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  1. Article ; Online: Advanced Endovascular Treatment of Complex Aortic Pathology.

    Li, Ruojia Debbie / Soult, Michael C

    The Surgical clinics of North America

    2023  Volume 103, Issue 4S, Page(s) e1–e11

    Abstract: Endovascular aortic aneurysm repair and thoracic endovascular aortic repair have been shown to reduce blood loss, operative time, length of hospital stay, mortality, and morbidity compared with open surgical repair for abdominal aortic aneurysms and ... ...

    Abstract Endovascular aortic aneurysm repair and thoracic endovascular aortic repair have been shown to reduce blood loss, operative time, length of hospital stay, mortality, and morbidity compared with open surgical repair for abdominal aortic aneurysms and thoracic aortic aneurysms. However, there are anatomical constraints that limit the application of the endovascular approach in 30% to 40% of patients, including those with short necks, excessive angulation, or aneurysms with the involvement of aortic side branches such as supra-aortic trunks, arch aneurysms, visceral arteries, or internal iliac arteries.
    MeSH term(s) Humans ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Stents ; Treatment Outcome ; Endovascular Procedures ; Risk Factors ; Aortic Aneurysm, Thoracic/surgery ; Aortic Aneurysm, Abdominal/surgery ; Prosthesis Design
    Language English
    Publishing date 2023-08-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215713-5
    ISSN 1558-3171 ; 0039-6109
    ISSN (online) 1558-3171
    ISSN 0039-6109
    DOI 10.1016/j.suc.2023.07.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Iliac artery-enteric fistulas following failed pancreatic transplant.

    Weise, Lorela B / Crisostomo, Paul R / Bechara, Carlos F / Soult, Michael C

    Journal of vascular surgery cases and innovative techniques

    2024  Volume 10, Issue 2, Page(s) 101427

    Abstract: Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant ... ...

    Abstract Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction.
    Language English
    Publishing date 2024-01-16
    Publishing country United States
    Document type Case Reports
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2024.101427
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Preoperative risk score for mortality within 3 years of visceral segment fenestrated endovascular aortic repair.

    Penton, Ashley / Li, Ruojia / Carmon, Lauren / Soult, Michael C / Bechara, Carlos F / Blecha, Matthew

    Journal of vascular surgery

    2024  

    Abstract: Objective: The purpose of this study was to create a risk score for the event of mortality within 3 years of complex fenestrated visceral segment endovascular aortic repair utilizing variables existing at the time of preoperative presentation.: ... ...

    Abstract Objective: The purpose of this study was to create a risk score for the event of mortality within 3 years of complex fenestrated visceral segment endovascular aortic repair utilizing variables existing at the time of preoperative presentation.
    Methods: After exclusions, 1916 patients were identified in the Vascular Quality Initiative who were included in the analysis. The first step in development of the risk score was univariable analysis for the primary outcome of mortality within 3 years of surgery. χ
    Results: The primary outcome of mortality within 3 years of surgery occurred in 12.8% of patients (245/1916). The mean age for the study population was 73.35 years (standard deviation [SD], 8.26 years). The mean maximal abdominal aortic aneurysm (AAA) diameter was 60.43 mm (SD, 10.52 mm). The mean number of visceral vessels stented was 3.3 (SD, 0.76). Variables present at the time of surgery that were included in the risk score were: hemodialysis (3 points); age >87, chronic obstructive pulmonary disease, hypertension, AAA diameter >77 mm (all 2 points); and body mass index <20 kg/m
    Conclusions: A novel risk score for mortality within 3 years of fenestrated visceral segment aortic endograft has been developed that has excellent accuracy in predicting which patients will survive and derive the strongest benefit from intervention. This facilitates risk-benefit analysis and counseling of patients and families with realistic long-term expectations. This potentially enhances patient-centered decision-making.
    Language English
    Publishing date 2024-03-11
    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.2024.03.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Dual true and false lumen stent graft technique for endovascular repair of isolated common iliac artery aneurysm in chronic type A

    Lin, Jonathan H / Zielke, Tara / Zorn, Mary K / Korepta, Lindsey M / Soult, Michael C / Bechara, Carlos F

    Journal of vascular surgery cases and innovative techniques

    2022  Volume 8, Issue 4, Page(s) 756–759

    Abstract: A 52-year-old man presented with a chronic type ... ...

    Abstract A 52-year-old man presented with a chronic type A
    Language English
    Publishing date 2022-10-22
    Publishing country United States
    Document type Case Reports
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2022.10.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019.

