Abstract:
BACKGROUND:Credentialing of vascular surgeons to perform carotid artery stenting (CAS) continues to be a major issue confronting the specialty of Vascular Surgery. Cannulation of aortic arch branches, and placement of carotid antiembolic devices and stents constitute the major technical challenges to vascular surgeons becoming credentialed to perform CAS. The multicenter Carotid Revascularization Endarterectomy vs Stenting Trial (CREST), supported by the National Institute of Neurological Disorders and Stroke, National Institute of Health, reviews credentials of interventionalists, including surgeons, for the trial's "lead-in" phase of CAS to treat symptomatic (>50% stenosis) and asymptomatic (>70% stenosis). METHODS:Vascular surgeons requesting participation in CREST must have achieved basic interventional credentialing criteria as recommended by the Society of Vascular Surgery. Each interventionalist is asked to submit notes and narrative summaries from a series of 10 to 30 CAS procedures for review by a multi-specialty review committee before being approved to participate in CREST. Thereafter, during the lead-in phase of CREST, each approved interventionalist is asked to perform CAS procedures using the study devices in as many as 20 patients. In this interim report from the CREST lead-phase, the association of specialty of operator (vascular surgeon, neurosurgeon, other specialist) and periprocedural stroke and death rate was examined in patients undergoing CAS. In addition, current enrollment volume in the lead-in phase by specialty of the principal investigator was examined. RESULTS:Thirty-two of 134 (23.9%) CREST-credentialed interventionalists are vascular surgeons (n = 22; 16.4%) or neurosurgeons (n = 10; 7.5%). For events monitored through March 31, 2004, 789 patients had undergone CAS procedures performed by these 134 specialists. Thirty-day stroke and death rate was 4.6%, and myocardial infarction was observed in 1.1% of patients. Serious adverse events have not been clustered at individual institutions, and no significant differences have been observed between vascular surgeons or neurosurgeons and other credentialed specialists. CONCLUSIONS:Vascular surgeons with basic catheter and guide wire skills, particularly those who have incorporated diagnostic cerebral angiography into their practice, can be credentialed to perform CAS. Individuals or groups should devote a number of cases (n = 10-30 per surgeon) to CAS to accomplish this goal. Pending US Food and Drug Administration approval of devices and Center for Medicaid and Medicare Services reimbursement, institutional financial support for the performance of these procedures must be secured. The learning curve for CAS should not be considered so formidable as to discourage surgeons from adding these techniques of CAS to their procedural inventory.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Hobson RW 2nd,Howard VJ,Roubin GS,Ferguson RD,Brott TG,Howard G,Sheffet AJ,Roberts J,Hopkins LN,Moore WS,CREST.doi
10.1016/j.jvs.2004.08.039subject
Has Abstractpub_date
2004-11-01 00:00:00pages
952-7issue
5eissn
0741-5214issn
1097-6809pii
S0741521404011310journal_volume
40pub_type
杂志文章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:OBJECTIVE:This study investigated the prevalence and distribution of deep vein thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE) to establish a screening protocol to reduce unnecessary venous duplex scanning using different D-dimer level rather than single cutoff point of 0.5 microg/mL in patients w...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.05.026
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVE:Impaired venous drainage in severe chronic venous insufficiency (CVI) leads to microcirculatory overload, characterized by erythrocyte diapedesis and subsequent extravascular hemolysis, resulting in typical dermal hemosiderin deposition. We hypothesized that hemosiderin, normally absent, could be present in t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2003.64
更新日期:2003-01-01 00:00:00
abstract::The lack of a rapid, noninvasive, and accurate method to confirm or rule out prosthetic graft infection continues to constitute a compelling and vexing clinical problem. A host of adjunctive diagnostic techniques has been used in the past, but early promising results subsequently have usually not yielded acceptable se...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1986.avs0030042
