Other search tools

About this data

The publication data currently available has been vetted by Vanderbilt faculty, staff, administrators and trainees. The data itself is retrieved directly from NCBI's PubMed and is automatically updated on a weekly basis to ensure accuracy and completeness.

If you have any questions or comments, please contact us.

Results: 1 to 10 of 10

Publication Record

Connections

Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.
Andersen ND, Bhattacharya SD, Williams JB, Fosbol EL, Lockhart EL, Patel MB, Gaca JG, Welsby IJ, Hughes GC
(2012) Ann Thorac Surg 93: 1921-8; discussion 1928-9
MeSH Terms: Aged, Aorta, Thoracic, Blood Coagulation Tests, Blood Transfusion, Blood Vessel Prosthesis Implantation, Cardiopulmonary Bypass, Cohort Studies, Critical Pathways, Dose-Response Relationship, Drug, Factor VIIa, Female, Heart Arrest, Induced, Hemostasis, Surgical, Hospital Costs, Humans, Intraoperative Period, Male, Matched-Pair Analysis, Middle Aged, Postoperative Hemorrhage, Propensity Score, Recombinant Proteins
Show Abstract · Added June 14, 2016
BACKGROUND - Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa in thoracic aortic operations, a strategy intended to improve safety by minimizing rFVIIa exposure.
METHODS - Between July 2005 and December 2010, 425 consecutive patients at a single referral center underwent thoracic aortic operations with cardiopulmonary bypass (CPB); 77 of these patients received intraoperative low-dose rFVIIa (≤60 μg/kg) for severe coagulopathy after CPB. Propensity matching produced a cohort of 88 patients (44 received intraoperative low-dose rFVIIa and 44 controls) for comparison.
RESULTS - Matched patients receiving intraoperative low-dose rFVIIa got an initial median dose of 32 μg/kg (interquartile range [IQR], 16-43 μg/kg) rFVIIa given 51 minutes (42-67 minutes) after separation from CPB. Patients receiving intraoperative low-dose rFVIIa demonstrated improved postoperative coagulation measurements (partial thromboplastin time 28.6 versus 31.5 seconds; p=0.05; international normalized ratio, 0.8 versus 1.2; p<0.0001) and received 50% fewer postoperative blood product transfusions (2.5 versus 5.0 units; p=0.05) compared with control patients. No patient receiving intraoperative low-dose rFVIIa required postoperative rFVIIa administration or reexploration for bleeding. Rates of stroke, thromboembolism, myocardial infarction, and other adverse events were equivalent between groups.
CONCLUSIONS - Intraoperative low-dose rFVIIa led to improved postoperative hemostasis with no apparent increase in adverse events. Intraoperative rFVIIa administration in appropriately selected patients may correct coagulopathy early in the course of refractory blood loss and lead to improved safety through the use of smaller rFVIIa doses. Appropriately powered randomized studies are necessary to confirm the safety and efficacy of this approach.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
0 Communities
1 Members
0 Resources
22 MeSH Terms
Access survival amongst hemodialysis patients referred for preventive angiography and percutaneous transluminal angioplasty.
Chan KE, Pflederer TA, Steele DJ, Lilly MP, Ikizler TA, Maddux FW, Hakim RM
(2011) Clin J Am Soc Nephrol 6: 2669-80
MeSH Terms: Aged, Angioplasty, Balloon, Arteriovenous Shunt, Surgical, Blood Vessel Prosthesis Implantation, Case-Control Studies, Chi-Square Distribution, Constriction, Pathologic, Female, Graft Occlusion, Vascular, Humans, Kidney Failure, Chronic, Linear Models, Male, Medicare, Middle Aged, Proportional Hazards Models, Radiography, Regional Blood Flow, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Vascular Patency
Show Abstract · Added May 20, 2014
BACKGROUND AND OBJECTIVES - Referring hemodialysis patients for elective access angiography and percutaneous transluminal angioplasty (PTA) is commonly done to prevent access failure, yet the effectiveness of this procedure remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASURES: An observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft was performed. Cox regression was used to determine whether access intervention was associated with improved 1-year access survival.
