Abstract:
BACKGROUND:There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits (AD), may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients. METHODS:Consecutive patients undergoing CEA between 1st January 2000 and 31st December 2010 were retrospectively identified. Seven of the deficit items from the Canadian Study of Health and Aging-frailty index (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) were tabulated for each patient. Predictors of perioperative and long-term outcomes were evaluated using regression analysis. RESULTS:About 1,782 CEAs in 1,496 patients (mean age: 71.3 ± 9.3 years, 56.3% male, 35.4% symptomatic) were included. The risk of major adverse events (stroke, death, or myocardial infarction) at 30 days for patients with ≤3 deficits was 2.53% vs. 8.81% for patients with ≥4 deficits (P < 0.001). For patients with ≥5 deficits, the risk was 15.18%. Each additional deficit increased the odds of a 30-day major adverse event and hospital stay >2 days by 1.64 (P < 0.001) and 1.15 (P < 0.001), respectively. In multivariate analysis, the presence of ≥4 deficits was more predictive of perioperative major adverse events (odds ratio [OR] = 3.62, P < 0.001) than symptomatology within 6 months (OR = 1.57, P = 0.08) or octogenarian status (OR = 2.00, P = 0.02). Kaplan-Meier analysis showed significantly decreased survival over time with accumulating deficits (P < 0.001). Patients with ≥4 deficits have a hazards ratio for death of 2.6 compared to patients with ≤3 deficits (P < 0.001). Overall survival is estimated at 79.5% (95% confidence interval [CI]: 0.77-0.82) at 5 years in patients with ≤3 deficits versus 52.4% (95% CI: 0.46-0.58) in patients with ≥4 deficits, respectively. In subgroup analysis of asymptomatic patients, 5-year survival for octogenarian male patients with ≥4 deficits was only 26.8%. For asymptomatic males aged 70-79 years with ≥4 deficits, 5-year survival was 59.9%. CONCLUSIONS:An AD model is more predictive of perioperative adverse events after CEA than age or symptomatic status. This model remains predictive of long-term survival. In asymptomatic male octogenarians with 4 or more AD, 5-year survival is severely limited.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Sridharan ND,Chaer RA,Wu BB,Eslami MH,Makaroun MS,Avgerinos EDdoi
10.1016/j.avsg.2017.06.150subject
Has Abstractpub_date
2018-01-01 00:00:00pages
97-103eissn
0890-5096issn
1615-5947pii
S0890-5096(17)30863-4journal_volume
46pub_type
杂志文章abstract:BACKGROUND:Almost 80% of patients with end-stage renal disease (ESRD) initiate dialysis via a central venous catheter (CVC). CVCs are associated with multiple complications and a high cost of care. The purpose of our project is to determine the impact of early cannulation arteriovenous grafts (ECAVGs) on quality of car...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.02.007
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The aim of the study is to determine whether performing endovascular aortic aneurysm repair (EVAR) in a dedicated vascular hybrid operating room (OR) is associated with a decreased patient radiation and contrast dose compared with mobile C-arm imaging in a conventional OR. METHODS:This is a retrospective st...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.04.019
更新日期:2019-11-01 00:00:00
abstract::We treated six patients with disseminated atheroembolism complicated by severe and unremitting pain from bilateral foot lesions. All patients had multiple and severe medical risk factors. One patient had a recent myocardial infarction, six patients had renal failure, and three were undergoing hemodialysis. Definitive ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02009454
更新日期:1990-05-01 00:00:00
abstract::Renal ischemia remains a vexing issue in the repair of suprarenal abdominal aortic aneurysms (SR-AAAs). Multiple reconstruction methods have been described, including fish-mouth anastomoses, renal artery reimplantation, and aortorenal interposition grafts. We present an alternative method of SR-AAA repair that minimiz...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-6602-5
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:The ability to salvage the mangled lower extremity is both technically challenging and time consuming. It requires the collaborative efforts among multiple surgical specialties in addition to comprehensive post-traumatic wound follow-up. Our institution has integrated a dynamic effort among these specialists...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.07.056
更新日期:2020-08-12 00:00:00
abstract:BACKGROUND:Femoropopliteal bypass is a common vascular reconstructive procedure. A significant proportion of bypasses become ineffective within 1 year because of occlusion due to progression of intimal hyperplasia (IH). METHODS:The clinical part of the study involved an analysis of 43 patients with proximal femoropopl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.06.008
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Arteriovenous fistulas (AVFs) are favored for hemodialysis (HD) access. However, in many instances, AVFs fail to mature. We examined the utility of postoperative color duplex ultrasound (CDU) in assessing AVF maturation and determining the need for balloon-assisted maturation (BAM). METHODS:A total of 633 p...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.10.006
更新日期:2020-11-21 00:00:00
abstract::Spinal cord ischemic injury is one of the feared complications during aortic cross-clamping. The aim of this study was to investigate whether cyclosporin A (CsA) has a protective effect on spinal cord during ischemia in a rabbit model. A total of 22 New Zealand white rabbits were studied in three groups. One of the gr...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9022-2
更新日期:2006-03-01 00:00:00
abstract::In 163 carotid reconstructions under peridural anesthesia performed from 1988 to 1991, we routinely measured residual systemic and carotid artery pressure during clamping. Seventy-nine patients (48.5%) were asymptomatic and 84 (51.5%) had a history of neurologic manifestations in the form of transient ischemic attacks...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02001887
更新日期:1996-05-01 00:00:00
abstract::Patients with tumors in limbs who undergo surgical treatment may present involvement of major vessels. The artery must be reconstructed for limb salvage and the vein may be reconstructed to avoid the onset of venous hypertension. The objective of this study was to analyze the results from surgical treatment of tumors ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-003-0031-0
更新日期:2003-07-01 00:00:00
abstract::This report describes the surgical management of 24 patients with concurrent abdominal aortic aneurysm (AAA) and urinary tract neoplasm. The patient population consisted of 22 men and two women whose average age was 65.5 years. AAA sizes ranged from 3.1 to 9.0 cm (mean 5.2 cm) in diameter. Urinary tract neoplasms incl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02143854