更新日期:1986-01-01 00:00:00
abstract::Popliteal artery aneurysms represent a common pathology that vascular surgeons are often confronted with. However, several issues remain incompletely understood, including indications for intervention and optimal methods of treatment. In the following article, our discussants debate the appropriate management of small...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.02.001
更新日期:2011-04-01 00:00:00
abstract::Heavily calcified aortic and iliac arteries are occasionally encountered that will not yield to currently available needles and sutures. The use of the Hall drill to penetrate such arterial walls, stopping short of the adventitial layer, and Teflon strips to buttress the anastomosis, is an effective means of dealing w...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVES:P-selectin inhibition has been found to limit venous thrombosis. We hypothesize that elevated levels of P-selectin will amplify thrombosis, mediated by procoagulant microparticles (MPs). METHODS:Male mice (Mus musculus, n659), 20 to 25 grams, underwent IVC ligation to induce thrombosis. Groups consisted of ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(03)01033-4
更新日期:2003-11-01 00:00:00
abstract:PURPOSE:We reviewed the history and preoperative investigations of patients with early postoperative neurologic events after carotid thromboendarterectomy in an attempt to identify risk factors for neurologic complications. METHODS:Patients with neurologic events/complications (S group, n = 14 patients) were compared ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVES:There has been a rapid increase in the number of endovascular procedures performed for peripheral artery disease, and especially aorto-iliac occlusive disease (AIOD). Results from single-center reports suggest a benefit for endovascular procedures; however, these benefits may not reflect general practice. We...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.05.100
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has typically resulted in upper respiratory symptoms. However, we have encountered acute arterial and venous thrombotic events after COVID-19 infection. Managing acute thrombotic events from the novel virus has presented unprecedented challenges...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.08.038
更新日期:2020-09-01 00:00:00
abstract::On the basis of our experience with more than 71 cases of totally laparoscopic aortic surgery by the retrocolic approach, we have developed a new technique by a simple transperitoneal approach. The purpose of this report is to describe that technique and the novel laparoscopic bowel retractor used to ensure stable exp...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.01.038
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:We have previously shown that arteriovenous fistulas (AVFs) are more expensive to create and to maintain than arteriovenous grafts (AVGs) in patients undergoing their first access. Because those for whom this first access fails may be a more disadvantaged group, we hypothesized that the cost of a second acces...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.03.419
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Reoperative carotid endarterectomy (CEA) is an accepted treatment for recurrent carotid stenosis. With reports of a higher operative morbidity than primary CEA and the advent of carotid stenting, catheter-based therapy has been advocated as the primary treatment for this reportedly "high-risk" subgroup. This...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.02.047
更新日期:2005-06-01 00:00:00
abstract:OBJECTIVES:Worldwide, increasing proportions of aortic aneurysms are repaired electively via the endovascular route. The purpose of this study was to report the recent utilization of endovascular repair in Canada by reviewing a national administrative database. METHODS:The Canadian Institute for Health Information dat...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.05.043
更新日期:2005-09-01 00:00:00
abstract::Complications of medicine are like the sand traps in golf courses. They are regrettable, cannot be completely avoided even by the best, and the real skill lies in solving the problems they present. Dr Al Mighty told a resident to ignore a barely elevated temperature in a postoperative patient. "It is nothing worthy of...
