Albeir Mousa - Academia.edu (original) (raw)

Papers by Albeir Mousa

Research paper thumbnail of Mesenteric/Celiac Duplex Ultrasound Interpretation Criteria Revisited

Research paper thumbnail of Acute abdomen with free air under the diaphragm after coitus: a review of the literature

The American Surgeon, Dec 1, 2010

Research paper thumbnail of Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for patients with post carotid endarterectomy stenosis

J Vasc Surg, 2010

Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients w... more Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients with post-carotid endarterectomy (CEA) stenosis. This study compares early and late clinical outcomes for both groups.This study analyzes 192 patients: 72 had reoperation (Group A) and 120 had CAS for post-CEA stenosis (Group B). Patients were followed prospectively and had duplex ultrasounds at 1 month, and every 6 to 12 months thereafter. The perioperative complications (perioperative stroke, myocardial infarction/death, cranial nerve injury) and 4-year end points were analyzed. A Kaplan-Meier lifetable analysis was used to estimate rates of freedom from stroke, stroke-free survival, ≥50% restenosis, and ≥80% restenosis.Demographic/clinical characteristics were comparable for both groups, except for diabetes mellitus and coronary artery disease, which were significantly higher in Group B. The indications for reoperations were transient ischemic attacks/stroke in 72% for Group A versus 57% for Group B (P = .0328). The mean follow-up was 33 months (range, 1-86 months) for Group A and 24 months (range, 1-78 months) for Group B (P = .0026). The proportion of early (<24 months) carotid restenosis prior to intervention was 51% in Group A versus 27% in Group B (P = .0013). The perioperative stroke rates were 3% and 1%, respectively (P = .5573). There were no myocardial infarctions or deaths in either group. The overall incidence of cranial nerve injury was 14% for Group A versus 0% for Group B (P < .0001). However, there was no statistical difference between the groups relating to permanent cranial nerve injury (1% versus 0%). The combined early and late stroke rates for Groups A and B were 3% and 2%, respectively (P = .6347). The stroke-free rates at 1, 2, 3, and 4 years for Groups A and B were 97%, 97%, 97%, and 97% and 98%, 98%, 98%, and 98%, respectively (P = .6490). The stroke-free survival rates were not significantly different. The rates of freedom from ≥50% restenosis at 1, 2, 3, and 4 years were 98%, 95%, 95%, and 95% for Group A versus 95%, 89%, 80%, and 72% for Group B (P = .0175). The freedom from ≥80% restenosis at 1, 2, 3, and 4 years for Groups A and B were 98%, 97%, 97%, and 97% versus 99%, 96%, 92%, and 87%, respectively (P = .2281). Four patients (one symptomatic) in Group B had reintervention for ≥80% restenosis. The rate of freedom from reintervention for Groups A and B were 100%, 100%, 100%, and 100% versus 94%, 89%, 83%, and 79%, respectively (P = .0634).CAS is as safe as redo CEA. Redo CEA has a higher incidence of transient cranial nerve injury; however, CAS has a higher incidence of ≥50% in-stent restenosis.

Research paper thumbnail of Granulocytic Sarcoma (GS) as first manifestation of AML

Ash Annual Meeting Abstracts, Nov 16, 2005

Research paper thumbnail of Correlation of Carotid Stump Pressure During Carotid Endarterectomy and the Contralateral Carotid/Cerebral Collateral Flow: Results from a Randomized Trial

Research paper thumbnail of Endovascular Treatment of Iliac Occlusive Disease: Review and Update

Vascular, 2007

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the ... more Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.

