Amrit Hingorani - Academia.edu (original) (raw)

Papers by Amrit Hingorani

Research paper thumbnail of Circumscribing laser cuts attenuate seizure propagation in a mouse model of focal epilepsy

In partial onset epilepsy, seizures arise focally in the brain and often propagate, causing acute... more In partial onset epilepsy, seizures arise focally in the brain and often propagate, causing acute behavior changes, chronic cognitive decline, and increased mortality. Patients frequently become refractory to medical management, leaving neurosurgical resection of the seizure focus as a primary treatment, which can cause neurologic deficits. In the cortex, focal seizures are thought to spread through horizontal connections in layers II/III, suggesting that selectively severing these connections could block seizure propagation while preserving normal columnar circuitry and function. We induced focal neocortical epilepsy in mice and used tightly-focused femtosecond-duration laser pulses to create a sub-surface, open-cylinder cut surrounding the seizure focus and severing cortical layers II-IV. We monitored seizure propagation using electrophysiological recordings at the seizure focus and at distant electrodes for 3-8 months. With laser cuts, only 5% of seizures propagated to the distan...

Research paper thumbnail of The Great Masquerader – TB Osteoarthritis

Annals of Vascular Surgery

Research paper thumbnail of A Trainee Perspective to Issues Needing Redressal in Current Vascular Surgery Training Programs: Survey Results from 2004 to 2015

Annals of Vascular Surgery

Research paper thumbnail of Value and Limitations of Postoperative Duplex Ultrasound for Iliac Vein Stenting

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of Spontaneous hemorrhage from varicose veins: A single-center experience

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of Success rate and factors predictive of redo radiofrequency ablation of perforator veins

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of IP277. The Role of Intravenous Sedation in Postoperative Back Pain After Iliac Vein Stenting for Nonthrombotic Iliac Vein Lesions

Journal of Vascular Surgery

Research paper thumbnail of Loss of Sirtuin 1 Alters the Secretome of Breast Cancer Cells by Impairing Lysosomal Integrity

Research paper thumbnail of Routine use of ultrasound to avert mechanical complications during placement of tunneled dialysis catheters for hemodialysis

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of IP167. Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training

Journal of Vascular Surgery

Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried fo... more Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried for all vascular surgery residencies and fellowships registered as of July 1, 2016. The programs were broken into two groups: those with solely dedicated vascular surgery fellowships and those that with a vascular surgery integrated residency. A program that had both a fellowship and residency was listed in the residency group. Department Web sites were examined for the total, male and female faculty personnel listings. Additionally, sex of VS-PDs and GS-PDs was also collected. Results: A total of 112 programs were found, of which 61 were solely fellowships. A total of 133 female faculty (16.4%) were identified in all programs of the 813 total faculty examined. The two groups are compared in the Table. Women comprised 23.8% GS-PD positions in vascular surgery fellowships vs 21.6% in integrated vascular surgery residencies (P ¼ .83, Fisher exact test) Conclusions: Integrated vascular surgery residencies were more likely to have more total and female vascular surgery faculty. VS-PD listings were not significantly different between the two groups. Comparatively there were fewer female VS-PDs compared to GS-PDs. These data should be used to enlighten potential recruiting efforts made by vascular surgery departments to address the lack of female presence not only as vascular surgery faculty but as program directors.

Research paper thumbnail of IP261 Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins

Journal of Vascular Surgery

found to be secondary to a congenital hypercoagulable state (hyperhomocysteinemia with MTHFR muta... more found to be secondary to a congenital hypercoagulable state (hyperhomocysteinemia with MTHFR mutation). DSRS was performed electively 5 months later for recurrent nonmassive hemorrhage. The patient developed worsening ascites and a CT performed 8 days postoperatively suggested DSRS thrombosis, which led to referral. Via a right femoral vein approach, the expected location of the shunt at the left adrenal vein was probed with a 2.8F microcatheter and microwire via a 5F catheter. The shunt anastomosis was crossed with a venogram revealing a severe anastomotic stenosis in the splenic vein (Fig, A). The system was exchanged for a 5F sheath, and via the sheath, a 5-mm  18-mm stent was deployed across the anastomotic stenosis. Poststent images demonstrated an improved caliber and flow but a small amount of nonocclusive residual thrombus within the shunt. Suction thrombectomy was performed via the guiding sheath. Post-treatment images demonstrated restored patency with resolution of thrombus and draining of the splenic vein into the left renal vein (Fig, B). Results: Follow-up cross-sectional imaging with duplex ultrasound and contrast-enhanced CT at 36 months demonstrated shunt patency. No episodes of hemorrhage have occurred since shunt revascularization. Conclusions: Our report demonstrates the feasibility of endovascular salvage of early postoperative occlusion of DSRS with documented long term clinical success and shunt patency.