journal_title:Journal of vascular surgery
pub_type: 社论
doi:10.1016/j.jvs.2013.10.068
更新日期:2013-12-01 00:00:00
abstract::Volume flow rates were measured in 31 expanded polytetrafluoroethylene grafts (6 mm) of 26 patients undergoing hemodialysis. Flow was calculated from the known access graft diameter and by measurement of the mean Doppler shift frequency waveform. Overall flow rates were 750 +/- 383 ml/min (range, 0 to 1921 ml/min). Th...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:Abdominal aortic aneurysm (AAA) progression and disease resistance are related to mural cellularity; adventitial macrophages and neocapillaries predominate in larger, advanced aneurysms, whereas smaller AAAs have fewer macrophages and retain more medial smooth muscle cells (SMCs). Expression analysis of mRNA ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.02.027
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:The prevalence of significant comorbidities among patients with abdominal aortic aneurysms (AAAs) has contributed to widespread enthusiasm for endovascular AAA repair (EVAR). However, the advantages of EVAR in patients at low risk for open surgical repair (OSR) remain unclear. The objective of this study was ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.05.018
更新日期:2014-11-01 00:00:00
abstract::The current problems and conflicts associated with training of vascular and general surgery residents exemplify the larger dilemma of educating subspecialists while preserving the wellspring of general surgery. Previous vascular fellowship programs during the era of evolution of our subspecialty were characterized by ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1990.17470
更新日期:1990-07-01 00:00:00
abstract:PURPOSE:The purpose of this study was to investigate in vivo the long-term development, differentiation, and proliferation of the subendothelial tissue on Dacron prostheses seeded with microvascular cells (MVC). METHODS:Autologous MVC from omental adipose tissue were seeded on 4 mm Dacron prostheses and the prostheses...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract:PURPOSE:This study assessed the clinical outcome, morphologic changes, and behavior of acute and chronic type B aortic dissections after endovascular repair and evaluated the extent of dissection and diameter changes in the true (TL), false (FL), and whole lumen (WL) during follow-up. METHODS:From May 2000 to Septembe...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.01.022
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:Despite the increased cardiovascular morbidity and mortality risk of patients with peripheral arterial disease, previous worldwide studies have documented undertreatment of cardiovascular risk factors in such patients. METHOD:The ATTEST study was an observational cross-sectional epidemiologic study. Patients...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2006.04.002
更新日期:2006-08-01 00:00:00
abstract:PURPOSE:Few data are available on long-term follow-up of arterial segments subjected to thrombolysis. We reviewed all cases of vascular occlusion treated with urokinase to identify early success and determine the influence of postlysis intervention and the nature of the thrombosed segment (i.e., artery vs graft) on lon...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(94)70104-0
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVE:This investigation describes the perioperative and early follow-up results associated with transcarotid artery revascularization (TCAR) in patients not participating in the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure II (ROADSTER-2) registry using the ENROUTE neuro...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.06.222
更新日期:2019-03-01 00:00:00
abstract::A 64-year-old man was admitted with abdominal pain 6 weeks after treatment with intravenous flucloxacillin for cellulitis of his right leg. Urgent operation was necessary for a mycotic aneurysm of the abdominal aorta due to infection with Pasteurella multocida, a microorganism residing in the oral cavity of domestic a...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.06.052
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:The decision about the type and location of a hemodialysis vascular access is challenging and can be affected by multiple factors. We explored the effect of several a priori chosen patient characteristics on access outcomes. METHODS:We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jvs.2016.01.053
更新日期:2016-07-01 00:00:00
abstract::Techniques for exposure of the popliteal artery via lateral approaches above and below the knee are described. These techniques were used successfully in 21 patients who required secondary arterial reconstructions in the presence of extensive scarring, infection, or both in the standard medial access routes. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1987.avs0060119
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To summarize the association of simple renal cyst (SRC) with abdominal aortic aneurysm (AAA), we reviewed currently available clinical studies with a systematic literature search and meta-analytic evaluation. METHODS:To identify all case-control studies evaluating the association of SRC with AAA, databases i...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jvs.2015.08.095
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:Open surgical repair (OSR) for chronic type B aortic dissection (CTBAD) has an associated morbidity and mortality. The role of thoracic endovascular aortic repair (TEVAR) in CTBAD has not been determined. We analyzed our contemporary experience of CTBAD undergoing OSR to identify high-risk patients who may be...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.11.002
更新日期:2014-05-01 00:00:00
abstract::Iatrogenic arteriovenous fistulas between the aorta or its major branches and the vena cava or its tributaries resulting from lumbar disc operations are uncommon but serious problems for the vascular surgeon. Using three cases from our experience and adding illustrations, x-ray films, and descriptive text we have prec...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1985.avs0020828
更新日期:1985-11-01 00:00:00