Research & Publications


Use of a pulsatile perfusion pump for renal autotransplantation in a patient undergoing thoracoabdominal bypass for malignant hypertension secondary to Takayasu arteritis.

Suckow BD1, Ihnat D2, Ward C2, Kim RD3, Campsen J3.

Aortorenal bypass is an effective and durable therapy for autoimmune-induced renovascular hypertension. However, when technical and patient factors preclude this option, renal autotransplantation can be a viable alternative. We present a 32-year-old woman who underwent aortobi-iliac bypass with left renal autotransplantation for malignant hypertension secondary to Takayasu arteritis. This is the first description of using machine preservation with a continuous pulsatile perfusion pump to maintain renal preservation before reimplantation. Our method proved safe to the patient and allowed for protection of the organ from prolonged warm ischemia and intraoperative hypoperfusion during a complex reconstruction. J Vasc Surg. 2019 Feb;69(2):545-554. doi: 10.1016/j.jvs.2018.05.222. Epub 2018 Aug 11.

Optimal medical management before lower extremity bypass for claudication in the veteran population. 

Williams CR1, Jellison A2, Martin L2, Zhang C3, Presson AP3, Kraiss LW2, Brooke BS4.

OBJECTIVE: Optimizing medical management through glucose control, smoking cessation, and drug therapy (ie, antiplatelet and statin agents) is recommended as first-line therapy for patients with claudication. The aims of this study were to determine how frequently veterans with claudication received optimal medical management (OMM) before undergoing elective open lower extremity bypass procedures nationwide and whether preoperative OMM was associated with improved surgical outcomes.

Prognostic implications of diagnosing frailty and sarcopenia in vascular surgery practice.

Ghaffarian AA1, Foss WT2, Donald G2, Kraiss LW2, Sarfati M2, Griffin CL2, Smith BK2, Brooke BS3.

OBJECTIVE:  Frailty and sarcopenia are related but independent conditions commonly diagnosed in older patients that can be used to assess their ability to tolerate the stress of major vascular surgery. For surgical decision-making, however, it is important to know the prognostic implications associated with each of these conditions. The study was designed to assess the association of frailty and sarcopenia phenotypes with long-term survival of patients undergoing surgical and nonsurgical management of vascular disease.

Preoperative frailty assessment predicts loss of independence after vascular surgery.

Donald GW1, Ghaffarian AA1, Isaac F1, Kraiss LW1, Griffin CL1, Smith BK1, Sarfati MR1, Beckstrom JL1, Brooke BS2.

OBJECTIVE: Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures.

Clinical effectiveness of open thrombectomy for thrombosed autogenous arteriovenous fistulas and grafts.

Ghaffarian AA1, Al-Dulaimi R2, Kraiss LW1, Sarfati M1, Griffin CL1, Smith BK1, Donald G1, Brooke BS3.

OBJECTIVE:  Arteriovenous (AV) fistulas are the preferred hemodialysis access for patients with end-stage renal disease, although multiple interventions are typically needed to maintain patency. When AV fistulas thrombose, however, there is debate as to whether open thrombectomy should be attempted, particularly for salvage of upper arm fistulas. This study was designed to evaluate outcomes after open thrombectomy of upper arm and forearm AV fistulas compared with AV grafts.

Repair of a symptomatic true radial artery aneurysm at the anatomic snuff box with interposition great saphenous vein graft.

Ghaffarian AA1, Brooke BS2, Rawles J2, Sarfati M2.

Radial artery aneurysms are exceedingly rare, with only a few reported cases of surgical revascularization. We describe a 25-year-old man who presented with severe ischemia of the right hand secondary to an idiopathic true radial artery aneurysm at the anatomic snuff box. The patient had embolic occlusions in his hand and fingers that were treated with catheter-directed thrombolysis. During angiography, the blood supply to the affected hand was determined to be radial artery dominant, and therefore the aneurysm was resected and revascularized using an interposition great saphenous vein graft. The patient denied ischemic symptoms postoperatively, and duplex ultrasound examination at a 10-month follow-up showed patent interposition graft.

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