Research paper thumbnail of PC096 Recent Trends in Publications of U.S. Vascular Surgery Program Directors

Journal of Vascular Surgery

Conclusions: Since the approval of a primary certificate in vascular surgery in 2005 and the subs... more Conclusions: Since the approval of a primary certificate in vascular surgery in 2005 and the subsequent rollout of integrated vascular residency programs in 2007, the number of residency programs and the quality of residency applicants has continued to increase. Demand from highly qualified medical school applicants vastly outweighs the current supply of training positions by eightfold. In contrast, demand from fellowship applicants matches the supply of fellowship positions. With a growing public health need for more vascular surgeons, these results suggest that additional residency positions would easily be filled with talented young surgeons.

Research paper thumbnail of Fellows Assessment of Their Training

Annals of Vascular Surgery

Research paper thumbnail of Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins

Journal of Vascular Surgery

patients, with a mean follow-up of 320 days. Kruskall-Wallis tests were significant for improveme... more patients, with a mean follow-up of 320 days. Kruskall-Wallis tests were significant for improvement quantified by symptoms (Clinical, Etiology, Anatomy, and Pathophysiology class) and physical examination findings in patients at 30 days (P ¼ .041), 90 days (P ¼ .045), 6 months (P ¼ .041), and 1 year (P ¼ .011). Ordered logistic regressions found the presence of edema (95% confidence interval [CI], 0.43-2.62; P ¼ .006), active ulceration (95% CI, 0.083-3.50; P ¼ .040), and decreased number of stents placed (95% CI, À1.07 to À0.035; P ¼ .036) to predict increased improvement at 30 days and a history of DVT (95% CI, À1.79 to À0.096; P ¼ .029) to predict decreased improvement 1 year postoperatively. Wilcoxon-Mann-Whitney tests were significant for more improvement in patients who had unilateral vs bilateral stents placed at 30 days (P ¼ .013) and 6 months (P ¼ .039). Major reinterventions (61.7% for recurrent symptoms, 17.6% for persistent symptoms, 6% for DVT) were performed in 37 patients (7.6%). Mean time to reintervention was 191 days. Reinterventions were more prevalent (29.4%) among patients with a history of DVT. Conclusions: Vein stenting for chronic PVOO has a satisfactory outcome at 1 year. Eight percent of patients require a major reintervention. DVT provided by history or suggested by intraoperative findings is common among chronic PVOO patients undergoing vein stent placement. Patient selection and procedural indications warrant further investigation and discussion.

Research paper thumbnail of Shortened protocol for radiofrequency ablation of perforator veins

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard ... more Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard treatment protocol at 85°C has a treatment time of 6 minutes. To make treatment time more efficient, we sought to determine the effect of a shortened protocol for radiofrequency stylet (RFS) ablation by comparing the early success using three different temperatures: 85°C, 90°C, and 95°C. A retrospective study examined 642 procedures of IPV closures in 255 patients with varying degrees of venous insufficiency treated with RFA from 2009 to 2015. The Covidien (Mansfield, Mass) RFA system allows the operator to regulate temperature and allows increments in temperature of the RFS to 85°C, 90°C, and 95°C. The RFS probe was angled at four 90-degree angles at the mentioned temperatures with a shorter treatment time at 6, 4, and 3 minutes, respectively. The three different treatment protocols were compared. All patients had comparative preoperative and postoperative duplex ultrasound scans. Postoperative duplex ultrasound scans were performed 3 to 7 days after the procedure. Successful obliteration was defined as lack of color flow on postoperative duplex ultrasound scanning. Clinical correlation with age, gender, laterality, presenting symptoms (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), location, and vein diameter was also performed. Of the 255 patients who underwent RFS ablation, 138 were female, with a mean age of 65 years (standard deviation, ±14.6 years). These patients had CEAP presentations from C1 to C6 (0 C1, 1 C2, 57 C3, 118 C4, 4 C5, 75 C6). The location of the 642 IPVs was distributed as 472 in the calf and 170 in the ankle; 322 of these procedures were performed on the right leg. Use of a shortened protocol had no significant effect on the early obliteration rates with the 85°C, 90°C, and 95°C protocols, which were 66.1%, 61.8%, and 67.1%, respectively. Significant correlation was seen between location of targeted vein and successful obliteration (P < .001). There was a borderline inverse linear association between higher stylet temperature and successful obliteration in the proximal calf at 85°C. After accounting for within-patient correlation, the middle and distal calf continued to show higher nonobliteration compared with the ankle. No clinical correlation with age, gender, laterality, presenting symptoms of CEAP, or vein diameter was observed. The study showed that shortening the protocol time for RFA of the perforator did not make a significant difference in the early success rate, regardless of the temperature. The overall early success rate is still low (65.1%). RFA of perforator veins has a higher successful closure rate in proximal calf and ankle areas compared with the middle and distal calf.