Research paper thumbnail of Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use

Journal of the American College of Surgeons, 2016

A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR)... more A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes. We performed a retrospective analysis of prospectively collected data on EVAR patients. Neck features outside IFU were analyzed. Kaplan-Meier and multivariate analyses were used to predict their effect as single features, or in combination, on outcomes. Fifty-two percent of 526 patients had 1 or more features outside the IFU. The overall technical success rate was 99%, and perioperative complication rates were 7% and 12% for IFU vs outside IFU use, respectively (p = 0.04). Type I early endoleak and early intervention rates were 7% and 10% for IFU vs 18% and 24% for outside IFU (p = 0.0002 and p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At a mean follow-up of 30 months, freedom from late type I endoleak and late reintervention at 1, 2, and 3 years for IFU were 99.5%, 99.5%, and 98.4%, and 99.4%, 98%, and 96.8%; vs 98.9%, 98.1%, and 98.1%, and 97.5%, 96.2%, and 95.2% for outside IFU (p = 0.049 and 0.799), respectively. Survival rates at 1, 2, and 3 years for IFU were 97%, 93.5%, and 89.8%; vs 93.7%, 88.8%, and 86.3% for outside IFU (p = 0.035). Multivariate analysis showed that a neck angle &amp;amp;amp;amp;amp;amp;amp;amp;gt; 60 degrees had odds ratios for death, sac expansion, and early intervention of 6, 2.6, and 3.3, respectively; neck length &amp;amp;amp;amp;amp;amp;amp;amp;lt; 10 mm had odds ratios of 2.8 for deaths, 3.4 for early intervention, 4.6 for late reintervention, and 4.3 for late type I endoleak. Patients with neck features outside IFU can be treated with EVAR; however, they have higher rates of early and late type I endoleak, early intervention, and late death.

Research paper thumbnail of Compliance of postendovascular aortic aneurysm repair imaging surveillance

Journal of Vascular Surgery, 2016

Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study ... more Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes. Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities. Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endoleak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance. Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.

Research paper thumbnail of SS25. Critical Appraisal of the Carotid Duplex Consensus Criteria in the Diagnosis of Carotid Artery Stenosis

J Vasc Surg, 2010

Background: Clinicians have relied on published institutional experience for interpreting carotid... more Background: Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies (CDUS). This study will validate the ultrasound imaging consensus criteria published in 2003. Methods: The CDUS and angiography results of 376 carotid arteries were analyzed. Receiver-operating characteristic (ROCs) curves were used to compare peak systolic velocities (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), and ICA/common carotid (CCA) ratios in detecting <50%, 50% to 69% (ICA PSV of 125-230 cm/s), and 70% to 99% (PSV of >230 cm/s) stenosis according to the consensus criteria. Results: The consensus criteria uses a PSV of 125 to 230 cm/s for detecting angiographic stenosis of 50% to 69%, which has a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of >230 cm/s for >70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better (area under the curve [AUC], 0.97) than EDV (AUC, 0.94) or ICA/CCA ratio (AUC, 0.84; P ‫؍‬ .036) in detecting >70% stenosis and >50% stenosis. Pearson correlations showed a statistical difference between the correlation of PSV with angiography (0.833; 95% confidence interval [CI], 0.8-0.86), EDV with angiography (0.755; 95% CI, 0.71-0.80), and ICA/CCA systolic ratio with angiography (0.601; 95% CI, 0.53-0.66; P < .0001) in detecting 70% to 99% stenosis. Adding the EDV values or the ratios to the PSV values did not improve accuracy. The consensus criteria for diagnosing 50% to 69% stenosis can be significantly improved by using an ICA PSV of 140 to 230 cm/s, with a sensitivity of 94%, specificity of 92%, and overall accuracy of 92%. Conclusions: The consensus criteria can be accurately used for diagnosing >70% stenosis; however, the accuracy can be improved for detecting 50% to 69% stenosis if the ICA PSV is changed to 140 to <230 cm/s. ( J Vasc Surg 2011;53: 53-60.)

