Albert Hakaim - Academia.edu (original) (raw)

Papers by Albert Hakaim

Stem Cell Research & Therapy, Mar 22, 2023

Background Therapeutic interventions that optimize angiogenic activities may reduce rates of end-... more Background Therapeutic interventions that optimize angiogenic activities may reduce rates of end-stage kidney disease, critical limb ischemia, and lower extremity amputations in individuals with diabetic kidney disease (DKD). Infusion of autologous mesenchymal stromal cells (MSC) is a promising novel therapy to rejuvenate vascular integrity. However, DKD-related factors, including hyperglycemia and uremia, might alter MSC angiogenic repair capacity in an autologous treatment approach. Methods To explore the angiogenic activity of MSC in DKD, the transcriptome of adipose tissue-derived MSC obtained from DKD subjects was compared to age-matched controls without diabetes or kidney impairment. Nextgeneration RNA sequencing (RNA-seq) was performed on MSC (DKD n = 29; Controls n = 9) to identify differentially expressed (DE; adjusted p < 0.05, |log 2 fold change|> 1) messenger RNA (mRNA) and microRNA (miRNA) involved in angiogenesis (GeneCards). Paracrine-mediated angiogenic repair capacity of MSC conditioned medium (MSCcm) was assessed in vitro using human umbilical vein endothelial cells incubated in high glucose and indoxyl sulfate for a hyperglycemic, uremic state. Results RNA-seq analyses revealed 133 DE mRNAs (77 upregulated and 56 down-regulated) and 208 DE miRNAs (119 up-and 89 down-regulated) in DKD-MSC versus Control-MSC. Interestingly, miRNA let-7a-5p, which regulates angiogenesis and participates in DKD pathogenesis, interacted with 5 angiogenesis-associated mRNAs (transgelin/TAGLN, thrombospondin 1/THBS1, lysyl oxidase-like 4/LOXL4, collagen 4A1/COL4A1 and collagen 8A1/COL8A1). DKD-MSCcm incubation with injured endothelial cells improved tube formation capacity, enhanced migration, reduced adhesion molecules E-selectin, vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 mRNA expression in endothelial cells. Moreover, angiogenic repair effects did not differ between treatment groups (DKD-MSCcm vs. Control-MSCcm).

Annals of Vascular Surgery, May 1, 2021

OBJECTIVE To review short- and long-term outcomes of all carotid artery stenting (CAS) in patient... more OBJECTIVE To review short- and long-term outcomes of all carotid artery stenting (CAS) in patients with radiation induced (RI) internal carotid artery (ICA) stenosis compared with patients with atherosclerotic stenosis (AS). METHODS We performed a single-center, multi-site case-control study of transfemoral carotid artery intervention in patients stented for RI or AS. Cases of stented RI carotid arteries were identified using a CAS database covering 01/2000-12/2019. These patients were randomly matched 2:1 with stented patients due to AS by age, sex and year of CAS. A conditional logistic regression model was performed to estimate the odds of re-intervention in the RI group. Lastly, a systematic review was performed to assess outcomes of RI stenosis treated with CAS. RESULTS There were 120 CAS in 113 patients due to RI ICA stenosis. 89 (78.8%) were male and 68 (60.2%) were symptomatic. Reasons for radiation included most commonly treatment for diverse malignancies of the head and neck in 109 (96.5%) patients. Mean radiation dose was 58.9±15.6Gy and time from radiation to CAS was 175.3±140.4 months. Symptoms included 31 transient ischemic attacks (TIA), 21 strokes (7 acute and 14 subacute) and 17 amaurosis fugax. Mean National Institutes of Health Stroke Scale (NIHSS) in acute strokes was 8.7±11.2. In asymptomatic patients, the indication for CAS was high grade stenosis determined by duplex ultrasound. All CAS were successfully completed. Re-interventions were more frequent in the RI ICA stenosis cohort compared with the AS cohort (10.1% versus 1.4%). Re-interventions occurred in 14 vessels and causes for re-intervention were restenosis in 12 followed by TIA/stroke in 2 vessels. On conditional regression modeling, patients with RI ICA stenosis were at a higher risk for re-intervention (OR=7.1 [95% CI=2.1-32.8]; p=0.004). Mean follow-up was 33.7±36.9 months and mortality across groups was no different (p=0.12). CONCLUSION In our single center, multi-site cohort study, patients who underwent CAS for RI ICA stenosis experienced a higher rate of restenosis and a higher number of re-interventions compared to CAS for AS. Although CAS is safe and effective for this RI ICA stenosis cohort, further data is needed to reduce the risk of restenosis and close patient surveillance is warranted. In our systematic review, CAS was considered an excellent alternative option for the treatment of patients with RI ICA stenosis. However, careful patient selection is warranted due to the increased risk of restenosis on long-term follow-up.