Research paper thumbnail of Fellows' Assessment of the Future of Vascular Surgery

Annals of Vascular Surgery, 2016

Research paper thumbnail of Interposition bypass of the popliteal artery using the popliteal vein in 1943

Journal of vascular surgery, 2016

The editors and reviewers of this article have no relevant financial relationships to disclose pe... more The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Research paper thumbnail of Recent trends in publications of US vascular surgery program directors

Vascular, 2013

Aim We reviewed the number of vascular publications listed in PubMed from 2001 to 2009 for US pro... more Aim We reviewed the number of vascular publications listed in PubMed from 2001 to 2009 for US program directors in vascular surgery and suggest that this can be used as a benchmark. Methods PubMed listed 3284 citations published during this time period. The average number of citations in PubMed per program director was 3.68 per year. The top third produced 67% of the publications. Journal of Vascular Surgery publications made up 37%. No statistical differences could be ascertained between the regions of the country and the number of publications. Results Compared to the first six years, the number of citations decreased during the last three years (13%). During the first period, there were no programs with no publications and seven with no Journal of Vascular Surgery publication. During the last three years, there were seven programs with no publications and 19 programs with no Journal of Vascular Surgery publications. The number of aortic-endovascular citations peaked in 2002 and 2...

Research paper thumbnail of Recent Trends in Publications of US and European Directors in Vascular Surgery

Annals of Vascular Surgery

Research paper thumbnail of Circumscribing laser cuts attenuate seizure propagation in a mouse model of focal epilepsy

In partial onset epilepsy, seizures arise focally in the brain and often propagate, causing acute... more In partial onset epilepsy, seizures arise focally in the brain and often propagate, causing acute behavior changes, chronic cognitive decline, and increased mortality. Patients frequently become refractory to medical management, leaving neurosurgical resection of the seizure focus as a primary treatment, which can cause neurologic deficits. In the cortex, focal seizures are thought to spread through horizontal connections in layers II/III, suggesting that selectively severing these connections could block seizure propagation while preserving normal columnar circuitry and function. We induced focal neocortical epilepsy in mice and used tightly-focused femtosecond-duration laser pulses to create a sub-surface, open-cylinder cut surrounding the seizure focus and severing cortical layers II-IV. We monitored seizure propagation using electrophysiological recordings at the seizure focus and at distant electrodes for 3-8 months. With laser cuts, only 5% of seizures propagated to the distan...

Research paper thumbnail of The Great Masquerader – TB Osteoarthritis

Annals of Vascular Surgery

Research paper thumbnail of A Trainee Perspective to Issues Needing Redressal in Current Vascular Surgery Training Programs: Survey Results from 2004 to 2015

Annals of Vascular Surgery

Research paper thumbnail of Value and Limitations of Postoperative Duplex Ultrasound for Iliac Vein Stenting

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of Spontaneous hemorrhage from varicose veins: A single-center experience

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of Success rate and factors predictive of redo radiofrequency ablation of perforator veins

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of IP277. The Role of Intravenous Sedation in Postoperative Back Pain After Iliac Vein Stenting for Nonthrombotic Iliac Vein Lesions

Journal of Vascular Surgery

Research paper thumbnail of Loss of Sirtuin 1 Alters the Secretome of Breast Cancer Cells by Impairing Lysosomal Integrity

Research paper thumbnail of Routine use of ultrasound to avert mechanical complications during placement of tunneled dialysis catheters for hemodialysis

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Research paper thumbnail of IP167. Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training

