Abstract:
PURPOSE:Conventional pre-endovascular procedural evaluation uses both noninvasive testing and diagnostic arteriography. Diagnostic and therapeutic procedures often must be performed separately because of concerns about excessive contrast administration or inappropriate location of vascular access for the interventional procedure. We wanted to determine if patients could successfully undergo endovascular procedures based on noninvasive modalities alone. METHODS:One hundred nineteen consecutive patients requiring intervention for lower-extremity ischemia were evaluated by means of physical examinations and segmental pressure measurements. Patients then underwent magnetic resonance angiography (MRA) to image native vessels or duplex scanning for failing bypass grafts. Suitable patients underwent endovascular procedures with "road map" arteriography, which was compared with preoperative duplex scanning or MRA findings. Costs of the conventional and noninvasive approaches were compared, on the basis of estimated hospital cost schedule. RESULTS:Sixty consecutive endovascular procedures were performed in 56 patients (105 lesions angioplastied), either alone (30, 50%) or in combination (30, 50%) with another vascular reconstruction. Completely noninvasive evaluation was accomplished in 43 procedures (72%), either by means of duplex scanning (11, 18%) or MRA (32, 53%). Conventional arteriography (CA) was required in 2 patients (3%) because of MRA contraindications and in 1 patient because of complex previous arterial reconstruction. Fourteen patients had earlier CAs. The findings of the noninvasive modalities were confirmed in every case by means of intraoperative arteriography, and no additional lesions were revealed (no false positive or negative studies). After endovascular interventions, the mean patient ankle-brachial index (ABI) improved from 0.64 +/- 0.03 to 0.81 +/- 0.03 (P <.001) and the mean limb-status category improved from 3.4 +/- 0.2 to 0.8 +/- 0.2 (P <.001). There were 4 initial technical failures (7%), 1 morbidity (1%), and no mortalities. The noninvasive approach was less costly than if preprocedural diagnostic CA had been used, allowing $551 saved for each duplex scanning case and $235 saved for each MRA case. If the cost of a short-stay unit after a diagnostic arteriogram was included, the savings were greater: $695 saved for each duplex scanning case and $379 saved for each MRA case. CONCLUSION:Endovascular procedures can be performed based on preprocedural noninvasive modalities alone. For patients requiring endovascular procedures, knowledge of the arterial anatomy before obtaining arterial access avoids the need for additional punctures or sessions (eg, antegrade puncture for femoral angioplasty after retrograde puncture for the diagnostic arteriogram). This approach is less costly than performing preprocedural diagnostic arteriography and avoids the hazards of arterial puncture and nephrotoxic contrast agents.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Levy MM,Baum RA,Carpenter JPdoi
10.1016/s0741-5214(98)70025-4subject
Has Abstractpub_date
1998-12-01 00:00:00pages
995-1003; discussion 1003-5issue
6eissn
0741-5214issn
1097-6809pii
S0741521498003747journal_volume
28pub_type
杂志文章abstract:PURPOSE:To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features. METHODS:From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had com...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70090-4
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVE:The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification has been shown to correlate well with risk of major amputation and time to wound healing in heterogeneous diabetic and nondiabetic populations. Major amputation continues to plague the most severe stage ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.12.123
更新日期:2017-06-01 00:00:00
abstract:PURPOSE:We studied the ability of recombinant adeno-associated virus (rAAV) vectors to achieve gene transfer in vivo to intact rat carotid arteries. METHODS:Isolated segments of uninjured rat carotid arteries were incubated with (1) rAAV vectors that expressed a beta-galactosidase gene, (2) a related vector with no pr...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(97)70357-4
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:We explored the role of angiotensin II in determining the histomorphometric features of plaque stability in apolipoprotein E-deficient mice submitted to ligation of the carotid artery. METHODS:Six-month-old apolipoprotein E-deficient mice underwent ligation of the common left carotid artery and were immedia...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.04.033
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:Peripheral arterial disease is a significant problem worldwide. In developing countries such as India, the increased incidence of smoking and other forms of nicotine intake has resulted in a large proportion of young individuals with Buerger's disease. The results of surgical and endovascular treatment for t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.09.005
更新日期:2008-12-01 00:00:00
abstract::Vascular surgery has relied upon the pool of general surgical residents for candidates for residency. This has significantly limited the pool of applicants. With the advent of new primary certificate training paradigms, we investigated factors that might alter the career choices for women medical students. A Web-based...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2006.12.072
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Ilio-caval stenting now represents the first line treatment for disabling obstructive ilio-caval lesions. Most patients are young women of child-bearing age. We herein report our experience of pregnancy in women who have a history of ilio-caval stenting. MATERIALS AND METHODS:From November 1995 to April 200...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.01.034
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Endovascular treatment of thoracoabdominal aortic aneurysms is becoming increasingly popular in clinical practice, mainly because of its reduced perioperative mortality and morbidity. However, the custom-made stent graft platform that companies offer requires detailed preoperative planning and production tim...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.jvs.2020.01.049
更新日期:2020-08-01 00:00:00
abstract::Occasionally symptomatic kinking of the internal carotid artery will require correction. More frequently one must rectify a kink that occurs after bifurcation endarterectomy when associated with a redundant internal carotid artery. Most procedures described for shortening of the carotid artery are somewhat cumbersome ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1987.avs0060197
更新日期:1987-08-01 00:00:00
abstract::Allergic reactions to contrast media, preexisting renal dysfunction, and hyperthyroidism are relative contraindications for angiography with conventional contrast medium. Carbon dioxide (CO(2)) angiography is an alternative method in high-risk patients because CO(2) is nontoxic, without allergic potential, and not iod...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.111746
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:Experimentally measured pullout forces for stent grafts (SGs) are used in clinical discussions and as reference values in bench studies and computer simulations. Previous values of these forces are available from studies in which the SG was pulled out in the straight caudal direction. However, clinical and nu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.06.115