RESULTS - Nonsurgical access intervention was found to be frequent at a rate of 20.9 procedures per 100 access years. In the 1-year period after intervention using angiography and PTA, the overall access failure rate was 53.7 per 100 access years in the intervention group and 49.6 in the nonintervention group (HR = 1.02; 95% CI, 0.96 to 1.08). Similar findings were also seen when the analysis was repeated in only fistulas (HR = 1.06; 95% CI, 0.98 to 1.15) and grafts (HR = 0.95; 95% CI, 0.86 to 1.05). In patients with a low intra-access flow rate (HR = 0.86; 95% CI, 0.75 to 0.99) or a new access (HR = 0.79; 95% CI, 0.71 to 0.89), angiography and PTA significantly increased access survival when compared with nonintervention (P for interaction was <0.0001). Angiography-PTA-related upper-extremity hematoma, vessel injury, or embolism-thrombosis occurred in 1.1% of all patients.
CONCLUSIONS - Access characteristics significantly modify the survival benefits of angiography and PTA intervention where the benefits of these interventions are most seen in newer accesses or accesses with insufficient flow.
0 Communities
2 Members
0 Resources
25 MeSH Terms
Early outcomes among those initiating chronic dialysis in the United States.
Chan KE, Maddux FW, Tolkoff-Rubin N, Karumanchi SA, Thadhani R, Hakim RM
(2011) Clin J Am Soc Nephrol 6: 2642-9
MeSH Terms: Aged, Arteriovenous Shunt, Surgical, Blood Vessel Prosthesis Implantation, Catheterization, Central Venous, Female, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States
Show Abstract · Added May 20, 2014
BACKGROUND AND OBJECTIVES - Approximately one million Americans initiated chronic dialysis over the past decade; the first-year mortality rate reported by the U.S. Renal Data System was 19.6% in 2007. This estimate has historically excluded the first 90 days of chronic dialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - To characterize the mortality and hospitalization risks for patients starting chronic renal replacement therapy, we followed all patients initiating dialysis in 1733 facilities throughout the United States (n = 303,289). Mortality and hospitalizations within the first 90 days were compared with outcomes after this period, and the results were analyzed. Standard time-series analyses were used to depict the weekly risk estimates for each outcome.
RESULTS - Between 1997 and 2009, >300,000 patients initiated chronic dialysis and were followed for >35 million dialysis treatments; the highest risk for morbidity and mortality occurred in the first 2 weeks of treatment. The initial 2-week risk of death for a typical dialysis patient was 2.72-fold higher, and the risk of hospitalization was 1.95-fold higher when compared to a patient who survived the first year of chronic dialysis (week 53 after initiation). Similarly, over the first 90 days, the risk of mortality and hospitalization remained elevated. Thereafter, between days 91 and 365, these risks decreased considerably by more than half. Surviving these first weeks of dialysis was most associated with the type of vascular access. Initiating dialysis with a fistula was associated with a decreased early death risk by 61%, whereas peritoneal dialysis decreased the risk by 87%.
CONCLUSIONS - The first 2 weeks of chronic dialysis are associated with heightened mortality and hospitalization risks, which remain elevated over the ensuing 90 days.
0 Communities
1 Members
0 Resources
17 MeSH Terms
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a delayed complication of aortic root replacement.
Entrikin DW, Shroff GS, Kon ND, Carr JJ
(2011) J Cardiovasc Comput Tomogr 5: 333-5
MeSH Terms: Adult, Aneurysm, False, Aorta, Aortic Valve, Blood Vessel Prosthesis Implantation, Cardiac Surgical Procedures, Echocardiography, Transesophageal, Heart Aneurysm, Humans, Male, Mitral Valve, Reoperation, Tomography, X-Ray Computed, Treatment Outcome
Show Abstract · Added February 15, 2014
A 41-year-old male with prior history of aortic root replacement for infectious endocarditis was found to have a pseudoaneurysm in the fibrous continuity between the aortic and mitral valves: the so called "mitral-aortic intervalvular fibrosa." Preoperative cardiac-gated computed tomographic angiography and intraoperative transesophageal echocardiography imaging findings used to guide surgical repair are presented.
