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10 results on '"Devin Zarkowsky"'

1. Endovascular release of an Adams-DeWeese clip and iliocaval reconstruction for debilitating lower extremity swelling

Author

Eric Sung, BA, Joel L. Ramirez, MD, and Devin Zarkowsky, MD

Subjects
Adam-DeWeese clip, Deep vein thrombosis, Iliocaval reconstruction, Inferior vena cava, Venous disease, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

More than 10 million cases of venous thromboembolisms are reported on an annual basis and are major contributors to morbidity and mortality. Studies have found that ≤90% of pulmonary embolisms originate from the abdominal and lower extremity veins. The mainstay of venous thromboembolism treatment has been, and still continues to be, anticoagulation. However, for patients for whom anticoagulation is contraindicated or has failed, physicians have turned to surgical innovations such as inferior vena cava (IVC) filters to create partial interruption of the IVC. Before the invention of IVC filters, the Adams-DeWeese clip was developed to create caval interruption, which allowed for venous return while preventing pulmonary emboli from distal veins. We report a case of endovascular release of a long-term Adams-DeWeese clip, which had caused IVC occlusion and debilitating bilateral lower extremity swelling.

Published
2024
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2. Spontaneous carotid blowout of the common carotid artery in a chronically immunosuppressed transplant patient

Author

Ali Hakimi, BS, Christina Stuart, MD, Devin Zarkowsky, MD, Michael R. Clay, MD, and Jeniann Yi, MD, MSCS

Subjects
Carotid blowout (CB), Carotid blowout syndrome (CBS), Cytomegalovirus (CMV), Chronic immunosuppression, Transplant, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Carotid blowout (CB) is a life-threatening surgical emergency with a mortality rate of up to 60%. CB is commonly seen in head and neck cancer patients after surgical and radiation therapy; other causes include iatrogenic, traumatic, or infectious etiologies. We report an unusual case of spontaneous CB presumed to be caused by cytomegalovirus (CMV) in a chronically immunosuppressed transplant recipient. Given the significant mortality of CB and the prevalence of post-transplant CMV, this case highlights an area of further investigation regarding the association between CMV and carotid pathology, as well as the need to include CB as a potential infectious complication in the immunosuppressed population.

Published
2022
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3. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell’s Diverticulum

Author

Clare Moffatt, Jonathan Bath, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchell R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley MBBCH, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Mario D'Oria, Sandro Lepidi, Peter Lawrence, and Karen Woo

Subjects
Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Published
2023

4. Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

Author

Cassra N. Arbabi, Joseph DuBose, Benjamin W. Starnes, Naveed Saqib, Elina Quiroga, Charles Miller, Ali Azizzadeh, Kristofer Charlton-Ouw, Rana Afifi, Michelle McNutt, Zain Al-Rustum, Binod Shrestha, Ben Starnes, Rami Gilani, David Turay, Xian Luo-Owen, Tiffany Bee, Suzanne Moyer, Joe DuBose, William Shutze, William Dockery, Laura Petrey, Timothy N. Phelps, Chuck Fox, Ernest Moore, Alexis Cralley, Pedro Teixeira, Emily Leede, Frank Buchanan, Emilio Ramos, Marielle Ngoue, Nicole Fox, Lisa Shea, Martin Zielinski, Marianna Martini Fischmann, Kenji Inaba, Desmond Khor, Gregory Magee, Malachi Sheahan, Marie Unruh, Neil Parry, Luc Dubois, John Berne, Ivan Puente, Mario F. Gomez, Dalier R. Mederos, John Bini, Karen Herzing, Claire Hardman, Andres Schanzer, Francesco Aiello, Edward Arous, Elias Arous, Douglas Jones, Dejah Judelson, Louis Messina, Tammy Nguyen, Jessica Simons, Robert Steppacher, Joao Rezende-Neto, James Haan, Kelly Lightwine, Julie Dunn, Brittany Smoot, Tal Horer, David McGreevy, Vincent Riambau, Gaspar Mestres, Xavier Yugueros, Marc Passman, Adam W. Beck, Mark Patterson, Ben Pearce, Emily Spangler, Graeme McFarland, Danielle Sutzko, Matt Smeds, Emad Zakhary, Michael Williams, Catherine Wittgen, Todd Vogel, Matt Eagleton, Bruce Gewertz, Galinos Barmparas, Cassra Arbabi, Rishi Kundi, Jonathan Morrison, Peter Rossi, Davide Pacini, Luca Botta, Ciro Amodio, Pierantonio Rimoldi, Ilenia D'Alessio, Nicola Monzio Compagnoni, Muhammad Aftab, Mohammed Al-Musawi, T. Brett Reece, Jay D. Pal, Donald Jacobs, Rafael D. Malgor, Devin Zarkowsky, Ravi Rajani, Jaime Benarroch-Gampel, Christopher R. Ramos, Marc Schermerhorn, Mark Wyers, Allen Hamdan, Lars Stangenberg, Andy Lee, Mark Davies, Lalithapriya (Priya) Jayakumar, Matthew J. Sideman, Christopher Mitromaras, Dimitrios Miserlis, Reshma Brahmbhatt, Ralph Darling, Xzabia Caliste, Benjamin B. Chang, Jeffrey C. Hnath, Paul B. Kreienberg, Alexander Kryszuk, Adriana Laser, Sean P. Roddy, Stephanie Saltzberg, Melissa Shah, Courtney Warner, Chin-Chin Yeh, Viktor Reva, Viktor Zhigalo, Alexander V. Krasikov, Santi Trimarchi, Maurizio Domanin, Trissa Babrowski, Ross Milner, Luka Pocivavsek, Christopher Skelly, Kimberly Malka, Brian Nolan, Mario D’Oria, and Sandro Lepidi

