Juliet Blakeslee-Carter | University of Alabama at Birmingham (original) (raw)

Papers by Juliet Blakeslee-Carter

Research paper thumbnail of Occurrence, Predictors, and Management of Late Vascular Complications following Extracorporeal Membrane Oxygenation

Journal of vascular surgery, Apr 1, 2024

Research paper thumbnail of Bidirectional Aortic Stent Graft Branches: The Direction of The Future?

European journal of vascular and endovascular surgery, May 1, 2024

Research paper thumbnail of Retrograde aortic dissection following fenestrated and branched endovascular aortic repair for an extent III thoracoabdominal aneurysm

Journal of Vascular Surgery Cases, Innovations and Techniques

Research paper thumbnail of Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection

Journal of Vascular Surgery, Aug 1, 2022

BACKGROUND Anatomic remodeling within the thoracic aorta following thoracic endovascular aortic r... more BACKGROUND Anatomic remodeling within the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBAD) has been well documented, but less is known about the response of the untreated visceral aorta. This study aims to investigate visceral aortic behavior following TEVAR for acute or subacute TBAD and identify associations with clinical outcomes. METHODS A multi-center retrospective review was performed of all imaging for all patients treated with TEVAR for acute (0-14 days) and subacute (14-90 days) non-traumatic TBAD between 2006-2020. Cohort was inclusive of uncomplicated, high-risk, and complicated (defined per SVS reporting guidelines) dissections. Centerline aortic measurements of the true and false lumen and total aortic diameter (TAD) were taken at standardized locations relative to aortic anatomy within each aortic zone (zones defined by SVS reporting guidelines). Diameter changes over time were evaluated using repeated measures mixed effects linear growth modeling. Visceral segment instability (VSI) was defined as any growth in TAD ≥ 5mm within aortic zones 5 through 9. RESULTS A total of 82 patients were identified. Median length of imaging follow-up was 2.1 years (IQR 3.9 years), with 15% of the cohort having follow-up longer than 5 years. VSI was present in 55% of the cohort, with an average maximal increase in TAD of 10.4±6.3 mm over a median follow-up of 2.1 years (IQR 3.9 years). Roughly a third of the cohort experienced rapid VSI (growth ≥5mm in first year), and 4.8% of the cohort developed a large para-visceral aneurysm aortic (TAD≥5cm) secondary to VSI. Linear growth modeling identified significant predictable growth in TAD across all visceral zones. Zones 7 had the highest rate of TAD dilation, with a fixed effect estimated rate of 1.3 mm per year (95%-CI 0.23-2.1, p=0.022). The preoperative factor most strongly associated with VSI was ≥6 cumulative number of zones dissected (OR 6.4, 95% OR 1.07-8.6, p=0.041). Odds for aortic reintervention were significantly increased in cases where VSI led to development of a para-visceral aortic aneurysm ≥5cm development (OR 3.7, 95%-CI 1.1-13, p=0.038). CONCLUSION VSI was identified in the majority of patients treated with TEVAR for management of acute and subacute TBAD. Preoperative anatomic features such as extent of dissection, rather than procedural details of graft coverage, may play a more significant role in VSI occurrence. Importantly, significant TAD growth occurred in all visceral segments. These results highlight the importance of lifelong surveillance following TEVAR, and identify a subset of patients that may be at increased risk for re-intervention.

Research paper thumbnail of Progressive aortic enlargement in medically managed acute type B aortic dissections with visceral aortic involvement

European Journal of Vascular and Endovascular Surgery, Dec 1, 2022

Research paper thumbnail of Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and Aortic Research Consortium

Journal of Vascular Surgery, 2022

Research paper thumbnail of Hybrid Pelvic Revascularization in Complex Aortoiliac Aneurysm Repair

Annals of Vascular Surgery

Research paper thumbnail of Type 3 endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative

Journal of Vascular Surgery, Nov 1, 2021

OBJECTIVE Type 3 Endoleaks (T3EL) following complex EVAR (c-EVAR) for abdominal aortic aneurysm h... more OBJECTIVE Type 3 Endoleaks (T3EL) following complex EVAR (c-EVAR) for abdominal aortic aneurysm have been historically difficult to study due to their relative rarity. Previous studies within standard infrarenal EVAR have found an association between T3EL and decreased survival. This study aims to evaluate the occurrence of T3EL in a national multicenter cohort, identify potential procedural characteristics associated with T3EL development, and determine their impact on clinical outcomes in c-EVAR. METHODS A retrospective cohort review was conducted of elective c-EVAR for non-ruptured aneurysms within the Vascular Quality Initiative (VQI) between January 2010 and March 2020. The VQI standards define c-EVAR as suprarenal or pararenal AAA repaired with any thoracoabdominal repairs, fenestrated/branched repairs, parallel stent repairs, custom manufactured devices, and physician modified endografts. End-points assessed were rates of T3EL within c-EVAR, and impact of T3EL on reintervention and survival. Index endoleaks were defined as endoleaks discovered during index hospitalization. Incident endoleaks were defined as new endoleaks, that were not present at index hospitalization, discovered at follow-up. RESULTS 4,070 c-EVAR cases were identified between January 2010 and March 2020, of which, 2,656 (65.2%) had appropriate follow-up data. Half the cohort had a modified or custom graft (n=2,055/4,070, 50.5%). Branches were employed in 3,687 patients (90.5%), while fenestrations and chimney techniques were documented in 13% (n=533) and 15.1% (n=613) respectively . The rate of index T3EL was 4.1% (n=167), and the rate of incident T3EL at follow-up was 0.04% (n=1). Devices categorized as either custom or physician modified were utilized more frequently in patients with index T3EL (78.4%, n=131/167) compared to patients without index T3EL (49.2%, n=1,924/3,903) (p<0.001). Compared to those without T3EL, the presence of index T3EL was not statistically associated with increased aortic reinterventions or increased mortality. CONCLUSIONS T3EL in c-EVAR remain relatively uncommon and are identified predominately at index hospitalization. Development of T3EL was associated with higher device modularity and modification, which suggests that as device technologies continue to advance and become more intricate the occurrence of T3EL may persist and continue to require evaluation. In this study, the presence of T3EL did not appear to have a statistically significant relationship with aortic reinterventions or survival, however these findings are not definitive due to low event rate numbers and high potential for Type 2 errors. Amid the theoretical risk of device fatigue and degeneration, continued evaluations of large cohorts at extended follow-up intervals and diligent reporting remain paramount.

Research paper thumbnail of Wound healing

Research paper thumbnail of Aneurysm Extent-based Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and the United States Aortic Research Consortium

Journal of Vascular Surgery

Research paper thumbnail of Progressive aortic enlargement in medically managed acute type B aortic dissections with visceral aortic involvement

Journal of Vascular Surgery

Research paper thumbnail of Aortic Instability in Medically Managed Acute and Subacute Type 3B Aortic Dissections

Journal of Vascular Surgery

Research paper thumbnail of Long-Term Trends in Preoperative Cardiac Evaluation and Myocardial Infarction after Elective Vascular Procedures

