Abstract：
BACKGROUND:The safety and efficacy of carotid endarterectomy (CEA) in stroke prevention has been well documented. But "high-risk" patients have traditionally been excluded from these studies and may be offered alternate therapies. We examined the safety of CEA in veterans, a medically high-risk group with multiple comorbidities. STUDY DESIGN:The records of all patients having CEAs performed between 1995 and 1999 in the Connecticut Veterans Affairs (VA) hospital were reviewed. Survival and freedom from stroke were determined using Kaplan-Meier survival analysis. The effects of risk factors on outcomes were analyzed with Cox regression. RESULTS:There were 128 CEAs performed in 120 patients, with a mean followup of 8.5 years. Most patients were symptomatic preoperatively and had a high incidence of hypertension (83%), coronary artery disease (64%), diabetes (37%), and pulmonary disease (22%). Incidences of perioperative (30-day) mortality (0.8%), stroke (1.6%), and myocardial infarction (0.8%) were low. Survival rates at 8.9 and 12 years were 50% and 13%, respectively, with 90% patient followup. Freedom from ipsilateral stroke was 90% at 12 years. Age (hazards ratio [HR] 1.1, p=0.004), hypertension (HR 2.6, p=0.04), and elevated creatinine (HR 3.7, p=0.001) were significant risk factors for mortality. Age (HR 0.8, p=0.07) and diastolic blood pressure (HR 1.2, p=0.06) were predictive of ipsilateral stroke. CONCLUSIONS:Despite poor health and symptomatic presentation, patients treated with CEA achieved excellent perioperative outcomes and were protected from stroke for the remainder of their lives. Multiple medical comorbidities should not be used as exclusion criteria for CEA.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Fitzgerald TN,Popp C,Federman DG,Dardik Adoi
10.1016/j.jamcollsurg.2008.02.033subject
Has Abstractpub_date
2008-08-01 00:00:00pages
219-26issue
2eissn
1072-7515issn
1879-1190pii
S1072-7515(08)00275-5journal_volume
207pub_type
杂志文章abstract：BACKGROUND:Ablation is increasingly used to treat primary and secondary liver cancer. Ablation near portal pedicles and hepatic veins is challenging. Irreversible electroporation (IRE) is a new ablation technique that does not rely on heat and, in animals, appears to be safe and effective when applied near hepatic vein...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.04.029
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:Although breast-conserving surgery is the standard of care for early-stage breast cancer, many women report breast asymmetry after this procedure. Risk factors for poor esthetic outcomes are not well understood. STUDY DESIGN:A self-administered survey was sent to patients who underwent lumpectomy (n = 898) ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.07.029
更新日期：2008-02-01 00:00:00
abstract：BACKGROUND:Classic emergency surgical management of complicated perforated sigmoid diverticulitis is based on the principle of a two-stage operation, with colon resection and temporary stoma (Hartmann's procedure). But the later second-stage operation can be technically difficult and can be associated with a significan...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.11.018
更新日期：2008-04-01 00:00:00
abstract：BACKGROUND:The only possible curative treatment in gastric carcinoma is surgery, and there is still controversy surrounding the value of extended lymph node dissection. STUDY DESIGN:A retrospective cohort study was conducted in patients who underwent curative D1 or D2 resection for operable gastric carcinoma. Survival...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00779-1
更新日期：2001-01-01 00:00:00
abstract：BACKGROUND:Hepatic resection of metastatic carcinoid cancer can prolong survival and control symptomatic endocrinopathy. Decompensated carcinoid heart disease (CHD) can develop in some patients with metastatic carcinoid cancers, which can preclude operation for resectable hepatic metastases. We hypothesized that outcom...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.03.029
更新日期：2011-07-01 00:00:00
abstract：BACKGROUND:Protecting future childbearing motivates young women with breast cancer to seek oocyte or embryo cryopreservation. Concerns about delays in cancer treatment may influence patients and practitioners considering these procedures. In this study, we compared timing of chemotherapy in women who underwent ovarian ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2009.08.006
更新日期：2009-11-01 00:00:00
abstract：BACKGROUND:The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy is rapidly becoming the preferred method of staging the axilla of the breast cancer patient. This report describes the impact of postinjection massage on the sensitivity of this surgical technique. STUDY DESIGN:Lymphatic mapping at the ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00771-7
更新日期：2001-01-01 00:00:00
abstract：BACKGROUND:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.05.010
更新日期：2011-09-01 00:00:00
abstract：BACKGROUND:In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable. STUDY DESIGN:For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the int...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1994-12-01 00:00:00
abstract：BACKGROUND:Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2016.06.383
更新日期：2016-10-01 00:00:00
abstract：BACKGROUND:The mortality rate of bleeding esophageal varices in cirrhosis is highest during the period of acute bleeding. This is a report of a randomized trial that compared endoscopic sclerotherapy (EST) with emergency portacaval shunt (EPCS) in cirrhotic patients with acute variceal hemorrhage. STUDY DESIGN:A total...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamcollsurg.2009.02.059
更新日期：2009-07-01 00:00:00
abstract：BACKGROUND:Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic s...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamcollsurg.2008.05.007
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT. STUDY DESIGN:We performed a cadaveric anatomic study analyzing jejunal lymph nodes...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2017.08.001
更新日期：2017-11-01 00:00:00