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Thoracic Injuries, Traumatic brain injury, Clinical Decision-Making, Hemodynamics, Aorta, Thoracic, Wounds, Nonpenetrating, Risk Assessment, Blood Vessel Prosthesis Implantation, Postoperative Complications, Blunt, Risk Factors, Brain Injuries, Traumatic, medicine, Humans, Hospital Mortality, Prospective Studies, Registries, Stroke, Multiple Trauma, business.industry, Endovascular Procedures, Middle Aged, Vascular System Injuries, Vascular surgery, medicine.disease, Surgery, Treatment Outcome, Blood pressure, Concomitant, Injury Severity Score, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Traumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy.The Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (6 vs ≥6 hours) or urgent (24 vs ≥24 hours) intervals.A total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke.In contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.

Published
2022

5. Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum

Author

Jonathan Bath, Mario D'Oria, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchelle R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Clare Moffatt, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Sandro Lepidi, Peter Lawrence, and Karen Woo

Subjects
Aberrant subclavian artery, Kommerell's diverticulum, Surgery, Cardiology and Cardiovascular Medicine, Settore MED/22 - CHIRURGIA VASCOLARE
Published
2023

6. Association of carotid revascularization approach with perioperative outcomes based on symptom status and degree of stenosis among octogenarians

Author

Pavel Kibrik, David P. Stonko, Ahmad Alsheekh, Courtenay Holscher, Devin Zarkowsky, Christopher J. Abularrage, and Caitlin W. Hicks

Subjects
Aged, 80 and over, Endarterectomy, Carotid, Octogenarians, Time Factors, Constriction, Pathologic, Risk Assessment, Stroke, Carotid Arteries, Treatment Outcome, Risk Factors, Humans, Surgery, Carotid Stenosis, Stents, Cardiology and Cardiovascular Medicine, Aged, Retrospective Studies
Abstract