Annals of Vascular Surgery, Feb 1, 2021

INTRODUCTION Vascular surgery has seen rapid increase in the use of less invasive endovascular th... more INTRODUCTION Vascular surgery has seen rapid increase in the use of less invasive endovascular therapies along with advancements in cardiac perioperative optimization in the past two decades. However, a recent NSQIP database study found no improvement in postoperative myocardial infarction (POMI) over a 10-year period in high-risk procedures. The national Society for Vascular Surgery Vascular Quality Initiative (VQI) registry provides a more in-depth characterization of vascular surgery procedures. Here we sought to evaluate long-term trends in POMI using VQI registry data for patients undergoing carotid endarterectomy (CEA), thoracic endovascular aortic repair (TEVAR), endovascular aortic repair (EVAR), open abdominal aortic aneurysm repair (oAAA), suprainguinal bypass (SIB), and infrainguinal bypass (IIB). METHODS A retrospective cohort study was performed using data on elective procedures from 2003-17. Procedures were subdivided by date of operation into 3-year era consecutive groups for subanalysis (2003-05, 2006-08, 2009-11, 2012-14, 2015-17). The incidence of POMI, preoperative risk factors (including individual patient VQI cardiac risk indices (CRI)), and demographics were determined over time. RESULTS A total of 227,837 elective procedures were identified: CEA (n=88,805, 39.0%), TEVAR (n=7,494, 3.3%), EVAR (n=34,376, 15.1%), oAAA (n= 7,568, 3.3%), SIB (n=11,354, 5.0%), and IIB (n=34,661, 15.2%). Across all procedures, the overall rate of POMI was 1.3%. POMI rates from 2003-05 to 2015- 17 for CEA decreased from 0.9% to 0.7% (p=0.21), EVAR from 2.0% to 0.7%, p= 0.003, oAAA from 6.8% to 5.1% (p=0.12), and IIB from 3.8% to 2.4% (p=0.003). SIB POMI decreased from 3.06% to 2.95%, p=0.85 from 2009-17. While POMI after TEVAR increased from 2.40% to 2.56% from 2009-17, p=0.91. Over these same time periods, only EVAR and IIB had a reduction in CRI (p=0.059 and p<0.001, respectively). CEA, EVAR, IIB, and oAAA all showed a significant (p<0.001) increase in preoperative statin use. CONCLUSIONS Except for TEVAR, the incidence of POMI has remained unchanged or decreased over the past 15 years in VQI registries. Patients undergoing IIB and EVAR demonstrated decreases in POMI rates that correspond with a reduction in CRI and increased preoperative statin use. CEA and SIB had no significant change in POMI rates nor CRI. The etiology of decreased POMI rate is uncertain, but increasing statin use, patient-specific factors, and patient selection for procedures may be important drivers of this improvement.

Research paper thumbnail of Is the retrograde in situ branched stentgraft (RIBS) technique for aortic arch repair as tasty as it sounds?

Journal of vascular surgery, 2022

Research paper thumbnail of Effects Of Statin And Antiplatelet Therapy On Mortality Rates In Abdominal Aortic Aneurysm Patients

Annals of Vascular Surgery, 2021

Research paper thumbnail of Association of Statin and Antiplatelet Use with Survival in Patients with AAA with and without Concomitant Atherosclerotic Occlusive Disease

Annals of Vascular Surgery

Research paper thumbnail of Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and Aortic Research Consortium

Journal of Vascular Surgery

Research paper thumbnail of Vascular Complications Based on Mode of Extracorporeal Membrane Oxygenation

Journal of Vascular Surgery, 2021

Research paper thumbnail of Occurrence and outcomes of type 3 endoleaks in endovascular aortic repair within the Vascular Quality Initiative database

BMJ surgery, interventions, & health technologies, 2020

Objectives Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressur... more Objectives Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressure. Previous studies have found a ~2% incidence of T3EL after standard infrarenal endovascular aneurysm repair (EVAR); however, no prior studies with new-generation devices have been able to determine an association between T3EL and clinical outcomes. Here we examine T3EL within the Society for Vascular Surgery Vascular Quality Initiative (VQI) to define rates of occurrence, rates and modes of reintervention, and clinical consequences of these endoleaks. Design and setting Participants receiving infrarenal EVAR in the VQI from January 2003 to September 2018 were analyzed in a retrospective cohort study. Participants Of 42 246 entries in the EVAR procedural registry, 41 604 had complete procedural information and were included in analysis. Of these, 36 082 had long-term follow-up, and 26 422 had follow-up (9–21 months per VQI reporting standards) with complete endoleak data recorded. Inter...