Copyright © 2011 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
0 Communities
1 Members
0 Resources
14 MeSH Terms
Change in vascular access and hospitalization risk in long-term hemodialysis patients.
Lacson E, Wang W, Lazarus JM, Hakim RM
(2010) Clin J Am Soc Nephrol 5: 1996-2003
MeSH Terms: Aged, Arteriovenous Shunt, Surgical, Blood Vessel Prosthesis Implantation, Catheterization, Peripheral, Chi-Square Distribution, Female, Hospitalization, Humans, Male, Middle Aged, North America, Proportional Hazards Models, Prospective Studies, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors
Show Abstract · Added May 20, 2014
BACKGROUND AND OBJECTIVES - Conversion from central venous catheters to a graft or a fistula is associated with lower mortality risk in long-term hemodialysis (HD) patients; however, a similar association with hospitalization risk remains to be elucidated.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - We conducted a prospective observational study all maintenance in-center HD patients who were treated in Fresenius Medical Care, North America legacy facilities; were alive on January 1, 2007; and had baseline laboratory data from December 2006. Access conversion (particularly from a catheter to a fistula or a graft) during the 4-month period from January 1 through April 30, 2007, was linked using Cox models to hospitalization risk during the succeeding 1-year follow-up period (until April 30, 2008).
RESULTS - The cohort (N = 79,545) on January 1, 2007 had 43% fistulas, 29% catheters, and 27% grafts. By April 30, 2007, 70,852 patients were still on HD, and among 19,792 catheters initially, only 10.3% (2045 patients) converted to either a graft or a fistula. With catheters as reference, patients who converted to grafts/fistulas had similar adjusted hazard ratios (0.69) as patients on fistulas (0.71), while patients with fistulas/grafts who converted to catheters did worse (1.22), all P < 0.0001.
CONCLUSIONS - Catheters remain associated with the greatest hospitalization risk. Conversion from a catheter to either graft or fistula had significantly lower hospitalization risk relative to keeping the catheter. Prospective studies are needed to determine whether programs that reduce catheters will decrease hospitalization risk in HD patients.
0 Communities
1 Members
0 Resources
17 MeSH Terms
The "right" of passage: surviving the first year of dialysis.
Wingard RL, Chan KE, Lazarus JM, Hakim RM
(2009) Clin J Am Soc Nephrol 4 Suppl 1: S114-20
MeSH Terms: Arteriovenous Shunt, Surgical, Biomarkers, Blood Vessel Prosthesis Implantation, Case-Control Studies, Catheterization, Central Venous, Drug Utilization, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Hemoglobins, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Patient Education as Topic, Phosphorus, Program Evaluation, Proportional Hazards Models, Renal Dialysis, Retrospective Studies, Risk Assessment, Risk Factors, Serum Albumin, Time Factors, Treatment Outcome, United States, Vitamin D
Show Abstract · Added May 20, 2014
Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n = 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n = 4308) versus matched controls (C; n = 4308) by 34% (hazard ratio = 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio = 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS = 15.5 days per patient year versus C = 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS = 22.4% versus C = 19.7%, P < 0.01), eKt/V > or = 1.2 (RS = 66% versus C = 53.5%, P < 0.01), albumin > or = 4.0 g/dl (RS = 26% versus C = 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS = 52.4% versus C = 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS = 32% versus C = 25%, P < 0.01) and more vitamin D orders (RS = 60% versus C = 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.
0 Communities
1 Members
0 Resources
28 MeSH Terms
Revascularization after segmental resection of lower extremity soft tissue sarcomas.
