178 results on '"Evan C. Lipsitz"'
Search Results
2. A comparison of endovascular repair to medical management for acute vs subacute uncomplicated type B aortic dissections
- Author
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Matthew Muller, Patricia Yau, Antoine Pham, Evan C. Lipsitz, Joseph J. DeRose, Jae S. Cho, Saadat Shariff, and Jeffrey E. Indes
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
3. Age is Associated With Increased Mortality but Not Other Complications in Patients Undergoing Catheter-directed Arterial Thrombolysis for Acute Lower Extremity Ischemia
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Maryam Hashmi, Matthew Muller, Jeffrey Indes, Evan C. Lipsitz, and Sonia Talathi
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
4. Aortic Neck Dilatation Following Thoracic Endovascular Aortic Repair
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Patricia Friedmann, Evan C. Lipsitz, Jeffrey E. Indes, Hasan Aldailami, and Patricia Yau
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Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Computed Tomography Angiography ,Aorta, Thoracic ,Dissection (medical) ,Vascular Remodeling ,030204 cardiovascular system & hematology ,Aortic repair ,Aortography ,Risk Assessment ,Thoracic aortic aneurysm ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Median follow-up ,medicine ,Humans ,Single institution ,Aged ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Smoking ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Aortic Dissection ,Treatment Outcome ,Landing zone ,cardiovascular system ,Female ,Aortic diameter ,Cardiology and Cardiovascular Medicine ,Aortic neck ,business ,Dilatation, Pathologic - Abstract
Objective Thoracic endovascular aortic repair (TEVAR) has become a mainstay of treatment for a variety of thoracic aortic pathologies. Expansion of the proximal aortic neck after endovascular repair of abdominal aortic aneurysms has been demonstrated; however, dilatation of the proximal aortic neck after TEVAR has not been well described. We sought to describe remodeling of the proximal neck following TEVAR. Methods This is a retrospective, single institution review of patients who underwent TEVAR for thoracic aortic aneurysm (TAA) and dissection with aneurysmal degeneration from 2010 to 2019. Postoperative computed tomography scans were reviewed and aortic diameter was measured in orthogonal planes using 3-dimensional centerline reconstruction software. The primary outcome was change in aortic diameter at the proximal aortic neck as compared to the initial postoperative computed tomography scan. Clinical and operative data were analyzed to identify factors associated with significant neck dilatation. Results Of 87 patients who underwent TEVAR during the study period, 30 met inclusion criteria. Median follow up was 20.5 months. Median age was 67 years, and 15 patients (50%) were female. The proximal aortic neck experienced an overall increase over time in aortic diameter. Five mm distal to the graft showed the greatest rate of expansion, with a median increase of 1.3, 2.9, and 6.2 mm at one year, two years, and three years, respectively. When comparing patients who had mean expansion at this location of >2.0 mm/year to patients who did not, a higher percentage had dissection pathology (81.8% vs. 31.6%, P = 0.008), had graft placement at aortic landing zone 2 (36.4% vs. 5.3%, P = 0.028), and were smokers (100% vs. 52.6%, P = 0.006). Higher percent oversizing was shown to be associated with significant aortic neck dilatation for true aneurysms only. Conclusions Aortic neck dilatation occurs over time for the majority of patients following TEVAR with the distal neck experiencing the highest rate of expansion. Dissection pathology, aortic landing zone 2, and smoking were found to be associated with a higher rate of neck dilatation.
- Published
- 2021
5. A Propensity-Matched Analysis of Endovascular Intervention versus Open Nonautologous Bypass as Initial Therapy in Patients with Chronic Limb-Threatening Ischemia
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John Futchko, John Denesopolis, Patricia Friedmann, Saadat Shariff, Karan Garg, Evan C. Lipsitz, Eric B. Trestman, John P. Phair, Larry Scher, and Francis J. Porreca
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Clinical Decision-Making ,Ischemia ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,Amputation, Surgical ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,cardiovascular diseases ,Propensity Score ,Vein ,Aged ,Proportional hazards model ,business.industry ,Endovascular Procedures ,Gold standard ,General Medicine ,Perioperative ,Limb Salvage ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Amputation ,Chronic Disease ,Propensity score matching ,cardiovascular system ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Endovascular therapies are increasingly used in patients with complex multilevel disease and chronic limb-threatening ischemia (CLTI). Infrageniculate bypass with autologous vein conduit is considered the gold standard in these patients. However, many patients often lack optimal saphenous vein, leading to the use of nonautologous prosthetic conduit. We compared limb salvage and survival rates for patients with CLTI undergoing first time revascularization with either open nonautologous conduit or endovascular intervention.We retrospectively reviewed consecutive patients undergoing first time endovascular or open surgical revascularization at our institution between 2009 and 2016. Patients were divided into endovascular intervention or open bypass with nonautologous conduit (NAC) cohorts. Primary endpoints were amputation-free survival (AFS), freedom from reintervention, primary patency, and overall survival. Propensity scoring was used to construct matched cohorts. Outcomes were evaluated using Kaplan-Meier and Cox Proportional Hazards models.A total of 125 revascularizations were identified. There were 65 endovascular interventions and 60 NAC bypasses. In unmatched analysis, there was an elevated risk of perioperative MI (7% vs. 0%, P = 0.05) and amputation (10% vs. 2%, P = 0.04) for the NAC groups compared to the endovascular group. In matched analysis, endovascular patients had a lower incidence of 30-day amputation (1.5% vs. 10% P = 0.04) and length of stay (median days, 1 vs. 9, P0.01) compared to the open cohort. While not statistically significant, the endovascular group trended towards increased rates of two-year AFS (76% vs. 65%, P = 0.07) compared to the NAC group. There was no significant difference in overall survival when the endovascular cohort was compared to NAC (85% vs. 77%, P = 0.29) patients. In matched Cox analysis, nonautologous conduit use was associated with an increased risk of limb loss (HR 2.03, 95% CI 0.94-4.38, P = 0.07) compared to endovascular revascularization.An "endovascular first" approach offers favorable perioperative outcomes and comparable AFS compared to NAC and may be preferable when autologous conduit is unavailable.
- Published
- 2021
6. Perioperative Opioid and Nonopioid Prescribing Patterns in AVF/AVG Creation
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Larry A. Scher, Brandon DeRuiter, Issam Koleilat, Matthew Carnevale, Krystina Choinski, John Phair, and Evan C. Lipsitz
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Male ,Time Factors ,Sedation ,Analgesic ,Arteriovenous fistula ,Anesthesia, General ,030204 cardiovascular system & hematology ,Drug Prescriptions ,Perioperative Care ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Arteriovenous Shunt, Surgical ,0302 clinical medicine ,Anesthesia, Conduction ,Renal Dialysis ,medicine ,Humans ,Pain Management ,Local anesthesia ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Inpatients ,Pain, Postoperative ,business.industry ,General Medicine ,Perioperative ,Analgesics, Non-Narcotic ,Middle Aged ,medicine.disease ,Drug Utilization ,Patient Discharge ,Analgesics, Opioid ,Treatment Outcome ,Ambulatory Surgical Procedures ,Opioid ,Anesthesia ,Ambulatory ,Morphine ,Female ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
To evaluate postoperative opioid prescribing patterns in patients undergoing hemodialysis access creation.Operative logs were reviewed to identify patients undergoing creation of arteriovenous fistula (AVF) or graft (AVG) from September 2016 to January 2018. Immediate postoperative opioid prescriptions were compared for ambulatory patients versus inpatients. Opioid prescriptions at the time of discharge for inpatients were recorded. Rates of opioid prescribing were standardized by conversion to morphine milligram equivalents (MMEs). Opioid use postoperatively and at the time of discharge based on anesthetic technique, general anesthesia versus regional or local anesthesia with sedation were compared. Alternative pain medications administered and pain scores were recorded. Comparisons were made between the percentage of opioid use and doses administered between AVF and AVG patient groups, ambulatory and inpatients, and type of anesthetic technique used. Statistical analysis was performed with chi-square and t-tests.We identified 164 patients undergoing AV access creation but not receiving chronic opioid therapy. A significantly higher percentage of inpatients received opioids in the immediate postoperative period than ambulatory patients (AVF: 72% vs. 19%, P 0.001; AVG: 62% vs. 25%, P = 0.001). Overall, all AVG patients were more likely to be discharged with an opioid prescription than all AVF patients (37% vs. 8%, P 0.001). Of AVG patients managed in the ambulatory setting, 48% were discharged with an opioid prescription. The mean total opioid postoperative dose prescribed to inpatients was significantly higher than that prescribed to ambulatory patients for both fistulas (28.73 MMEs vs. 1.27 MMEs, P 0.001) and grafts (22.11 MMEs vs. 2.16 MMEs, P = 0.005). General anesthesia patient groups were more likely to receive opioids postoperatively than local anesthesia with sedation patients for both AVF (54% vs. 24%, P = 0.027) and AVG creation (61% vs. 17% P 0.001). Postoperative alternative medication use in the hospital was low with 18% acetaminophen and 1% nonsteroidal anti-inflammatory drug use for AVF patient groups and 24% acetaminophen and 0% nonsteroidal anti-inflammatory drug use for AVG patient groups. The percentage of patients reporting postoperative pain in the recovery room and on the inpatient units was comparable between ambulatory and inpatient settings (AVF: 21% vs. 28%, P = 0.534; AVG: 23% vs. 44%, P = 0.061).A higher percentage of inpatients undergoing hemodialysis access received opioids when compared with ambulatory patients in the immediate postoperative period. Inpatients were prescribed higher mean doses than ambulatory patients. AVG patient groups were prescribed more opioids than AVF patient groups. Alternative analgesic agent use was low, suggesting an opportunity for improved pain control and opioid reduction. Dialysis access creation represents an opportunity to improve on opioid prescribing patterns.
