.7% specificity). On the other hand, 309 patients were sent directly to VDU without DD; of those, 43 (13.9%) were positive for DVT. However, 266 (86.1%) patients were negative for DVT by VDU without DD and these were deemed improper by our current study protocol. Potential charge savings were calculated as VDU for all (360 × $1000 = $360,000), DD for all (360 × $145 = $52,200), and VDU for both true and false positives (estimated to be about 25% of the cases; 90 × $1000 = $90,000); this equals a charge savings of $217,800 and would avoid unnecessary VDUs. Conclusions Based on the results of our study, we suggest that the DD test be utilized during the initial work-up for patients with limb swelling/pain in the emergency room. Appropriate utilization of DD, as well as other clinical criteria, may limit the over-utilization and added cost of VDU, without a negative impact on patient care. The results of DD tests should be utilized to limit the number of patients sent for VDU to only those patients with a positive DD or other significant underlying concerns.
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- 2015
9. Current Treatment Strategies for Acute Type B Aortic Dissection
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Patrick A. Stone, Michael Yacoub, Albeir Y. Mousa, Ali F. AbuRahma, John E. Campbell, Shadi Abu-Halimah, Stephen M. Hass, and Gurpreet Gill
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medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Lumen (anatomy) ,Blood Pressure ,Aortography ,Severity of Illness Index ,Time-to-Treatment ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Internal medicine ,Humans ,Medicine ,Antihypertensive Agents ,Ultrasonography, Interventional ,Aortic dissection ,business.industry ,Endovascular Procedures ,Atherosclerotic disease ,Stent ,General Medicine ,medicine.disease ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,Treatment Outcome ,Acute type ,Cardiology ,Treatment strategy ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute type B aortic dissection (ATBAD) is a medical emergency that is a common occurrence in patients with atherosclerotic disease. The presentation is usually severe, with tearing pain that radiates to the back, and various levels of end-organ ischemia and malperfusion, even rupture, may occur. Everyone agrees that prompt and aggressive blood pressure control with β-blockers and nitroprusside is imperative, but when to surgically intervene is still not well characterized. However, the advent of minimally invasive stent graft placement has reshaped our thoughts regarding therapeutic intervention for ATBAD. This review is an attempt to define the current surgical indications for treating ATBAD.
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- 2015
10. Regarding 'Data, guidelines, and practice of revascularization for claudication'
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Mike Broce, Michael Yacoub, and Albeir Y. Mousa
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Treatment outcome ,030204 cardiovascular system & hematology ,Intermittent Claudication ,Revascularization ,Intermittent claudication ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,medicine ,Physical therapy ,Humans ,Surgery ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Claudication ,business ,Vascular Surgical Procedures - Published
- 2017
11. Comparative study of clinical outcome of endovascular aortic aneurysms repair in large diameter aortic necks (31 mm) versus smaller necks
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Ali F. AbuRahma, Trevor DerDerian, Michael Yacoub, L. Scott Dean, Shadi Abu-Halimah, Albeir Y. Mousa, Zachary AbuRahma, and Stephen M. Hass
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Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Endoleak ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Endovascular aneurysm repair ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,In patient ,Large diameter ,Aged ,Retrospective Studies ,Intermediate term ,Aged, 80 and over ,Aortic aneurysm repair ,business.industry ,Late type ,Endovascular Procedures ,Middle Aged ,Progression-Free Survival ,Surgery ,Treatment Outcome ,Instructions for use ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aortic neck ,Aortic Aneurysm, Abdominal - Abstract
BACKGROUND: This study compares short-term (30 days) and intermediate term (3 years) clinical outcomes in patients with large (≥31 mm) versus small aortic neck diameters (≤28 and ≤31 mm). METHODS: Prospectively collected data from 741 patients who underwent endovascular aortic aneurysm repair were analyzed. Some surgeons have reported the threshold for a large aortic neck for endovascular aortic aneurysm repair to be 28 mm, whereas for others it is 31 mm. Therefore, we classified aortic neck diameter into less than or equal to 28 versus greater than 28 mm; and less than or equal to 31 versus greater than 31 mm. Logistic regression and Kaplan-Meier analyses were used to compare outcomes. RESULTS: There were 688 patients who had a defined aortic neck diameter: 592 with less than or equal to 28 mm, 96 with greater than 28 mm, 655 with less than or equal to 31 mm, and 33 with greater than 31 mm. The mean follow-up was 25.2 months for less than or equal to 31 mm versus 31.8 months for greater than 31 mm. Clinical