Adelani MA, Holt GE, Dittus RS, Passman MA, Schwartz HS
(2007) J Surg Oncol 95: 455-60
MeSH Terms: Adolescent, Adult, Aged, Amputation, Blood Vessel Prosthesis Implantation, Cohort Studies, Female, Humans, Limb Salvage, Liposarcoma, Lower Extremity, Male, Middle Aged, Reconstructive Surgical Procedures, Retrospective Studies, Saphenous Vein, Sarcoma, Soft Tissue Neoplasms, Surgical Wound Dehiscence, Thigh, Treatment Outcome
Show Abstract · Added March 5, 2014
BACKGROUND AND OBJECTIVES - Limb salvage surgery combined with vascular reconstruction has replaced amputation as the preferred treatment of soft tissue sarcomas involving major vascular structures of the extremities. We describe our experience with soft tissue sarcomas involving major vascular structures and examine outcomes according to the type of graft selected for arterial reconstruction. We also examine the effect of venous reconstruction on post-operative edema.
METHODS - This retrospective review includes 14 patients with lower extremity soft-tissue sarcomas that encased major vessels, requiring combined limb-preserving tumor resection and revascularization with a synthetic or autogenous saphenous vein graft. Edema in patients with and without venous reconstruction was compared. The incidence of infection, wound dehiscence, and graft thrombosis were compared according to arterial graft type.
RESULTS - There was no significant difference in edema in patients with venous reconstruction and those without. There was also no significant difference in infection and graft thrombosis in patients with synthetic grafts and those with autogenous saphenous vein grafts. Wound dehiscence occurred more often in patients with synthetic grafts (P = 0.029).
CONCLUSIONS - Although this study was small, these results suggest that further studies are needed to determine the roles that vascular graft selection and venous reconstruction play in clinical outcome.
Copyright 2007 Wiley-Liss, Inc.
0 Communities
1 Members
0 Resources
21 MeSH Terms
Carotid body tumor resection: does the need for vascular reconstruction worsen outcome?
Smith JJ, Passman MA, Dattilo JB, Guzman RJ, Naslund TC, Netterville JL
(2006) Ann Vasc Surg 20: 435-9
MeSH Terms: Academic Medical Centers, Adult, Aged, Blood Vessel Prosthesis Implantation, Carotid Arteries, Carotid Body, Carotid Body Tumor, Cranial Nerve Diseases, Embolization, Therapeutic, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Postoperative Complications, Retrospective Studies, Tennessee, Veins
Show Abstract · Added March 5, 2014
We evaluated outcomes after carotid body tumor resection (CBR) requiring vascular reconstruction. Patients undergoing CBR at an academic medical center between 1990 and 2005 were identified. Medical records were retrospectively reviewed for clinical data, operative details, Shamblin's classification, tumor pathology, complications, and mortality. Comparisons were performed between those undergoing CBR alone and CBR requiring vascular reconstruction (CBR-VASC). Of the 71 CBRs performed in 62 patients, 16 required vascular reconstruction (23%). Although there was no difference in mean tumor size (CBR 29.1 +/- 11.9 mm, CBR-VASC 32.5 +/- 9.9 mm; p = 0.133), carotid body tumors were more commonly Shamblin's I when CBR was performed alone (CBR 53% vs. CBR-VASC 25%, p = 0.045) and Shamblin's II/III when vascular reconstruction was required (CBR 47% vs. CBR-VASC 75%, p = 0.045). There was also a significant difference in malignant tumor pathology when vascular reconstruction was required (CBR 4.4% vs. CBR-VASC 25%, p = 0.034). Cranial nerve dysfunction was higher in patients requiring vascular repair (CBR 27% vs. CBR-VASC 63%, p = 0.012), but there was no difference in baroreflex failure (CBR 7.27% vs. CBR-VASC 0%, p = 0.351), Horner's syndrome (CBR 5.5% vs. CBR-VASC 6.25%, p = 0.783), or first bite syndrome (CBR 7.27% vs. CBR-VASC 12.5%, p = 0.877). There were no perioperative strokes in either group, and one death was unrelated to operation. When required, carotid artery reconstruction at the time of CBR can be performed safely. Although cranial nerve dysfunction is more common when vascular repair is required, this is more likely related to locally advanced disease and tumor pathology rather than operative techniques.