Research paper thumbnail of The Utilization of the Double-Bubble Aortic Configuration to Seal Infra-Renal Aortic Aneurysms: A Case Report and Review of Literature

Vascular and Endovascular Surgery, Mar 1, 2011

An 80-year-old Caucasian female with a symptomatic pararenal aortic aneurysm (AAA) presented with... more An 80-year-old Caucasian female with a symptomatic pararenal aortic aneurysm (AAA) presented with severe abdominal pain radiating to the back, which was associated with a significantly tender pulsating abdominal mass. The patient was deemed unfit for open repair, secondary to her significant multiple comorbidities. Her preoperative computed tomography (CT) angiography showed a 6 cm pararenal AAA with a short hostile neck; however, her aneurysm had a double-bubble sign, which we utilized as an adjunct for sealing zones. A 36-mm Cook Zenith device was deployed with complete exclusion of the AAA. The patient recovered uneventfully with complete resolution of her abdominal pain. On her 2-month follow-up CT angiography, there was no migration or endoleak, with a decrease in the aneurysm sac size. This case report highlights the benefit of having such an aortic configuration as an adjunct tool for proximal sealing zones and demonstrates that certain anatomy may be beneficial in selected patients.

Research paper thumbnail of Acute abdomen with free air under the diaphragm after coitus: A review of the literatur

Research paper thumbnail of Corrélation entre la pression de perfusion collatérale peropératoire pendant l'endartériectomie carotidienne et le statut de l'artère carotide controlatérale et du flux sanguin cérébral collatéral

Annales de Chirurgie Vasculaire, 2011

Introduction : La m ethode optimale pour pr evoir quand le shunting carotidien n'est pas n ecessa... more Introduction : La m ethode optimale pour pr evoir quand le shunting carotidien n'est pas n ecessaire pendant l'endart eriectomie carotidienne (CEA) est controvers ee. Cette etude analysera la corr elation entre la pression collat erale de perfusion et les statuts de la carotide/collat erales c er ebrales controlat eraux et d eterminera si l' echodoppler pr eop eratoire/angiographie c er ebrale peuvent pr evoir quand la CEA peutêtre faite sans shunt. M ethodes : Quatre-vingt-dix-huit patients ont et e randomis es en shunt syst ematique et 102 en shunt s electif quand la pression collat erale de perfusion (pression carotidienne systolique r esiduelle) etait <40 mmHg pendant la CEA. Tous les patients avaient eu un echodoppler carotidien pr eop eratoire et 87 avaient eu une angiographie. Les r esultats ont et e evalu es en regardant la pr esence de flux collat eral dans l'art ere carotide controlat erale, ou dans la circulation post erieure par les art eres communicantes ant erieures et/ou post erieures. R esultats : Le taux d'accident vasculaire c er ebral p eriop eratoire etait de 1,5% pour le groupe entier. Il n'y avait aucune corr elation entre les symptômes pr eop eratoires et le statut de l'art ere carotide controlat erale (normale, st enos ee, ou occluse). La pression moyenne de perfusion collat erale

Research paper thumbnail of Compliance of Post-EVAR Imaging Surveillance

Journal of Vascular Surgery, 2015

Research paper thumbnail of Prospective Randomized Double-blinded Trial Comparing 2 Anti-MRSA Agents With Supplemental Coverage of Cefazolin Before Lower Extremity Revascularization

Annals of surgery, 2015

To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashio... more To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion. Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections? Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days. Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in...

Research paper thumbnail of Validation of Venous Duplex Ultrasound in Determining Iliac Vein Stenosis and Predictors of Recurrence After Standard Treatment of Active Chronic Venous Ulcers

Journal of Vascular Surgery, 2015

Research paper thumbnail of WITHDRAWN: Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2014

Research paper thumbnail of Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

Journal of Vascular Surgery, 2015

Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary h... more Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.