characteristics were similar in all groups, except that there were more patients outside the instructions for use in the greater than 31 mm versus less than or equal to 31 mm group (94% vs 44%; P < .0001). There was a significant increase in early type I endoleak for patients with an aortic neck diameter of greater than 31 versus less than or equal to 31 mm (9 [27%] vs 74 [11%]; P = .01); late type I endoleaks (4 [14%] vs 18 [3%]; P = .01); sac expansion (5 [17%] vs 28 [5%]; P = .01); late intervention (5 [17%] vs 23 [4%]; P = .01); and death (9 [31%] vs 48 [8%]; P < .0001). There were no differences in outcomes between the patients with greater than 28 mm aortic neck diameters and the less than or equal to 28 mm diameters. Freedom from late type I endoleak at 1,2, and 3 years were 96%, 88%, and 88% for patients with a neck diameter of greater than 31 mm versus 97%, 97%, and 97% for a diameter less than or equal to 31 mm (P = .19). The rate of freedom from sac expansion for patients with a diameter greater than 31 mm was 88%, 81%, and 81% at 1, 2, and 3 years versus 99%, 97%, and 92% for a diameter less than or equal to 31 mm (P = .02). Freedom from late intervention for 1, 2, and 3 years for patients with a diameter greater than 31 mm were 91%, 91%, and 91% versus 99%, 97%, and 96% for those with a diameter less than or equal to 31 mm. Survival rates at 1,2, and 3 years for a diameter greater than 31 mm were 83%, 74%, and 68% versus 96%, 92%, and 90% for a diameter less than or equal to 31 mm (P < .001). Multivariate logistic regression analysis showed that patients with a diameter greater than 31 mm had an odds ratio of 6.1 (95% confidence interval [CI], 2.2–16.8) for mortality, 4.7 (95% CI, 1.4–15.5) for sac expansion, and 4.9 (95% CI, 1.4–17.4) for late type I endoleak. CONCLUSIONS: Patients with large aortic neck diameters (>31 mm) had higher rates of early and late type I endoleak, sac expansion, late intervention, and mortality.
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- 2017
12. Appropriate Use of Venous Imaging and Analysis of the D-Dimer/Clinical Probability Testing Paradigm in the Diagnosis and Location of Deep Venous Thrombosis
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Mike Broce, Albeir Y. Mousa, Mina Baskharoun, Michael Yacoub, Shadi Abu-Halimah, David De Wit, and Mark C. Bates
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Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Unnecessary Procedures ,Severity of Illness Index ,Article ,Decision Support Techniques ,Fibrin Fibrinogen Degradation Products ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Predictive Value of Tests ,Risk Factors ,Popliteal vein ,Severity of illness ,D-dimer ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,Receiver operating characteristic ,business.industry ,Ultrasound ,Reproducibility of Results ,Retrospective cohort study ,General Medicine ,Health Care Costs ,Middle Aged ,medicine.disease ,Prognosis ,Venous thrombosis ,ROC Curve ,Predictive value of tests ,Area Under Curve ,Surgery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Hospitals, High-Volume - Abstract
BACKGROUND: The D-dimer (DD) level combined with the pretest Wells criteria probability (WCP) score can safely exclude deep venous thrombosis (DVT). The objective of this study was to examine the correlation between DD results alongside WCP score with findings on venous duplex ultrasound (VDU). The hypothesis is that VDU remains overutilized in low-risk patients with negative DD and that higher DD levels may correlate with thrombus burden and location. METHODS: Patients who presented to a high-volume tertiary care center with lower limb swelling with or without associated pain were retrospectively examined through June and July for 4 consecutive years (2012 to 2015). After calculating WCP, patients were divided into low-, moderate-, and high-risk categories. Electronic DD results utilizing enzyme linked immunosorbent assay, WCP data, and VDU analysis data were merged and analyzed based on receiver operator characteristic curve to determine the DD cutoff point for each WCP. Abnormal DD with an average value ≥ 0.6 mg/L fibrinogen equivalent units (FEUs) was correlated to positive DVT to differentiate proximal DVT (above popliteal vein) from distal DVT (below popliteal vein). RESULTS: Data of 1,909 patients were analyzed, and 239 (12.5%) patients were excluded secondary to serial repeat visits or follow-ups, surveillance screens, and if they had a previous history of DVT. The average age was 62.1 ± 16.3 years with more women (55.7%) and the majority presented with limb pain and edema (87%). DD studies were ordered and completed in 202 patients and correlated with all positive and negative DVT patients (100% sensitivity and negative predictive value, with specificity and positive predictive value of 14.9% and 15.9%, respectively). Twenty-six of 202 patients had DD that were in the normal range 0.1–0.59 mg/L (FEU), all of which were negative for DVT (100% sensitive). Fifty one of 202 patients had DD values of 0.6–1.2 mg/L FEU, of which only 3 DVTs were recorded, and all of them were distal DVTs. In addition, 685 patients with WCP 1.2 mg/L FEU) may raise concern for proximal DVT. Concern on cost-effectiveness exists and raises the demand for a proposed algorithm to be followed.