- Published
- 2021
7. Ambulatory Status following Major Lower Extremity Amputation
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Katherine Maccallum, Karan Garg, Evan C. Lipsitz, John Phair, Larry Scher, and Patricia Yau
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Lower extremity amputation ,030204 cardiovascular system & hematology ,Risk Assessment ,Amputation, Surgical ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,In patient ,Mobility Limitation ,Assistive device ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Ambulatory Status ,Recovery of Function ,General Medicine ,Middle Aged ,Dependent Ambulation ,Functional Status ,Treatment Outcome ,Lower Extremity ,Amputation ,Ambulatory ,Physical therapy ,Female ,Surgery ,Functional status ,Cardiology and Cardiovascular Medicine ,business ,Major amputation - Abstract
The ability to ambulate following major lower extremity amputation, either below (BKA) or above knee (AKA), is a major concern for all prospective patients. This study analyzed ambulatory rates and risk factors for nonambulation in patients undergoing a major lower extremity amputation.A retrospective review of 811 patients who underwent BKA or AKA at our institution between January 2009 and December 2014 was conducted. Demographic information and co-morbid conditions, including the patients' functional status prior to surgery, at 6 months, and at latest follow up were recorded. Following exclusion criteria, 538 patients were included. Patients who were either independent or used an assistive device were considered ambulatory, while those who were completely wheelchair-dependent or bed-bound were considered nonambulatory.Pre-operatively, 83.1% of BKA patients were ambulatory, significantly more so than those undergoing AKA (44.9%, P 0.0001). At 6-month follow-up these percentages dropped to 58.0% and 25.2%, respectively, for all patients. For patients who were ambulatory pre-operatively, 182/246 (73.9%) of BKA and 32/51 (62.7%) of AKA remained so post-amputation. Of those patients with both 6-month and greater than 1-year follow-up, there was no change in ambulatory status between the 2 time periods. On multivariable logistic regression, age greater than 70 years and female sex were associated with nonambulation post-operatively (P = 0.001, P = 0.015, respectively). None of the co-morbid conditions recorded (diabetes, renal insufficiency, end-stage renal disease, peripheral vascular disease, or body mass index 35) was found to have a statistically significant correlation with post-operative ambulation using multivariable analysis.The majority of ambulatory patients undergoing a major amputation were able to remain ambulatory. Patients who failed to ambulate 6 months after their amputation, failed to resume ambulating. Age greater than 70 and female sex were found to have a statistically significant association with becoming nonambulatory following surgery.
- Published
- 2021
8. Underutilization of Nonopioid Pain Medication in Patients Undergoing Abdominal Aortic Aneurysm Repair
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John Phair, Larry Scher, Saadat Shariff, Dov Levine, Karan Garg, Matthew Carnevale, and Evan C. Lipsitz
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Male ,medicine.medical_specialty ,Time Factors ,Percutaneous ,Analgesic ,030204 cardiovascular system & hematology ,Health Services Misuse ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,medicine ,Humans ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pain, Postoperative ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,General Medicine ,Perioperative ,Length of Stay ,medicine.disease ,Drug Utilization ,Abdominal aortic aneurysm ,Surgery ,Analgesics, Opioid ,Treatment Outcome ,Opioid ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Abdominal surgery ,medicine.drug - Abstract
With increased focus on the opioid crisis, it was our goal to describe rates and risk factors for postoperative use of opioids in patients undergoing abdominal aortic aneurysm (AAA) repair as well as identify pain modalities that are underutilized.We retrospectively analyzed perioperative analgesic prescriptions for endovascular (EVAR) and open AAA repair between January 1, 2010 and January 1, 2018. Patients' baseline opioid use, demographics, and medical comorbidities were obtained. The EVAR group was further subdivided into percutaneous (pEVAR) and cutdown (cEVAR) groups. Primary outcomes were postoperative and discharge pain medication prescriptions. Relative rates of opioid prescribing were obtained through the electronic medical record and normalized into morphine milligram equivalents (MMEs).Of the 128 patients analyzed in the entire cohort, 21.8% (n = 28) underwent open repair and 78.12% (n = 100) underwent EVAR (46 pEVAR, 54 cEVAR). As expected, open repair had increased postoperative pain reported compared to EVAR (2.67 ± 0.75 vs. 0.96 ± 0.19, P 0.01). Adjunctive epidural reduced postoperative pain for open repair (0.77 ± 0.48 vs. 3.50 ± 0.96, P 0.01). EVAR had less postoperative opioid prescriptions compared to open repair (35.0% vs. 77.3%, P 0.01). In the endovascular group, there was no difference between postoperative opioid prescription based on access, pEVAR versus cEVAR (65.8% vs. 80.1%, P = 0.11). When stratifying patients by number of cutdowns, patients with bilateral cutdown as opposed to a single cutdown received more opioid prescriptions than pEVAR patients (84.44% vs. 65.8%, P = 0.036). Of those receiving opioids, the average MME for open repair was 320.94 mg compared to 28.82 mg for EVAR (P 0.01). Those undergoing percutaneous repair had significantly less MME use during hospitalization compared to femoral cutdown (17 ± 3.52 vs. 31.90 ± 5.43 mg, P 0.01). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and ketorolac, were rarely used in the postoperative period for open or EVAR (8.3% vs 1.1%). Percutaneous EVAR patients reported less pain at discharge compared to cEVAR patients (0.18 ± 0.12 vs. 0.88 ± 0.29, P = 0.036). Open and EVAR had comparable low rates of NSAID and acetaminophen prescriptions at discharge. Open patients had longer postoperative length of stay compared to EVAR patients (9.82 ± 1.27 vs. 3.86 ± 0.47, P 0.01). pEVAR had a shorter length of postoperative course compared to cEVAR (3.2 ± 0.26 vs. 4.12 ± 0.30, P 0.01). Patients undergoing EVAR with use of pain medications amounting to20 MME had a significantly shorter length of stay.This single institutional retrospective study evaluated pain prescription patterns for patients undergoing AAA repair. AAA patients are predominantly treated with opioid pain medications with few adjunctive therapies. Intraoperative epidural and pEVAR may aid in decreasing the total MME used; however, the total number of opioids prescribed is similar for pEVAR and cEVAR despite the difference in approach. Clinicians must consider alternative nonopioid based pain management strategies.
- Published
- 2020
9. Someone will care for us
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Evan C. Lipsitz
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Medical education ,Portrait ,Cost–benefit analysis ,business.industry ,MEDLINE ,Medicine ,Surgery ,Health knowledge ,Workload ,Clinical competence ,Cardiology and Cardiovascular Medicine ,business ,Curriculum - Published
- 2020
10. Amputation-free Survival in Patients with Critical Limb Ischemia Treated with Paclitaxel-eluting Stents and Paclitaxel-coated Balloons
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Matthew Carnevale, Saadat Shariff, John Phair, Larry Scher, Karan Garg, and Evan C. Lipsitz
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Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,Paclitaxel ,Critical Illness ,medicine.medical_treatment ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Prosthesis Design ,Amputation, Surgical ,030218 nuclear medicine & medical imaging ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Coated Materials, Biocompatible ,Ischemia ,Risk Factors ,Angioplasty ,medicine ,Clinical endpoint ,Humans ,Vascular Patency ,Progression-free survival ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Patient Selection ,Cardiovascular Agents ,Drug-Eluting Stents ,Retrospective cohort study ,General Medicine ,Critical limb ischemia ,Middle Aged ,Limb Salvage ,Progression-Free Survival ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Vascular Access Devices - Abstract
The aim of this study was to evaluate the performance of paclitaxel-eluting stents (PESs) and paclitaxel-coated balloons (PCBs) on amputation-free survival in patients with critical limb ischemia (CLI).A retrospective review of all patients with Rutherford stage 5 and 6 limb ischemia undergoing endovascular revascularization with paclitaxel-related technology, both PES and PCB, was carried out over a 4-year period. Clinical grading was determined by Rutherford classification and the Society for Vascular Surgery's Wound, Ischemia, and foot Infection (WIfI) scoring system. Clinical and angiographic follow-up was reviewed based on intention-to-treat analysis. The primary endpoint of this study was amputation-free survival at 12 months. Secondary endpoints included wound healing, freedom from target lesion revascularization, and patency of target vessels at 12 months. Follow-up occurred at 3, 6, and 12 months postoperatively. Target lesion patency was defined as50% stenosis, based on a duplex velocity ratio of less than or equal to 2. Postoperative ankle-brachial index (ABI) and duplex ultrasound were performed to verify successful treatment. Outcomes were evaluated using Kaplan-Meier and Cox proportional-hazards models.A total of 88 limbs were revascularized in 88 patients. Drug-eluting stent (DES) was used as the sole drug technology in 56 patients (60.7% men, median age 70.5 years) and drug-coated balloon (DCB) was used as the sole drug technology in 32 patients (46.9% men, median age 66 years). Baseline demographics were well matched except for a higher prevalence of occluded target lesions in the DES group (41.1% vs. 12.5%; P = 0.004). Limbs were treated for Rutherford stage 5 CLI in 71.6% and stage 6 CLI in 28.4%. Univariate analysis identified no dependent factors affecting limb salvage, except for the use of DCBs. After 12 months of follow-up, amputation-free survival was significantly higher in the DES group than in the DCB group (88.5% vs. 71.1%; P = 0.0443). Wound healing rates after 1 year were also higher in the DES group (83.9% vs. 59.4%; P = 0.0198). Freedom from target lesion revascularization was no different between patients treated with DESs and patients treated with DCBs (90.6% vs. 85.7%; P = 0.518). Primary patency at 12 months in patients treated with DESs was significantly higher than in patients treated with PCBs (80.4% vs. 58.1%; P = 0.0255).Overall, drug technology represents a viable option for patients with CLI; a cohort not represented in major randomized trials. In our experience, femoropopliteal lesions treated with DESs have higher primary patency rates than those treated with DCBs. This was found to support higher amputation-free survival rates in patients treated with paclitaxel DESs than those treated with paclitaxel DCB. The use of paclitaxel DESs for CLI was also associated with significantly improved wound healing compared with DCBs. Our data suggest improved outcomes with DESs compared with DCBs; however, these patients represent a nonrandomized, heterogenous group that were treated with the operator's best judgment.
