Abstract:
PURPOSE:The selection of surgeons to participate in a prospective randomized trial comparing the efficacy of a surgical method with medical management is critically important because it will have a direct impact on the outcome of the study and the future use of the operation. We report the success of the method used for selecting surgeons who participated in the Asymptomatic Carotid Atherosclerosis Study (ACAS) by examining the surgical morbidity and mortality rates and the outcome of the study. METHODS:A Surgical Management Committee established criteria for auditing surgeons who wished to participate in the study. The parameters included a minimum performance of at least 12 carotid endarterectomies (CEA) per year and an audit of each surgeon's last 50 consecutive CEAs with required documentation of a combined neurologic morbidity and mortality rate of <3.0% for asymptomatic patients and <5.0% for all indications including symptomatic patients. RESULTS:As of February 1991, 164 surgeons from 48 medical centers applied for ACAS participation. One hundred seventeen were approved, and their aggregate experience of 5641 operations yielded a combined neurologic morbidity and mortality rate of 2.3% for asymptomatic and symptomatic patients combined. The morbidity and mortality rate for CEA on asymptomatic patients was 1.7%. These surgeons, plus those recruited after February 1991, became investigators in the ACAS trial and were responsible for the surgical care of 825 patients who were randomized to the surgical arm. Seven hundred twenty-four patients actually underwent CEA. One patient (0.14%) died and ten patients (1.38%) had strokes within the 30-day perioperative interval, for a combined stroke or death incidence of 1.52%. The 5-year stroke event rate in the surgical group (including perioperative morbidity and mortality rates) was 5.1%. compared with 11% of patients treated medically, yielding a relative risk reduction of 53% in favor of surgery (p=0.004). CONCLUSIONS:A method for selecting surgeons for participation in the ACAS trial was successful in providing low perioperative morbidity and mortality rates. This materially influenced the outcome of the study in favor of CEA.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Moore WS,Young B,Baker WH,Robertson JT,Toole JF,Vescera CL,Howard VJdoi
10.1016/s0741-5214(96)70277-xsubject
Has Abstractpub_date
1996-02-01 00:00:00pages
323-8issue
2eissn
0741-5214issn
1097-6809pii
S0741521496000225journal_volume
23pub_type
杂志文章abstract:PURPOSE:Although standard heparin has been demonstrated to reduce endothelial cell dysfunction in acute ischemia-reperfusion injury, its mechanism of action remains unknown. We hypothesized that heparin's salutary endothelial effects are independent of its conventional anticoagulant activity and are not caused by nonsp...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(95)70290-3
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:Intravascular ultrasound (IVUS) examination is an integral technique used for treating type B aortic dissection (TBAD) because it verifies true lumen access. The purpose of this study was to evaluate the use of IVUS, to determine factors associated with IVUS use, and to investigate the potential survival bene...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.10.073
更新日期:2020-08-01 00:00:00
abstract::Sciatic artery aneurysms (SAAs) develop in a persistent sciatic artery, which is a congenital anomalous continuation of the internal iliac artery and may be the major blood supply to the lower extremity. SAAs may appear clinically with rupture, thrombosis, distal embolization, or compression of the sciatic nerve. We h...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1986-10-01 00:00:00
abstract::Among various methods to achieve rapid occlusion of the aorta during endovascular repair for ruptured abdominal aortic aneurysm, particular emphasis is placed on two techniques that have been incorporated into our endovascular repair practice. The sheath-over-balloon technique (the Loan SOB technique) facilitates hemo...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.03.033
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of endovascular stent grafting for surgical management of aortic pseudoaneurysm in patients with Behcet's disease (BD). METHODS:We present a single-institution retrospective cohort of patients with aortic pseudoaneurysm and BD treated with aortic stent grafting. Computed tomogra...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.09.052
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:Totally percutaneous aortic aneurysm repair has been shown to be technically feasible, with low morbidity. Complications from percutaneous arterial closure are not insignificant, however, and can be fatal. We sought to evaluate our experience with this technique, compare it with the published literature, and ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.11.004
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to determine whether calf muscle hemoglobin oxygen saturation (Sto2) obtained during a standardized treadmill test is associated with ambulatory function and health-related quality of life (HRQoL) in patients with symptomatic peripheral artery disease (PAD). We hypothesized tha...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.09.057
更新日期:2020-08-01 00:00:00
abstract::Based on our previous study that the outcome of reconstructive surgery for lower limbs could well be predicted by flow waveforms and that this state was defined by variation of wall shear stress (tau) in a cardiac cycle, we set up a desktop computer that could calculate wall shear stress in a given patient. This work ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract:PURPOSE:This study was performed to determine whether early duplex findings predicted restenosis after carotid endarterectomy. METHODS:One hundred ninety-two symptomatic patients who underwent carotid endarterectomy were studied with color duplex imaging at 1 day and 1 week after surgery to identify minor residual dis...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(97)70145-9
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVE:The mechanism of spinal cord injury has been thought to be related to the vulnerability of spinal motor neuron cells against ischemia. However, the mechanisms of such vulnerability are not fully understood. We previously reported that spinal motor neurons may be lost by programmed cell death and thus now inve...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2003.100
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVES:A variety of endovascular specialists perform carotid artery stenting (CAS), but little data exist on outcomes and resource utilization among these specialists. We analyzed differences in outcomes after CAS was performed by radiologists (RAD), cardiologists (CRD), and vascular surgeons (VAS). METHODS:Second...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.12.006
更新日期:2009-05-01 00:00:00
abstract::This study tests the hypothesis that reperfusion injury is the principal cause of limb loss after acute arterial occlusion and that this injury is avoidable. Of 61 isolated hindlimbs amputated at the level of the hip joint, 17 were controls (group I), 5 were perfused without ischemia to establish the validity of the m...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:
更新日期:1989-06-01 00:00:00
abstract:OBJECTIVE:Vein graft adaptation is characterized by loss of expression of the tyrosine kinase receptor Eph-B4, the embryonic determinant of venous identity, without increased expression of its ligand ephrin-B2, the embryonic determinant of arterial identity. Endothelial nitric oxide synthase (eNOS) is an important medi...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.11.041
更新日期:2017-01-01 00:00:00
abstract::Although abdominal aortic aneurysm (AAA) is a common problem in elderly patients, AAA is rare in children. Despite its rarity, early diagnosis is imperative to prevent limb-threatening or fatal complications. The treatment may be complicated, because it must allow for the growth of the child. A saccular AAA in an 11-y...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70100-4
更新日期:1998-10-01 00:00:00
abstract::We performed radiofrequency ablation to treat a symptomatic facial venous malformation of a 24-year-old woman under ultrasound scan-guidance. The 20.25-cm sized original facial venous malformation in her right cheek markedly reduced without any scar formation and was grossly not visible after 1 month of the procedure....