Age ≥80 years is known to be an independent risk factor for periprocedural stroke after transfemoral carotid artery stenting (TF-CAS) but not after carotid endarterectomy (CEA). The objective of the present study was to compare the perioperative outcomes for CEA, TF-CAS, and transcarotid artery revascularization (TCAR) among octogenarian patients (aged ≥80 years) overall and stratified by symptom status and degree of stenosis.All patients aged ≥80 years with 50% to 99% carotid artery stenosis who had undergone CEA, TF-CAS, or TCAR in the Vascular Quality Initiative (2005-2020) were included. We compared the perioperative (30-day) incidence of ipsilateral stroke or death for CEA vs TF-CAS vs TCAR using analysis of variance and multivariable logistic regression models. The results were confirmed in a sensitivity analysis stratified by symptom status and degree of stenosis.Overall, 28,571 carotid revascularization procedures were performed in patients aged ≥80 years: CEA, n = 20,912 (73.2%), TF-CAS, n = 3628 (12.7%), and TCAR, n = 4031 (14.1%). The median age was 83 years (interquartile range, 81.0-86.0 years); 49.8% of the patients were symptomatic (51.9% CEA, 46.2% TF-CAS, 42.4% TCAR); and 60.7% had high-grade stenosis (59.0% CEA, 65.2% TF-CAS, 65.4% TCAR). Perioperative stroke/death occurred most frequently following TF-CAS (6.6%), followed by TCAR (3.1%) and CEA (2.5%; P .001). After adjusting for baseline differences between groups, the odds ratio (OR) for stroke/death was greater for TF-CAS vs CEA (adjusted OR [aOR], 3.35; 95% confidence interval [CI], 2.65-4.23), followed by TCAR vs CEA (aOR 1.49, 95% CI 1.18-1.87). The risk of perioperative stroke/death remained significantly greater for TF-CAS compared with CEA regardless of symptom status and degree of stenosis (P .05 for all). In contrast, the risk of stroke/death was higher for TCAR vs CEA for asymptomatic patients (aOR, 2.04; 95% CI, 1.41-2.94) and those with high-grade stenosis (aOR, 1.49; 95% CI, 1.11-2.05) but similar for patients with symptomatic and moderate-grade disease (P.05 for both). The risk of myocardial infarction was lower with TCAR (aOR, 0.59; 95% CI, 0.40-0.87) and TF-CAS (aOR, 0.56; 95% CI, 0.40-0.87) compared with CEA overall.Overall, TCAR and CEA can be safely offered to older adults, in particular, symptomatic patients and those with moderate-grade stenosis. TF-CAS should be avoided in older patients when possible.

Published
2021

7. Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

Author

Cassra N. Arbabi, Joseph DuBose, Kristofer Charlton-Ouw, Benjamin W. Starnes, Naveed Saqib, Elina Quiroga, Charles Miller, Ali Azizzadeh, Rana Afifi, Michelle McNutt, Zain Al-Rustum, Binod Shrestha, Edmundo Dipasupil, Ben Starnes, Rami Gilani, David Turay, Xian Luo-Owen, Tiffany Bee, Suzanne Moyer, Joe DuBose, William Shutze, William Dockery, Laura Petrey, Timothy N. Phelps, Chuck Fox, Ernest Moore, Alexis Cralley, Pedro Teixeira, Emily Leede, Frank Buchanan, Emilio Ramos, Marielle Ngoue, Nicole Fox, Lisa Shea, Martin Zielinski, Marianna Martini Fischmann, Kenji Inaba, Desmond Khor, Gregory Magee, Malachi Sheahan, Marie Unruh, Neil Parry, Luc Dubois, John Berne, Ivan Puente, Mario F. Gomez, Dalier R. Mederos, John Bini, Karen Herzing, Claire Hardman, Andres Schanzer, Francesco Aiello, Edward Arous, Elias Arous, Douglas Jones, Dejah Judelson, Louis Messina, Tammy Nguyen, Jessica Simons, Robert Steppacher, Joao Rezende-Neto, James Haan, Kelly Lightwine, Julie Dunn, Brittany Smoot, Tal Horer, David McGreevy, Vincent Riambau, Gaspar Mestres, Xavier Yugueros, Marc Passman, Adam W. Beck, Mark Patterson, Ben Pearce, Emily Spangler, Graeme McFarland, Danielle Sutzko, Matt Smeds, Emad Zakhary, Michael Williams, Catherine Wittgen, Todd Vogel, Matt Eagleton, Bruce Gewertz, Galinos Barmparas, Cassra Arbabi, Rishi Kundi, Jonathan Morrison, Peter Rossi, Davide Pacini, Luca Botta, Ciro Amodio, Pierantonio Rimoldi, Ilenia D'Alessio, Nicola Monzio Compagnoni, Muhammad Aftab, Mohammed Al-Musawi, T. Brett Reece, Jay D. Pal, Donald Jacobs, Rafael D. Malgor, Devin Zarkowsky, Ravi Rajani, Jaime Benarroch-Gampel, Christopher R. Ramos, Marc Schermerhorn, Mark Wyers, Allen Hamdan, Lars Stangenberg, Andy Lee, Mark Davies, Lalithapriya (Priya) Jayakumar, Matthew J. Sideman, Christopher Mitromaras, Dimitrios Miserlis, Reshma Brahmbhatt, Ralph Darling, Xzabia Caliste, Benjamin B. Chang, Jeffrey C. Hnath, Paul B. Kreienberg, Alexander Kryszuk, Adriana Laser, Sean P. Roddy, Stephanie Saltzberg, Melissa Shah, Courtney Warner, Chin-Chin Yeh, Viktor Reva, Viktor Zhigalo, Alexander V. Krasikov, Santi Trimarchi, Maurizio Domanin, Trissa Babrowski, Ross Milner, Luka Pocivavsek, Christopher Skelly, Kimberly Malka, Brian Nolan, Mario D’Oria, and Sandro Lepidi