Research paper thumbnail of Aortic Visceral Segment Instability Is Evident After Thoracic Endovascular Aortic Repair for Acute Type B Aortic Dissections

Journal of Vascular Surgery, 2021

Research paper thumbnail of Occurrence, Predictors, and Management of Late Vascular Complications following Extracorporeal Membrane Oxygenation

Journal of vascular surgery, Apr 1, 2024

Research paper thumbnail of Bidirectional Aortic Stent Graft Branches: The Direction of The Future?

European journal of vascular and endovascular surgery, May 1, 2024

Research paper thumbnail of Retrograde aortic dissection following fenestrated and branched endovascular aortic repair for an extent III thoracoabdominal aneurysm

Journal of Vascular Surgery Cases, Innovations and Techniques

Research paper thumbnail of Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection

Journal of Vascular Surgery, Aug 1, 2022

BACKGROUND Anatomic remodeling within the thoracic aorta following thoracic endovascular aortic r... more BACKGROUND Anatomic remodeling within the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBAD) has been well documented, but less is known about the response of the untreated visceral aorta. This study aims to investigate visceral aortic behavior following TEVAR for acute or subacute TBAD and identify associations with clinical outcomes. METHODS A multi-center retrospective review was performed of all imaging for all patients treated with TEVAR for acute (0-14 days) and subacute (14-90 days) non-traumatic TBAD between 2006-2020. Cohort was inclusive of uncomplicated, high-risk, and complicated (defined per SVS reporting guidelines) dissections. Centerline aortic measurements of the true and false lumen and total aortic diameter (TAD) were taken at standardized locations relative to aortic anatomy within each aortic zone (zones defined by SVS reporting guidelines). Diameter changes over time were evaluated using repeated measures mixed effects linear growth modeling. Visceral segment instability (VSI) was defined as any growth in TAD ≥ 5mm within aortic zones 5 through 9. RESULTS A total of 82 patients were identified. Median length of imaging follow-up was 2.1 years (IQR 3.9 years), with 15% of the cohort having follow-up longer than 5 years. VSI was present in 55% of the cohort, with an average maximal increase in TAD of 10.4±6.3 mm over a median follow-up of 2.1 years (IQR 3.9 years). Roughly a third of the cohort experienced rapid VSI (growth ≥5mm in first year), and 4.8% of the cohort developed a large para-visceral aneurysm aortic (TAD≥5cm) secondary to VSI. Linear growth modeling identified significant predictable growth in TAD across all visceral zones. Zones 7 had the highest rate of TAD dilation, with a fixed effect estimated rate of 1.3 mm per year (95%-CI 0.23-2.1, p=0.022). The preoperative factor most strongly associated with VSI was ≥6 cumulative number of zones dissected (OR 6.4, 95% OR 1.07-8.6, p=0.041). Odds for aortic reintervention were significantly increased in cases where VSI led to development of a para-visceral aortic aneurysm ≥5cm development (OR 3.7, 95%-CI 1.1-13, p=0.038). CONCLUSION VSI was identified in the majority of patients treated with TEVAR for management of acute and subacute TBAD. Preoperative anatomic features such as extent of dissection, rather than procedural details of graft coverage, may play a more significant role in VSI occurrence. Importantly, significant TAD growth occurred in all visceral segments. These results highlight the importance of lifelong surveillance following TEVAR, and identify a subset of patients that may be at increased risk for re-intervention.

Research paper thumbnail of Progressive aortic enlargement in medically managed acute type B aortic dissections with visceral aortic involvement

European Journal of Vascular and Endovascular Surgery, Dec 1, 2022

Research paper thumbnail of Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and Aortic Research Consortium

Journal of Vascular Surgery, 2022

Research paper thumbnail of Hybrid Pelvic Revascularization in Complex Aortoiliac Aneurysm Repair

Annals of Vascular Surgery

Research paper thumbnail of Type 3 endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative

Journal of Vascular Surgery, Nov 1, 2021

OBJECTIVE Type 3 Endoleaks (T3EL) following complex EVAR (c-EVAR) for abdominal aortic aneurysm h... more OBJECTIVE Type 3 Endoleaks (T3EL) following complex EVAR (c-EVAR) for abdominal aortic aneurysm have been historically difficult to study due to their relative rarity. Previous studies within standard infrarenal EVAR have found an association between T3EL and decreased survival. This study aims to evaluate the occurrence of T3EL in a national multicenter cohort, identify potential procedural characteristics associated with T3EL development, and determine their impact on clinical outcomes in c-EVAR. METHODS A retrospective cohort review was conducted of elective c-EVAR for non-ruptured aneurysms within the Vascular Quality Initiative (VQI) between January 2010 and March 2020. The VQI standards define c-EVAR as suprarenal or pararenal AAA repaired with any thoracoabdominal repairs, fenestrated/branched repairs, parallel stent repairs, custom manufactured devices, and physician modified endografts. End-points assessed were rates of T3EL within c-EVAR, and impact of T3EL on reintervention and survival. Index endoleaks were defined as endoleaks discovered during index hospitalization. Incident endoleaks were defined as new endoleaks, that were not present at index hospitalization, discovered at follow-up. RESULTS 4,070 c-EVAR cases were identified between January 2010 and March 2020, of which, 2,656 (65.2%) had appropriate follow-up data. Half the cohort had a modified or custom graft (n=2,055/4,070, 50.5%). Branches were employed in 3,687 patients (90.5%), while fenestrations and chimney techniques were documented in 13% (n=533) and 15.1% (n=613) respectively . The rate of index T3EL was 4.1% (n=167), and the rate of incident T3EL at follow-up was 0.04% (n=1). Devices categorized as either custom or physician modified were utilized more frequently in patients with index T3EL (78.4%, n=131/167) compared to patients without index T3EL (49.2%, n=1,924/3,903) (p<0.001). Compared to those without T3EL, the presence of index T3EL was not statistically associated with increased aortic reinterventions or increased mortality. CONCLUSIONS T3EL in c-EVAR remain relatively uncommon and are identified predominately at index hospitalization. Development of T3EL was associated with higher device modularity and modification, which suggests that as device technologies continue to advance and become more intricate the occurrence of T3EL may persist and continue to require evaluation. In this study, the presence of T3EL did not appear to have a statistically significant relationship with aortic reinterventions or survival, however these findings are not definitive due to low event rate numbers and high potential for Type 2 errors. Amid the theoretical risk of device fatigue and degeneration, continued evaluations of large cohorts at extended follow-up intervals and diligent reporting remain paramount.

Research paper thumbnail of Wound healing

Research paper thumbnail of Aneurysm Extent-based Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and the United States Aortic Research Consortium

Journal of Vascular Surgery

Research paper thumbnail of Progressive aortic enlargement in medically managed acute type B aortic dissections with visceral aortic involvement

Journal of Vascular Surgery

Research paper thumbnail of Aortic Instability in Medically Managed Acute and Subacute Type 3B Aortic Dissections

Journal of Vascular Surgery

Research paper thumbnail of Long-Term Trends in Preoperative Cardiac Evaluation and Myocardial Infarction after Elective Vascular Procedures