- Published
- 2020
11. Acute Versus Subacute Endovascular Repair for Uncomplicated Type B Aortic Dissections
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Matthew Muller, Patricia Yau, Antoine Pham, Evan C. Lipsitz, and Jeffrey Indes
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
12. Cardiac valve replacement for infective endocarditis in patients with end stage renal disease on hemodialysis — A single institution experience
- Author
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William Jakobleff, Evan C. Lipsitz, Matthew Carnevale, Larry Scher, Ratna C. Medicherla, and John Phair
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Adult ,Male ,Cardiac valve replacement ,Catheterization, Central Venous ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Heart Valve Diseases ,End stage renal disease ,Blood Vessel Prosthesis Implantation ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Single institution ,education ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,education.field_of_study ,business.industry ,Endocarditis, Bacterial ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Infective endocarditis ,Bacteremia ,Kidney Failure, Chronic ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Complications from vascular access are the leading cause of morbidity in the hemodialysis population. The use of tunneled catheters is associated with a greater risk of bacteremia and mortality when compared to other types of hemodialysis access. Infective endocarditis is a serious complication occurring in 2–5% of patients undergoing hemodialysis and is likely secondary to transient bacteremia from repetitive vascular access. Objective To review outcomes in hemodialysis-dependent patients requiring cardiac valve replacement for infective endocarditis. Methods A retrospective chart review was conducted to identify all patients who underwent valve replacement within a six-year period (January 2009–December 2014). Inclusion criteria included a diagnosis of infective endocarditis and end stage renal disease on hemodialysis. Relevant clinical information including demographics, comorbidities, valve involvement, causative organisms, and type of hemodialysis access (arteriovenous fistula, arteriovenous graft, or tunneled catheter) was collected. Results A total of 1497 patients underwent cardiac valve replacement within the six-year period. Of these, 167 patients (11.2%) had infective endocarditis and 119 patients (7.9%) had end stage renal disease on hemodialysis. Overall 30-day mortality for valve replacement was 5.0% (75/1497). Mortality for patients with infective endocarditis was 7.2% (12/167) and for patients with end stage renal disease on hemodialysis was 10.1% (12/119). Thirty-three patients (2.2%) had infective endocarditis and end stage renal disease on hemodialysis. Of these, 12 patients were being dialyzed via arteriovenous fistula, 4 via arteriovenous graft, and 17 via tunneled catheter. Mortality occurred in 2 of 12 patients with arteriovenous fistula, 1 of 4 patients with arteriovenous graft, and 2 of 17 patients with tunneled catheter for an overall mortality of 15.2% (5/33). Conclusion Infective endocarditis remains a significant problem in patients with end stage renal disease on hemodialysis, particularly when tunneled catheters are utilized for hemodialysis access. Although appropriate algorithms have been developed to minimize long term use of tunneled catheters, bacteremia remains a significant problem. We reviewed our institutional experience and the medical literature to determine outcomes in hemodialysis-dependent patients with infective endocarditis requiring valve replacement. Despite mortality rates between 42 and 73% reported in the literature, our mortality rate was 15.2%. 1 Care of these critically ill patients must emphasize early diagnosis and aggressive management to optimize outcomes.
- Published
- 2019
13. Aortic Dissection
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Evan C. Lipsitz and Ratna C. Singh
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Aortic dissection ,medicine.medical_specialty ,business.industry ,medicine ,Endovascular treatment ,medicine.disease ,business ,Surgery - Published
- 2018
14. Perioperative outcomes of carotid endarterectomy and transfemoral and transcervical carotid artery stenting in radiation-induced carotid lesions
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Michael K. Parides, Evan C. Lipsitz, Issam Koleilat, Matthew Carnevale, Paola Batarseh, and Jeffrey E. Indes
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Carotid endarterectomy ,Revascularization ,Risk Assessment ,Postoperative Complications ,Risk Factors ,Internal medicine ,Catheterization, Peripheral ,medicine ,Humans ,Carotid Stenosis ,Myocardial infarction ,Registries ,education ,Radiation Injuries ,Stroke ,Aged ,Retrospective Studies ,education.field_of_study ,Endarterectomy, Carotid ,business.industry ,Endovascular Procedures ,Perioperative ,Vascular surgery ,Middle Aged ,medicine.disease ,Femoral Artery ,Stenosis ,Treatment Outcome ,Cardiology ,Surgery ,Female ,Stents ,business ,Cardiology and Cardiovascular Medicine - Abstract
Limited data are available to guide the choice of intervention for patients with radiation-induced carotid stenosis (RICS), either transcarotid artery revascularization (TCAR), transfemoral carotid artery stenting (TFCAS), or carotid endarterectomy (CEA). The purpose of the present study was to evaluate patients who had undergone these carotid artery interventions for RICS and the associated outcomes.Patients in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) carotid artery stenting surveillance project registry and the SVS VQI CEA modules who had undergone carotid artery intervention (TCAR, TFCAS, or CEA) for RICS were included. Those aged90 years and those with concomitant interventions (eg, coronary bypass) were excluded. A composite of death, myocardial infarction (MI), and stroke was the primary outcome. The secondary outcomes included death, MI, stroke, cranial nerve injury (CNI), and other local and systemic complications. Multivariable logistic regression controlling for presenting symptomatic status and comorbid medical conditions was conducted for the outcome variables, except for death, which was analyzed using Cox regression modeling.A total of 1927 patients with RICS had undergone CEA (n = 1172), TCAR (n = 253), or TFCAS (n = 502). The CEA group had a higher rate of diabetes (31% vs 25% for TCAR and 25% for TFCAS; P = .01), hypertension (85% vs 82% for TCAR and 79% for TFCAS; P .01), and peripheral vascular disease (8% vs 4% for TCAR and 4% for TFCAS; P .01). The TCAR and TFCAS groups had higher rates of coronary artery disease (21% for CEA vs 30% for TCAR and 29% for TFCAS; P .01). The patients who had undergone TFCAS were more likely to have had symptomatic lesions (57% for TFCAS vs 47% for CEA and 41% for TCAR; P .01) and prior stroke (55% for TFCAS vs 47% for CEA and 40% for TCAR; P .001). The composite outcome occurred in 3.2% of TCAR patients, 11.2% of TFCAS patients, and 11.1% of CEA patients (P .01) with an odds ratio of 0.27 for TCAR, 0.91 for TFCAS, and 1.00 for CEA. However, no differences in the individual outcomes were noted for any procedure. TCAR exhibited the lowest odds ratio for CNI (0.15) compared with TFCAS at 0.9, both relative to CEA (P = .03).RICS patients treated by TCAR in the SVS VQI had the lowest risk of the composite of stroke, death, and MI and CNI. Therefore, TCAR might be the preferred treatment modality. Further comparative studies are needed to evaluate the long-term outcomes in this population and to elucidate the relationship of these procedures to the individual outcomes of stroke, MI, and death.