    Warrior, Krishnan / Chung, Paul A / Ahmed, Nida / Soult, Michael C / Simpson, Kevin P

    Critical care explorations

    2020  Volume 2, Issue 6, Page(s) e0140

    Abstract: Objectives: To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019.: Design: Clinical observation of a patient.: Setting: Academic medical center.: Patient: A 59-year-old female with history of ... ...

    Abstract Objectives: To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019.
    Design: Clinical observation of a patient.
    Setting: Academic medical center.
    Patient: A 59-year-old female with history of hypertension, hyperlipidemia, and prior smoking.
    Intervention: Clinical observation and data extraction from electronic medical records.
    Measurements and main results: We report a case of peripheral arterial thrombosis associated with coronavirus disease 2019, resulting in acute limb ischemia of the right lower extremity. This event was heralded by a sudden and significant elevation in d-dimer levels. At the time of surgery, a long, gelatinous clot was retrieved from the right popliteal artery. Perioperatively, she continued to have absent pedal Doppler signals and after multiple embolectomy attempts, required distal arterial cut down with removal of additional thrombi and resultant improvement of distal arterial flow.
    Conclusions: This case demonstrates the importance of regularly checking d-dimer levels and vigilant monitoring for arterial thrombotic events, as they can rapidly become catastrophic.
    Keywords covid19
    Language English
    Publishing date 2020-06-11
    Publishing country United States
    Document type Case Reports
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000140
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019

    Warrior, Krishnan / Chung, Paul A. / Ahmed, Nida / Soult, Michael C. / Simpson, Kevin P.

    Critical Care Explorations

    Abstract: Objectives: To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019 Design: Clinical observation of a patient Setting: Academic medical center Patient: A 59-year-old female with history of hypertension, ... ...

    Abstract Objectives: To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019 Design: Clinical observation of a patient Setting: Academic medical center Patient: A 59-year-old female with history of hypertension, hyperlipidemia, and prior smoking Intervention: Clinical observation and data extraction from electronic medical records Measurements and Main Results: We report a case of peripheral arterial thrombosis associated with coronavirus disease 2019, resulting in acute limb ischemia of the right lower extremity This event was heralded by a sudden and significant elevation in d-dimer levels At the time of surgery, a long, gelatinous clot was retrieved from the right popliteal artery Perioperatively, she continued to have absent pedal Doppler signals and after multiple embolectomy attempts, required distal arterial cut down with removal of additional thrombi and resultant improvement of distal arterial flow Conclusions: This case demonstrates the importance of regularly checking d-dimer levels and vigilant monitoring for arterial thrombotic events, as they can rapidly become catastrophic
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #605833
    Database COVID19

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  7. Article ; Online: Fourth-Year Medical Students' Perceptions of Vascular Surgery: Can We Improve the Pipeline?

    Arismendi, Tyler / Schaper, Nicholas / Falkenhain, Alec / Karabetsos, Konstantinos C / Syed, Ali / Branch, Rheyana / Moreno, Marvi / Pickney, Cole / Obayi, Ikpechukwu / Lucas, Spencer J / González, Eduardo / Graves, Aaron / Kauffman, Brittany / Maningat, Alexandra / Zielke, Tara / Nam, Janice / Soult, Michael C / Aziz, Faisal / Bose, Saideep /
    Smeds, Matthew R

    Annals of vascular surgery

    2023  Volume 97, Page(s) 147–156

    Abstract: Background: Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular ... ...

    Abstract Background: Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular techniques. However, despite substantial modifications to the training paradigm, a shortage of vascular surgeons is still projected through 2050. We aimed to gather and analyze fourth-year medical students' knowledge and perceptions of vascular surgery (VS) to further inform strategies for recruiting future vascular surgeons.
    Methods: We sent anonymous electronic questionnaires to fourth-year medical students at 7 allopathic and 3 osteopathic medical schools, with questions detailing demographics, specialty preferences, and exposure to and perceptions of VS. Descriptive statistics were obtained, and responses were compared between students applying to surgical specialties (SS) and nonsurgical specialties (NSS).
    Results: Two hundred eleven of 1,764 (12%) participants responded (56% female). 56% reported VS exposure, most commonly during the third year. 64 (30%) planned to apply to SS. 57% of respondents reported knowledge of the management of vascular disease, and 56% understood procedures performed by vascular surgeons. Ranking the importance of factors in choosing specialties, SS selected "experiences gained during medical school rotations" (P < 0.05), "types and/or variety of treatment modalities used in this field" (P < 0.001), and "interest in the pathology or disease processes treated" (P < 0.05) as highest priorities. NSS preferred "lifestyle (work-life balance) as an attending" (P < 0.001). Only 7% of all respondents believed vascular surgeons have a good work-life balance, with a larger percentage of SS (P < 0.001) agreeing. Stratified by gender, female students rated "limited ability of childbirth during residency and/or postponement of family plans" (P < 0.05), "gender-related concerns, such as discrimination at work or unfair career possibilities" (P < 0.001), and "fear of unfair competition" (P < 0.05) as potential negative aspects of VS careers. 55% of respondents believed the IVSR makes VS more appealing.
    Conclusions: Medical students perceive poor quality of life and work-life balance as deterring factors to a career in VS. Opportunities exist to educate students on the pathologies treated, procedures performed, and attainable quality of life available in our field. We should also continue to develop recruitment strategies to stimulate student interest and increase early exposure in VS.
    MeSH term(s) Humans ; Female ; Male ; Students, Medical ; Quality of Life ; Career Choice ; Treatment Outcome ; Internship and Residency ; Specialties, Surgical/education ; Surveys and Questionnaires ; Endovascular Procedures
    Language English
    Publishing date 2023-07-24
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2023.07.099
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Sarcopenia predicts mortality and adverse outcomes after endovascular aneurysm repair and can be used to risk stratify patients.