Neurocritical Care, Sep 25, 2019

2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for aaa i... more 2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for aaa in a large cohort of asymptomatic people. independent predictors of aaa were male sex, older age and a history of smoking. accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy.

Mayo Clinic Proceedings, Oct 1, 1999

midterm results seem consistent with those of traditional open repair of aneurysms. This review d... more midterm results seem consistent with those of traditional open repair of aneurysms. This review describes the current indications, minimal requirements, different devices and associated techniques, and potential complications of endoluminal repair of abdominal aortic aneurysms. Future aspects of endoluminal grafting are also discussed.

Annals of Vascular Surgery, Jul 1, 2019

Hybrid repair involves both open and endovascular interventions. This technique has been increasi... more Hybrid repair involves both open and endovascular interventions. This technique has been increasingly used in treating complex aortic aneurysms as an alternative to conventional open repairs, mainly due to the avoidance of aortic cross-clamping and the associated increased ischemia time to the viscera. We report a hybrid repair of a juxtarenal abdominal aortic aneurysm (AAA) complicated by a nonstandard right renal artery originating just proximal to the aortic bifurcation in the setting of a nonfunctional left kidney.

Journal of Vascular and Endovascular Therapy, 2018

World Journal of Clinical Cases, Jan 7, 2022

BACKGROUND Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typ... more BACKGROUND Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typically treated initially with anticoagulation therapy, and if this fails, with endovascular interventions. However, due to its rarity, there are not many studies that have explored the effectiveness of anticoagulation and endovascular therapies in treating SMVT. AIM To evaluate patients diagnosed with SMVT who received endovascular therapy in addition to anticoagulation and report technical and clinical outcomes. METHODS A retrospective analysis of the patients who underwent endovascular treatment for SMVT at Mayo Clinic from 2000-2019 was performed. Technical success was defined as angiographic improvement in SMV flow after intervention. Primary patency was defined as the interval from reestablishing mesenteric venous flow until the first repeat thrombotic event or need for additional intervention. Secondary patency was defined as successful restoration of flow after repeat intervention until rethrombosis or last follow-up. The adverse events were reported through Clavien-Dindo classification. RESULTS Twenty-four patients were included for analysis. The median age at intervention was 60 years (35-74 years) and 16 (67%) were men. Nineteen patients presented with acute thrombosis (79.2%) and 5 with chronic thrombosis with acute manifestations (20.8%). The most commonly used endovascular modalities were thrombectomy in 12 patients (50.0%) and catheter-directed thrombolysis in 10 patients (41.7%). Technical success was achieved in 18 patients (75%). The 14-d and 30-d primary patency rates were 88.9% and 83.3%, respectively. Adverse events were reported in two patients (8.3%), one marked as grade IIIB, and 1 death marked as grade V. Five-year overall survival rate was 82% (58%-100%). CONCLUSION Endovascular intervention with anticoagulation appears to be effective for managing SMVT. This treatment combination may be considered as first-line therapy for SMVT management in select patients.

Annals of Vascular Surgery, Nov 1, 2019

Journal of Vascular Surgery, Jun 1, 2018

reports describe removal by femoral arteriotomy, so the severity of this IABP rupture was rare in... more reports describe removal by femoral arteriotomy, so the severity of this IABP rupture was rare in the need for aortotomy to remove the IABP secondary to the abundance of dense clot material within the balloon. Recommendation for removal at the first sign of rupture as well as avoidance of larger balloons than are needed will reduce the incidence of this problem. A review of the literature and subsequent recommendations for the surgical management of IABP entrapment are discussed in the context of our case.