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- 2017
13. Telehealth electronic monitoring to reduce postdischarge complications and surgical site infections after arterial revascularization with groin incision
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Barbara McKee, Elaine Davis, Mike Broce, Michael Yacoub, and Albeir Y. Mousa
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medicine.medical_specialty ,Time Factors ,Psychological intervention ,Telehealth ,030204 cardiovascular system & hematology ,Groin ,Article ,law.invention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Randomized controlled trial ,Clinical Protocols ,law ,medicine ,Humans ,Surgical Wound Infection ,030212 general & internal medicine ,Prospective Studies ,Intensive care medicine ,Prospective cohort study ,business.industry ,Remote Consultation ,Critical limb ischemia ,medicine.disease ,Mobile Applications ,Patient Discharge ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Research Design ,Computers, Handheld ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
It is intuitive that postdischarge surgical complications are associated with increased patient dissatisfaction, and are directly associated with an increase in medical expenditures. It is also easy to make the connection that many post-hospital discharge surgical complications, including surgical site infections (SSIs), could be influenced or exacerbated by patient comorbidities. The authors of a recent study reported that female gender, obesity, diabetes, smoking, hypertension, coronary artery disease, critical limb ischemia, chronic obstructive pulmonary disease, dyspnea, and neurologic disease were significant predictors of SSIs after vascular reconstruction was performed. The main concern for optimal patient care, especially in geographically isolated areas of West Virginia, is to have early, expeditious, and prompt diagnosis of complications and SSI. This adjunct to existing approaches could lead to improved outcomes and patient satisfaction, minimizing third-party interventions and decreasing the total cost of care. It seems reasonable to believe that monitoring using telehealth technology and managing the general health care of patients after a hospital vascular intervention will improve overall health and reduce 30-day readmissions and SSIs.
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- 2017
14. Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes
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L. Scott Dean, Stephen M. Hass, Ali F. AbuRahma, Albeir Y. Mousa, Patrick A. Stone, Shadi Abu-Halimah, Zachary AbuRahma, and Michael Yacoub
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Endoleak ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Endovascular treatment ,Survival analysis ,Computed tomography angiography ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aortic aneurysm repair ,medicine.diagnostic_test ,business.industry ,Incidence ,Endovascular Procedures ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,Female ,Radiology ,business ,Abdominal surgery ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks.This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B). Kaplan-Meier analysis was used for survival analysis, sac expansion, late type Ia endoleak, and reintervention.Seventy-one of 565 (12.6%) patients had immediate post-EVAR type Ia endoleak. Early intervention (proximal aortic cuffs and/or stenting) was used in 56 of 71 (79%) in group A vs 31 of 494 (6%) in group B (p0.0001). Late type Ia endoleak was noted in 9 patients (13%) in group A at a mean follow-up of 28 months vs 10 patients (2%) in group B at a mean follow-up of 32 months (p0.0001). Late sac expansion and reintervention rates were 9% and 10% for group A vs 5% and 3% for group B (p = 0.2698 and p = 0.0198), respectively. Freedom rates from late type Ia endoleaks at 1, 3, and 5 years for group A were 88%, 85%, and 80% vs 98%, 98%, and 96% for group B (p0.001); and for late intervention, were 94%, 92%, and 77% for group A, and 99%, 97%, and 95% for group B (p = 0.007), respectively. Survival rates were similar.Immediate post-EVAR type Ia endoleaks are associated with higher rates of early interventions, late endoleaks and reintervention, which will necessitate strict post-EVAR surveillance.
- Published
- 2016
15. IP135. Telehealth Electronic Monitoring to Reduce Postdischarge Complications and Surgical Site Infections After Arterial Revascularization With Groin Incision (A Randomized Controlled Study)
- Author
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Mike Broce, Albeir Y. Mousa, Michael Yacoub, and Elaine A. Davis
- Subjects
medicine.medical_specialty ,Groin ,business.industry ,Telehealth ,Surgery ,law.invention ,medicine.anatomical_structure ,Randomized controlled trial ,law ,Surgical site ,Arterial revascularization ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
16. IP265. Treatment of Iliocaval Obstruction May Alleviate the Need for Superficial Venous Ablation in Patients With Significant Varicose Venous Disease
- Author
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Michael Yacoub, Albeir Y. Mousa, Stephen M. Hass, Ali F. AbuRahma, Shadi Abu-Halimah, and Mike Broce
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Venous disease ,Ablation - Published
- 2018
17. Factors that influence lymph node retrieval in the surgical treatment of colorectal cancer: a comparison of the laparoscopic versus open approach
- Author
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Steven Dawood, Abdelkader Hawasli, Samson Chan, Tiffany Chichester, Richard Berri, Stephen Swistak, and Michael Yacoub
- Subjects
Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Body Mass Index ,Risk Factors ,medicine ,Humans ,Surgical treatment ,Lymph node ,Neoplasm Staging ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Lymphatic Metastasis ,Lymph Node Excision ,Female ,Laparoscopy ,Lymphadenectomy ,Lymph ,Colorectal Neoplasms ,business ,Colorectal Surgery ,Chi-squared distribution ,Body mass index - Abstract
Background The purpose of this study was to determine whether surgical approach and patient demographics are important factors that influence lymph node retrieval. Methods This was a retrospective review of patients receiving surgical treatment for colorectal cancer at a single institution. Results Two hundred three patients underwent resection for colorectal cancer. The total number of lymph nodes recovered and the number of lymph nodes involved were similar in both the laparoscopic group and the open group. Patients who had right-sided colon resection had a higher total number of lymph nodes recovered. There was no effect of age, sex, race, or body mass index (BMI) on the total number of lymph nodes harvested or on the number of positive lymph nodes. Conclusions Adequate regional lymphadenectomy for colorectal cancer can be successfully performed using a laparoscopic approach. Patient demographics did not make a difference in the number of total or positive lymph nodes recovered.