    Cheng, Brian T / Soult, Michael C / Helenowski, Irene B / Rodriguez, Heron E / Eskandari, Mark K / Hoel, Andrew W

    Journal of vascular surgery

    2019  Volume 70, Issue 5, Page(s) 1576–1584

    Abstract: Background: Endovascular aneurysm repair (EVAR) is currently the most common treatment of abdominal aortic aneurysms. Potential predictors of long-term survival after EVAR include physiologic, functional, and cognitive status, but assessments of these ... ...

    Abstract Background: Endovascular aneurysm repair (EVAR) is currently the most common treatment of abdominal aortic aneurysms. Potential predictors of long-term survival after EVAR include physiologic, functional, and cognitive status, but assessments of these conditions have been difficult to standardize. Objective radiographic findings, such as skeletal muscle atrophy, or sarcopenia, may provide an additional means for selection of patients. This study investigates sarcopenia as a method to predict 1-year survival in patients undergoing EVAR.
    Methods: A single-institution retrospective review was conducted of all patients who underwent elective EVAR from September 2002 to June 2014. Patients with an available periprocedural computed tomography (CT) scan and clinical data were included in the analysis. Normalized total psoas cross-sectional area (nTPA) was measured on axial CT images using the area of the bilateral psoas muscle at the third lumbar vertebral level normalized to the square of patient height. A threshold for optimal estimate of sarcopenia based on nTPA was determined using a receiver operating characteristic curve. Sarcopenia was evaluated as an independent risk predictor using univariate, multivariate, and survival analysis.
    Results: A total of 272 EVAR-treated patients were evaluated, including 237 men and 35 women with a median age of 72 years and mean body mass index of 28.6 kg/m
    Conclusions: Sarcopenia can assist in identifying EVAR candidates who are less likely to benefit from surgery. It can be readily evaluated from preoperative CT scans and may be a useful tool in evaluation of abdominal aortic aneurysm patients with applications in risk evaluation and telemedicine.
    MeSH term(s) Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/mortality ; Aortic Aneurysm, Abdominal/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/methods ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/methods ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Patient Selection ; Predictive Value of Tests ; Psoas Muscles/diagnostic imaging ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Sarcopenia/diagnosis ; Sarcopenia/epidemiology ; Sarcopenia/etiology ; Tomography, X-Ray Computed ; Treatment Outcome
    Language English
    Publishing date 2019-03-07
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2018.12.038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: There Is Limited Value in the One Month Post Endovascular Aortic Aneurysm Repair Surveillance Computed Tomography Scan.

    Soult, Michael C / Cheng, Brian T / Mansukhani, Neel A / Rodriguez, Heron E / Eskandari, Mark K / Hoel, Andrew W

    Annals of vascular surgery

    2018  Volume 54, Page(s) 27–32

    Abstract: Background: Endovascular aortic aneurysm repair (EVAR) is the preferred first-line treatment for abdominal aortic aneurysms. Current postprocedure surveillance recommendations by manufacturers are a 1-month computed tomography angiography (CTA) followed ...