International Journal of Angiology, Jun 27, 2020

Prior studies suggest high prevalence of intracranial aneurysms (IA) in patients with infrarenal ... more Prior studies suggest high prevalence of intracranial aneurysms (IA) in patients with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience in clinical detection/treatment of IAs in AAA patients and estimated the risk of IA in patients with AAA relative to patients without AAA. We reviewed cases of vascular surgery infrarenal AAA repairs at three Mayo Clinic sites from January 1998 to December 2018. Concurrent controls were randomly matched in a 1:1 ratio by age, sex, smoking history, and head imaging characteristics. Conditional logistic regression was used to calculate odds ratios. We reviewed 2,300 infrarenal AAA repairs. Mean size of AAA at repair was 56.9 ± 11.4 mm; mean age at repair, 75.8 ± 8.0 years. 87.5% of the cases ( n = 2014) were men. Head imaging was available in 421 patients. Thirty-seven patients were found to have 45 IAs for a prevalence of 8.8%. Mean size of IA was 4.6 ± 3.5 mm; mean age at IA detection, 72.0 ± 10.8 years. Thirty (81%) out of 37 patients were men. Six patients underwent treatment for IA: four for ruptured IAs and two for unruptured IAs. All were diagnosed before AAA repair. Treatment included five clippings and one coil-assisted stenting. Time from IA diagnosis to AAA repair was 16.4 ± 11.0 years. Two of these patients presented with ruptured AAA, one with successful repair and a second one that resulted in death. Odds of IA were higher for patients with AAA versus those without AAA (8.8% [37/421] vs. 3.1% [13/421]; OR 3.18; 95% confidence interval, 1.62–6.27, p < 0.001). Co-prevalence of IA among patients with AAA was 8.8% and is more than three times the rate seen in patients without AAA. All IAs were diagnosed prior to AAA repair. Surveillance for AAA after IA treatment could have prevented two AAA ruptures and one death.

Journal of Vascular Surgery, Oct 1, 2018

necessary" about their AAA (Fig). Nearly half (37%) reported that they did not receive any inform... more necessary" about their AAA (Fig). Nearly half (37%) reported that they did not receive any information at all about the options for open surgical repair or endovascular repair (Fig). In terms of other sources of information about their treatment options beyond their primary care provider, few used the Internet (12%) and family or friends (14%), and more than half reported that their views on treatment options had not been influenced at all by anyone (55%; Fig). Conclusions: Patients with AAA are commonly referred with little information from their primary care physicians, and many do not garner information about their options for surgical or endovascular treatment of their AAA from the Internet or other sources. Vascular surgeons have the primary responsibility in educating patients about the best option for the treatment of their AAA.

Blackwell Publishing eBooks, Jan 14, 2008

Mayo Clinic Proceedings, Oct 1, 1999

midterm results seem consistent with those of traditional open repair of aneurysms. This review d... more midterm results seem consistent with those of traditional open repair of aneurysms. This review describes the current indications, minimal requirements, different devices and associated techniques, and potential complications of endoluminal repair of abdominal aortic aneurysms. Future aspects of endoluminal grafting are also discussed.

Annals of Vascular Surgery, Oct 1, 2018

Blackwell Publishing eBooks, 2006

The results of any surgical technique must be compared among surgeons and medical centers. Given ... more The results of any surgical technique must be compared among surgeons and medical centers. Given the relatively new technique of endovascular aneurysm repair (EVAR), and the consequent development of complications and situations unique to it, a system of uniform reporting standards is essential. Regardless of the background of the practitioner or the venue of device deployment, placement of a graft for EVAR must be viewed as the beginning of a lifelong commitment between the patient and the physician. As emphasized throughout this monograph, the majority of postoperative complications with EVAR are usually asymptomatic at detection and are only discovered with vigilant, scheduled patient imaging and physical examination. In addition, endoleaks may first appear or reappear years after EVAR. The purpose of this appendix is to briefly review the published standards of clinical specialists who perform EVAR and provide postoperative follow-up. In 1997, the need for reporting standards after EVAR was initially addressed. These early attempts at standardization were largely patterned after the standards applied to traditional vascular surgical procedures. The main focus was primary and secondary patency and classification of the cause of the aneurysm. Also reported at that time were the first attempts to characterize persistent flow into the excluded aneurysm segment, or endoleak. Initially, endoleaks were classified as primary (demonstrated on completion angiogram or first computed tomographic scan); secondary (not detected early); or recurrent (after an endoleak had been sealed) [1]. Also at that time, the Society for Vascular Surgery and the International Society for Cardiovascular Surgery published their recommendations for risk stratification based on aortoiliac anatomy [2]. As experience with EVAR and follow-up imaging increased, further refinements in endoleak classification followed. Specifically, the classification expanded from type I and type II endoleaks to include type III (fabric defect, inadequate modular seal, or modular disconnection) and type IV (graft porosity causing "a blush"). In addition, endopressure, or nonendoleak aneurysm sac pressurization, was first described. Unlike an endoleak of unknown cause, "endopressure" referred to a situation in which the aneurysm sac exhibited

