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Article: Early Thoracic Endovascular Aortic Repair of Uncomplicated Type B Thoracic Aortic Dissection: An Aorta Team Approach.

Ammar, Khawaja A / McDiarmid, Matthew / Richards, Lauren / Mewissen, Mark W / Jan, M Fuad / Weiss, Eric S / Bajwa, Tanvir

Aorta (Stamford, Conn.)

2023 Volume 11, Issue 2, Page(s) 50–56

Abstract: Background: Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest ... ...

Abstract	Background: Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest superiority of thoracic endovascular aortic repair (TEVAR) over OMT due to recent advancements in endovascular technologies. We report a large, single-center, case control study of TEVAR versus OMT in this population, undertaken solely in a cardiac catheterization laboratory (CCL) with a cardiologist and surgeon. We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT. Methods: This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group). Results: In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; Conclusion: TEVAR performed solely in the CCL is safe and effective, with lower all-cause mortality than OMT. These data, in collaboration with previous data on TEVAR in different settings, call for consideration of an update of practice guidelines.
Language	English
Publishing date	2023-05-31
Publishing country	Germany
Document type	Journal Article
ISSN	2325-4637
ISSN	2325-4637
DOI	10.1055/s-0043-1768201
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry.

Effoe, Valery S / Mewissen, Mark W / Bajwa, Tanvir K / Khitha, Jayant / Kostopoulos, Louie / Ammar, Khawaja A / Nfor, Tonga K

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2023 Volume 103, Issue 1, Page(s) 106–114

Abstract: Background: Atherectomy use in treatment of femoropopliteal disease has significantly increased despite scant evidence of benefit to long-term clinical outcomes.: Aims: We investigated the clinical benefits of atherectomy over standard treatment for ... ...

Abstract	Background: Atherectomy use in treatment of femoropopliteal disease has significantly increased despite scant evidence of benefit to long-term clinical outcomes. Aims: We investigated the clinical benefits of atherectomy over standard treatment for femoropopliteal interventions. Methods: Using data from the Society of Vascular Surgery's Vascular Quality Initiative (VQI) registry, we identified patients who underwent isolated femoropopliteal interventions for occlusive disease. We compared 13,423 patients treated with atherectomy with 47,371 receiving standard treatment; both groups were allowed definitive treatment with a drug-coated balloon or stenting. The primary endpoint was major adverse limb events (MALEs), which is a composite of target vessel re-occlusion, ipsilateral major amputation, and target vessel revascularization. Results: Mean age was 69 ± 11 years, and patients were followed for a median of 30 months. Overall rates of complications were slightly higher in the atherectomy group than the standard treatment group (6.2% vs. 5.9%, p < 0.0001). In multivariable analysis, after adjusting for demographic and clinical covariates, atherectomy use was associated with a 13% reduction in risk of MALEs (adjusted odds ratio [aOR]: 0.87; 95% confidence interval [CI]: 0.77-0.98). Rates of major and minor amputations were significantly lower in the atherectomy group (3.2% vs. 4.6% and 3.3% vs. 4.3%, respectively, both p < 0.001), primarily driven by a significantly decreased risk of major amputations (aOR 0.69; 95% CI: 0.52-0.91). There were no differences in 30-day mortality, primary patency, and target vessel revascularization between the atherectomy and standard treatment groups. Conclusions: In adults undergoing femoropopliteal interventions, the use of atherectomy was associated with a reduction in MALEs compared with standard treatment.
MeSH term(s)	Male ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Femoral Artery/diagnostic imaging ; Popliteal Artery/diagnostic imaging ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/therapy ; Angioplasty, Balloon/adverse effects ; Treatment Outcome ; Atherectomy/adverse effects ; Registries ; Vascular Patency ; Risk Factors
Language	English
Publishing date	2023-11-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.30912
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Article ; Online: Vascular Medicine

Mark W. Mewissen

Journal of Patient-Centered Research and Reviews, Vol 2, Iss 3, Pp 85-

A ‘Primary’ Specialty

2015 Volume 86

Abstract: Message from the Guest Editor introducing special issue on vascular disease. ...