    Abstract Background: Endovascular aortic aneurysm repair (EVAR) is the preferred first-line treatment for abdominal aortic aneurysms. Current postprocedure surveillance recommendations by manufacturers are a 1-month computed tomography angiography (CTA) followed by a 12-month CTA in most circumstances. The objective of this study is to determine the utility of the 1-month CTA following elective EVAR and determine if initial surveillance at 6-month CTA is appropriate.
    Methods: A single-center retrospective chart review of all elective EVARs at a tertiary medical center over a 12-year period was conducted. Patients were excluded if postoperative surveillance imaging was not available. Data analysis encompassed demographics, chart review, and imaging including angiogram and cross-sectional imaging to asses for endoleaks and other findings.
    Results: There were 363 patients who underwent elective EVAR and had available postoperative imaging during the study period. Within the 1-month follow-up, a CTA group of 316 patients was detected with 98 (31%) endoleaks. Of these, 5 (1.5%) required intervention: 1 for infolding of an iliac limb and 4 for type I endoleak which was present on completion angiogram-3 in patients treated outside of instructions for use and 1 with a type Ib endoleak on intraoperative completion imaging. In the 158 patients with 1 and 3-month CTAs, there were 47 persistent endoleaks, 9 previously undetected endoleaks not seen in 1-month CTA, and 13 resolved endoleaks. Three patients (1.2%) underwent intervention for type II endoleak and aneurysm expansion. In 47 patients with only a 6-month CTA, there were 16 endoleaks not seen on completion angiography and 2 of which were treated with reintervention-1 for a type I endoleak and 1 for a type II endoleak.
    Conclusions: There is limited utility to 1-month surveillance CTA in patients undergoing elective EVAR within the device instructions for use that has no evidence of type I endoleak on completion angiography. It is safe to start routine EVAR surveillance at 6 months in this patient population. This has implications when considering bundled and value-based payments in the longitudinal care of abdominal aortic aneurysm patients.
    MeSH term(s) Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Aortography/methods ; Blood Vessel Prosthesis Implantation/adverse effects ; Computed Tomography Angiography ; Early Diagnosis ; Endoleak/diagnostic imaging ; Endoleak/etiology ; Endoleak/therapy ; Endovascular Procedures/adverse effects ; Female ; Humans ; Illinois ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2018-09-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1027366-9
    ISSN 1615-5947 ; 0890-5096
    ISSN (online) 1615-5947
    ISSN 0890-5096
    DOI 10.1016/j.avsg.2018.08.075
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Detecting iliac vein thrombosis with current protocols of lower extremity venous duplex ultrasound.

    Jain, Ashish K / Soult, Michael C / Resnick, Scott A / Desai, Kush / Astleford, Patricia / Eskandari, Mark K / Rodriguez, Heron E

    Journal of vascular surgery. Venous and lymphatic disorders

    2018  Volume 6, Issue 6, Page(s) 724–729

    Abstract: Background: Deep venous thrombosis isolated to the iliac veins is uncommon. Venous duplex ultrasound (DU) is widely accepted as the screening modality of choice for lower extremity deep venous thromboses. This investigation evaluated the accuracy and ... ...

    Abstract Background: Deep venous thrombosis isolated to the iliac veins is uncommon. Venous duplex ultrasound (DU) is widely accepted as the screening modality of choice for lower extremity deep venous thromboses. This investigation evaluated the accuracy and efficacy of DU in diagnosis of iliac vein thrombosis.
    Methods: We conducted a single-center retrospective review of patients who were diagnosed with iliac vein thrombosis between January 1, 2006, and December 31, 2015. Patients included in our analysis needed to have both DU and cross-sectional imaging performed within a month of each other. The efficacy of DU in diagnosis of iliac vein thrombosis was determined using cross-sectional imaging as a standard for diagnosis.
    Results: In total, our query yielded 80 patients with a diagnosis of iliac vein thrombosis in the medical chart; 48 patients had both cross-sectional imaging and DU performed within 1 month of each other. There were 36 patients who had cross-sectional imaging positive for iliac vein thrombosis; only 10 (27.8%) of these patients were found to have iliac vein thrombosis by DU. Thus, 26 patients (72.2%) were not diagnosed accurately by DU. On the basis of our data, the sensitivity and positive predictive value of DU compared with cross-sectional imaging in diagnosis of iliac vein thrombosis were 27.8% and 76.9%, respectively. We did not identify any patient-specific factors that influenced the discrepancy between DU and cross-sectional imaging.
    Conclusions: Our current protocol of lower extremity venous DU is not an effective tool in diagnosis of iliac vein thrombosis. All patients with clinically suspected iliac vein thrombosis should be evaluated with specific pelvic ultrasound protocols or cross-sectional imaging.
    MeSH term(s) Computed Tomography Angiography ; Databases, Factual ; Humans ; Iliac Vein/diagnostic imaging ; Magnetic Resonance Angiography ; Phlebography/methods ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Ultrasonography, Doppler, Duplex ; Venous Thrombosis/diagnostic imaging
    Language English
    Publishing date 2018-09-05
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 2213-3348
    ISSN (online) 2213-3348
    DOI 10.1016/j.jvsv.2018.06.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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