Journal of Vascular Surgery Cases and Innovative Techniques, Jun 1, 2021

This case describes a 72-year-old woman with a history of chronic kidney disease stage III presen... more This case describes a 72-year-old woman with a history of chronic kidney disease stage III presented with bilateral renal artery stenosis with a progressively atrophied right kidney. At the time of surgery, the atrophied kidney was nonfunctional. Therefore, the patient underwent unilateral renal artery revascularization via the inferior mesenteric artery as an inflow. A 7-year follow-up revealed improvement in the kidney function and stabilization of blood pressure, which was controlled with less number of antihypertensive medications. In brief, open surgical correction of the renal artery stenosis using the inferior mesenteric artery as an inflow source can retrieve renal function in selected hypertensive patients with ischemic nephropathy.

Journal of Vascular Surgery Cases and Innovative Techniques, Dec 1, 2020

The management of an infected endovascular aortic stent graft can be complex and morbid. Therefor... more The management of an infected endovascular aortic stent graft can be complex and morbid. Therefore, caution should be exercised before an endovascular approach is considered in patients presenting with a saccular aneurysm who are younger than 65 years and without risk factors for this may indicate a mycotic aneurysm. An open approach with consideration of aneurysm excision should be entertained to prevent an endovascular implantation in the setting of an infected aorta. We report a case of endovascular aortic stent graft infection that led to complex surgical management and prolonged postoperative care.

Journal of Vascular Surgery, 1993

PUBLISHED BY IMPERIAL COLLEGE PRESS AND DISTRIBUTED BY WORLD SCIENTIFIC PUBLISHING CO. eBooks, May 1, 2001

Annals of Vascular Surgery, Jul 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Stem Cell Research & Therapy, Mar 22, 2023

Background Therapeutic interventions that optimize angiogenic activities may reduce rates of end-... more Background Therapeutic interventions that optimize angiogenic activities may reduce rates of end-stage kidney disease, critical limb ischemia, and lower extremity amputations in individuals with diabetic kidney disease (DKD). Infusion of autologous mesenchymal stromal cells (MSC) is a promising novel therapy to rejuvenate vascular integrity. However, DKD-related factors, including hyperglycemia and uremia, might alter MSC angiogenic repair capacity in an autologous treatment approach. Methods To explore the angiogenic activity of MSC in DKD, the transcriptome of adipose tissue-derived MSC obtained from DKD subjects was compared to age-matched controls without diabetes or kidney impairment. Nextgeneration RNA sequencing (RNA-seq) was performed on MSC (DKD n = 29; Controls n = 9) to identify differentially expressed (DE; adjusted p < 0.05, |log 2 fold change|> 1) messenger RNA (mRNA) and microRNA (miRNA) involved in angiogenesis (GeneCards). Paracrine-mediated angiogenic repair capacity of MSC conditioned medium (MSCcm) was assessed in vitro using human umbilical vein endothelial cells incubated in high glucose and indoxyl sulfate for a hyperglycemic, uremic state. Results RNA-seq analyses revealed 133 DE mRNAs (77 upregulated and 56 down-regulated) and 208 DE miRNAs (119 up-and 89 down-regulated) in DKD-MSC versus Control-MSC. Interestingly, miRNA let-7a-5p, which regulates angiogenesis and participates in DKD pathogenesis, interacted with 5 angiogenesis-associated mRNAs (transgelin/TAGLN, thrombospondin 1/THBS1, lysyl oxidase-like 4/LOXL4, collagen 4A1/COL4A1 and collagen 8A1/COL8A1). DKD-MSCcm incubation with injured endothelial cells improved tube formation capacity, enhanced migration, reduced adhesion molecules E-selectin, vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 mRNA expression in endothelial cells. Moreover, angiogenic repair effects did not differ between treatment groups (DKD-MSCcm vs. Control-MSCcm).