- Published
- 2021
15. Early Outcomes of Acute Limb Ischemia in Coronavirus Disease 2019: A Multicenter, Retrospective Cohort Study
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Jeffrey Indes, John Denesopolis, Emily Goodman, Antoine Pham, Prannoy Kaushal, and Evan C. Lipsitz
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Internal medicine ,Medicine ,Surgery ,Retrospective cohort study ,Cardiology and Cardiovascular Medicine ,business ,Limb ischemia ,Article - Published
- 2021
16. Impact of tibial bypass conduit on long-term amputation-free survival and primary patency in the Vascular Quality Initiative
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Patricia Friedmann, Varun Dalmia, Issam Koleilat, Jeffrey E. Indes, Matthew Carnevale, John Futchko, and Evan C. Lipsitz
- Subjects
medicine.medical_specialty ,Infrainguinal bypass ,Blood Vessel Prosthesis Implantation ,Small saphenous vein ,Electrical conduit ,Ischemia ,medicine ,Humans ,Popliteal Artery ,Saphenous Vein ,Vein ,Polytetrafluoroethylene ,Vascular Patency ,Retrospective Studies ,business.industry ,Great saphenous vein ,Vascular surgery ,Blood Vessel Prosthesis ,Amputation free survival ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Concomitant ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Much research remains focused on tibial bypass conduit selection. We sought to describe long-term amputation-free survival (AFS) and primary patency (PP) of patients undergoing tibial bypass by conduit type and configuration across several permutations in the Society for Vascular Surgery Vascular Quality Initiative.Patients in the Vascular Quality Initiative registry undergoing elective first-time femoral- or popliteal-to-tibial bypass for occlusive disease involving rest pain or tissue loss were identified. Prior ipsilateral infrainguinal bypass or concomitant procedures were excluded. Outcomes of interest included patient AFS at 22 months and PP at 1 year (defined as freedom from revision, thrombectomy, or graft occlusion).A total of 4192 bypasses were identified. The majority utilized great saphenous vein (GSV) (76.2%), followed by polytetrafluoroethylene (10.6%), nonautologous biologic (6.5%), composite (3.3%), arm vein (2.8%), and small saphenous vein (0.6%). Compared with all prosthetic and composite bypasses, vein grafts had the best AFS (76.4%; P .0001) and PP (68.1%; P = .041). Of the single segment vein conduits, GSV bypasses had the best PP (69.1%) and arm vein the worst (60.2%). AFS and PP were similar between single-segment GSV orientations. Single-segment GSV bypasses exhibited better PP than multiple segment bypasses (69.1% vs 54.6%; P = .0016). PP was significantly better for polytetrafluoroethylene compared with nonautologous biologic (68.4% vs 51.2%; P = .0039). PP did not significantly differ between vein cuff for prosthetic bypass compared with no vein cuff (69.1% vs 59.7%; P = .091). PP was not significantly different between single-segment GSV and prosthetic grafts with vein cuff (69.1% vs 69.1%; P = .51). There were no significant differences in AFS comparing arm vein, prosthetic bypass with vein cuff, or composite grafts (67.2% vs 63.8% vs 59.3%; P = .092), as well as in PP (60.2% vs 69.1% vs 54.8%; P = .14).Single-segment vein bypass was only marginally the most optimal conduit. Surprisingly, there may be more equipoise among conduit types, particularly in the absence of adequate GSV. Prosthetic grafts overall may not be as disadvantaged in the long term as initially thought, especially when compared with arm vein, as prosthetic bypass with vein cuff did not significantly differ in PP. Similarly, a composite conduit may not impact long-term outcomes. These data suggest that conduit choice may not impact outcomes to the degree previously thought and that other factors may have a greater impact than presumed, especially in conduit limited situations.
- Published
- 2022
17. Commentary: Aortic graft infections—A potpourri of pathology without a panacea
- Author
-
Evan C. Lipsitz
- Subjects
Pulmonary and Respiratory Medicine ,Aortic graft ,medicine.medical_specialty ,biology ,business.industry ,General surgery ,MEDLINE ,biology.organism_classification ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Potpourri ,Panacea (butterfly) - Published
- 2021
18. Reply
- Author
-
Matthew L. Carnevale, Issam Koleilat, Evan C. Lipsitz, Patricia Friedmann, and Jeffrey E. Indes
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2020
19. Early experience with arterial thromboembolic complications in patents with COVID-19
- Author
-
Henny H. Billett, John M. Denesopolis, Davis Brent Jones, Hasan Aldailami, Evan C. Lipsitz, Krystina Choinski, Issam Koleilat, Jeffrey E. Indes, and Ayesha Nzeribe Hatch
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,Magnetic resonance angiography ,Article ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Internal medicine ,Thromboembolism ,medicine ,Humans ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,SARS-CoV-2 ,Mortality rate ,Case-control study ,Anticoagulants ,COVID-19 ,Thrombosis ,Odds ratio ,medicine.disease ,Confidence interval ,Cardiology ,Surgery ,Hyperinflammatory ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Little is known about the arterial complications and hypercoagulability associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We sought to characterize our experience with arterial thromboembolic complications in patients with hospitalized for coronavirus disease 2019 (COVID-19). Methods All patients admitted from March 1 to April 20, 2020, and who underwent carotid, upper, lower and aortoiliac arterial duplex, computed tomography angiogram or magnetic resonance angiography for suspected arterial thrombosis were included. A retrospective case control study design was used to identify, characterize and evaluate potential risk factors for arterial thromboembolic disease in SARS-CoV-2 positive patients. Demographics, characteristics, and laboratory values were abstracted and analyzed. Results During the study period, 424 patients underwent 499 arterial duplex, computed tomography angiogram, or magnetic resonance angiography imaging studies with an overall 9.4% positive rate for arterial thromboembolism. Of the 40 patients with arterial thromboembolism, 25 (62.5%) were SARS-CoV-2 negative or admitted for unrelated reasons and 15 (37.5%) were SARS-CoV-2 positive. The odds ratio for arterial thrombosis in COVID-19 was 3.37 (95% confidence interval, 1.68-6.78; P = .001). Although not statistically significant, in patients with arterial thromboembolism, patients who were SARS-CoV-2 positive compared with those testing negative or not tested tended to be male (66.7% vs 40.0%; P = .191), have a less frequent history of former or active smoking (42.9% vs 68.0%; P = .233) and have a higher white blood cell count (14.5 vs 9.9; P = .208). Although the SARS-CoV-2 positive patients trended toward a higher the neutrophil-to-lymphocyte ratio (8.9 vs 4.1; P = .134), creatinine phosphokinase level (359.0 vs 144.5; P = .667), C-reactive protein level (24.2 vs 13.8; P = .627), lactate dehydrogenase level (576.5 vs 338.0; P = .313), and ferritin level (974.0 vs 412.0; P = .47), these differences did not reach statistical significance. Patients with arterial thromboembolic complications and SARS-CoV-2 positive when compared with SARS-CoV-2 negative or admitted for unrelated reasons were younger (64 vs 70 years; P = .027), had a significantly higher body mass index (32.6 vs 25.5; P = .012), a higher d -dimer at the time of imaging (17.3 vs 1.8; P = .038), a higher average in hospital d -dimer (8.5 vs 2.0; P = .038), a greater distribution of patients with clot in the aortoiliac location (5 vs 1; P = .040), less prior use of any antiplatelet medication (21.4% vs 62.5%; P = .035), and a higher mortality rate (40.0% vs 8.0%; P = .041). Treatment of arterial thromboembolic disease in COVID-19 positive patients included open thromboembolectomy in six patients (40%), anticoagulation alone in four (26.7%), and five (33.3%) did not require or their overall illness severity precluded additional treatment. Conclusions Patients with SARS-CoV-2 are at risk for acute arterial thromboembolic complications despite a lack of conventional risk factors. A hyperinflammatory state may be responsible for this phenomenon with a preponderance for aortoiliac involvement. These findings provide an early characterization of arterial thromboembolic disease in SARS-CoV-2 patients.
- Published
- 2020
20. The current state of vascular surgery presence and educational content in Google and YouTube internet search results
- Author
-
Matthew Carnevale, Anvit Rai, Omar Sanon, Varun Dalmia, Issam Koleilat, Evan C. Lipsitz, Christine Leinbach, and John P. Phair
- Subjects
medicine.medical_specialty ,Referral ,Specialty ,Inferior vena cava filter ,030204 cardiovascular system & hematology ,computer.software_genre ,Access to Information ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,medicine ,Humans ,030212 general & internal medicine ,medicine.diagnostic_test ,Consumer Health Information ,business.industry ,Online presence management ,Information Dissemination ,General surgery ,Interventional radiology ,Vascular surgery ,Rib resection ,Search Engine ,Cross-Sectional Studies ,Surgery ,The Internet ,Cardiology and Cardiovascular Medicine ,business ,computer ,Social Media ,Vascular Surgical Procedures - Abstract
Background Information on the internet regarding vascular disease has not been extensively assessed. Our goal was to compile and appraise the information available via Google and YouTube searches regarding various topics of interest for vascular surgeons (VS) and related procedures with a focus on the role of the VS. Methods The Google and YouTube platforms were independently queried for 25 keywords/phrases relating to common vascular diagnoses and procedures by two separate researchers from March to July 2019. Paid advertisements or a Society for Vascular Surgery (SVS) webpage or affiliated video in the first 25 results was documented. Results were reviewed for information regarding the responsible medical specialty and the target audience, and disease-related information (screening, risk factors, risk reduction, diagnostic testing, operative treatment, alternative treatment, follow-up, complications, and recovery). Results From the Google search, 357 unique domains of 1241 total webpages were identified with 75% directed toward the public. An SVS page was present in 56% of the first-page results and least likely to be present in searches for claudication, gangrene, carotid stent, rib resection, and thrombolysis. VS were mentioned as referral physicians in 56% of the 68% of websites that mentioned a specialty, endovascular specialists/interventional radiology in 20%, and cardiothoracic surgeons in 19%. Only 4% of the websites contained information from all categories, with the greatest number for aortic dissection. Advertisements were present in 18% of all searches (most commonly for “varicose vein,” “varicose vein surgery,” and “inferior vena cava filter”). From YouTube, 1247 search results (613 unique videos) were evaluated with 64% directed toward the public. An SVS affiliated video was present in 36% of searches. In the 47% of videos where a specialty was mentioned, 56% mentioned VS, interventional radiology in 10%, and cardiothoracic surgeons in 7%. Only 0.24% of the videos contained information from all categories. The greatest number of content categories was in videos related to peripheral arterial disease. Across both platforms, dialysis access searches yielded results with the least number of content categories. Conclusions Patient-related information regarding vascular surgical topics is readily available on the internet, but the content is highly variable and not comprehensive. Only half of the searches mention VS as the referral physician of choice or authority for these medical conditions. Further efforts should focus on developing the online presence of vascular surgery, improving the quality of education of vascular disease on the internet, and directing patients to the vascular specialists to treat these conditions.