Subjects
Adult, Male, medicine.medical_specialty, Thoracic Injuries, Aortic injury, Aorta, Thoracic, Wounds, Nonpenetrating, Blunt, Injury Severity Score, medicine, Humans, Hospital Mortality, Prospective Studies, Registries, Cause of death, Practice patterns, business.industry, Incidence, Endovascular Procedures, Disease Management, Vascular surgery, Middle Aged, Vascular System Injuries, United States, Surgery, Blood pressure, Treatment Outcome, Blunt trauma, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Blunt thoracic aortic injury (BTAI) is the second leading cause of death from blunt trauma. In the present study, we aimed to determine the outcomes of medical management (MM) for BTAI. We hypothesized from the results of several previously reported studies, that patients with a minimal aortic injury (BTAI grades 1 and 2) could safely be treated with definitive MM alone.The Aortic Trauma Foundation international prospective multicenter registry was used to examine the demographics, injury characteristics, management, and outcomes of patients with BTAI. We analyzed a subset of patients for whom MM was initiated as definitive therapy.From November 2016 to April 2020, 432 patients (median age, 41 years; 76% male; median injury severity score, 34) with BTAI (Society for Vascular Surgery grade 1, 23.6%; grade 2, 14.4%; grade 3, 51.2%; grade 4, 10.9%) were evaluated. Of the 432 patients, 245 (57%) had received MM in the initial period and 114 (26.4%) had received MM as the planned definitive therapy (grade 1, 59.6%; grade 2, 23.7%; grade 3, 15.8%; grade 4, 0.9%). The most common mechanism of BTAI was a motor vehicle collision (60.4%). Hypotension was present on arrival in 74 patients (17.2%). Continuous titratable infusion of antihypertensive medication was used for 49.1%, followed by intermittent bolus administration (29.8%), with beta-blockers (74.6%) the most common agent used. Treatments were targeted to a goal systolic blood pressure for 83.3%, most often to a target goal systolic blood pressure120 mm Hg (66.3%). The MM goals based on blood pressure control were attained in 64.0% (73 of 114). Twelve patients (10.5%; grade 1, 1; grade 2, 0; grade 3, 10; grade 4, 1) had required subsequent intervention after MM. Eleven patients (9.6%) had undergone thoracic endovascular aortic repair and one (0.9%) had required open repair for a grade 4 injury. The overall in-hospital mortality for patients selected for definitive MM was 7.9%. No aortic-related deaths had occurred in the patients receiving definitive MM.Approximately one in four patients with BTAI will receive MM as definitive therapy. The variation in the pharmacologic therapies used is considerable. MM for patients with minimal aortic injury (BTAI grades 1 and 2) is safe and effective, with a low overall intervention rate and no aortic-related deaths. These findings support the use of definitive MM for grade 2 BTAI.

Published
2021

10. A Multi-Institutional Experience in Vascular Ehlers-Danlos Syndrome

Author

Sherene, Shalhub, Kelli, Hicks, Karen, Woo, Dawn, Coleman, Frank, Davis, DE CARIDI, Giovanni, Nicole Weaver, K., Erin, Miller, Marc, Schermerhorn, Katie, Shean, Gustavo, Oderich, Mauricio, Ribiero, Cole, Nishikawa, Charlton-Ouw, Kristofer M., Christian-Alexander, Behrendt, Sebastian, Debus, Yskert von Kodolitsch, Devin, Zarkowsky, Powell, Richard J., Melanie, Pepin, Peter, Byers, and Peter, Lawrence

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Ehlers–Danlos syndrome, business.industry, medicine, Surgery, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, medicine.disease, business, Dermatology
Published
2017

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