- Published
- 2013
18. Validation of subclavian duplex velocity criteria to grade severity of subclavian artery stenosis
- Author
-
Ravi Viradia, Michael Yacoub, Mike Broce, Ali F. AbuRahma, Mark C. Bates, Ramez Morkous, Albeir Y. Mousa, and Andrew Sticco
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Vertebral artery ,medicine.medical_treatment ,Lumen (anatomy) ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Subclavian Steal Syndrome ,Predictive Value of Tests ,Internal medicine ,medicine.artery ,medicine ,Humans ,Subclavian artery ,Computed tomography angiography ,Aged ,Retrospective Studies ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Prognosis ,Stenosis ,ROC Curve ,Regional Blood Flow ,Predictive value of tests ,Area Under Curve ,cardiovascular system ,Cardiology ,Surgery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Blood Flow Velocity - Abstract
Background Validation of subclavian duplex ultrasound velocity criteria (SDUS VC) to grade the severity of subclavian artery stenosis has not been established or systematically studied. Currently, there is a paucity of published literature and lack of practitioner consensus for how subclavian duplex velocity findings should be interpreted in patients with subclavian artery stenosis. Objective The objective of the present study was to validate SDUS measurements using subclavian conventional or computed tomography angiogram (subclavian angiogram [SA])-derived measurements. Secondary objectives included measuring the correlation between SDUS peak systolic velocities and SA measurements, and to determine the optimal cutoff value for predicting significant stenosis (>70%). Methods This is a retrospective review of all patients with suspected subclavian artery stenosis and a convenience sample of carotid artery patients who underwent SDUS and SA from May 1999 to July 2013. SA reference vessel and intralesion minimal lumen diameters were measured and compared with SDUS velocities obtained within 3 months of the imaging study. Percent stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial method for detecting stenosis in a sufficiently large cohort. Receiver operating characteristic curves was generated for SDUS VC to predict >70% stenosis. Velocity cutoff points were determined with equal weighting of sensitivity and specificity. Results We examined 268 arteries for 177 patients. The majority of the arteries were for female patients (52.5%) with a mean age of 66.7 ± 11.1 years. Twenty-three arteries had retrograde vertebral artery flow and excluded from further analysis. For the remaining 245 arteries, the average peak systolic velocity was 212.6 ± 110.7 cm/s, with a range of 45-626 cm/s. Average stenosis was 25.8% ± 28.2%, with a range of 0% to 100%. Following receiver operating characteristic analysis, we found a cutoff value of >240 cm/s to be most predictive of >70%. Area under the curve was 0.94 with 95% confidence intervals of 0.91 to 0.97. The sensitivity and specificity for predicting >70% stenosis was 90.9 and 82.5%, respectively. Conclusions In patients with known or suspected disease involving the great vessels, a subclavian artery flow velocity exceeding 240 cm/s seems to be predictive of significant subclavian stenosis. Thus, we propose new SDUS VC, for predicting subclavian artery stenosis. However, because of the use of a convenience sample, it is possible that the current proposed cutoff point might need to be adjusted for other populations.
