Abstract:
BACKGROUND:The Centers for Medicare and Medicaid Services (CMS) have established guidelines that outline patients who are considered "high risk" for complications after carotid endarterectomy (CEA) for which carotid artery stenting (CAS) may provide benefit. The validity of these high-risk criteria are yet unproven. In this study, we stratified patients who underwent CAS or CEA by CMS high-risk criteria and symptom status and examined their 30-day outcomes. METHODS:A nonrandomized, retrospective cohort study was performed by chart review of all patients undergoing CEA or CAS from January 1, 2005, to December 31, 2010, at our institution. Demographic data and data pertaining to the presence or absence of high-risk factors were collected. Patients were stratified using symptom status and high-risk status as variables, and 30-day adverse events (stroke, death, myocardial infarction [MI]) were compared. RESULTS:A total of 271 patients underwent CAS, with 30-day complication rates of stroke (3.0%), death (1.1%), MI (1.5%), stroke/death (3.7%), and stroke/death/MI (5.2%). A total of 830 patients underwent CEA with 30-day complication rates of stroke (2.0%), death (0.1%), MI (0.6%), stroke/death (1.9%), and stroke/death/MI (2.7%). Among symptomatic patients, physiologic high-risk status was associated with increased stroke/death (6 of 42 [14.3%] vs 2 of 74 [2.7%]; P < .01), and anatomic high-risk status was associated with a trend toward increased stroke/death (5 of 31 [16.1%] vs 0 of 20 [0.0%]; P = .14) in patients who underwent CAS vs CEA. Analysis of asymptomatic patients showed no differences between the two groups overall, except for a trend toward a higher rate of MI after CAS than after CEA (3 of 71 [4.2%] vs 0 of 108 [0.0%]; P = .06) in those who were physiologically at high risk. Among symptomatic patients who underwent CAS, patients with physiologic and anatomic high-risk factors had a higher rate of stroke/death than non-high-risk patients (6 of 42 [14.3%] vs 0 of 24 [0.0%] and 5 of 31 [16.1%] vs 0 of 24 [0.0%], respectively; both P ≤ .05). CONCLUSIONS:Physiologic high-risk status was associated with increased stroke/death, whereas anatomic high-risk status showed a trend toward increased stroke/death in symptomatic patients undergoing CAS compared with non-high-risk patients undergoing CAS or physiologically high-risk patients undergoing CEA. Our results suggest that the current national criteria for CAS overestimate its efficacy in patients who are symptomatic and at high risk.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Yoshida S,Bensley RP,Glaser JD,Nabzdyk CS,Hamdan AD,Wyers MC,Chaikof EL,Schermerhorn MLdoi
10.1016/j.jvs.2012.12.075subject
Has Abstractpub_date
2013-07-01 00:00:00pages
120-7issue
1eissn
0741-5214issn
1097-6809pii
S0741-5214(13)00134-1journal_volume
58pub_type
杂志文章abstract:BACKGROUND:Intermittent claudication (IC) is the most common symptom of peripheral arterial disease, which significantly affects walking ability, functional capacity and quality of life. Supervised exercise programs (SEP) are recommended as first-line treatment, but recruitment and adherence rates are poor. The time re...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.03.050
更新日期:2019-12-01 00:00:00
abstract::Portal and mesenteric venous thrombosis is an uncommon condition that is usually treated with systemic anticoagulation. Catheter-directed thrombolysis via the superior mesenteric artery may be a viable adjunct to treatment of this potentially morbid condition. We present a case of portal and mesenteric venous thrombos...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(03)01052-8
更新日期:2003-12-01 00:00:00
abstract::Fenestrated-branched endovascular repair has been applied to treat chronic postdissection thoracoabdominal aortic aneurysms (TAAAs). We report a patient with diffuse postdissection aortic aneurysm involving the arch and thoracoabdominal aorta treated in a staged fashion with redo aortic arch repair using the frozen el...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.09.042
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:Venoarterial extracorporeal membrane oxygenation (ECMO) is a salvage therapy in patients with severe cardiopulmonary failure. Owing to the large size of the cannulas inserted via the femoral vessels (≤24-F) required for adequate oxygenation, this procedure could result in significant limb ischemic complicatio...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.10.059
更新日期:2017-04-01 00:00:00
abstract:PURPOSE:This is a review of 100 consecutive supraaortic trunk reconstructions (SAT) performed over 16 years. METHODS:There were eight innominate endarterectomies and 92 bypass procedures based on the thoracic aorta (n = 86) or proximal innominate artery (n = 6) in 98 patients 24 to 79 years of age. Indications include...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70289-7
