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Increased susceptibility of endovascular grafts to infection: A comparison of endovascular and standard grafts

Parsons, Richard E.; Sanchez, Luis A.; Marin, Michael L.; Holbrook, Karen A.; Faries, Peter L.; Lowy, Franklin D.; Veith, Frank J.
BIOABSTRACTS:BACD199698588978
ISSN: 0071-8041
CID: 80128

Images in clinical medicine. Transfemoral repair of abdominal aortic aneurysm [Case Report]

Marin, M L; Veith, F J
PMID: 7984196
ISSN: 0028-4793
CID: 79912

RETROPERITONEAL HEMATOMA AFTER CARDIAC-CATHETERIZATION - PREVALENCE, RISK-FACTORS, AND OPTIMAL MANAGEMENT [Meeting Abstract]

KENT, KC; MOSCUCCI, M; MANSOUR, KA; DIMATTIA, S; GALLAGHER, S; KUNTZ, R; SKILLMAN, JJ; SPENCE, RK; VEITH, FJ; PANETTA, TF; ASCER, E; RICOTTA, JJ; BUSH, HL
Purpose: Retroperitoneal hematoma is an unusual, but potentially serious, complication after cardiac catheterization. The predisposing factors, typical presentation, and clinical course of this iatrogenic complication are identified, and the role of surgery in its treatment is defined. Methods: A retrospective review of 9585 femoral artery catheterizations over a 5-year period allowed identification and evaluation of all patients with retroperitoneal hemorrhage. Results: Retroperitoneal hematoma developed in 45 patients (overall prevalence 0.5%), with the highest frequency after coronary artery stenting (3%). In the group of patients who underwent coronary artery stenting, statistically significant predictors of this complication included protocol for sheath removal female sex, nadir platelet count, and excessive anticoagulation. Signs and symptoms included suprainguinal tenderness and fullness in 100%, severe back and lower quadrant pain in 64%, and femoral neuropathy in 36%. Most patients were treated successfully with transfusion alone. Seven patients (16%) required operation; in four, hypotension unresponsive to volume resuscitation developed early after catheterization; and, in three, a progressive fall in hematocrit level led to surgery 24 to 72 hours after catheterization. Conclusions: Retroperitoneal hematoma after cardiac catheterization can usually be treated by transfusion alone. A small subset of patients who have development of hypotension unresponsive to volume resuscitation require urgent operation. $$:
ISI:A1994PX33500008
ISSN: 0741-5214
CID: 80134

INFLUENCE OF SEX ON THE RESULTS OF ABDOMINAL AORTIC-ANEURYSM REPAIR [Meeting Abstract]

JOHNSTON, KW; RICOTTA, JJ; LOGERFO, FW; CRONENWETT, JL; VEITH, FJ; SHAH, DM; BUSH, HL
Purpose: The purpose of this study is to determine the effect of sex on the survival rate and complications after repair of nonruptured and ruptured abdominal aortic aneurysms (AAA). Methods: The Canadian Society for Vascular Surgery Aneurysm Registry formed the database for analysis and provided current, ongoing follow-up of the patients. Statistical methods included t tests, chi-squared analysis, Kaplan-Meier analysis, and Cox regression analysis. Results: Of the 679 patients undergoing repair of a nonruptured AAA, 19.7% were women and 82.3% men. The following risk factors were significantly different (p < 0.05) in women and men: women were older; more had never smoked; more had a positive family history of AAA; fewer had an electrocardiogram showing evidence of an old myocardial infarction; more had coexisting aortoiliac occlusive disease; fewer had popliteal or femoral aneurysms; and the average size of the AAA was smaller. In spite of potential differences in risk, the in-hospital mortality rates were not affected by sex: 5.2% mortality rate for women and 4.4% for men. Early and late vascular complications occurred with a similar prevalence. The late survival rates were not different in women and men: for women, the 1-, 3-, and 5-year cumulative survival rates were 93.0%, 74.2%, and 63.3%, respectively, and for men 90.3%, 82.8%, and 68.9%. To control for the potential effects of other confounding variables on survival, the Cox proportional hazards method was used. When sex was included in a model along with other significant predictive variables of late survival, sex was not found to be a significant predictor of late results. Of the 146 patients with a ruptured AAA, 13.7% were women and 83.3% men. The in-hospital mortality rates were not significantly different: 55.0% for women and 49.2% for men. There was no difference between the cumulative survival rates: the 3- and 5-year survival rates for women were 36.0% and 9.0%, respectively, and for men 33.9% and 26.9%. Conclusions: Sex was not found to have an effect on the early or late results after repair of nonruptured or ruptured AAA. However, a literature review suggests the possibility of a gender bias in the diagnosis and/or selection of patients for surgical treatment because the proportion of women in surgical series is generally less than the proportion determined from autopsy studies, ultrasound studies, hospital discharge data, and national mortality information. $$:
ISI:A1994PX33500009
ISSN: 0741-5214
CID: 80133