0 Communities
1 Members
0 Resources
18 MeSH Terms
Use of aortic cuffs to exclude iliac artery aneurysms during AneuRx stent-graft placement: initial experience.
Brown DB, Sanchez LA, Hovsepian DM, Rubin BG, Sicard GA, Picus D
(2001) J Vasc Interv Radiol 12: 1383-7
MeSH Terms: Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis Implantation, Dilatation, Pathologic, Feasibility Studies, Humans, Iliac Aneurysm, Radiography, Retrospective Studies
Show Abstract · Added March 5, 2014
PURPOSE - As many as 39% of patients who undergo aortic endografting for abdominal aortic aneurysm disease will have ectasia of the iliac arteries that will require intervention. Coil embolization of the internal iliac artery and extension of the graft to the external iliac artery is one solution to this problem. However, 19%-41% of these patients experience buttock claudication, which may be permanent, after unilateral embolization. The authors examined an alternative: the use of larger-sized aortic cuffs to seal the iliac limb. Outcomes and short-term results are presented in this article.
MATERIALS AND METHODS - From October 1999 to August 2000, 144 AneuRx stent-grafts were placed at the authors' institution. Among the population receiving stent-grafts, 14 patients had 15 aortic cuffs placed across the distal iliac graft limbs to seal them and preserve flow to the internal iliac artery. One patient had bilateral cuffs placed. Five patients had embolization of the contralateral internal iliac artery because of bilateral disease. Patients were followed with computed tomography (CT) at 1, 6, and 12 months to evaluate for endoleaks.
RESULTS - One- and 6-month endoleak rates, determined from only those patients with follow-up CT, were 0% and 10%, respectively. One type II endoleak was first discovered 9 months after graft placement. It sealed spontaneously at 15-month follow-up. One patient among the five who had internal iliac artery embolization had claudication. Mean CT follow-up was 7.8 months (range, 1-15). One patient declined CT but was alive and well 11 months after endografting. One patient moved across the country and declined follow-up.
CONCLUSION - Placement of aortic cuffs in dilated iliac arteries can preserve flow to the ipsilateral internal iliac artery and provide an adequate seal. Additionally, the option of later treatment is maintained. Patients with bilateral iliac ectasia can undergo stent-graft placement without bilateral internal iliac artery embolization. Longer-term follow-up in larger numbers of patients will be important to determine the ultimate durability of this technique.
0 Communities
1 Members
0 Resources
8 MeSH Terms
Hemodialysis access failure: a call to action.
Hakim R, Himmelfarb J
(1998) Kidney Int 54: 1029-40
MeSH Terms: Arteriovenous Shunt, Surgical, Blood Vessel Prosthesis Implantation, Costs and Cost Analysis, Humans, Hyperplasia, Materials Testing, Morbidity, Nephrology, Physician's Role, Polytetrafluoroethylene, Renal Dialysis, Thrombosis, United States, Vascular Surgical Procedures
Show Abstract · Added May 20, 2014
Recent evidence suggests that the cost as well as the morbidity associated with the maintenance of hemodialysis access is increasing rapidly; currently, the cost exceeds 1 billion dollars and access related hospitalization accounts for 25% of all hospital admissions in the U.S.A. This increase in cost and morbidity has been associated with several epidemiological trends that may contribute to access failure. These include late patient referral to nephrologists and surgeons, late planning of vascular access as well as a shift from A-V fistulaes to PTFE grafts and temporary catheters, which have a higher failure rate. The reasons for this shift in the types of access is multifactorial and is not explained by changes in the co-morbidities of patients presenting to dialysis. Surgical preference and training also appear to play an important role in the large regional variation and patency rate of these PTFE grafts. We propose a program for early placement of A-V fistulae, a continuous quality improvement, multidisciplinary program to monitor access outcome, the development of new biomaterials, and a research plan to investigate pharmacological intervention to reduce development of stenosis and clinical interventions to treat those that do develop, prior to thrombosis.
0 Communities
1 Members
0 Resources
14 MeSH Terms