- Published
- 2020
21. Trends in Sex and Racial/Ethnic Diversity in Applicants to Surgery Residency and Fellowship Programs
- Author
-
Qi Gao, John Phair, Jeffrey E. Indes, Krystina Choinski, Issam Koleilat, John M. Denesopolis, and Evan C. Lipsitz
- Subjects
Male ,medicine.medical_specialty ,media_common.quotation_subject ,MEDLINE ,030230 surgery ,Specialties, Surgical ,03 medical and health sciences ,0302 clinical medicine ,Cultural diversity ,Research Letter ,Medicine ,Humans ,Fellowships and Scholarships ,Sex Distribution ,media_common ,Service (business) ,business.industry ,Racial Groups ,Internship and Residency ,Racial ethnic ,United States ,030220 oncology & carcinogenesis ,Family medicine ,Job Application ,Surgery ,Female ,business ,Diversity (politics) - Abstract
This study uses the Electronic Residency Application Service database and Association of American Medical Colleges records to investigate trends in sex and racial/ethnic diversity of the applicant pool to US surgical residency and fellowship programs.
- Published
- 2020
22. Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019
- Author
-
Ayesha Nzeribe Hatch, Davis Brent Jones, Henny H. Billett, Evan C. Lipsitz, Krystina Choinski, Benjamin T. Galen, Jeff Indes, and Issam Koleilat
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Reference range ,030204 cardiovascular system & hematology ,Article ,Duplex scanning ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,COVID-19 Testing ,Interquartile range ,Risk Factors ,Internal medicine ,D-dimer ,medicine ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,thrombosis ,Aged ,Retrospective Studies ,COVID ,Aged, 80 and over ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,business.industry ,SARS-CoV-2 ,COVID-19 ,Odds ratio ,Middle Aged ,medicine.disease ,Thrombosis ,Venous thrombosis ,Lower Extremity ,Case-Control Studies ,Surgery ,Female ,business ,Cardiology and Cardiovascular Medicine ,DVT - Abstract
Objective Little is known about coronavirus disease (COVID-19)-associated hypercoagulability. We sought to characterize patients with deep venous thrombosis (DVT) identified after admission for COVID-19. Methods All adult patients admitted to Montefiore Medical Center (MMC) from March 1, 2020 to April 10, 2020 and undergoing lower extremity venous duplex for DVT evaluation were included. Patients admitted with suspicion of COVID-19 were divided into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and SARS-CoV-2 negative groups based on in-hospital test results. Patients without clinical suspicion for COVID-19 were not tested. A retrospective case-control study design was used to identify potential risk factors for DVT in patients with COVID-19. Demographic, radiographic and laboratory values were abstracted and analyzed. Results During the study period, 3,404 patients with confirmed COVID-19 were admitted to the hospital. Of the 135 SARS-CoV-2 patients who underwent duplex scanning, there were 18 (13.3%) noted to have DVT compared to 72 of the 711 patients (10.1%) who were either SARS-CoV-2 negative or untested. The odds ratio for DVT in COVID-19 was 1.35 (95% CI 0.78 – 2.34, p=0.289). Baseline characteristics for COVID-19 patients with and without DVT were overall similar. COVID-19 patients with DVT had an elevated median first D-dimer (18.88 mcg/mL [IQR 7.79, 20.00] versus 2.55 mcg/mL [IQR 1.45, 6.28], p=0.002, reference range, Article Highlights • Type of Research: Single center retrospective case-control study. • Key Findings: Elevated D-dimer and a less elevated fibrinogen were associated with DVT in 18 of 135 patients with COVID-19 who underwent duplex scanning , who appear to form thrombus despite conventional chemical thromboprophylaxis. An increasing D-dimer over time may be a reflection of the development of DVT in patients with COVID-19. • Take-home Message: The D-dimer level and trend over time may be important in triggering DVT evaluation and therapy in patients with COVID-19.
- Published
- 2020
23. Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging
- Author
-
David Esses, Jeffrey M. Levsky, Alana Fruauff, Evan C. Lipsitz, Vishal K. Patel, and Linda B. Haramati
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Population ,Contrast Media ,Dissection (medical) ,Radiation Dosage ,Aortography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Thioguanine ,Pelvis ,CT protocol ,Aged ,Retrospective Studies ,Aortic dissection ,Acute aortic syndrome ,education.field_of_study ,business.industry ,Cytarabine ,Middle Aged ,Radiation Exposure ,medicine.disease ,Decision Support Systems, Clinical ,Radiation exposure ,Aortic Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Abdomen ,Female ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored ‘aortic dissection screening protocol’ that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the ‘aortic dissection screening’ protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the ‘aortic dissection screening’ protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored ‘aortic dissection screening’ protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection.
- Published
- 2020
24. Extended screening guidelines for the diagnosis of abdominal aortic aneurysm
- Author
-
Patricia Friedmann, Issam Koleilat, Jeffrey E. Indes, Matthew Carnevale, and Evan C. Lipsitz
- Subjects
Male ,medicine.medical_specialty ,Canada ,medicine.medical_treatment ,Clinical Decision-Making ,macromolecular substances ,Endovascular aneurysm repair ,Risk Assessment ,Decision Support Techniques ,Blood Vessel Prosthesis Implantation ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Prevalence ,Humans ,Mass Screening ,cardiovascular diseases ,Registries ,Aged ,Retrospective Studies ,Ultrasonography ,Smokers ,Heavy smoking ,business.industry ,Endovascular Procedures ,Smoking ,Age Factors ,Perioperative ,Non-Smokers ,Vascular surgery ,Middle Aged ,medicine.disease ,Comorbidity ,Abdominal aortic aneurysm ,United States ,Cohort ,Practice Guidelines as Topic ,cardiovascular system ,Surgery ,Female ,Guideline Adherence ,business ,Complication ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal - Abstract
Background The U.S. Preventive Services Task Force (USPSTF) guidelines are the most widely used criteria for screening for abdominal aortic aneurysms (AAA). However, when the USPSTF criteria are applied retrospectively to a group of patients who have undergone treatment for AAA, there are many patients who satisfy none of the AAA screening criteria. The more sensitive Society for Vascular Surgery (SVS) guidelines have expanded the criteria for screening for AAA with the hope of capturing a greater fraction of those individuals who can undergo treatment for their AAA before presenting with AAA rupture. We sought to identify the number of patients who would have been identified as having criteria for screening for AAA by both the USPSTF and SVS criteria, in a cohort of patients who have undergone treatment for AAA. Methods We assessed demographic, comorbidity, and perioperative complication data for all patients undergoing endovascular and open AAA repair in the Vascular Quality Initiative. Patients meeting each of the screening criteria were identified. Clinical factors and demographic variables were collected. Results We identified 55,197 patients undergoing AAA repair in the Vascular Quality Initiative, including 44,602 patients who underwent endovascular aneurysm repair (EVAR) and 10,595 patients undergoing open repair. Of these, the USPTF guidelines would have identified fewer than one-third of patients (32% EVAR and 33% open repair). Applying the SVS guidelines increased the number meeting criteria for screening by 6% and 12% for the EVAR and open repair cohorts, respectively. Finally, adoption of the expanded SVS guidelines (including the “weak recommendations”) would have identified an additional 34% of EVAR patients and 21% of open AAA repair patients. Use of the expanded criteria would have resulted in 27% of patients undergoing EVAR and 33% of patients undergoing open AAA repair who would not have met any screening criteria. In EVAR patients not meeting the criteria, 52% were younger than 65 years had a history of heavy smoking. Of all those who did not meet screening criteria, ruptured AAA was twice as prevalent as those who met screening criteria (8.5% vs 4.4%; P ≤ .0001). Conclusions Expanding established USPSTF screening guidelines to include the expanded SVS criteria may potentially double the number of patients identified with AAA. Smokers under the age of 65, and elderly patients 70 and older with no smoking history, represent two groups with AAA and potentially twice the risk of presenting with rupture.
- Published
- 2019
25. Why Do Vascular Surgeons Get Sued? Analysis of Claims and Outcomes in Malpractice Litigation
- Author
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Eric B. Trestman, Evan C. Lipsitz, John P. Phair, Issam Koleilat, Edvard Skripochnik, and Larry Scher
- Subjects
medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Psychological intervention ,MEDLINE ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Expert witness ,Malpractice ,medicine ,Humans ,Surgeons ,Plaintiff ,Medical Errors ,business.industry ,General surgery ,General Medicine ,Vascular surgery ,Insurance, Liability ,030220 oncology & carcinogenesis ,Compensation and Redress ,Surgery ,Patient Safety ,Professional Misconduct ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Allegation - Abstract
Background The objective of the study was to analyze causes and outcomes of malpractice claims against vascular surgeons in the United States. Methods Cases entered into the Westlaw database from January 1, 1999 to December 31, 2014 were reviewed. Search terms “vascular” and “surgeon” were used. Data were compiled on the allegation, subject matter, and outcome of each case. Additional data including demographics of the defendant were obtained from the U.S. News Health reports on practicing physicians. Results Of a total of 785 cases identified from the Westlaw database using the search terms “vascular” and “surgeon”, 485 (61.8%) were identified where a vascular surgeon was the defendant or expert witness. Of these, 135 (27.8%) had a vascular surgeon identified as a defendant. Among these 135 cases, 88 (65.2%) were found for the defendant with 31 (23%) and 15 (11.1%) being found for the plaintiff or settled, respectively. Of the 31 cases found for the plaintiff, the median award was $750,000 and mean award was $1,830,000. Mean time from incident to verdict was 4.8 years. The most common procedures which led to litigation were open or endovascular peripheral revascularization (PR) (14.8%), carotid interventions (CIs) (11.85%), aortic interventions (AI) (11.1%), vascular trauma (9.63%), dialysis access (8.15%), and venous surgery (5.93%). The most common allegation was “failure to diagnose and treat” (48.9%), followed by complication of open surgery (31.85%) and negligent procedure (25.19%). The most common injuries reported were death (31.85%), major amputation (23.7%), neurovascular injury (14.8%), and bleeding (5.9%). Conclusions Analysis of vascular surgery malpractice litigation in the Westlaw database revealed details regarding the subject matter and outcomes of these cases. Through this closed claims analysis, the most common procedures leading to litigation were found to be PR, CI, and AI and not thoracic outlet syndrome procedures as commonly believed. Furthermore, the most common allegations were a “failure to diagnose and treat” and “open surgical complication”. Analysis of the salient features and outcomes in these cases can provide a framework for heightened awareness of issues which lead to malpractice claims and can ultimately improve patient care and safety.