更新日期:1998-01-01 00:00:00
abstract:PURPOSE:The incidence rate of disease progression and stroke after the diagnosis of a moderate (50% to 79%) carotid stenosis was determined by means of color-flow duplex scanning. METHODS:During a 4-year period, 344 male veterans with moderate internal carotid artery stenoses, on one or both sides, were examined at re...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70375-7
更新日期:1999-02-01 00:00:00
abstract::Surgical management of major venous injuries remains controversial. The medical records of 184 patients with major venous injury were reviewed. Forty-three patients had isolated venous injury; 31 of 43 patients (72%) underwent ligation to treat their vein injury. Another 141 patients had combined arterial and venous i...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1986-12-01 00:00:00
abstract::Congenital vascular malformations (CVMs) of the limb include simple and cavernous hemangiomas, microarteriovenous and macroarteriovenous fistulas, venous angiomas, and mixed CVMs. In differentiating these lesions, Doppler waveform analysis, labeled microsphere studies, arteriography, closed-space phlebography, and con...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1988.avs0080064
更新日期:1988-07-01 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:OBJECTIVE:Our aim was to identify the incidence of and predictors for common carotid artery (CCA) stent fractures (SFs) and to examine the effect of SFs on the development of in-stent restenosis (ISR). METHODS:Seventy patients (37 women; median age, 60.9 years) who were stented for significant (≥60%) proximal CCA sten...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.04.492
更新日期:2020-03-01 00:00:00
abstract:PURPOSE:Nitric oxide (NO), frequently cited for its protective role, can also generate toxic metabolites known to degrade elastin. Both abdominal aortic aneurysms (AAAs) and inducible nitric oxide synthase (iNOS) are associated with inflammatory states, yet the relationship between NO production by iNOS and AAA develop...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.111805
更新日期:2001-03-01 00:00:00
abstract::The diagnosis-related groups have encouraged physicians to become more efficient in the care of their patients; often, however, raising the question of safety. For 3 years all patients undergoing carotid endarterectomy at our institution were monitored in the intensive care unit for 24 hours and the majority were disc...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/0741-5214(92)90056-e
更新日期:1992-12-01 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:BACKGROUND:Symptoms of pelvic venous congestion (chronic pelvic pain, dyspareunia, dysuria, and dysmenorrhea) have been attributed to massive gonadal reflux. However, obstruction of the gonadal outflow may produce similar symptoms. Mesoaortic compression of the left renal vein (nutcracker syndrome) produces both obstru...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.118802
更新日期:2001-11-01 00:00:00
abstract:PURPOSE:Neointimal hyperplasia (NIH) is complete by 3 weeks in rabbit vein grafts implanted into the arterial circulation. Activation of the mitogen-activated protein kinase (MAPK) family of protein kinases is thought to be critical in remodeling events such as cellular proliferation, differentiation, and migration, as...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2003.130
更新日期:2003-04-01 00:00:00
abstract:PURPOSE:The clinical success and patency of central and peripheral venous stents in patients with symptomatic venous obstruction (SVO) were assessed. METHODS:The records of patients with SVO treated with venous stents from 1992 to 1999 were reviewed. Demographic and procedural variables were analyzed to determine thei...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1067/mva.2000.107988
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVE:Although endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is widely accepted for elective surgery, the uptake of emergency EVAR for ruptured AAA (REVAR) has trailed behind. This study was intended to identify the barriers to widespread application of REVAR in Australia and New Zealand. METHODS:A cr...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.01.037
更新日期:2016-08-01 00:00:00
abstract:INTRODUCTION:Racial disparities in open thoracic aortic aneurysm repair have been well documented, with black patients reported to suffer from poor outcomes compared with their white counterparts. It is unclear whether these disparities extend to the less invasive thoracic endovascular aortic repair (TEVAR). This study...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.10.087
更新日期:2020-12-02 00:00:00