Annals of Vascular Surgery, May 1, 2021

OBJECTIVE To review short- and long-term outcomes of all carotid artery stenting (CAS) in patient... more OBJECTIVE To review short- and long-term outcomes of all carotid artery stenting (CAS) in patients with radiation induced (RI) internal carotid artery (ICA) stenosis compared with patients with atherosclerotic stenosis (AS). METHODS We performed a single-center, multi-site case-control study of transfemoral carotid artery intervention in patients stented for RI or AS. Cases of stented RI carotid arteries were identified using a CAS database covering 01/2000-12/2019. These patients were randomly matched 2:1 with stented patients due to AS by age, sex and year of CAS. A conditional logistic regression model was performed to estimate the odds of re-intervention in the RI group. Lastly, a systematic review was performed to assess outcomes of RI stenosis treated with CAS. RESULTS There were 120 CAS in 113 patients due to RI ICA stenosis. 89 (78.8%) were male and 68 (60.2%) were symptomatic. Reasons for radiation included most commonly treatment for diverse malignancies of the head and neck in 109 (96.5%) patients. Mean radiation dose was 58.9±15.6Gy and time from radiation to CAS was 175.3±140.4 months. Symptoms included 31 transient ischemic attacks (TIA), 21 strokes (7 acute and 14 subacute) and 17 amaurosis fugax. Mean National Institutes of Health Stroke Scale (NIHSS) in acute strokes was 8.7±11.2. In asymptomatic patients, the indication for CAS was high grade stenosis determined by duplex ultrasound. All CAS were successfully completed. Re-interventions were more frequent in the RI ICA stenosis cohort compared with the AS cohort (10.1% versus 1.4%). Re-interventions occurred in 14 vessels and causes for re-intervention were restenosis in 12 followed by TIA/stroke in 2 vessels. On conditional regression modeling, patients with RI ICA stenosis were at a higher risk for re-intervention (OR=7.1 [95% CI=2.1-32.8]; p=0.004). Mean follow-up was 33.7±36.9 months and mortality across groups was no different (p=0.12). CONCLUSION In our single center, multi-site cohort study, patients who underwent CAS for RI ICA stenosis experienced a higher rate of restenosis and a higher number of re-interventions compared to CAS for AS. Although CAS is safe and effective for this RI ICA stenosis cohort, further data is needed to reduce the risk of restenosis and close patient surveillance is warranted. In our systematic review, CAS was considered an excellent alternative option for the treatment of patients with RI ICA stenosis. However, careful patient selection is warranted due to the increased risk of restenosis on long-term follow-up.

Neurocritical Care, Sep 25, 2019

2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for aaa i... more 2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for aaa in a large cohort of asymptomatic people. independent predictors of aaa were male sex, older age and a history of smoking. accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy.

Mayo Clinic Proceedings, Oct 1, 1999

midterm results seem consistent with those of traditional open repair of aneurysms. This review d... more midterm results seem consistent with those of traditional open repair of aneurysms. This review describes the current indications, minimal requirements, different devices and associated techniques, and potential complications of endoluminal repair of abdominal aortic aneurysms. Future aspects of endoluminal grafting are also discussed.

Annals of Vascular Surgery, Jul 1, 2019

Hybrid repair involves both open and endovascular interventions. This technique has been increasi... more Hybrid repair involves both open and endovascular interventions. This technique has been increasingly used in treating complex aortic aneurysms as an alternative to conventional open repairs, mainly due to the avoidance of aortic cross-clamping and the associated increased ischemia time to the viscera. We report a hybrid repair of a juxtarenal abdominal aortic aneurysm (AAA) complicated by a nonstandard right renal artery originating just proximal to the aortic bifurcation in the setting of a nonfunctional left kidney.