- Published
- 2016
19. Validation of venous duplex ultrasound imaging in determining iliac vein stenosis after standard treatment of active chronic venous ulcers
- Author
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Patrick A. Stone, Mike Broce, Mark C. Bates, Albeir Y. Mousa, Michael Yacoub, Ali F. AbuRahma, Mina Baskharoun, and Peter Hanna
- Subjects
Male ,medicine.medical_specialty ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,Iliac Vein ,Constriction ,Varicose Ulcer ,03 medical and health sciences ,0302 clinical medicine ,Intravascular ultrasound ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Ultrasonography ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Standard treatment ,Ultrasound ,Reflux ,Area under the curve ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Venous Insufficiency ,Chronic Disease ,Quality of Life ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Chronic venous ulcer (CVU) is a potentially debilitating condition that remains the most common etiology for leg ulcers. The condition has significant associated costs and effect on patient quality of life. That truncal reflux can be worsened by iliac vein occlusive disease is well known. However, there has not been systematic investigation of venous duplex ultrasound (VDUS) criteria to correlate common femoral vein (CFV) reflux with iliac vein stenosis. We sought to correlate VDUS criteria for predicting iliac vein stenosis and to investigate venous outflow factors associated with CVU recurrence. Methods We conducted a systematic retrospective review of a consecutive series of 36 patients who received standard therapies, including compression therapy along with ablation of incompetent great saphenous veins for treating CVU, but in whom the treatment failed. Elevated CVF reflux was considered as reflux duration (RD) measured by VDUS to last >1 second. A receiver operator characteristic curve analysis was performed to determine the optimal CFV threshold value to predict 50% iliac vein stenosis measured by intravascular ultrasound. Results The 36 patients presented with 54 CVUs on 38 limbs. The median (25th-75th quartiles) age was 61.2 (57.6-68.8) years, body mass index was 36.8 (25.2-52.3) kg/m 2 , CFV RD was 2.7 (1.6-3.5) seconds, ulcer diameter was 4.2 (3.0-4.0) cm, and ulcer depth was 2.5 (2.0-3.0) mm. The optimal cutoff RD value was >2.5 seconds by receiver operator characteristic curve analysis, with an area under the curve of 0.77 ( P = .001). CVUs associated with an RD >2.5 seconds had significantly more iliac vein stenosis >50% by intravascular ultrasound (24 of 30; 80%) than those with an RD P 50% stenosis for those above and below an RD >1 second was 61.4% vs 30%, respectively ( P = .089). Significantly less recurrence of CVU was found for patients taking pentoxifylline (43.6% vs 80.0%; P = .031) and those with stents placed (40.0% vs 70.8%; P = .031). A nonsignificant trend was found for iliac vein interrogation (44.4% vs 72.2%; P = .082). Conclusions This study highlights the utility of VDUS in diagnosing iliac vein stenosis with 2.5 seconds to predict ≥50% iliac vein stenosis. Stent placement and pentoxifylline were associated with ulcer healing and reduced risk of venous ulcer recurrence.
- Published
- 2015
20. Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type 1A Endoleaks and Late Outcomes
- Author
-
Shadi Abu-Halimah, Zachary T. AbuRahma, Ali AbuRahma, Michael Yacoub, Stephen M. Hass, and Albeir Y. Mousa
- Subjects
medicine.medical_specialty ,Aortic aneurysm repair ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
21. Utilization of D-Dimer Along with Clinical Probability Testing in Determining the Magnitude and Location of Deep Venous Thrombosis in a High-Volume Tertiary Practice
- Author
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Trevor Derdian, David De Wit, Ali F. AbuRahma, Zachary AbuRahma, Elliot Adams, Mike Broce, Ramez Morkos, Albeir Mousa, Aravindra Nanjundappa, and Michael Yacoub
- Subjects
Venous thrombosis ,medicine.medical_specialty ,business.industry ,Magnitude (astronomy) ,D-dimer ,medicine ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Volume (compression) - Published
- 2017
22. PC104. Predictors of Failure After Placement of Peritoneal Dialysis Catheters: A Single-Center Cohort Study
- Author
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Ali F. AbuRahma, Michael Yacoub, Mike Broce, and Albeir Y. Mousa
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Single Center ,business ,Peritoneal dialysis ,Cohort study - Published
- 2018
23. Research Highlights: Highlights from the latest articles on femoral artery access
- Author
-
Michael Yacoub, Patrick A. Stone, and Gurpreet Gill
- Subjects
medicine.medical_specialty ,business.industry ,medicine.artery ,Medicine ,Femoral artery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
24. Iliac Vein Interrogation Augments Venous Ulcer Healing in Patients Who Have Failed Standard Compression Therapy along with Pathological Venous Closure
- Author
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Michael Yacoub, Ali F. AbuRahma, Mike Broce, and Albeir Y. Mousa
- Subjects
Ablation Techniques ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Compression stockings ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,Iliac Vein ,Venous stasis ,Varicose Ulcer ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,Intravascular ultrasound ,medicine ,Humans ,Saphenous Vein ,030212 general & internal medicine ,Treatment Failure ,Vein ,Ultrasonography, Interventional ,Vascular Patency ,Aged ,Retrospective Studies ,Wound Healing ,medicine.diagnostic_test ,business.industry ,Great saphenous vein ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Venous Insufficiency ,Chronic Disease ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Stockings, Compression - Abstract