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.03.047
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Controversy exists surrounding gender outcome disparity and abdominal aortic aneurysm (AAA) repair. Previous reports have demonstrated worse outcomes for women undergoing open aneurysm repair (OAR); however, these differences are less evident with endovascular aneurysm repair (EVAR). Epidemiologic studies ha...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.01.086
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:Occlusion of the common carotid artery (CCA) is generally associated with occlusion of the ipsilateral internal carotid artery (ICA) and external carotid artery (ECA). Occasionally, however, collateral circulation to the ECA may preserve patency of the ICA via retrograde perfusion through the bulb. These patien...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1993-06-01 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 Zenith Fenestrated Endovascular Graft (ZFEN; Cook Medical, Bloomington, Ind) has expanded the anatomic eligibility of endovascular aneurysm repair (EVAR) for complex abdominal aortic aneurysms (AAAs). Current data on ZFEN mainly consist of single-institution experiences and show conflicting results. There...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2018.08.192
更新日期:2019-06-01 00:00:00
abstract::When proximal arterial control cannot be obtained by standard methods, it may be achieved safely and bloodlessly by intraluminal routes with balloon catheters, hemostatic sheaths, and catheter-guide wire techniques. This method was used successfully in 20 patients to achieve proximal arterial control without complicat...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70338-6
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:Lower limb ischemia-reperfusion results in skeletal muscle mitochondrial alterations, production of reactive oxygen species (ROS), and remote organ impairments that are largely involved in patient prognosis. However, whether ischemia without reperfusion increases ROS production and precedes mitochondrial alte...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.07.100
更新日期:2014-10-01 00:00:00
abstract::We report four consecutive cases of Kommerell's aneurysm of an aberrant left subclavian artery in patients with a right-sided aortic arch and the results of a systematic review of the literature. In our cohort of patients, three had an aneurysm limited to the origin of the aberrant subclavian artery, causing dysphagia...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2003.07.021
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to review our 27-year clinical experience with open proximal abdominal aortic aneurysm repairs, with a focus on long-term survival. METHODS:A retrospective cohort study was undertaken of all patients who underwent proximal abdominal aortic aneurysm repair between 1986 and 2013...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.01.008
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:Our objective was to characterize the predictive impact of computed tomography (CT) scan volumetric analysis on the natural history of acute uncomplicated type B aortic dissections (ADs). METHODS:We conducted a retrospective review of patients with acute type B ADs from 2009 to 2014. On an iNtuition workstat...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.04.449
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:Carotid intervention is safe and effective in stroke prevention in appropriately selected patients. Despite minimal neurologic complications, procedure-related subclinical microemboli are common and their cognitive effects are largely unknown. In this prospective longitudinal study, we sought to determine lon...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.09.057
更新日期:2017-03-01 00:00:00
abstract::Chronic postthrombotic occlusion of the iliofemoral venous segments produces severe morbidity, which can be alleviated if venous drainage is restored. The common femoral vein (CFV) cannot always be fully recanalized with percutaneous endovenous techniques alone. We report the technique combining operative endovenectom...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.02.260
更新日期:2010-07-01 00:00:00
abstract::Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control o...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.114997
更新日期:2001-06-01 00:00:00
abstract::We present a case report of simultaneous pulmonary emboli and paradoxical embolism to the cerebellum causing a stroke and severe ischemia to the left leg. This patient had risk factors for thromboembolic events that included autoimmune disease, cancer, and recent pelvic surgery. The presence of a perforate foramen ova...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.03.063
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:Studies have shown that a sizable percentage of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is performed outside the instructions for use (IFU). We report our long-term outcomes after EVAR with respect to device-specific IFU. METHODS:Computed tomography angiography data from a c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.01.034
更新日期:2016-07-01 00:00:00
abstract::Use of the milliwatt CO2 laser to perform microvascular anastomoses is associated with characteristic histologic changes, including intimal hyperplasia and medial necrosis. The extent of myointimal proliferation after both suture and laser-assisted vascular anastomosis was assessed in the rat femoral artery model. At ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1986.avs0040217
更新日期:1986-09-01 00:00:00