Abstract	Message from the Guest Editor introducing special issue on vascular disease.
Keywords	vascular medicine ; vascular disease ; stenting ; aorta ; imaging ; Medicine ; R
Language	English
Publishing date	2015-08-01T00:00:00Z
Publisher	Advocate Aurora Health
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: National trends and variability of atherectomy use for peripheral vascular interventions from 2010 to 2019.

Nfor, Tonga / Dababneh, Ehab / Jan, M Fuad / Khitha, Jayant / Allaqaband, Suhail Q / Bajwa, Tanvir / Mewissen, Mark W

Journal of vascular surgery

2022 Volume 76, Issue 3, Page(s) 778–785

Abstract: Objective: Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy ... ...

Abstract	Objective: Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVIs across the United States and identified the main predictors of atherectomy use. Methods: Using the Vascular Quality Initiative registry, we identified all patients who had undergone endovascular PVIs for occlusive lower extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device had been used as the primary or secondary device were classified as the atherectomy group. We calculated the frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified the factors that were independently associated with atherectomy use. Results: A total of 205,377 PVIs had been performed for 152,693 unique patients. During the 10-year period, 16.6% of the PVI procedures had used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019 (P Conclusions: Atherectomy use in PVI significantly increased from 2010 to 2019. We found wide regional variability in the use of atherectomy that seemed to be driven more strongly by nonclinical factors.
MeSH term(s)	Atherectomy/adverse effects ; Databases, Factual ; Humans ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/surgery ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; United States
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.03.864
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Article ; Online: Effectiveness and Safety of Atherectomy versus Plain Balloon Angioplasty for Limb Salvage in Tibioperoneal Arterial Disease.

Sharma, Payal / Ortiz, Daniel / Jan, M Fuad / Khitha, Jayant / Allaqaband, Suhail Q / Bajwa, Tanvir / Mewissen, Mark W / Nfor, Tonga

Journal of vascular and interventional radiology : JVIR

2022 Volume 34, Issue 3, Page(s) 428–435

Abstract: Purpose: To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD).: Materials and methods: Patients enrolled in the ... ...

Abstract	Purpose: To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD). Materials and methods: Patients enrolled in the Vascular Quality Initiative registry who had CLI (Rutherford Class 4-6) and underwent atherectomy versus POBA alone for isolated TPAD were retrospectively identified. Of eligible patients, a cohort of 2,908 patients was propensity matched 1:1 by clinical and angiographic characteristics. The atherectomy group comprised 1,454 patients with 2,183 arteries treated, and the POBA group comprised 1,454 patients with 2,141 arteries treated. The primary study endpoint was major ipsilateral limb amputation. Secondary endpoints were minor ipsilateral amputations, any ipsilateral amputation, primary patency, target vessel reintervention (TVR), and wound healing at 12 months. Results: The median follow-up period was 507 days, the mean patient age was 69 years ± 11.7, and the mean occluded length was 6.9 cm ± 6.5. There was a trend toward higher technical success rates with atherectomy than with POBA (92.9% vs 91.0%, respectively; P = .06). The rates of major adverse events during the procedure were not significantly different. The 12-month major amputation rate was similar in the atherectomy and POBA groups (4.5% vs 4.6%, respectively; P = .92; odds ratio, 0.97; 95% CI, 0.68-1.37). There was no difference in 12-month TVR (17.9% vs 17.8%; P = .97) or primary patency (56.4% vs 54.5%; P = .64) between the atherectomy and POBA groups. Conclusions: In a large national registry, treatment of CLI from TPAD using atherectomy versus POBA showed no significant differences in procedural adverse events, major amputations, TVR, or vessel patency at 12 months.
MeSH term(s)	Humans ; Aged ; Retrospective Studies ; Limb Salvage ; Ischemia ; Risk Factors ; Peripheral Arterial Disease/therapy ; Treatment Outcome ; Angioplasty, Balloon/adverse effects ; Atherectomy/adverse effects ; Vascular Patency
Language	English
Publishing date	2022-11-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2022.11.021
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Zs.A 3720: Show issues

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Article ; Online: Thrombolysis for lower-extremity deep vein thrombosis.

Mewissen, Mark W

Seminars in vascular surgery

2010 Volume 23, Issue 4, Page(s) 228–234

Abstract: Elimination of the embolic potential of existing thrombus, restoration of unobstructed flow, prevention of further thrombosis, and preservation of venous valve function are the ideal goals of therapy for acute deep vein thrombosis (DVT). Meeting these ... ...