更新日期:2016-02-01 00:00:00
abstract::Takayasu aortitis (TA) is a chronic inflammatory disease predominantly seen in young Asian women. The disease is idiopathic and largely affects the aorta and its major branches. The basic pathologic changes in TA are fibrosis and subsequent occlusion of the large arteries. TA is classically termed "pulseless" disease,...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2003.158
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:To examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon. METHODS:Patients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperativ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.01.013
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Abdominal aortic aneurysm (AAA) rupture occurs when wall stress exceeds wall strength. Engineering principles suggest that aneurysm diameter is only one aspect of its geometry that influences wall stress. Finite element analysis considers the complete geometry and determines wall stresses throughout the stru...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.09.002
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Current long-term surveillance after endovascular abdominal aortic aneurysm repair (EVAR) is based on high-resolution contrast-enhanced computed tomography (CT) scans at scheduled, lifelong intervals. The cancer and nephrotoxicity risks of interval CT scanning and prolonged radiation exposure are concerning. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.06.019
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate the roles of the kallikrein-kinin system and matrix metalloproteinases (MMPs) in the development of arterial restenosis attributable to intimal hyperplasia in the femoropopliteal arteries. METHODS:This report describes a single-center prospective study of 27 patie...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.06.106
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Thrombolysis is a common method in the treatment of lower extremity bypass graft occlusion. The purpose of this study was to investigate the results of thrombolytic therapy in the management of acute bypass graft occlusion and to identify risk factors for technical failure and amputation. METHODS:All patien...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2011.05.008
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:Endovascular aneurysm repair (EVAR) is rapidly becoming the predominant technique for repair of abdominal aortic aneurysms. Results from current studies, however, are conflicting on the effect of EVAR on renal function compared with standard open repair. Furthermore, data for open repair in patients with base...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.05.049
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:Infrapopliteal angioplasty (percutaneous transluminal angioplasty [PTA]) is routinely used to treat critical limb ischemia (CLI) despite limited data on long-term outcomes. METHODS:We reviewed all patients undergoing infrapopliteal PTA for CLI from 2004 to 2012 stratified by TransAtlantic Inter-Society Conse...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.10.109
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to describe the technique of transfemoral superselective coil embolization of type II endoleak and its influence on abdominal aortic aneurysm diameter. METHODS:Over 23 months, 104 aortic stent grafts were deployed to exclude abdominal aortic aneurysms, at an academic medical center....
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(02)75467-0
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:This study proposes to establish a simulation-based technique for evaluating shear accumulation in stent grafts and to use the technique to assess the performance of a novel branched stent graft system. METHODS:Computational fluid dynamics models, with transient boundary conditions, particle injection, and r...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.07.108
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:This study analyzed predictors and the long-term consequence of type II endoleak in a large series of elective endovascular abdominal aneurysm repairs (EVARs). METHODS:Baseline characteristics and operative and follow-up data of consecutive patients undergoing EVAR were prospectively collected. Patients who...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.10.092
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:The CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical classification for chronic venous disease (CVD) is based on physician-evaluated clinical signs of CVD. The relationship between CEAP clinical classification and patient-perceived quality of life (QOL) has not been evaluated, but is important...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2003.12.007
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic an...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jvs.2017.05.119
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Prosthetic graft infection is a major complication of peripheral vascular surgery. We investigated the experience of a single institution over 10 years with bypass grafts involving the femoral artery to determine the incidence and risk factors for prosthetic graft infection. METHODS:A retrospective cohort s...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.09.049
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:Endovascular aneurysm repair (EVAR) has reduced early adverse outcomes from abdominal aortic aneurysm (AAA) repair. Preferential use of EVAR may have altered the profile of patients who undergo open repair. The validity of scoring systems such as the Glasgow Aneurysm Score (GAS), devised when open surgery was...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2011.01.029
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to describe the outcomes of patients with acute aortic syndrome (AAS) during and after transfer to a regional aortic center by a rapid transport system. METHODS:Review of patients with AAS who were transferred by a rapid transport system to a regional aortic center was perform...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.08.081
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVES:Technical proficiency in carotid artery stent (CAS) procedures is paramount to ensure patient safety. If virtual reality (VR) simulation is to be used as a valid means for credentialing physicians for CAS procedures, the assessment parameters must be able to evaluate the performance during CAS and to differe...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.06.028
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare findings at presentation and surgical outcomes in patients in whom abdominal aortic aneurysms (AAAs) ruptured after endovascular repair and in patients in whom AAAs ruptured before any treatment during a defined period at a single center. METHODS:This is a retrospecti...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.05.090
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVES:Our aim was to identify important microRNAs (miRNAs) that might play an important role in contributing to aortic dissection by conducting a miRNA profile comparison between thoracic aortic dissection (TAD) and normal thoracic aorta. METHODS:The differentially expressed miRNA profiles of the aortic tissue be...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.11.113
更新日期:2011-05-01 00:00:00