- Published
- 2018
26. Inferior Vena Cava Filter Malpractice Litigation: Damned if You Do, Damned if You Don't
- Author
-
John P. Phair, John Denesopolis, Larry Scher, and Evan C. Lipsitz
- Subjects
medicine.medical_specialty ,Delayed Diagnosis ,Vena Cava Filters ,Inferior vena cava filter ,030204 cardiovascular system & hematology ,Inferior vena cava ,Time-to-Treatment ,Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Informed consent ,Malpractice ,medicine ,Humans ,030212 general & internal medicine ,Plaintiff ,Medical Errors ,business.industry ,General surgery ,General Medicine ,Insurance, Liability ,medicine.disease ,Discontinuation ,Pulmonary embolism ,medicine.vein ,Compensation and Redress ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Allegation - Abstract
Background The aim of this study was to analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving inferior vena cava filters (IVCF) to prevent future litigation and improve physician education. Methods Jury verdict reviews from the Westlaw database from January 1, 2000, to December 31, 2015, were reviewed. The search term “inferior vena cava filter” was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. Results A total of 156 cases were identified. Duplicates and cases in which the IVCF was incidentally included were excluded from the analysis. Forty-nine cases involving either failure to place or a complication of IVCF placement were identified. Throughout the last 15 years, there has been increased number of jury verdicts toward IVCF. The most frequent defendants were internal medicine physicians (38%), vascular surgeons (19%), and cardiothoracic surgeons (12%). The most frequent claims were denied treatment or delay in treatment (in 35% of cases), negligent surgery (in 24% of cases), and failure to diagnose and treat complications (in 24% of cases). Of these, the most frequent specific claims were failure to place IVC filter (41%), implantation failure such as misplacement and/or misaligned implant (24%), erosion of IVC/retroperitoneal bleed (6%), and discontinuation of anticoagulation prematurely (6%). Seventeen cases (35%) were found for the plaintiff, with median awards worth of $1,092,500. In the 21 cases where pulmonary embolism (PE) was involved (43% of cases), 19 were fatal (90%). Of the fatal PE cases, 8 cases ended with verdicts in favor of the plaintiff (42%). Both nonfatal PE cases were won by the defense. Conclusions IVCF placement with subsequent PE and death results in verdicts that favor the plaintiffs. This study emphasizes that adequate and transparent communication regarding preoperative planning, decision for IVCF placement, and informed consent may reduce the frequency of litigation. Public awareness of complications related to the placement of IVCF is increasing largely and spurned by aggressive advertising and marketing by plaintiff attorneys. Conditions for which IVCF placement is contemplated carry significant risk of malpractice litigation.
- Published
- 2018
27. Risk factors for unplanned readmission and stump complications after major lower extremity amputation
- Author
-
Larry Scher, Charles DeCarlo, Evan C. Lipsitz, Saadat Shariff, Issam Koleilat, John P. Phair, and Karan Garg
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Exacerbation ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,Patient Readmission ,Amputation, Surgical ,Coronary artery disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,medicine ,Humans ,Surgical Wound Infection ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Amputation Stumps ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Logistic Models ,Treatment Outcome ,Lower Extremity ,Amputation ,Multivariate Analysis ,Female ,New York City ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Chi-squared distribution - Abstract
Objective The unplanned 30-day readmission rate is a marker of quality of patient care across many disciplines. Data regarding risk factors for unplanned readmission after major lower extremity amputation (LEA) are limited. We evaluated predictors of readmission at our institution after major LEA. Methods We conducted a retrospective review of all patients undergoing above-knee amputation (AKA) or below-knee amputation (BKA) between November 2009 and November 2014. Patient demographic variables were collected. Predictors of unplanned 30-day readmission and stump complications were determined by multivariable logistic regression. Results A total of 811 patients were identified (AKA, 325; BKA, 486). Of these, 739 patients were included in the final analysis after excluding 30-day decedents without readmission. The overall 30-day readmission rate was 28.8% (AKA 27.9%; BKA 29.4%; P = .730). Stump complications accounted for 28.6% of readmissions (16.5% of AKA; 35.8% of BKA; P = .004). Other common diagnoses included nonsurgical site infection (33.8%), exacerbation of congestive heart failure (7.0%), and diabetes-related complications (6.1%). Surgical intervention was performed on 61% of stump complications (35.9% of AKA readmitted with stump complications; 68.7% of BKA readmitted with stump complications). BKA stump complications were converted to AKAs in 34.1% of cases (3.2% of the total BKA). None of the AKA stump complications required a higher level of amputation (ie, hip disarticulation). Independent predictors of all 30-day readmission included coronary artery disease and end-stage renal disease. American Society of Anesthesiologists class 3 as compared with class 4 was protective. Independent predictors of 30-day readmission for stump complications included rest pain and BKA. Patients who underwent BKA, rest pain as an indication for amputation, and having an occluded bypass graft were predictors of having a stump complication requiring surgery. Conclusions The 30-day readmission rate after major LEA is high, with wound infections accounting for a significant proportion of these readmissions. There was no difference in readmission rates based on level of amputation. Those undergoing BKA were more likely to present with stump complications requiring a surgical intervention, and often a higher level of amputation. Identification of high-risk patients may play a role in reducing postoperative readmissions and stump complications.
- Published
- 2018
28. Management of Distal Deep Vein Thrombosis with Warfarin Versus Direct Oral Anticoagulant Agents
- Author
-
Ryan Cotto, Emily Goodman, Antoine Pham, Adele Heib, John Denesopolis, and Evan C. Lipsitz
- Subjects
medicine.medical_specialty ,business.industry ,Deep vein ,Warfarin ,medicine.disease ,Thrombosis ,Surgery ,medicine.anatomical_structure ,Oral anticoagulant ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
29. Fifty years of hemodialysis access literature: The fifty most cited publications in the medical literature
- Author
-
Larry A. Scher, David O'Connor, Eric B Trestman, Edvard Skripochnik, and Evan C. Lipsitz
- Subjects
Catheterization, Central Venous ,medicine.medical_specialty ,Pediatrics ,Biomedical Research ,Time Factors ,medicine.medical_treatment ,Fistula ,Alternative medicine ,Hemodialysis Catheter ,Arteriovenous fistula ,030204 cardiovascular system & hematology ,Bibliometrics ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Arteriovenous Shunt, Surgical ,0302 clinical medicine ,Renal Dialysis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,business.industry ,General surgery ,Science Citation Index ,General Medicine ,medicine.disease ,Surgery ,Hemodialysis ,Periodicals as Topic ,Cardiology and Cardiovascular Medicine ,business ,Medical literature - Abstract
Objectives The modern era of hemodialysis access surgery began with the publication in 1966 by Brescia et al. describing the use of a surgically created arteriovenous fistula. Since then, the number of patients on chronic hemodialysis and the number of publications dealing with hemodialysis access have steadily increased. We have chronicled the increase in publications in the medical literature dealing with hemodialysis access by evaluating the characteristics of the 50 most cited articles. Methods We queried the Science Citation Index from the years 1960–2014. Articles were selected based on a subject search and were ranked according to the number of times they were cited in the medical literature. Results The 50 most frequently cited articles were selected for further analysis and the number of annual publications was tracked. The landmark publication by Dr Brescia et al. was unequivocally the most cited article dealing with hemodialysis access (1109 citations). The subject matter of the papers included AV fistula and graft (9), hemodialysis catheter (9), complications and outcomes (24), and other topics (8). Most articles were published in nephrology journals (33), with fewer in surgery (7), medicine (7), and radiology (3) journals. Of the 17 journals represented, Kidney International was the clear leader, publishing 18 articles. There has been an exponential rise in the frequency of publications regarding dialysis access with 42 of 50 analyzed papers being authored after 1990. Conclusion As the number of patients on hemodialysis has increased dramatically over the past five decades, there has been a commensurate increase in the overall number of publications related to hemodialysis access
- Published
- 2017
30. Statin use and other factors associated with mortality after major lower extremity amputation
- Author
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Charles DeCarlo, Karan Garg, Saadat Shariff, Evan C. Lipsitz, Larry Scher, and John P. Phair
- Subjects
Male ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Aged, 80 and over ,Gangrene ,education.field_of_study ,Middle Aged ,Treatment Outcome ,Lower Extremity ,Practice Guidelines as Topic ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Population ,Risk Assessment ,Amputation, Surgical ,Peripheral Arterial Disease ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,education ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Proportional hazards model ,business.industry ,Retrospective cohort study ,Odds ratio ,Protective Factors ,medicine.disease ,Professional Practice Gaps ,Surgery ,Logistic Models ,Amputation ,Multivariate Analysis ,New York City ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business - Abstract