Research paper thumbnail of The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

Journal of vascular surgery, Jan 9, 2015

Several studies have reported on the role of postoperative duplex ultrasound surveillance after c... more Several studies have reported on the role of postoperative duplex ultrasound surveillance after carotid endarterectomy (CEA) with varying results. Most of these studies had a small sample size or did not analyze cost-effectiveness. We analyzed 489 of 501 CEA patients with patch closure. All patients had immediate postoperative duplex ultrasound examination and were routinely followed up both clinically and with duplex ultrasound at regular intervals of 1 month, 6 months, 12 months, and every 12 months thereafter. A Kaplan-Meier analysis was used to estimate the rate of ≥50% and ≥80% post-CEA restenosis over time and the time frame of progression from normal to ≥50% or ≥80% restenosis. The cost of post-CEA duplex surveillance was also estimated. Overall, 489 patients with a mean age of 68.5 years were analyzed. Ten of these had residual postoperative ≥50% stenosis, and 37 did not undergo a second duplex ultrasound examination and therefore were not included in the final analysis. The...

Research paper thumbnail of Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 15, 2015

To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de n... more To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de novo carotid stenosis vs patients treated for restenosis after carotid endarterectomy (CEA). A retrospective review was conducted of all 385 patients (mean age 68.6±9.6 years; 231 men) who underwent 435 CAS procedures at a large tertiary care center between January 1999 and December 2013. For analysis, patients were stratified based on their lesion type [de novo (dn) vs post-CEA restenosis (res)] and subclassified by symptoms status [symptomatic (Sx) or asymptomatic (Asx)], creating 4 groups: (1) CAS-dn Asx, (2) CAS-dn Sx, (3) CAS-res Asx, and (4) CAS-res Sx. For the CAS-res group, the mean elapsed time from CEA to CAS was 72.4±63.6 months. Outcomes included target vessel reintervention (TVR) and in-stent restenosis (ISR), the latter defined by a carotid duplex ultrasound velocity >275 cm/s. The main indication for initial carotid angiography with possible revascularization was severe ...

Research paper thumbnail of Bilateral lower extremity anterior compartment syndrome in a severely hypothyroid patient

The American surgeon, 2014

Research paper thumbnail of Mesenteric/Celiac Duplex Ultrasound Interpretation Criteria Revisited

Research paper thumbnail of Acute abdomen with free air under the diaphragm after coitus: a review of the literature

The American Surgeon, Dec 1, 2010

Research paper thumbnail of Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for patients with post carotid endarterectomy stenosis

J Vasc Surg, 2010

Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients w... more Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients with post-carotid endarterectomy (CEA) stenosis. This study compares early and late clinical outcomes for both groups.This study analyzes 192 patients: 72 had reoperation (Group A) and 120 had CAS for post-CEA stenosis (Group B). Patients were followed prospectively and had duplex ultrasounds at 1 month, and every 6 to 12 months thereafter. The perioperative complications (perioperative stroke, myocardial infarction/death, cranial nerve injury) and 4-year end points were analyzed. A Kaplan-Meier lifetable analysis was used to estimate rates of freedom from stroke, stroke-free survival, ≥50% restenosis, and ≥80% restenosis.Demographic/clinical characteristics were comparable for both groups, except for diabetes mellitus and coronary artery disease, which were significantly higher in Group B. The indications for reoperations were transient ischemic attacks/stroke in 72% for Group A versus 57% for Group B (P = .0328). The mean follow-up was 33 months (range, 1-86 months) for Group A and 24 months (range, 1-78 months) for Group B (P = .0026). The proportion of early (<24 months) carotid restenosis prior to intervention was 51% in Group A versus 27% in Group B (P = .0013). The perioperative stroke rates were 3% and 1%, respectively (P = .5573). There were no myocardial infarctions or deaths in either group. The overall incidence of cranial nerve injury was 14% for Group A versus 0% for Group B (P < .0001). However, there was no statistical difference between the groups relating to permanent cranial nerve injury (1% versus 0%). The combined early and late stroke rates for Groups A and B were 3% and 2%, respectively (P = .6347). The stroke-free rates at 1, 2, 3, and 4 years for Groups A and B were 97%, 97%, 97%, and 97% and 98%, 98%, 98%, and 98%, respectively (P = .6490). The stroke-free survival rates were not significantly different. The rates of freedom from ≥50% restenosis at 1, 2, 3, and 4 years were 98%, 95%, 95%, and 95% for Group A versus 95%, 89%, 80%, and 72% for Group B (P = .0175). The freedom from ≥80% restenosis at 1, 2, 3, and 4 years for Groups A and B were 98%, 97%, 97%, and 97% versus 99%, 96%, 92%, and 87%, respectively (P = .2281). Four patients (one symptomatic) in Group B had reintervention for ≥80% restenosis. The rate of freedom from reintervention for Groups A and B were 100%, 100%, 100%, and 100% versus 94%, 89%, 83%, and 79%, respectively (P = .0634).CAS is as safe as redo CEA. Redo CEA has a higher incidence of transient cranial nerve injury; however, CAS has a higher incidence of ≥50% in-stent restenosis.