Background Treatment of venous ulcers is demanding for patients, as well as clinicians, and the investigation of underlying venous hypertension is the cornerstone of therapy. We propose that occult iliac vein stenosis should be ruled out by iliac vein interrogation (IVI) in patients with advanced venous stasis. Methods We conducted a systematic retrospective analysis of a consecutive series of patients who presented with CEAP (clinical, etiological, anatomical, and pathophysiological) 6 venous disease. All patients had great saphenous vein ablation, compressive treatment, wound care (including Unna boot compression), and perforator closure using ablation therapy. Iliac vein stenosis was defined as ≥50% stenosis in cross-sectional surface area on intravascular ultrasound. Primary outcomes include time of venous ulcer healing and/or measurable change in the Venous Clinical Severity Score. Results Twenty-two patients with CEAP 6 venous disease met the inclusion criteria (active ulcers >1.5 cm in diameter). The average age and body mass index were 62.2 ± 9.2 years and 41.7 ± 16.7, respectively. The majority were female (72.7%) with common comorbidities, such as hyperlipidemia (54.5%), hypertension (36.4%), and diabetes mellitus (27.3%). Twenty-nine ulcers with an average diameter of 3.4 ± 1.9 cm and a depth of 2.2 ± 0.5 mm were treated. The majority of the ulcers occurred on the left limb (n = 17, 58.6%). Average perforator venous reflux was 3.6 ± 0.8 sec, while common femoral reflux was 1.8 ± 1.6. The majority (n = 19, 64.5%) of the perforator veins were located at the base of the ulcer, while the remainder (n = 10, 34.5%) were within 2 cm from the base. Of the 13 patients who underwent IVI, 8 patients (61.5%) had stenosis >50% that was corrected with iliac vein angioplasty and stenting (IVAS). There was a strong trend toward shorter healing time in the IVI group (7.9 ± 9.5 weeks) than for patients in the no iliac vein interrogation (NIVI) group (20.2 ± 15.3 weeks, P = 0.055). The final VCCS score was not significantly different (IVI = 7.9 ± 9.5 vs. NIVI = 10.0 ± 6.5, P = 0.578). However, compared with the NIVI group, the healing time for patients who actually received IVAS was marginally lower (5.8 ± 3.6 weeks, P = 0.075) and final VCCS was significantly lower (2.4 ± 2.9, P = 0.031). Veins that received IVI and IVAS remained patent and the associated ulcers were healed (100%). Conclusion The small sample size and retrospective design limit the strength of the conclusions but the findings suggest that further studies are needed to define the exact role of IVI including angioplasty/stenting for patients with chronic venous ulcers.
- Published
- 2015
25. Inflammatory biomarkers in peripheral arterial disease
- Author
-
Patrick A. Stone and Michael Yacoub
- Subjects
medicine.medical_specialty ,Pathology ,Arterial disease ,Severity of Illness Index ,Peripheral Arterial Disease ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Severity of illness ,Medicine ,Humans ,biology ,business.industry ,Vascular disease ,C-reactive protein ,medicine.disease ,Inflammatory biomarkers ,Troponin ,Peripheral ,C-Reactive Protein ,Treatment Outcome ,Predictive value of tests ,Cardiology ,biology.protein ,Disease Progression ,Surgery ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Biomarkers - Abstract
Biochemical markers have the potential to aid the vascular specialist in many ways. On a daily basis, we rely on such markers as d-dimer to help exclude thromboembolic disease and thus limit low-probability ultrasound imaging. Additionally, we use troponin levels to determine myocardial events perioperatively. During the past decade, use of the inflammatory marker C-reactive protein has been recommended by the American Heart Association to further stratify patient cardiovascular risk, and has been studied more extensively in patients with peripheral vascular disease. This review details clinical information published during the past several decades on the application of serum C-reactive protein levels in peripheral arterial disease patients in correlation with disease severity and likelihood of future cardiovascular events, including recent predictive models.
- Published
- 2015
26. Abstract 258: Significant Predictors of Survival Following Endovascular Abdominal Aortic Aneurysm Repair
- Author
-
Mike Broce, Albeir Mousa, Mark C. Bates, Michael Yacoub, and Ali F. AbuRahma
- Subjects
Retrospective review ,medicine.medical_specialty ,Patient registry ,business.industry ,Renal function ,Vascular surgery ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,One year mortality ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Objective: To identify significant predictors of survival after abdominal aortic aneurysm (AAA) repair. Methods: A retrospective review of the prospective endovascular aortic repair (EVAR) patient registry of the “Virginia’s group” maintained by the Society for Vascular Surgery Patient Safety Organization. Patients were classified into normal (eGFR ≥60 mL/min/1.73 m 2 ), moderate chronic renal insufficiency (CRI; eGFR ≥30-59) or severe CRI (eGFR Results: A total of 6410 EVAR patients were included with an age of 73.5 ± 8.4 years (majority were male 81.2%), with an average follow-up of 2.3 ± 2.0 years. Compared to patients with eGFR 30-59 and >60, those with the lowest eGFR Conclusion: Reduced renal function at baseline was found to be associated with increased post operative cardiovascular events and long-term mortality following EVAR. Increased monitoring of patients with CRI seems warranted.
- Published
- 2015
27. Tips and tricks for retrieval of permanent TRAPEASE filters for inferior vena cava
- Author
-
Iqra Sheikh, Albeir Mousa, Michael Yacoub, Shadi Abu-Halimah, and Ali F. AbuRahma
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Vena Cava Filters ,Vena Cava, Inferior ,Prosthesis Design ,Inferior vena cava ,Prosthesis Implantation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Device Removal ,business.industry ,General Medicine ,Phlebography ,Surgery ,Treatment Outcome ,medicine.vein ,Filter (video) ,Critical Pathways ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
The placement of permanent inferior vena cava filters has definite indications and some filters have been shown to be more problematic in the long term than others. This report outlines the technique for TRAPEASE® filter removal in two patients. The first filter was retrieved four weeks after insertion and the second filter was retrieved 14 months after it was inserted at another institution. A planned approach for retrieval is described in these case reports.