Above-knee amputations (AKAs) and below-knee amputations (BKAs) are associated with high postoperative mortality rates. In this study, we examined factors associated with 30-day, 90-day, and 1-year mortality in patients who underwent a major lower extremity amputation.We queried a prospectively collected institutional database for all patients who underwent AKA or BKA with primary or secondary closure, during a 5-year period, between November 2009 and November 2014. Predictors of 30- and 90-day mortality were determined by multivariable logistic regression, and risk indexes for 1-year mortality were determined with Cox proportional hazards model.We identified 811 patients who underwent AKA (n = 325) or BKA (n = 486). The 30-day mortality was 8.4% (AKA, 13.5%; BKA, 4.9%; P .001) and 90-day mortality was 15.4% (AKA, 24.3%; BKA, 9.45%; P .001). Predictors of 30-day mortality included AKA (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.76-5.53), emergency operation (OR, 2.86; 95% CI, 1.56-5.14), chronic obstructive pulmonary disease (OR, 3.09; 95% CI, 1.07-7.81), end-stage renal disease (ESRD) on hemodialysis (HD; OR, 2.35; 95% CI, 1.24-4.33), and chronic kidney disease stages 3 (OR, 1.84; 95% CI, 1.00-3.37) and 4 (OR, 2.33; 95% CI, 1.01-4.98). Predictors of 90-day mortality included age (OR, 1.02; 95% CI, 1.00-1.04), ESRD on HD (OR, 2.56; 95% CI, 1.55-4.22), AKA (OR, 2.61; 95% CI, 1.70-4.05), history of coronary artery bypass grafting (OR, 2.04; 95% CI, 1.06-3.87), and medium-intensity or high-intensity statin (OR, 0.46; 95% CI, 0.29-0.73). One-year survival for the overall cohort was 73.7% (95% CI, 70.8%-76.8%). Predictors of 1-year mortality included AKA (hazard ratio [HR], 2.07; 95% CI, 1.54-2.77), coronary artery bypass grafting (HR, 1.57; 95% CI, 1.07-2.32), age70 years (HR, 1.39; 95% CI, 1.02-1.88), gangrene (HR, 1.44; 95% CI, 1.07-1.94), ESRD on HD (HR, 1.96; 95% CI, 1.42-2.70), chronic obstructive pulmonary disease (HR, 2.54; 95% CI, 1.52-4.25), Caucasian race (HR, 1.62; 95% CI, 1.18-2.22), history of open lower extremity revascularization (HR, 0.71; 95% CI, 0.51-1.00) and undergoing bilateral amputations (HR, 2.10; 95% CI, 1.06-4.15). In the year after amputation, medium-intensity statin (HR, 0.64; 95% CI, 0.47-0.87) and high-intensity statin (HR, 0.56; 95% CI, 0.33-0.95) conferred a mortality benefit. Low-intensity statins did not confer protection from mortality. At 1 year after amputation, only 44.7% of patients were receiving appropriate statin therapy.AKA and BKA have historically been associated with high mortality rates. Medium-intensity and high-intensity statin therapies were associated with a mortality benefit at 1 year. We have identified initiation of statin therapy in this high-risk population as a gap in patient care.
- Published
- 2017
31. Fenestrated Endovascular Repair of Abdominal Aortic Aneurysms with a Large Diameter Graft Does Not Impact Postoperative Outcomes
- Author
-
Evan C. Lipsitz, Issam Koleilat, Matthew Carnevale, Anvit Rai, Juan Lin, Analena Alcabes, and Jeffrey Indes
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,business ,Large diameter - Published
- 2020
32. Sex Representation in Vascular Surgery Conference Presentations
- Author
-
Utsav Soni, Evan C. Lipsitz, Issam Koleilat, Sonia Bellara, Krystina Choinski, Smita Mascharak, and John P. Phair
- Subjects
Cognitive science ,medicine.medical_specialty ,business.industry ,Representation (systemics) ,Medicine ,Surgery ,Vascular surgery ,business - Published
- 2020
33. Primary Patency of Long-Segment Femoropopliteal Artery Lesions in Patients with Peripheral Arterial Occlusive Disease Treated with Paclitaxel-Eluting Technology
- Author
-
Karan Garg, Evan C. Lipsitz, Larry Scher, Saadat Shariff, Matthew Carnevale, and John Phair
- Subjects
Target lesion ,Male ,Duplex ultrasonography ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Paclitaxel ,medicine.medical_treatment ,Critical Illness ,030204 cardiovascular system & hematology ,Prosthesis Design ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Restenosis ,Coated Materials, Biocompatible ,Interquartile range ,Ischemia ,Recurrence ,Angioplasty ,medicine ,Vascular Patency ,Humans ,Popliteal Artery ,Aged ,Retrospective Studies ,business.industry ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Femoral Artery ,Treatment Outcome ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
Background The aim of this study is to evaluate the performance and predictors of failure of paclitaxel drug-eluting stents and paclitaxel-coated balloons in the treatment of long-segment femoropopliteal disease. We report a retrospective cohort analysis of patients treated with paclitaxel-eluting stents and paclitaxel-coated balloons in lesions >100 mm, which were not included in any of the pivotal trials. Methods Ninety-seven patients with peripheral vascular disease (Rutherford III–VI) underwent long-segment (≥100 mm) femoropopliteal drug-eluting stent (DES) implantation or angioplasty with drug-coated balloons (DCB). Patients were followed after their initial procedure for target lesion restenosis, defined as a reduction in lumen diameter by greater than 50% as measured by duplex ultrasonography (ratio >2). Results The median length of the affected arterial segments was 110 mm (interquartile range [IQR] 100–150, absolute range 100–260) using up to 4 overlapping stents. During the median 13-month follow-up (IQR 7–16), no early thrombotic occlusions occurred within 30 days, but 28 (29%) patients developed a target lesion restenosis after 1 year. Cumulative primary patency at 6 and 12 months was 87% and 71% overall, respectively. The cumulative patency during the same follow-up periods varied between patients treated with different paclitaxel modalities with 88% and 80% primary patency in patients treated with DES (n = 63) versus 81% and 49% in patients treated with DCB (n = 21) (adjusted hazard ratio 2.46, P = 0.03). Lesion length, concurrent tibial intervention, and recurrent target lesions were not associated with restenosis. Conclusions Short-term outcomes in patients treated with paclitaxel-eluting stents and paclitaxel-coated balloons in long lesions, mirror results from the clinical trials. The primary patency observed in patients treated with DES was significantly higher than in patients treated with DCB.
- Published
- 2019
34. Field testing and refining the hemodialysis access creation episode-based cost measure
- Author
-
Karen Woo, Paula K. Shireman, and Evan C. Lipsitz
- Subjects
business.industry ,Measure (physics) ,Health Care Costs ,Industrial engineering ,Field (computer science) ,United States ,Blood Vessel Prosthesis Implantation ,Physician Incentive Plans ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Medicine ,Humans ,Surgery ,Medicare Access and CHIP Reauthorization Act of 2015 ,Cardiology and Cardiovascular Medicine ,business ,Policy Making ,Reimbursement, Incentive ,Hemodialysis access ,Refining (metallurgy) - Published
- 2019
35. Hemodialysis access creation episode-based cost measure
- Author
-
Karen Woo, Evan C. Lipsitz, and Paula K. Shireman
- Subjects
business.industry ,Episode of Care ,Measure (physics) ,Health Care Costs ,medicine.disease ,United States ,Blood Vessel Prosthesis Implantation ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,medicine ,Humans ,Surgery ,Medical emergency ,Medicare Access and CHIP Reauthorization Act of 2015 ,Cardiology and Cardiovascular Medicine ,business ,Hemodialysis access - Published
- 2019
36. Aortic Neck Dilatation Following Endovascular Repair Of Thoracic Aortic Aneurysm
- Author
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Hasan Aldailami, Patricia Friedmann, Evan C. Lipsitz, Jeffrey Indes, and Patricia Yau
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine ,Aortic neck ,medicine.disease ,business ,Thoracic aortic aneurysm - Published
- 2021
37. Impact Of Tibial Bypass Conduit On Long-term Patency And Survival In The Vascular Quality Initiative
- Author
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Patricia Friedmann, Jeffrey Indes, Matthew Carnevale, Varun Dalmia, Issam Koleilat, John Futchko, and Evan C. Lipsitz
- Subjects
medicine.medical_specialty ,Electrical conduit ,business.industry ,media_common.quotation_subject ,medicine ,Surgery ,Quality (business) ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Term (time) ,media_common - Published
- 2021
38. Physician-Modified Endografts vs Chimney/Snorkel for Ruptured and Symptomatic Paravisceral Aneurysm in the Vascular Quality Initiative
- Author
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Issam Koleilat, Evan C. Lipsitz, Patricia Friedmann, Brandon Nussenblatt, and Jeffrey Indes
- Subjects
medicine.medical_specialty ,Aneurysm ,business.industry ,Medicine ,Surgery ,Chimney ,business ,medicine.disease - Published
- 2020
39. Incidence of Procedure-Related Complication in Patients Treated with Atherectomy in Femoropopliteal and Tibial Vessels
- Author
-
Qi Gao, Jeffrey Indes, Matthew Carnevale, Issam Koleilat, Evan C. Lipsitz, Analena Alcabes, and Omar Sanon
- Subjects
Atherectomy ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,medicine ,Surgery ,In patient ,Complication ,business - Published
- 2020
40. Nephropathy Risk and Contrast Volume in Intact Versus Ruptured Endovascular Aneurysm Repair in the Vascular Quality Initiative
- Author
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Matthew Carnevale, Pavel Goriacko, Evan C. Lipsitz, Harshal Shukla, Issam Koleilat, Samantha N. LaFontaine, and Jeffrey Indes
- Subjects
medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.medical_treatment ,medicine.disease ,Endovascular aneurysm repair ,Nephropathy ,medicine ,Contrast (vision) ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,media_common ,Volume (compression) - Published