Abstract	Elimination of the embolic potential of existing thrombus, restoration of unobstructed flow, prevention of further thrombosis, and preservation of venous valve function are the ideal goals of therapy for acute deep vein thrombosis (DVT). Meeting these goals will not only prevent pulmonary embolus, but will also minimize long-term sequelae of venous hypertension and development of postthrombotic syndrome (PTS). Treatment strategies aimed at eliminating or reducing risk of PTS should focus on preserving valvular function and eliminating risk of continued venous obstruction after acute DVT. Thrombolytic agents are an attractive form of early therapy because they have the ability to eliminate obstructive thrombus in the deep veins, and should therefore help provide protection against PTS. Perceived benefits of early and rapid recanalization in preserving valve function have been the basis for lytic therapy to treat acute DVT. Data from the National Venous Registry and subsequent reports on the role of catheter-directed thrombolysis for treatment of acute lower-extremity DVT indicate that the technique is safe and effective in select patients. More recently, implementation of percutaneous mechanical devices designed to quickly remove acute thrombus has had a significant impact on time and cost of catheter-directed thrombolysis procedure. Although the long-term benefits of this form of therapy are not yet completely known, the Venous Registry can serve as a guide to the judicious selection of patients who will most benefit from this aggressive form of therapy.
MeSH term(s)	Adult ; Female ; Fibrinolytic Agents/therapeutic use ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Thrombolytic Therapy/methods ; Venous Thrombosis/therapy
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2010-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	645131-7
ISSN	1558-4518 ; 0895-7967
ISSN (online)	1558-4518
ISSN	0895-7967
DOI	10.1053/j.semvascsurg.2010.10.002
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Zs.A 2503: Show issues

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Article: Primary nitinol stenting for femoropopliteal disease.

Mewissen, Mark W

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2009 Volume 16, Issue 2 Suppl 2, Page(s) II63–81

Abstract: The 1- to 2-year primary patency rates associated with self-expanding nitinol stents for the treatment of symptomatic femoropopliteal disease are superior to those for percutaneous transluminal angioplasty (PTA) and the first-generation stainless steel ... ...

Abstract	The 1- to 2-year primary patency rates associated with self-expanding nitinol stents for the treatment of symptomatic femoropopliteal disease are superior to those for percutaneous transluminal angioplasty (PTA) and the first-generation stainless steel balloon-expandable stents. The advantages of nitinol stents include improved radial strength and flexibility, the ability to recover from being crushed, reduced foreshortening, and (importantly) deployability without balloon dilation of the stent edge (which may decrease the incidence of the edge stenosis, or "candy-wrap" effect, often observed with balloon-expandable stents). The technical success rate associated with primary deployment of nitinol stents is very high, and acute to 6-month patency results are predictably excellent. Prior to the introduction of nitinol stents, the original guidelines (2000) of the multidisciplinary TransAtlantic Inter-Society Consensus (TASC I) recommended only an adjunctive role for femoropopliteal stents following suboptimal PTA. The abbreviated 2007 TASC II report essentially extended this recommendation to nitinol stents. Here, current trials of nitinol stenting in the femoropopliteal segment are discussed, with emphasis on the advantages of primary (and often direct) deployment in selected circumstances dependent on factors including lesion length, lesion location, indication for treatment (critical limb ischemia or claudication, in-stent restenosis, stent-graft restenosis), and the relative appropriateness of other modalities (e.g., covered stents). Technical considerations in primary nitinol stenting are briefly reviewed. Open questions regarding the factors involved in nitinol stent fracture and the possible association of fracture and restenosis are examined in the context of current clinical trials. A new generation of femoropopliteal nitinol stents combining superior durability and flexibility is expected soon. Development and implementation of uniform reporting and surveillance standards is important for optimizing current and future research.
MeSH term(s)	Alloys ; Angioplasty, Balloon/adverse effects ; Angioplasty, Balloon/instrumentation ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/physiopathology ; Arterial Occlusive Diseases/therapy ; Constriction, Pathologic ; Femoral Artery/diagnostic imaging ; Femoral Artery/physiopathology ; Humans ; Popliteal Artery/diagnostic imaging ; Popliteal Artery/physiopathology ; Practice Guidelines as Topic ; Prosthesis Design ; Prosthesis Failure ; Radiography ; Recurrence ; Risk Assessment ; Stents ; Time Factors ; Treatment Outcome ; Vascular Patency
Chemical Substances	Alloys ; nitinol (2EWL73IJ7F)
Language	English
Publishing date	2009-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1583/08-2658.1
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Article: Early Thoracic Endovascular Aortic Repair of Uncomplicated Type B Thoracic Aortic Dissection: An Aorta Team Approach