- Published
- 2014
28. IP087. Validation of Subclavian Duplex Velocity Criteria to Grade the Degree of Stenosis in Occlusive Subclavian Artery Disease
- Author
-
Albeir Y. Mousa, Mike Broce, Andrew Sticco, Ali F. AbuRahma, Shane Monnett, Michael Yacoub, Mark C. Bates, and Ravi Viradia
- Subjects
medicine.medical_specialty ,business.industry ,Occlusive ,Disease ,medicine.disease ,Stenosis ,Duplex (building) ,Internal medicine ,medicine.artery ,medicine ,Cardiology ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Subclavian artery - Published
- 2016
29. Comparative Study of Clinical Outcome of Endovascular Aneurysm Repair in Large-Diameter Aortic Necks (>31 mm) Versus Smaller Neck: Word of Caution
- Author
-
Trevor DerDerian, Michael Yacoub, Ali F. AbuRahma, Albeir Mousa, Stephen M. Hass, Shadi Abu-Halimah, L. Scott Dean, and Zachary AbuRahma
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,Large diameter ,business ,Endovascular aneurysm repair - Published
- 2017
30. Renal imaging: duplex ultrasound, computed tomography angiography, magnetic resonance angiography, and angiography
- Author
-
Michael Yacoub and Ali F. AbuRahma
- Subjects
Diagnostic Imaging ,Male ,medicine.medical_specialty ,Captopril ,Contrast Media ,Renal artery stenosis ,Renal Artery Obstruction ,Sensitivity and Specificity ,Magnetic resonance angiography ,medicine ,Humans ,Ultrasonography, Doppler, Color ,Computed tomography angiography ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Angiography ,medicine.disease ,Radiographic Image Enhancement ,Renal imaging ,Duplex (building) ,Surgery ,Female ,Radiology ,Tomography ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Radioisotope Renography ,Magnetic Resonance Angiography - Abstract
Renal artery stenosis (RAS) is one of the most common causes of severe hypertension (approximately 1-5% of all patients with hypertension). Presently, there is no universally accepted screening test for RAS. However, most clinicians use renal duplex ultrasound (RDU) imaging; while others use magnetic resonance angiography (MRA) or contrast computed tomography angiography in selected patients. This review will highlight various imaging modalities and discuss the pros and cons of each.
- Published
- 2014
31. Significant Long-Term Predictors of Reintervention Following Percutaneous Subclavian Artery Revascularization◊
- Author
-
Aravindra Nanjundappa, Ali F. AbuRahma, Patrick A. Stone, Mohit Srivastava, Stephen M. Hass, Albeir Y. Mousa, Michael Yacoub, Mike Broce, Mark C. Bates, John E. Campbell, and Shadi AbuHaliamh
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.artery ,medicine.medical_treatment ,Medicine ,Surgery ,business ,Revascularization ,Cardiology and Cardiovascular Medicine ,Subclavian artery ,Term (time) - Published
- 2014
- Full Text
- View/download PDF
32. Community-Acquired Methicillin-Resistant Staphylococcus aureus USA 300 Genotype Causing Pyomyositis and Kikuchi-Fujimoto Disease
- Author
-
Michael Yacoub, Samer Fahmy, and Louis D. Saravolatz
- Subjects
Microbiology (medical) ,Kikuchi-Fujimoto Disease ,Infectious Diseases ,Pyomyositis ,business.industry ,Genotype ,medicine ,medicine.disease_cause ,medicine.disease ,business ,Methicillin-resistant Staphylococcus aureus ,Microbiology - Published
- 2008
33. Compliance of Post-EVAR Imaging Surveillance
- Author
-
Mohit Srivastava, Patrick A. Stone, Michael Yacoub, Ali F. AbuRahma, Ravi Viradia, Shadi Abu-Halimah, Joseph AbuRahma, Albeir Y. Mousa, L. Scott Dean, and Stephen M. Hass
- Subjects
Compliance (physiology) ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2015
34. Validation of Venous Duplex Ultrasound in Determining Iliac Vein Stenosis and Predictors of Recurrence After Standard Treatment of Active Chronic Venous Ulcers
- Author
-
Mark C. Bates, Mike Broce, Michael Yacoub, Ali F. AbuRahma, Patrick A. Stone, Albeir Y. Mousa, Aravindra Nanjundappa, Shadi AbuHaliamh, and Jenna Kazil
- Subjects
medicine.medical_specialty ,Active chronic ,business.industry ,Standard treatment ,Ultrasound ,medicine.disease ,Surgery ,Stenosis ,Duplex (building) ,Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Lower limbs venous ultrasonography - Published
- 2015
35. Validation of Subclavian Duplex Ultrasound Velocity Criteria to Grade the Degree of Stenosis in Occlusive Subclavian Artery Disease
- Author
-
Mike Broce, Aravinda Nanjundappa, Shadi AbuHaliamh, Michael Yacoub, Zackary AbuRahma, Ali F. AbuRahma, Albeir Y. Mousa, and Andrew Sticco
- Subjects