Research paper thumbnail of Granulocytic Sarcoma (GS) as first manifestation of AML

Ash Annual Meeting Abstracts, Nov 16, 2005

Research paper thumbnail of Correlation of Carotid Stump Pressure During Carotid Endarterectomy and the Contralateral Carotid/Cerebral Collateral Flow: Results from a Randomized Trial

Research paper thumbnail of Endovascular Treatment of Iliac Occlusive Disease: Review and Update

Vascular, 2007

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the ... more Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.

Research paper thumbnail of Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use

Journal of the American College of Surgeons, 2016

A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR)... more A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes. We performed a retrospective analysis of prospectively collected data on EVAR patients. Neck features outside IFU were analyzed. Kaplan-Meier and multivariate analyses were used to predict their effect as single features, or in combination, on outcomes. Fifty-two percent of 526 patients had 1 or more features outside the IFU. The overall technical success rate was 99%, and perioperative complication rates were 7% and 12% for IFU vs outside IFU use, respectively (p = 0.04). Type I early endoleak and early intervention rates were 7% and 10% for IFU vs 18% and 24% for outside IFU (p = 0.0002 and p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At a mean follow-up of 30 months, freedom from late type I endoleak and late reintervention at 1, 2, and 3 years for IFU were 99.5%, 99.5%, and 98.4%, and 99.4%, 98%, and 96.8%; vs 98.9%, 98.1%, and 98.1%, and 97.5%, 96.2%, and 95.2% for outside IFU (p = 0.049 and 0.799), respectively. Survival rates at 1, 2, and 3 years for IFU were 97%, 93.5%, and 89.8%; vs 93.7%, 88.8%, and 86.3% for outside IFU (p = 0.035). Multivariate analysis showed that a neck angle &amp;amp;amp;amp;amp;amp;amp;amp;gt; 60 degrees had odds ratios for death, sac expansion, and early intervention of 6, 2.6, and 3.3, respectively; neck length &amp;amp;amp;amp;amp;amp;amp;amp;lt; 10 mm had odds ratios of 2.8 for deaths, 3.4 for early intervention, 4.6 for late reintervention, and 4.3 for late type I endoleak. Patients with neck features outside IFU can be treated with EVAR; however, they have higher rates of early and late type I endoleak, early intervention, and late death.

Research paper thumbnail of Compliance of postendovascular aortic aneurysm repair imaging surveillance

Journal of Vascular Surgery, 2016

Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study ... more Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes. Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities. Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endoleak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance. Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.