更新日期:1995-09-01 00:00:00
abstract::Although retrograde vertebral artery flow was described over 100 years ago, its relationship to symptoms remains unclear. We documented 43 patients who were found by duplex scanning to have reverse flow in the vertebral artery. Of this group, seven patients (16%) were found to have symptoms described as typical for th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015293
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:The incidence of localized popliteal disease is rare. Currently, patients presenting with symptomatic popliteal disease are offered femoropopliteal or tibial bypass if the disease is not amenable to radiologic intervention. We feel that popliteal endarterectomy by means of a posterior approach with patch ang...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.09.005
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to review our experiences treating peripheral artery disease (PAD) by common femoral artery endarterectomy (CFE) with and without endovascular therapy (EVT), and to describe the role of CFE in the endovascular era. METHODS:We retrospectively reviewed a contemporary series of 38...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.05.005
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:To develop and verify a risk predictive model/scoring system for pulmonary embolism (PE) among hospitalized patients with deep venous thrombosis of the lower extremities (LDVT). METHODS:776 patients with LDVT were enrolled in a case-control study between January 2016 and June 2017 from the Vascular Surgery ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.12.008
更新日期:2020-07-01 00:00:00
abstract::The aim of this study was to describe the results of resection and graft replacement for type III and IV thoracoabdominal aortic aneurysm repair. In this retrospective study, 27 patients underwent resection and graft replacement for type III (10) or type IV (17) thoracoabdominal aortic aneurysms. Nine patients had rup...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-004-0048-z
更新日期:2004-07-01 00:00:00
abstract::Venous thrombosis of pancreas transplant allografts often leads to graft loss. It is an worrisome complication and difficult to treat, forming the most common nonimmunological cause of graft loss. Multiple risk factors have been implicated in the development of venous thrombosis of pancreas transplant. Color Doppler u...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.11.021
更新日期:2017-07-01 00:00:00
abstract::Large-vessel occlusion is uncommon in association with antiphospholipid antibodies. This report describes the first case involving occlusion of the infrarenal abdominal aorta and inferior vena cava in a 46-year-old woman with circulating lupus-like anticoagulants who presented with subacute lower extremity ischemia. T...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0231-4
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:Surgical site infections (SSIs) are a significant burden to patients and health care systems. This retrospective study evaluates the observed rates of SSI after our institution implemented chlorhexidine gluconate-impregnated (CHG) cloth as a preoperative antiseptic preparation in elective vascular surgery. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.11.011
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Inferior vena cava filters (IVCFs) are indicated for therapeutic and prophylactic treatment of venous thromboembolism in patients when anticoagulation has failed or is contraindicated. Retrievable IVCFs are not always retrieved despite clinical recommendations. The purpose of this review is to compare result...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2018.02.010
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Acute arterial thromboembolism to the renal arteries can be treated promptly by local thrombolysis, conventional surgical thrombectomy, or anticoagulation. METHODS:We report a patient who presented with acute loin pain as a result of atrial fibrillation-related thromboembolism to the right renal artery supp...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.02.030
更新日期:2016-10-01 00:00:00
abstract::In recent decades, the increasing complexity of arterial bypasses in the management of chronic limb-threatening ischemia has spurred the development of alternative techniques, such as revascularization of genicular arteries. Few publications on this technique can be found in the literature, and its use has been restri...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2020.06.008
更新日期:2020-11-01 00:00:00
abstract::Previous investigations reveal in the absence of endothelial cell (EC) injury, intraarterial polytetrafluoroethylene (PTFE) stent graft (SG) exhibit greater EC repaving than PTFE interposition grafts (CG). The investigation evaluated EC repaving of SG compared to CG after balloon injury. Twenty adult dogs underwent SG...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900010
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:This retrospective study evaluated the long-term results of endovascular repair in the management of arterial stenosis caused by Takayasu's arteritis (TA). METHODS:Sixty-seven endovascular procedures (percutaneous transluminal balloon angioplasty or stenting) were performed for 49 arterial lesions in 35 pat...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.10.066
更新日期:2017-07-01 00:00:00
abstract::Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.12.007
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Hereditary hemorrhagic telangiectasia (HHT) is a rare disease consistent in vascular dysplasias affecting different organs. Liver involvement includes telangiectases, arteriovenous shunting, and ischemic cholangitis, and its prevalence ranges from 8% to 31%. Spontaneous pseudoaneurysms have never been report...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.12.022
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentio...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.02.018
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:To report the prevalence of silent brain infarcts (SBI) at magnetic resonance imaging (MRI) before and after surgery for asymptomatic high grade carotid stenosis. METHODS:This is a single center retrospective observational study. Asymptomatic patients who underwent carotid endarterectomy between October 201...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.10.067
更新日期:2017-08-01 00:00:00
abstract::The inferior mesenteric artery (IMA) is the nutrient artery for the descending colon. Colon ischemia after repair of abdominal aortic aneurysm (AAA) can be prevented by routine or elective revascularization of the IMA. In case of occlusion of the IMA, revascularization of the internal iliac artery (IIA) has been recom...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100160010050
更新日期:2001-03-01 00:00:00
abstract::Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.01.010
更新日期:2010-08-01 00:00:00