Ammar, Khawaja A. / McDiarmid, Matthew / Richards, Lauren / Mewissen, Mark W. / Jan, M. Fuad / Weiss, Eric S. / Bajwa, Tanvir

AORTA

2023 Volume 11, Issue 02, Page(s) 50–56

Abstract: ... p = 0.006). The risk of all-cause long-term mortality was markedly reduced in the TEVAR group (RR ...

Abstract	Background: Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest superiority of thoracic endovascular aortic repair (TEVAR) over OMT due to recent advancements in endovascular technologies. We report a large, single-center, case control study of TEVAR versus OMT in this population, undertaken solely in a cardiac catheterization laboratory (CCL) with a cardiologist and surgeon. We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT. Methods: This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group). Results: In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; p = 0.04 in early TEVAR cases), but a longer length of stay (12.9 vs. 8.5 days: p = 0.006). The risk of all-cause long-term mortality was markedly reduced in the TEVAR group (RR = 0.38; p = 0.01), irrespective of early (<14 days) versus late intervention. On follow-up computed tomography imaging, the false lumen stabilized or decreased in 85% of cases, irrespective of intervention timing. Conclusion: TEVAR performed solely in the CCL is safe and effective, with lower all-cause mortality than OMT. These data, in collaboration with previous data on TEVAR in different settings, call for consideration of an update of practice guidelines.
Keywords	aneurysm ; aortic dissection ; endovascular repair ; thoracic aorta
Language	English
Publishing date	2023-04-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2325-4637
ISSN (online)	2325-4637
DOI	10.1055/s-0043-1768201
Database	Thieme publisher's database

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Article ; Online: Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks.

Mewissen, Mark W / Jan, M Fuad / Kuten, David / Krajcer, Zvonimir

Journal of vascular and interventional radiology : JVIR

2017 Volume 28, Issue 11, Page(s) 1600–1603

Abstract: A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was ... ...

Abstract	A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was treated with Onyx (Medtronic, Minneapolis, Minnesota). TGE resulted in successful embolization, as demonstrated on 1-year follow-up CT angiography, which showed complete elimination of the type II endoleak and shrinkage of the aneurysmal sac. TGE is an alternative to transarterial embolization, translumbar embolization, and transcaval embolization.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2017.07.029
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Article: Stenting in the femoropopliteal arterial segment.

Mewissen, Mark W

Techniques in vascular and interventional radiology

2005 Volume 8, Issue 4, Page(s) 146–149

Abstract: In the femoropopliteal arterial segment, balloon angioplasty is a recommended treatment strategy for short lesions. Over the past few years, several reports have emerged on the potential role of self-expanding stents for treating longer, more complex ... ...

Abstract	In the femoropopliteal arterial segment, balloon angioplasty is a recommended treatment strategy for short lesions. Over the past few years, several reports have emerged on the potential role of self-expanding stents for treating longer, more complex disease segments where the patency following balloon angioplasty is notoriously dismal. This paper will attempt to review the emerging role of nitinol stents for treating patients with chronic lower limb ischemia, secondary to severe femoropopliteal arterial disease.
MeSH term(s)	Arterial Occlusive Diseases/therapy ; Femoral Artery ; Humans ; Leg/blood supply ; Peripheral Vascular Diseases/therapy ; Popliteal Artery ; Practice Guidelines as Topic ; Stents ; Vascular Patency
Language	English
Publishing date	2005-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2170922-1
ISSN	1557-9808 ; 1089-2516
ISSN (online)	1557-9808
ISSN	1089-2516
DOI	10.1053/j.tvir.2006.05.003
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