abstract:OBJECTIVE:Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) that also involve the common iliac artery (CIA) typically is accomplished by endograft limb extension into the external iliac artery (EIA). In order to prevent endoleak, the internal iliac artery (IIA) is usually embolized, or alternativ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.08.063
更新日期:2012-08-01 00:00:00
abstract::To evaluate the role of selective intra-arterial low-dose thrombolytic therapy (SILDT) as an alternative to the surgical management of acute arterial occlusion, the hospital records of 40 patients who underwent 43 SILDT treatments with either streptokinase (36) or urokinase (7) between December 1979 and March 1984 wer...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::Vascular smooth muscle cells exhibit varied responses after vessel injury and surgical interventions, including phenotypic switching, migration, proliferation, protein synthesis, and apoptosis. Although the source of the smooth muscle cells that accumulate in the vascular wall is controversial, possibly reflecting mig...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2007.02.061
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:The treatment of femoropopliteal peripheral artery disease (PAD) using paclitaxel-coated devices (PCDs) has been shown to improve patency in several randomized trials. However, a recent meta-analysis of trial data suggested an increased risk of mortality with PCD usage. Although subsequent studies have found ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.08.146
更新日期:2020-10-07 00:00:00
abstract:PURPOSE:This study is an analysis of the outcome of a common method of management of the external carotid artery (ECA) during routine carotid endarterectomy (CEA). METHODS:Between 1986 and 1997, 1069 primary CEAs were performed with a combination of proximal eversion technique and blind distal endarterectomy on the EC...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70080-1
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:Patients with blunt traumatic thoracic aortic transection (BTTAT) just distal to the takeoff of the left subclavian artery typically have concomitant injuries that make open emergent surgical repair highly risky. Over the past decade, endovascular repair of the injured thoracic aorta with commercially availa...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.12.006
更新日期:2006-04-01 00:00:00
abstract:PURPOSE:Neointimal hyperplasia frequently develops after placement of prosthetic vascular grafts and is a major cause of graft failure. This study was an attempt to prevent vascular lesion formation by coating the graft luminal surface with a thin layer of nonporous silicone polymer, and subsequently with an ultrathin ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(96)70019-8
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Patients with venous thromboembolic disease are treated with anticoagulation or vena cava filter placement to prevent pulmonary embolism. A recent report suggested that filter placement may increase the risk of recurrent deep venous thrombosis (DVT) and prompted a review of our experience. METHODS:Prospecti...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.111733
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:Haptoglobin (Hp) polymorphism is associated with the prevalence and clinical evolution of many inflammatory diseases and atherosclerosis. Circulating neutrophils and neutrophil-associated proteases are an important initial component of experimental abdominal aortic aneurysm (AAA) formation. Elastase and C-re...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.03.016
更新日期:2010-09-01 00:00:00
abstract::From 1957 to 1985, 116 consecutive operations for recurrent carotid stenosis were performed in 99 patients at the University of California, San Francisco. Ninety-four patients underwent 103 reoperations for primary recurrent stenosis (nine patients had bilateral repairs). Seventy-two operations (70%) were performed to...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to compare blood flow rates measured by Doppler ultrasound (DUS) and phase-contrast magnetic resonance imaging (MRI) in patients having a hemodialysis arteriovenous fistula (AVF) and to identify scenarios in which there was significant discordance between these two approaches. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.02.043
更新日期:2018-12-01 00:00:00
abstract::An aberrant right subclavian artery arising distal to the origin of the left subclavian artery is the most common anomaly of the aortic arch. Degenerative diseases of aberrant subclavian arteries including aneurysms and occlusive disease have been reported previously. We believe that this case is the first reported ca...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(94)70173-3
更新日期:1994-11-01 00:00:00