- 2020
41. Outcomes of Femoral Endarterectomy and Femoropopliteal Intervention Versus Endarterectomy and Femoropopliteal Bypass
- Author
-
Issam Koleilat, Evan C. Lipsitz, Matthew Carnevale, Sharon Leung, Christine Leinbach, and Jeffrey Indes
- Subjects
medicine.medical_specialty ,business.industry ,Intervention (counseling) ,medicine.medical_treatment ,Medicine ,Surgery ,Femoropopliteal bypass ,Femoral endarterectomy ,Cardiology and Cardiovascular Medicine ,business ,Endarterectomy - Published
- 2020
42. Interest in Vascular Surgery as a Specialty in a Climate of Competitive Fields
- Author
-
John P. Phair, Issam Koleilat, Vinoth Birabaharan, John Denesopolis, Jeffrey Indes, and Evan C. Lipsitz
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Specialty ,Medicine ,Surgery ,Vascular surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
43. Outcomes for Antecubital Arteriovenous Fistulas in Patients With High Brachial Artery Bifurcation
- Author
-
Evan C. Lipsitz, John Futchko, Caroline T. Dong, Larry Scher, Patricia Yau, and John Denesopolis
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.artery ,Cardiology ,Medicine ,Surgery ,In patient ,Brachial artery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
44. Field testing for the critical limb ischemia cost measure
- Author
-
Karen Woo, Paula K. Shireman, Evan C. Lipsitz, and Jill Rathbun
- Subjects
medicine.medical_specialty ,Field (physics) ,business.industry ,Critical Illness ,Measure (physics) ,Ischemia ,Critical limb ischemia ,030204 cardiovascular system & hematology ,medicine.disease ,Medicare ,United States ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Critical illness ,medicine ,Costs and Cost Analysis ,Humans ,Surgery ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Published
- 2018
45. Factors Associated with Ipsilateral Limb Ischemia in Patients Undergoing Femoral Cannulation Extracorporeal Membrane Oxygenation
- Author
-
Saadat Shariff, Karan Garg, William Jakobleff, Larry Scher, S. Forest, Evan C. Lipsitz, Patricia Yau, and Y. Xia
- Subjects
Adult ,Male ,medicine.medical_treatment ,Ischemia ,Femoral artery ,Comorbidity ,Punctures ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Fasciotomy ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Risk Factors ,medicine.artery ,Catheterization, Peripheral ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Hospital Mortality ,Stroke ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,Femoral Artery ,Treatment Outcome ,Amputation ,Lower Extremity ,Regional Blood Flow ,Anesthesia ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Background Extracorporeal membrane oxygenation (ECMO) is an important life-saving modality for patients with cardiopulmonary failure. Vascular complications, including clinically significant limb ischemia, may occur as a result of femoral artery cannulation for venoarterial (VA) ECMO. This study examines our institutional experience with femoral VA ECMO and the development of ipsilateral limb ischemia. Methods We performed a retrospective review of all consecutive patients undergoing femoral VA ECMO between 2011 and 2016. The primary endpoint was clinical evidence of limb-threatening ischemia. Multivariate logistic regression analysis was used to identify predictors for limb ischemia after cannulation. Results Between March 2011 and September 2016, 154 patients underwent femoral cannulation for VA ECMO. Overall in-hospital mortality was 59.7%. Clinically significant ipsilateral limb ischemia occurred in 34 (22%) patients; 7 required four-compartment fasciotomy, and 3 of these patients required amputation. On univariate analysis, a history of pulmonary disease, peripheral arterial disease, and stroke or transient ischemic attack was significantly associated with clinical limb ischemia. On multivariate analysis, younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93–0.99), diabetes (OR, 2.77; 95% CI, 1.08–7.12), pulmonary disease (OR, 3.86; 95% CI, 1.38–10.78), and peripheral arterial disease (OR, 13.68; CI, 2.75–68.01) were associated with limb ischemia. Lack of prophylactic distal perfusion catheter and arterial cannula size were not independently associated with limb ischemia. Conclusions Femoral ECMO cannulation can be associated with significant limb ischemia necessitating surgical intervention. Younger patients, as well as those with a history of diabetes, pulmonary disease, and peripheral arterial disease, may be at increased risk for this complication.
- Published
- 2018
46. Carotid Artery Webs as an Atypical Cause of Ischemic Stroke; Risk Factors, Diagnosis, and Management
- Author
-
Issam Koleilat, John P. Phair, Evan C. Lipsitz, and Matthew Carnevale
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Carotid arteries ,Ischemic stroke ,Cardiology ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
47. Ambulatory Patients Undergoing Above-Knee Amputation have Significantly Higher Post-Operative Mortality Compared to Non-Ambulatory Patients
- Author
-
Patricia Yau, Katherine Maccallum, Saadat Shariff, Larry A. Scher, Charles DeCarlo, Karan Garg, Evan C. Lipsitz, and Patricia Friedmann
- Subjects
medicine.medical_specialty ,business.industry ,Ambulatory ,medicine ,Surgery ,Post operative mortality ,General Medicine ,Above knee amputation ,Non ambulatory ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
48. Endarterectomy for a symptomatic carotid web
- Author
-
Eric B. Trestman, Evan C. Lipsitz, John P. Phair, and Chetra Yean
- Subjects
Adult ,Carotid Artery Diseases ,medicine.medical_specialty ,Carotid Artery, Common ,Computed Tomography Angiography ,medicine.medical_treatment ,Biopsy ,Fibromuscular dysplasia ,Carotid endarterectomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Embolus ,Right Common Carotid Artery ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Embolization ,Ultrasonography, Doppler, Color ,Stroke ,Computed tomography angiography ,Endarterectomy ,Endarterectomy, Carotid ,medicine.diagnostic_test ,business.industry ,Hemodynamics ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Regional Blood Flow ,Cardiology ,Surgery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Background We report a symptomatic carotid web successfully treated with carotid endarterectomy. A healthy 43-year-old woman presented with acute-onset left-sided weakness. Carotid web was evident on computed tomography angiography as a focal filling defect in the right common carotid artery. This right common carotid artery web extended into the ICA created an eddy resulting in turbulent flow. Subsequent acute embolus formation led to embolization and acute stroke. Method Review of the literature was performed using Medline Plus and PubMed databases. Result The patient underwent carotid endarterectomy with primary closure. Procedure was well tolerated and there was an uneventful recovery. Conclusion Arterial webs are a rare arteriopathy and a usual arrangement of fibromuscular intralumenal in-growth with unclear etiology. It is however, an important potential etiology of stroke in patients without traditional atherosclerotic risk factors. Carotid web and atypical carotid fibromuscular dysplasia should be considered in young, otherwise healthy patients presenting with stroke and without the typical risk factors for atherosclerotic carotid disease and stroke.
- Published
- 2017
49. Repair of Isolated Innominate Artery Pathology with a Modified Endovascular Graft
- Author
-
Saadat Shariff, Brent Safran, Larry Scher, Karan Garg, and Evan C. Lipsitz
- Subjects
Surgical repair ,Pathology ,medicine.medical_specialty ,business.industry ,Fistula ,medicine.medical_treatment ,Technical success ,Stent ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,Vessel diameter ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Right Common Carotid Artery ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Anatomic Location ,business ,Artery - Abstract
Innominate artery pathology is traditionally treated with open surgical repair and is associated with significant morbidity. No dedicated endovascular solution exists for this anatomic location. We report a series of 3 cases of successful management of innominate artery injuries using an off-label, modified Zenith ESLE stent graft (Cook Medical, Bloomington, IN). Two patients presented with pseudoaneurysms after attempted central venous catheterization, and 1 patient developed a tracheo-innominate fistula. Access was obtained in a retrograde fashion via the right common carotid artery in 2 cases, and via the right axillary artery in the other. Additional anatomic considerations included a prior sternotomy in 2 cases and a bovine arch in 2 cases. Due to the emergent nature of the cases, no cerebral protection maneuvers were taken. The ESLE limbs are of uniform diameter with 3 Z-stent wireforms and measure 55 mm in length. Removal of the distal stent reduces the length to 38 mm. Fourteen- to 18-mm diameter grafts were used. All 3 cases resulted in technical success with complete exclusion of the defect. There were no new neurologic deficits and all patients recovered uneventfully. This approach represents an effective off-label solution for what frequently presents as an emergent problem. In 2 cases, it obviated the need for a complicated redo sternotomy and facilitated endovascular repair in a vessel for which there was no indicated off-the-shelf conduit. Modification of existing devices successfully addressed the need for a nontapered graft of short length and moderate vessel diameter and allowed for minimally invasive treatment of anatomically complex pathology.
- Published
- 2019
50. The Impact of Integrated Vascular Surgery Residency Programs on General Surgery Residents
- Author
-
Issam Koleilat, Yin Zhao, Jeffrey Indes, Larry A. Scher, Evan C. Lipsitz, John P. Phair, and Matthew Carnevale
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,Surgery ,Vascular surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
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