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For ascending aortic pseudoaneurysms with a large aortic entry site and thrombus burden, temporary stent-graft placement at induction of circulatory arrest can prevent thrombotic complication.
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Peripheral Arterial Disease of the Lower Limbs Arterial disease of the lower limbs is often encountered in general and specialist practice. This video presents the systematic assessment of arterial perfusion of the lower limbs to prevent... more
Peripheral Arterial Disease of the Lower Limbs Arterial disease of the lower limbs is often encountered in general and specialist practice. This video presents the systematic assessment of arterial perfusion of the lower limbs to prevent limb or tissue loss.
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Research Interests: Adolescent, Medicine, Linear models, Multivariate Analysis, Health Care reform, and 15 moreHumans, Young Adult, Massachusetts, Patient Protection and Affordable Care Act, Aged, Middle Aged, Adult, Retrospective Studies, Risk Adjustment, Peripheral Arterial Disease, Insurance Coverage, Severity of Illness Index, Health Services Accessibility, healthcare disparities, and Medical and Health Sciences
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Research Interests: Nephrology, Molecular Biology, Biology, Dialysis, Apoptosis, and 15 moreMedicine, Gene expression, Humans, Kidney, Cell Death, Physiological Response, Clinical Sciences, Apoptose, DNA content, Chronic Renal Failure, Epithelial cells, Endothelial cell, DNA binding proteins, Gene Transfer, and Nephritis
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Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Ischemia, and 15 moreFemale, Male, Incidence, Aged, Myocardial Infarction, New England, Retrospective Studies, Prognosis, Risk Factors, Confidence Interval, Revascularization, Postoperative Complications, Myocardial Ischemia, Medical and Health Sciences, and hazard ratio
Research Interests: Chronic kidney disease, Treatment Outcome, Medicine, Humans, Internal Medicine, and 15 moreUnited States, Female, Male, Propensity Score, Propensity Score Matching, Length of Stay, Medicare, Aged, Survival Rate, Retrospective Studies, Kidney Disease, Abdominal Aortic Aneurysm, Postoperative Complications, Perioperative, and Medical and Health Sciences
The benefit of fenestrated endovascular aortic aneurysm repair (FEVAR) compared with open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs) is unknown. This study compares 30-day outcomes of these procedures from two... more
The benefit of fenestrated endovascular aortic aneurysm repair (FEVAR) compared with open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs) is unknown. This study compares 30-day outcomes of these procedures from two high-volume centers where FEVAR was undertaken for high-risk patients. Patients undergoing FEVAR with commercially available devices and OSR of CAAAs (total suprarenal/supravisceral clamp position) were propensity matched by demographic, clinical, and anatomic criteria to identify similar patient cohorts. Perioperative outcomes were evaluated using univariate and multivariate methods. From July 2001 to August 2012, 59 FEVAR and 324 OSR patients were identified. After 1:4 propensity matching for age, gender, hypertension, congestive heart failure, coronary disease, chronic obstructive pulmonary disease, stroke, diabetes, preoperative creatinine, and anticipated/actual aortic clamp site, the study cohort consisted of 42 FEVARs and 147 OSRs. The most freq...
Research Interests: Risk assessment, Medicine, Stents, Humans, Female, and 15 moreMale, Propensity Score, Incidence, Risk factors, Propensity Score Matching, Aged, Odds ratio, Retrospective Studies, Risk Factors, Risk Assessment, Abdominal Aortic Aneurysm, Endovascular Procedures, Endovascular Aneurysm Repair, Postoperative Complications, and Medical and Health Sciences
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Research Interests: Treatment Outcome, Vascular Surgery, Medicine, Stents, Humans, and 15 moreFemale, Male, Follow-up studies, Risk factors, Aged, Time Factors, Retrospective Studies, Risk Factors, Proportional Hazards Models, Endovascular Procedures, Endoleak, Reoperation, Aorta Abdominal, Medical and Health Sciences, and Computed tomography angiography
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Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information... more
Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information exchange between generalists and specialists in order to provide value while preserving quality. Our objective was to evaluate patient and referring provider satisfaction and outcomes of asynchronous electronic consultations in vascular care in a large tertiary academic medical center. Referring providers were offered a vascular 'e-consult' option through an electronic referral management system. We conducted chart review to understand the downstream effects and surveyed patients and referring providers to assess satisfaction. From 24 March 2014 to 1 March 2015, 54 e-consults were completed. Additional testing and recommendations were made in 49/54 (90.7%) e-consults, including lower-extremity venous duplex ultrasonography with reflux testing, d...
Research Interests: Program Evaluation, Humans, Chronic Disease, Feasibility Studies, Patient Satisfaction, and 14 moreDiagnostic Imaging, Clinical Sciences, Accountable Care Organizations, Prognosis, Remote Consultation, Medical Records, Pilot Projects, Exercise Test, Vascular Medicine, Predictive value of tests, Surveys and Questionnaires, Vascular Diseases, Delivery of Health Care, and Referral and consultation
To date, murine models of treadmill exercise have been used to study general exercise physiology and angiogenesis in ischemic hindlimbs. The purpose of these experiments was to develop a murine model of demand ischemia in an ischemic limb... more
To date, murine models of treadmill exercise have been used to study general exercise physiology and angiogenesis in ischemic hindlimbs. The purpose of these experiments was to develop a murine model of demand ischemia in an ischemic limb to mimic claudication in humans. The primary goal was to determine whether treadmill exercise reflected a hemodynamic picture which might be consistent with the hyperemic response observed in humans. Aged hypercholesterolemic ApoE null mice (ApoE(-/-), n = 13) were subjected to femoral artery ligation (FAL) and allowed to recover from the acute ischemic response. Peripheral perfusion of the hindlimbs at rest was determined by serial evaluation using laser Doppler imaging (LDI) on days 0, 7, and 14 following FAL. During the experiments, mice were also assessed on an established five-point clinical ischemic score, which assessed the degree of digital amputation, necrosis, and cyanosis compared to the nonischemic contralateral limb. After stabilizatio...
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This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at... more
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Research Interests: Treatment Outcome, Multivariate Analysis, Stroke, Humans, Female, and 15 moreMale, Risk factors, Recurrence, Boston, Aged, Middle Aged, Time Factors, Odds ratio, Retrospective Studies, Risk Factors, Proportional Hazards Models, Logistic Models, Carotid Stenosis, Disease Free Survival, and Medical and Health Sciences
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Background Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a... more
Background Iatrogenic Type A aortic dissection (IAD) is a rare but devastating complication of cardiac and aortic surgery with reported operative mortality of 30 to 50%. In this study, we report our experience with IAD and propose a standardized approach to management. Methods From January 1, 2000 through December 31, 2016, 23,275 patients underwent cardiac surgery at our institution. We identified 15 patients who developed IAD. Our approach to management included (1) immediate repair, (2) involvement of a second attending surgeon, (3) aggressive monitoring of malperfusion, (4) securing true lumen arterial perfusion access and systemic cooling, and (5) performance of hemiarch or total arch replacement based on the presence of suspected brain malperfusion. The index operation was also completed at the same time. Patient preoperative characteristics, operative sequence and technique, complications, and outcomes were analyzed with chart review. Results The incidence of IAD at our insti...