Journal of Vascular and Endovascular Therapy, 2018

World Journal of Clinical Cases, Jan 7, 2022

BACKGROUND Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typ... more BACKGROUND Superior mesenteric venous thrombosis (SMVT) is a rare but fatal condition that is typically treated initially with anticoagulation therapy, and if this fails, with endovascular interventions. However, due to its rarity, there are not many studies that have explored the effectiveness of anticoagulation and endovascular therapies in treating SMVT. AIM To evaluate patients diagnosed with SMVT who received endovascular therapy in addition to anticoagulation and report technical and clinical outcomes. METHODS A retrospective analysis of the patients who underwent endovascular treatment for SMVT at Mayo Clinic from 2000-2019 was performed. Technical success was defined as angiographic improvement in SMV flow after intervention. Primary patency was defined as the interval from reestablishing mesenteric venous flow until the first repeat thrombotic event or need for additional intervention. Secondary patency was defined as successful restoration of flow after repeat intervention until rethrombosis or last follow-up. The adverse events were reported through Clavien-Dindo classification. RESULTS Twenty-four patients were included for analysis. The median age at intervention was 60 years (35-74 years) and 16 (67%) were men. Nineteen patients presented with acute thrombosis (79.2%) and 5 with chronic thrombosis with acute manifestations (20.8%). The most commonly used endovascular modalities were thrombectomy in 12 patients (50.0%) and catheter-directed thrombolysis in 10 patients (41.7%). Technical success was achieved in 18 patients (75%). The 14-d and 30-d primary patency rates were 88.9% and 83.3%, respectively. Adverse events were reported in two patients (8.3%), one marked as grade IIIB, and 1 death marked as grade V. Five-year overall survival rate was 82% (58%-100%). CONCLUSION Endovascular intervention with anticoagulation appears to be effective for managing SMVT. This treatment combination may be considered as first-line therapy for SMVT management in select patients.

Annals of Vascular Surgery, Nov 1, 2019

Journal of Vascular Surgery, Jun 1, 2018

reports describe removal by femoral arteriotomy, so the severity of this IABP rupture was rare in... more reports describe removal by femoral arteriotomy, so the severity of this IABP rupture was rare in the need for aortotomy to remove the IABP secondary to the abundance of dense clot material within the balloon. Recommendation for removal at the first sign of rupture as well as avoidance of larger balloons than are needed will reduce the incidence of this problem. A review of the literature and subsequent recommendations for the surgical management of IABP entrapment are discussed in the context of our case.

International Journal of Angiology, Jun 27, 2020

Prior studies suggest high prevalence of intracranial aneurysms (IA) in patients with infrarenal ... more Prior studies suggest high prevalence of intracranial aneurysms (IA) in patients with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience in clinical detection/treatment of IAs in AAA patients and estimated the risk of IA in patients with AAA relative to patients without AAA. We reviewed cases of vascular surgery infrarenal AAA repairs at three Mayo Clinic sites from January 1998 to December 2018. Concurrent controls were randomly matched in a 1:1 ratio by age, sex, smoking history, and head imaging characteristics. Conditional logistic regression was used to calculate odds ratios. We reviewed 2,300 infrarenal AAA repairs. Mean size of AAA at repair was 56.9 ± 11.4 mm; mean age at repair, 75.8 ± 8.0 years. 87.5% of the cases ( n = 2014) were men. Head imaging was available in 421 patients. Thirty-seven patients were found to have 45 IAs for a prevalence of 8.8%. Mean size of IA was 4.6 ± 3.5 mm; mean age at IA detection, 72.0 ± 10.8 years. Thirty (81%) out of 37 patients were men. Six patients underwent treatment for IA: four for ruptured IAs and two for unruptured IAs. All were diagnosed before AAA repair. Treatment included five clippings and one coil-assisted stenting. Time from IA diagnosis to AAA repair was 16.4 ± 11.0 years. Two of these patients presented with ruptured AAA, one with successful repair and a second one that resulted in death. Odds of IA were higher for patients with AAA versus those without AAA (8.8% [37/421] vs. 3.1% [13/421]; OR 3.18; 95% confidence interval, 1.62–6.27, p < 0.001). Co-prevalence of IA among patients with AAA was 8.8% and is more than three times the rate seen in patients without AAA. All IAs were diagnosed prior to AAA repair. Surveillance for AAA after IA treatment could have prevented two AAA ruptures and one death.

Journal of Vascular Surgery, Oct 1, 2018

necessary" about their AAA (Fig). Nearly half (37%) reported that they did not receive any inform... more necessary" about their AAA (Fig). Nearly half (37%) reported that they did not receive any information at all about the options for open surgical repair or endovascular repair (Fig). In terms of other sources of information about their treatment options beyond their primary care provider, few used the Internet (12%) and family or friends (14%), and more than half reported that their views on treatment options had not been influenced at all by anyone (55%; Fig). Conclusions: Patients with AAA are commonly referred with little information from their primary care physicians, and many do not garner information about their options for surgical or endovascular treatment of their AAA from the Internet or other sources. Vascular surgeons have the primary responsibility in educating patients about the best option for the treatment of their AAA.