Annals of Vascular Surgery, Feb 1, 2021

INTRODUCTION Vascular surgery has seen rapid increase in the use of less invasive endovascular th... more INTRODUCTION Vascular surgery has seen rapid increase in the use of less invasive endovascular therapies along with advancements in cardiac perioperative optimization in the past two decades. However, a recent NSQIP database study found no improvement in postoperative myocardial infarction (POMI) over a 10-year period in high-risk procedures. The national Society for Vascular Surgery Vascular Quality Initiative (VQI) registry provides a more in-depth characterization of vascular surgery procedures. Here we sought to evaluate long-term trends in POMI using VQI registry data for patients undergoing carotid endarterectomy (CEA), thoracic endovascular aortic repair (TEVAR), endovascular aortic repair (EVAR), open abdominal aortic aneurysm repair (oAAA), suprainguinal bypass (SIB), and infrainguinal bypass (IIB). METHODS A retrospective cohort study was performed using data on elective procedures from 2003-17. Procedures were subdivided by date of operation into 3-year era consecutive groups for subanalysis (2003-05, 2006-08, 2009-11, 2012-14, 2015-17). The incidence of POMI, preoperative risk factors (including individual patient VQI cardiac risk indices (CRI)), and demographics were determined over time. RESULTS A total of 227,837 elective procedures were identified: CEA (n=88,805, 39.0%), TEVAR (n=7,494, 3.3%), EVAR (n=34,376, 15.1%), oAAA (n= 7,568, 3.3%), SIB (n=11,354, 5.0%), and IIB (n=34,661, 15.2%). Across all procedures, the overall rate of POMI was 1.3%. POMI rates from 2003-05 to 2015- 17 for CEA decreased from 0.9% to 0.7% (p=0.21), EVAR from 2.0% to 0.7%, p= 0.003, oAAA from 6.8% to 5.1% (p=0.12), and IIB from 3.8% to 2.4% (p=0.003). SIB POMI decreased from 3.06% to 2.95%, p=0.85 from 2009-17. While POMI after TEVAR increased from 2.40% to 2.56% from 2009-17, p=0.91. Over these same time periods, only EVAR and IIB had a reduction in CRI (p=0.059 and p<0.001, respectively). CEA, EVAR, IIB, and oAAA all showed a significant (p<0.001) increase in preoperative statin use. CONCLUSIONS Except for TEVAR, the incidence of POMI has remained unchanged or decreased over the past 15 years in VQI registries. Patients undergoing IIB and EVAR demonstrated decreases in POMI rates that correspond with a reduction in CRI and increased preoperative statin use. CEA and SIB had no significant change in POMI rates nor CRI. The etiology of decreased POMI rate is uncertain, but increasing statin use, patient-specific factors, and patient selection for procedures may be important drivers of this improvement.

Research paper thumbnail of Is the retrograde in situ branched stentgraft (RIBS) technique for aortic arch repair as tasty as it sounds?

Journal of vascular surgery, 2022

Research paper thumbnail of Effects Of Statin And Antiplatelet Therapy On Mortality Rates In Abdominal Aortic Aneurysm Patients

Annals of Vascular Surgery, 2021

Research paper thumbnail of Association of Statin and Antiplatelet Use with Survival in Patients with AAA with and without Concomitant Atherosclerotic Occlusive Disease

Annals of Vascular Surgery

Research paper thumbnail of Mortality Differences in Complex Endovascular Repair of Thoracoabdominal Aneurysms in the VQI and Aortic Research Consortium

Journal of Vascular Surgery

Research paper thumbnail of Vascular Complications Based on Mode of Extracorporeal Membrane Oxygenation

Journal of Vascular Surgery, 2021

Research paper thumbnail of Occurrence and outcomes of type 3 endoleaks in endovascular aortic repair within the Vascular Quality Initiative database

BMJ surgery, interventions, & health technologies, 2020

Objectives Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressur... more Objectives Type 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressure. Previous studies have found a ~2% incidence of T3EL after standard infrarenal endovascular aneurysm repair (EVAR); however, no prior studies with new-generation devices have been able to determine an association between T3EL and clinical outcomes. Here we examine T3EL within the Society for Vascular Surgery Vascular Quality Initiative (VQI) to define rates of occurrence, rates and modes of reintervention, and clinical consequences of these endoleaks. Design and setting Participants receiving infrarenal EVAR in the VQI from January 2003 to September 2018 were analyzed in a retrospective cohort study. Participants Of 42 246 entries in the EVAR procedural registry, 41 604 had complete procedural information and were included in analysis. Of these, 36 082 had long-term follow-up, and 26 422 had follow-up (9–21 months per VQI reporting standards) with complete endoleak data recorded. Inter...

Research paper thumbnail of Aortic Visceral Segment Instability Is Evident After Thoracic Endovascular Aortic Repair for Acute Type B Aortic Dissections

Journal of Vascular Surgery, 2021