medicine.medical_specialty ,business.industry ,Ultrasound ,Occlusive ,medicine.disease ,Surgery ,Stenosis ,Duplex (building) ,medicine.artery ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Subclavian artery - Published
- 2016
36. Preoperative Risk Score Model to Characterize Predictors of Spinal Cord Ischemia Following Thoracic Endovascular Aortic Repair
- Author
-
Michael Yacoub, Glibert R. Upchurch, Aravindra Nanjundappa, Albeir Y. Mousa, Ali F. AbuRahma, Andrew Sticco, Mike Broce, Mina Baskharoun, and Jenna Kazil
- Subjects
medicine.medical_specialty ,business.industry ,Anesthesia ,Preoperative risk ,medicine ,Spinal cord ischemia ,Surgery ,Cardiology and Cardiovascular Medicine ,Aortic repair ,business - Published
- 2016
37. A Risk Score Model to Characterize Predictors of Survival Following Elective Endovascular Abdominal Aortic Aneurysm Repair
- Author
-
Jenna Kazil, Albeir Y. Mousa, Ali F. AbuRahma, Mark C. Bates, Michael Yacoub, Stephen M. Hass, and Mike Broce
- Subjects
medicine.medical_specialty ,Framingham Risk Score ,business.industry ,medicine.medical_treatment ,Stent ,Critical limb ischemia ,Anastomosis ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Coronary artery disease ,Pseudoaneurysm ,medicine ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Survival rate - Abstract
comorbidities included hypertension (90%), diabetes (65%), coronary artery disease (60%), smoking (50%), chronic renal insufficiency (50%), and hyperlipidemia (75%). The mean American Society of Anesthesiologists class was 3.5 6 0.7, and the Rutherford category of the lesions was 4.9 6 0.8. In addition, 36% of patients had cellulitis present. Standard percutaneous techniques were used for stent placement. Outcomes were measured in terms of wound healing, limb salvage, relief of symptoms, and stent patency. Results: The lesions included 4 below-knee popliteal, 10 tibioperoneal trunk, 7 anterior tibial, 7 peroneal, 9 posterior tibial, and 8 distal anastomotic stenoses. Simultaneous proximal interventions were performed during 36% of the procedures. Average stent diameter was 2.96 6 0.5 mm. Median follow-up was 1285 days (range, 111732 days). Five patients died of causes unrelated to the procedure. Of the surviving patients, pain relief was observed in 84%, the amputation-free survival rate was 86%, and wounds healed in 80% of patients. In addition, duplex ultrasound imaging at follow-up showed the patency of the stents was 85%. Three patients had minor complications (two hematomas and one puncture-site pseudoaneurysm) Conclusions: Intermediate term follow-up demonstrates that the use infrageniculate drug-eluting stents is a safe and effective method for treatment of critical limb ischemia in high-risk surgical patients and may even be better than bypass in patients. Further studies to determine long-term follow-up are warranted.
- Published
- 2015
38. Syncytial giant cell hepatitis associated with chronic lymphocytic leukemia: a case report
- Author
-
Eva Gupta, Ayad M Al-Katib, Martha Higgins, and Michael Yacoub
- Subjects
Hepatitis ,medicine.medical_specialty ,Syncytial giant cell ,Hematology ,medicine.diagnostic_test ,biology ,lcsh:RC633-647.5 ,business.industry ,Chronic lymphocytic leukemia ,Case Report ,lcsh:Diseases of the blood and blood-forming organs ,medicine.disease ,Liver biopsy ,Internal medicine ,hemic and lymphatic diseases ,Immunology ,medicine ,biology.protein ,Etiology ,Antibody ,business ,Molecular Biology ,Angiology - Abstract
Background Syncytial giant cell hepatitis (GCH) is an uncommon and an underreported disease entity. In two previously reported cases of GCH in patients with Chronic Lymphocytic Leukemia (CLL) liver failure ensued. Autoimmune and infective causes have been implicated but its etiology remains unclear. Case Presentation A 60-year-old female with CLL presented with acute hepatitis with negative viral and auto-immune serologies and without any prior toxic exposure. Liver biopsy showed typical histological features of GCH. The patient was successfully treated with corticosteroids and intravenous immunoglobulin (IVIG). Her liver enzymes returned to baseline and have remained normal as of the last follow up almost 4 years later. Conclusions Association of GCH with CLL may be under recognized. Clinical suspicion of GCH in CLL patients with serology-negative hepatitis, early liver biopsy and therapeutic intervention may influence outcome. This is the first case report of successful treatment of GCH in CLL patients. Moreover, our case also demonstrates the ability to resume effective CLL therapy post-GCH diagnosis without detriment to the liver.
- Published
- 2012
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