Research paper thumbnail of SS25. Critical Appraisal of the Carotid Duplex Consensus Criteria in the Diagnosis of Carotid Artery Stenosis

J Vasc Surg, 2010

Background: Clinicians have relied on published institutional experience for interpreting carotid... more Background: Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies (CDUS). This study will validate the ultrasound imaging consensus criteria published in 2003. Methods: The CDUS and angiography results of 376 carotid arteries were analyzed. Receiver-operating characteristic (ROCs) curves were used to compare peak systolic velocities (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), and ICA/common carotid (CCA) ratios in detecting <50%, 50% to 69% (ICA PSV of 125-230 cm/s), and 70% to 99% (PSV of >230 cm/s) stenosis according to the consensus criteria. Results: The consensus criteria uses a PSV of 125 to 230 cm/s for detecting angiographic stenosis of 50% to 69%, which has a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of >230 cm/s for >70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better (area under the curve [AUC], 0.97) than EDV (AUC, 0.94) or ICA/CCA ratio (AUC, 0.84; P ‫؍‬ .036) in detecting >70% stenosis and >50% stenosis. Pearson correlations showed a statistical difference between the correlation of PSV with angiography (0.833; 95% confidence interval [CI], 0.8-0.86), EDV with angiography (0.755; 95% CI, 0.71-0.80), and ICA/CCA systolic ratio with angiography (0.601; 95% CI, 0.53-0.66; P < .0001) in detecting 70% to 99% stenosis. Adding the EDV values or the ratios to the PSV values did not improve accuracy. The consensus criteria for diagnosing 50% to 69% stenosis can be significantly improved by using an ICA PSV of 140 to 230 cm/s, with a sensitivity of 94%, specificity of 92%, and overall accuracy of 92%. Conclusions: The consensus criteria can be accurately used for diagnosing >70% stenosis; however, the accuracy can be improved for detecting 50% to 69% stenosis if the ICA PSV is changed to 140 to <230 cm/s. ( J Vasc Surg 2011;53: 53-60.)

Research paper thumbnail of The Utilization of the Double-Bubble Aortic Configuration to Seal Infra-Renal Aortic Aneurysms: A Case Report and Review of Literature

Vascular and Endovascular Surgery, Mar 1, 2011

An 80-year-old Caucasian female with a symptomatic pararenal aortic aneurysm (AAA) presented with... more An 80-year-old Caucasian female with a symptomatic pararenal aortic aneurysm (AAA) presented with severe abdominal pain radiating to the back, which was associated with a significantly tender pulsating abdominal mass. The patient was deemed unfit for open repair, secondary to her significant multiple comorbidities. Her preoperative computed tomography (CT) angiography showed a 6 cm pararenal AAA with a short hostile neck; however, her aneurysm had a double-bubble sign, which we utilized as an adjunct for sealing zones. A 36-mm Cook Zenith device was deployed with complete exclusion of the AAA. The patient recovered uneventfully with complete resolution of her abdominal pain. On her 2-month follow-up CT angiography, there was no migration or endoleak, with a decrease in the aneurysm sac size. This case report highlights the benefit of having such an aortic configuration as an adjunct tool for proximal sealing zones and demonstrates that certain anatomy may be beneficial in selected patients.

Research paper thumbnail of Acute abdomen with free air under the diaphragm after coitus: A review of the literatur

Research paper thumbnail of Corrélation entre la pression de perfusion collatérale peropératoire pendant l'endartériectomie carotidienne et le statut de l'artère carotide controlatérale et du flux sanguin cérébral collatéral