Journal of Vascular Surgery

Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried fo... more Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried for all vascular surgery residencies and fellowships registered as of July 1, 2016. The programs were broken into two groups: those with solely dedicated vascular surgery fellowships and those that with a vascular surgery integrated residency. A program that had both a fellowship and residency was listed in the residency group. Department Web sites were examined for the total, male and female faculty personnel listings. Additionally, sex of VS-PDs and GS-PDs was also collected. Results: A total of 112 programs were found, of which 61 were solely fellowships. A total of 133 female faculty (16.4%) were identified in all programs of the 813 total faculty examined. The two groups are compared in the Table. Women comprised 23.8% GS-PD positions in vascular surgery fellowships vs 21.6% in integrated vascular surgery residencies (P ¼ .83, Fisher exact test) Conclusions: Integrated vascular surgery residencies were more likely to have more total and female vascular surgery faculty. VS-PD listings were not significantly different between the two groups. Comparatively there were fewer female VS-PDs compared to GS-PDs. These data should be used to enlighten potential recruiting efforts made by vascular surgery departments to address the lack of female presence not only as vascular surgery faculty but as program directors.

Research paper thumbnail of IP261 Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins

Journal of Vascular Surgery

found to be secondary to a congenital hypercoagulable state (hyperhomocysteinemia with MTHFR muta... more found to be secondary to a congenital hypercoagulable state (hyperhomocysteinemia with MTHFR mutation). DSRS was performed electively 5 months later for recurrent nonmassive hemorrhage. The patient developed worsening ascites and a CT performed 8 days postoperatively suggested DSRS thrombosis, which led to referral. Via a right femoral vein approach, the expected location of the shunt at the left adrenal vein was probed with a 2.8F microcatheter and microwire via a 5F catheter. The shunt anastomosis was crossed with a venogram revealing a severe anastomotic stenosis in the splenic vein (Fig, A). The system was exchanged for a 5F sheath, and via the sheath, a 5-mm  18-mm stent was deployed across the anastomotic stenosis. Poststent images demonstrated an improved caliber and flow but a small amount of nonocclusive residual thrombus within the shunt. Suction thrombectomy was performed via the guiding sheath. Post-treatment images demonstrated restored patency with resolution of thrombus and draining of the splenic vein into the left renal vein (Fig, B). Results: Follow-up cross-sectional imaging with duplex ultrasound and contrast-enhanced CT at 36 months demonstrated shunt patency. No episodes of hemorrhage have occurred since shunt revascularization. Conclusions: Our report demonstrates the feasibility of endovascular salvage of early postoperative occlusion of DSRS with documented long term clinical success and shunt patency.

Research paper thumbnail of PC096 Recent Trends in Publications of U.S. Vascular Surgery Program Directors

Journal of Vascular Surgery

Conclusions: Since the approval of a primary certificate in vascular surgery in 2005 and the subs... more Conclusions: Since the approval of a primary certificate in vascular surgery in 2005 and the subsequent rollout of integrated vascular residency programs in 2007, the number of residency programs and the quality of residency applicants has continued to increase. Demand from highly qualified medical school applicants vastly outweighs the current supply of training positions by eightfold. In contrast, demand from fellowship applicants matches the supply of fellowship positions. With a growing public health need for more vascular surgeons, these results suggest that additional residency positions would easily be filled with talented young surgeons.

Research paper thumbnail of Fellows Assessment of Their Training

Annals of Vascular Surgery

Research paper thumbnail of Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins

Journal of Vascular Surgery

patients, with a mean follow-up of 320 days. Kruskall-Wallis tests were significant for improveme... more patients, with a mean follow-up of 320 days. Kruskall-Wallis tests were significant for improvement quantified by symptoms (Clinical, Etiology, Anatomy, and Pathophysiology class) and physical examination findings in patients at 30 days (P ¼ .041), 90 days (P ¼ .045), 6 months (P ¼ .041), and 1 year (P ¼ .011). Ordered logistic regressions found the presence of edema (95% confidence interval [CI], 0.43-2.62; P ¼ .006), active ulceration (95% CI, 0.083-3.50; P ¼ .040), and decreased number of stents placed (95% CI, À1.07 to À0.035; P ¼ .036) to predict increased improvement at 30 days and a history of DVT (95% CI, À1.79 to À0.096; P ¼ .029) to predict decreased improvement 1 year postoperatively. Wilcoxon-Mann-Whitney tests were significant for more improvement in patients who had unilateral vs bilateral stents placed at 30 days (P ¼ .013) and 6 months (P ¼ .039). Major reinterventions (61.7% for recurrent symptoms, 17.6% for persistent symptoms, 6% for DVT) were performed in 37 patients (7.6%). Mean time to reintervention was 191 days. Reinterventions were more prevalent (29.4%) among patients with a history of DVT. Conclusions: Vein stenting for chronic PVOO has a satisfactory outcome at 1 year. Eight percent of patients require a major reintervention. DVT provided by history or suggested by intraoperative findings is common among chronic PVOO patients undergoing vein stent placement. Patient selection and procedural indications warrant further investigation and discussion.