Blackwell Publishing eBooks, Jan 14, 2008

Mayo Clinic Proceedings, Oct 1, 1999

midterm results seem consistent with those of traditional open repair of aneurysms. This review d... more midterm results seem consistent with those of traditional open repair of aneurysms. This review describes the current indications, minimal requirements, different devices and associated techniques, and potential complications of endoluminal repair of abdominal aortic aneurysms. Future aspects of endoluminal grafting are also discussed.

Annals of Vascular Surgery, Oct 1, 2018

Blackwell Publishing eBooks, 2006

The results of any surgical technique must be compared among surgeons and medical centers. Given ... more The results of any surgical technique must be compared among surgeons and medical centers. Given the relatively new technique of endovascular aneurysm repair (EVAR), and the consequent development of complications and situations unique to it, a system of uniform reporting standards is essential. Regardless of the background of the practitioner or the venue of device deployment, placement of a graft for EVAR must be viewed as the beginning of a lifelong commitment between the patient and the physician. As emphasized throughout this monograph, the majority of postoperative complications with EVAR are usually asymptomatic at detection and are only discovered with vigilant, scheduled patient imaging and physical examination. In addition, endoleaks may first appear or reappear years after EVAR. The purpose of this appendix is to briefly review the published standards of clinical specialists who perform EVAR and provide postoperative follow-up. In 1997, the need for reporting standards after EVAR was initially addressed. These early attempts at standardization were largely patterned after the standards applied to traditional vascular surgical procedures. The main focus was primary and secondary patency and classification of the cause of the aneurysm. Also reported at that time were the first attempts to characterize persistent flow into the excluded aneurysm segment, or endoleak. Initially, endoleaks were classified as primary (demonstrated on completion angiogram or first computed tomographic scan); secondary (not detected early); or recurrent (after an endoleak had been sealed) [1]. Also at that time, the Society for Vascular Surgery and the International Society for Cardiovascular Surgery published their recommendations for risk stratification based on aortoiliac anatomy [2]. As experience with EVAR and follow-up imaging increased, further refinements in endoleak classification followed. Specifically, the classification expanded from type I and type II endoleaks to include type III (fabric defect, inadequate modular seal, or modular disconnection) and type IV (graft porosity causing "a blush"). In addition, endopressure, or nonendoleak aneurysm sac pressurization, was first described. Unlike an endoleak of unknown cause, "endopressure" referred to a situation in which the aneurysm sac exhibited

Journal of Vascular Surgery Cases and Innovative Techniques, Jun 1, 2021

This case describes a 72-year-old woman with a history of chronic kidney disease stage III presen... more This case describes a 72-year-old woman with a history of chronic kidney disease stage III presented with bilateral renal artery stenosis with a progressively atrophied right kidney. At the time of surgery, the atrophied kidney was nonfunctional. Therefore, the patient underwent unilateral renal artery revascularization via the inferior mesenteric artery as an inflow. A 7-year follow-up revealed improvement in the kidney function and stabilization of blood pressure, which was controlled with less number of antihypertensive medications. In brief, open surgical correction of the renal artery stenosis using the inferior mesenteric artery as an inflow source can retrieve renal function in selected hypertensive patients with ischemic nephropathy.

Journal of Vascular Surgery Cases and Innovative Techniques, Dec 1, 2020

The management of an infected endovascular aortic stent graft can be complex and morbid. Therefor... more The management of an infected endovascular aortic stent graft can be complex and morbid. Therefore, caution should be exercised before an endovascular approach is considered in patients presenting with a saccular aneurysm who are younger than 65 years and without risk factors for this may indicate a mycotic aneurysm. An open approach with consideration of aneurysm excision should be entertained to prevent an endovascular implantation in the setting of an infected aorta. We report a case of endovascular aortic stent graft infection that led to complex surgical management and prolonged postoperative care.

Journal of Vascular Surgery, 1993

PUBLISHED BY IMPERIAL COLLEGE PRESS AND DISTRIBUTED BY WORLD SCIENTIFIC PUBLISHING CO. eBooks, May 1, 2001

Annals of Vascular Surgery, Jul 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.