Annales de Chirurgie Vasculaire, 2011

Introduction : La m ethode optimale pour pr evoir quand le shunting carotidien n'est pas n ecessa... more Introduction : La m ethode optimale pour pr evoir quand le shunting carotidien n'est pas n ecessaire pendant l'endart eriectomie carotidienne (CEA) est controvers ee. Cette etude analysera la corr elation entre la pression collat erale de perfusion et les statuts de la carotide/collat erales c er ebrales controlat eraux et d eterminera si l' echodoppler pr eop eratoire/angiographie c er ebrale peuvent pr evoir quand la CEA peutêtre faite sans shunt. M ethodes : Quatre-vingt-dix-huit patients ont et e randomis es en shunt syst ematique et 102 en shunt s electif quand la pression collat erale de perfusion (pression carotidienne systolique r esiduelle) etait <40 mmHg pendant la CEA. Tous les patients avaient eu un echodoppler carotidien pr eop eratoire et 87 avaient eu une angiographie. Les r esultats ont et e evalu es en regardant la pr esence de flux collat eral dans l'art ere carotide controlat erale, ou dans la circulation post erieure par les art eres communicantes ant erieures et/ou post erieures. R esultats : Le taux d'accident vasculaire c er ebral p eriop eratoire etait de 1,5% pour le groupe entier. Il n'y avait aucune corr elation entre les symptômes pr eop eratoires et le statut de l'art ere carotide controlat erale (normale, st enos ee, ou occluse). La pression moyenne de perfusion collat erale

Research paper thumbnail of Compliance of Post-EVAR Imaging Surveillance

Journal of Vascular Surgery, 2015

Research paper thumbnail of Prospective Randomized Double-blinded Trial Comparing 2 Anti-MRSA Agents With Supplemental Coverage of Cefazolin Before Lower Extremity Revascularization

Annals of surgery, 2015

To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashio... more To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion. Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections? Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days. Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in...

Research paper thumbnail of Validation of Venous Duplex Ultrasound in Determining Iliac Vein Stenosis and Predictors of Recurrence After Standard Treatment of Active Chronic Venous Ulcers

Journal of Vascular Surgery, 2015

Research paper thumbnail of WITHDRAWN: Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2014

Research paper thumbnail of Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

Journal of Vascular Surgery, 2015

Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary h... more Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.

Research paper thumbnail of The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

Journal of vascular surgery, Jan 9, 2015

Several studies have reported on the role of postoperative duplex ultrasound surveillance after c... more Several studies have reported on the role of postoperative duplex ultrasound surveillance after carotid endarterectomy (CEA) with varying results. Most of these studies had a small sample size or did not analyze cost-effectiveness. We analyzed 489 of 501 CEA patients with patch closure. All patients had immediate postoperative duplex ultrasound examination and were routinely followed up both clinically and with duplex ultrasound at regular intervals of 1 month, 6 months, 12 months, and every 12 months thereafter. A Kaplan-Meier analysis was used to estimate the rate of ≥50% and ≥80% post-CEA restenosis over time and the time frame of progression from normal to ≥50% or ≥80% restenosis. The cost of post-CEA duplex surveillance was also estimated. Overall, 489 patients with a mean age of 68.5 years were analyzed. Ten of these had residual postoperative ≥50% stenosis, and 37 did not undergo a second duplex ultrasound examination and therefore were not included in the final analysis. The...

Research paper thumbnail of Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 15, 2015

To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de n... more To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de novo carotid stenosis vs patients treated for restenosis after carotid endarterectomy (CEA). A retrospective review was conducted of all 385 patients (mean age 68.6±9.6 years; 231 men) who underwent 435 CAS procedures at a large tertiary care center between January 1999 and December 2013. For analysis, patients were stratified based on their lesion type [de novo (dn) vs post-CEA restenosis (res)] and subclassified by symptoms status [symptomatic (Sx) or asymptomatic (Asx)], creating 4 groups: (1) CAS-dn Asx, (2) CAS-dn Sx, (3) CAS-res Asx, and (4) CAS-res Sx. For the CAS-res group, the mean elapsed time from CEA to CAS was 72.4±63.6 months. Outcomes included target vessel reintervention (TVR) and in-stent restenosis (ISR), the latter defined by a carotid duplex ultrasound velocity >275 cm/s. The main indication for initial carotid angiography with possible revascularization was severe ...

Research paper thumbnail of Bilateral lower extremity anterior compartment syndrome in a severely hypothyroid patient

The American surgeon, 2014