Transluminally placed endovascular stented grafts and their impact on vascular surgery

Veith, F J
PMID: 7990179
ISSN: 0741-5214
CID: 79913

Alternative approaches to the deep femoral, popliteal, and infrapopliteal arteries in the leg and foot: Part II

Veith, F J
PMID: 7865401
ISSN: 0890-5096
CID: 79906

Selective preservation of infected prosthetic arterial grafts. Analysis of a 20-year experience with 120 extracavitary-infected grafts

Calligaro, K D; Veith, F J; Schwartz, M L; Goldsmith, J; Savarese, R P; Dougherty, M J; DeLaurentis, D A
OBJECTIVE: The authors report on their 20-year experience with 120 patients with infected extracavitary prosthetic arterial grafts (95 polytetraflouroethylene, 25 Dacron). Throughout this experience, an effort was made, when appropriate, to salvage all or a portion of these infected grafts. METHODS: When patients had arterial bleeding (20 cases) or systemic sepsis (6 cases), immediate graft excision was performed. When the infected graft was occluded (43 cases), subtotal graft excision was performed, leaving an oversewn 2- to 3-mm graft remnant to maintain patency of the artery. Complete graft preservation was attempted in 51 cases in which the graft was patent, the patient was not septic, and the anastomoses were intact. Aggressive operative wound debridement was repeated, as necessary, to achieve wound healing. The preferred method of revascularization, when necessary, included secondary bypasses tunneled through uninfected (often lateral) routes. Follow-up averaged 3 years (range, 1 month-20 years). RESULTS: This strategy resulted in a hospital mortality of 12% (14/120) and a hospital amputation rate in survivors of 13% (14/106 threatened limbs). Of the surviving patients treated by complete graft preservation, the hospital amputation rate was only 4% (2/45) and long-term complete graft preservation was successful in 71% (32/45) of cases. Partial graft preservation also proved successful in 85% (35/41) of surviving patients who had occluded grafts. Successful complete graft preservation was as likely when gram-negative or gram-positive bacteria were cultured from the wound, with the exception of Pseudomonas (successful graft preservation in only 40% [4/10] of cases). CONCLUSION: Based on this 20-year experience, the authors conclude that selective partial or complete graft preservation represents a simpler and better method of managing infected extracavitary prosthetic grafts than routine total graft excision
PMCID:1234416
PMID: 7944658
ISSN: 0003-4932
CID: 79909

Peripheral Vascular Disease in the Elderly

Lyon RT; Rivers SP; Veith FJ
This paper is reproduced with permission from the book, Cardiovascular Disease in the Elderly, edited by Donald D. Tresch, MD and Wilbert S. Aronow, MD and published by Marcel Dekker, Inc
PMID: 11416315
ISSN: 1076-7460
CID: 79547

The role of stented grafts in the management of failed arterial reconstructions [Case Report]

Marin, M L; Veith, F J
PMID: 7812495
ISSN: 0895-7967
CID: 79904

Reoperative approaches for failed infrainguinal polytetrafluoroethylene (PTFE) grafts

Schwartz, M L; Veith, F J; Panetta, T F; Wengerter, K R; Suggs, W D; Marin, M L; Sanchez, L A
PMID: 7812491
ISSN: 0895-7967
CID: 79902