Research paper thumbnail of Shortened protocol for radiofrequency ablation of perforator veins

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard ... more Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard treatment protocol at 85°C has a treatment time of 6 minutes. To make treatment time more efficient, we sought to determine the effect of a shortened protocol for radiofrequency stylet (RFS) ablation by comparing the early success using three different temperatures: 85°C, 90°C, and 95°C. A retrospective study examined 642 procedures of IPV closures in 255 patients with varying degrees of venous insufficiency treated with RFA from 2009 to 2015. The Covidien (Mansfield, Mass) RFA system allows the operator to regulate temperature and allows increments in temperature of the RFS to 85°C, 90°C, and 95°C. The RFS probe was angled at four 90-degree angles at the mentioned temperatures with a shorter treatment time at 6, 4, and 3 minutes, respectively. The three different treatment protocols were compared. All patients had comparative preoperative and postoperative duplex ultrasound scans. Postoperative duplex ultrasound scans were performed 3 to 7 days after the procedure. Successful obliteration was defined as lack of color flow on postoperative duplex ultrasound scanning. Clinical correlation with age, gender, laterality, presenting symptoms (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), location, and vein diameter was also performed. Of the 255 patients who underwent RFS ablation, 138 were female, with a mean age of 65 years (standard deviation, ±14.6 years). These patients had CEAP presentations from C1 to C6 (0 C1, 1 C2, 57 C3, 118 C4, 4 C5, 75 C6). The location of the 642 IPVs was distributed as 472 in the calf and 170 in the ankle; 322 of these procedures were performed on the right leg. Use of a shortened protocol had no significant effect on the early obliteration rates with the 85°C, 90°C, and 95°C protocols, which were 66.1%, 61.8%, and 67.1%, respectively. Significant correlation was seen between location of targeted vein and successful obliteration (P < .001). There was a borderline inverse linear association between higher stylet temperature and successful obliteration in the proximal calf at 85°C. After accounting for within-patient correlation, the middle and distal calf continued to show higher nonobliteration compared with the ankle. No clinical correlation with age, gender, laterality, presenting symptoms of CEAP, or vein diameter was observed. The study showed that shortening the protocol time for RFA of the perforator did not make a significant difference in the early success rate, regardless of the temperature. The overall early success rate is still low (65.1%). RFA of perforator veins has a higher successful closure rate in proximal calf and ankle areas compared with the middle and distal calf.

Research paper thumbnail of Fellows' Assessment of the Future of Vascular Surgery

Annals of Vascular Surgery, 2016

Research paper thumbnail of Interposition bypass of the popliteal artery using the popliteal vein in 1943

Journal of vascular surgery, 2016

The editors and reviewers of this article have no relevant financial relationships to disclose pe... more The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Research paper thumbnail of Recent trends in publications of US vascular surgery program directors

Vascular, 2013

Aim We reviewed the number of vascular publications listed in PubMed from 2001 to 2009 for US pro... more Aim We reviewed the number of vascular publications listed in PubMed from 2001 to 2009 for US program directors in vascular surgery and suggest that this can be used as a benchmark. Methods PubMed listed 3284 citations published during this time period. The average number of citations in PubMed per program director was 3.68 per year. The top third produced 67% of the publications. Journal of Vascular Surgery publications made up 37%. No statistical differences could be ascertained between the regions of the country and the number of publications. Results Compared to the first six years, the number of citations decreased during the last three years (13%). During the first period, there were no programs with no publications and seven with no Journal of Vascular Surgery publication. During the last three years, there were seven programs with no publications and 19 programs with no Journal of Vascular Surgery publications. The number of aortic-endovascular citations peaked in 2002 and 2...

Research paper thumbnail of Recent Trends in Publications of US and European Directors in Vascular Surgery

Annals of Vascular Surgery