abstract：BACKGROUND:One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few posto...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(02)01541-7
更新日期：2003-01-01 00:00:00
abstract：BACKGROUND:Parathyroid hormone (PTH) levels after total thyroidectomy have been shown to predict the development of symptomatic hypocalcemia and the need for calcium supplementation. This study aimed to determine whether a PTH level drawn 4 hours postoperatively is as effective as a level drawn on postoperative day 1 (...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.06.003
更新日期：2014-10-01 00:00:00
abstract：BACKGROUND:Many patients seek greater accessibility to health care. Meanwhile, surgeons face increasing time constraints due to workforce shortages and elevated performance demands. Online postoperative care may improve patient access while increasing surgeon efficiency. We aimed to evaluate patient and surgeon accepta...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.08.429
更新日期：2015-12-01 00:00:00
abstract：BACKGROUND:Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine pr...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2008.08.010
更新日期：2008-12-01 00:00:00
abstract：BACKGROUND:Although the overall incidence of venous thromboembolism (VTE) after open aortic surgery is low, it is not known whether specific factors can place patients at increased risk for this complication. The goal of our study was to identify patient and procedure characteristics that are associated with increased ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.12.031
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:Autologous transfusion (AT) has long been considered unsafe in major oncologic operations due to a theoretic risk of spreading metastatic disease, however, few data support this assumption. STUDY DESIGN:We conducted a retrospective analysis of 147 patients who underwent partial hepatectomy for colorectal ca...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2018.10.020
更新日期：2019-06-01 00:00:00
abstract：BACKGROUND:Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings. STUDY DESIGN:Twenty semi-structured interviews were conducted with practicing...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2018.01.008
更新日期：2018-05-01 00:00:00
abstract：BACKGROUND:Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2018.03.021
更新日期：2018-06-01 00:00:00
abstract：BACKGROUND:Falls from a height are a major cause of morbidity and hospital cost. Spinal injury is frequently associated with falls from height, but reliable predictive factors have not been identified. Diagnostic evaluation of the spine is complex and debated. Our objective was to characterize spinal injury after falls...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2006.07.002
更新日期：2006-11-01 00:00:00
abstract：BACKGROUND:The benefit of splenectomy, performed for complications of chronic lymphocytic leukemia (CLL) including autoimmune hemolytic anemia, thrombocytopenia, hypersplenism, and symptomatic splenomegaly, has not been clearly demonstrated. The objective of this study was to determine if splenectomy achieves a predict...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(97)00057-4
更新日期：1997-09-01 00:00:00
abstract：BACKGROUND:We sought to examine our institutional experience (1998 to 2014) with minimally invasive repairs of pectus excavatum (MIRPE). STUDY DESIGN:We conducted a retrospective review and a mailed survey (quality of life assessment). Associations with reoperation due to bar migration and recurrence after bar removal...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.11.020
更新日期：2016-03-01 00:00:00
abstract：BACKGROUND:Although laparoscopic appendectomy is a safe and effective procedure for management of acute appendicitis, data about the feasibility and safety during pregnancy are limited. We aimed to study our experience in this field and to review the scientific evidence available. STUDY DESIGN:All patients undergoing ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.01.068
更新日期：2007-07-01 00:00:00
abstract：BACKGROUND:Pancreatectomy can be complicated by pancreatic anastomotic leakage, causing major morbidity. STUDY DESIGN:Our aim was to determine if vapreotide, a potent long-acting somatostatin analogue, would decrease pancreas-related complications. This prospective, multicenter, randomized, double-blind, placebo-contr...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1016/S1072-7515(03)00104-2
更新日期：2003-04-01 00:00:00
abstract：BACKGROUND:The role of preoperative ERCP and endoscopic sphincterotomy (ES) in the diagnosis and treatment of suspected common bile duct stones (CBDS) in the laparoscopic age is controversial. The preoperative diagnosis of CBDS by ERCP and the removal of CBDS by ES are advantageous because of technical difficulties in ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,评审
doi：10.1016/s1072-7515(98)00241-5
更新日期：1998-12-01 00:00:00
abstract：BACKGROUND:The choice between breast-conserving surgery and modified radical mastectomy in the treatment of women with early stage breast cancer in the Department of Defense Healthcare System may be influenced by demographic factors. STUDY DESIGN:The Department of Defense Automated Central Tumor Registry (ACTUR) was q...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(00)00803-6
更新日期：2001-03-01 00:00:00
abstract：:The management of PABC is very difficult. The incidence of PABC is low, but may be increasing because of the number of women who are becoming pregnant at a later age. More investigation is needed to understand whether the biology of PABC is different from that of breast cancer in nonpregnant women. One exciting area o...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,评审
doi：10.1016/s1072-7515(01)01105-x
更新日期：2002-01-01 00:00:00
abstract：BACKGROUND:Recent population-based studies have demonstrated that the use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is associated with a decrease in the rate of common bile duct (CBD) injury. The cost implications of a management strategy involving routine IOC use have not been ad...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/S1072-7515(02)01806-9
更新日期：2003-03-01 00:00:00
