Publications by authors named "Indrani Sen"

Article Synopsis
  • Regional anesthesia, specifically the anterior transversus abdominis (TAP) block, is being explored for its potential benefits in vascular surgery, as a study compares opioid usage post-lower extremity revascularization surgery in patients who received this block versus those who didn't.
  • A retrospective review of 107 patients (41 with TAP block and 66 without) showed no significant differences in procedural metrics, but the group receiving the regional block experienced shorter hospital stays and used significantly less opioids both during and after surgery.
  • The findings suggest that incorporating the anterior TAP block with local anesthesia may lead to lower opioid consumption and improved recovery post-surgery, highlighting the advantages of regional anesthesia in vascular procedures.
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Background: The long-term neuro-ophthalmic outcomes after carotid intervention in patients presenting with preoperative visual symptoms vary widely based on the underlying etiology of retinal ischemia and are not well understood.

Methods: We performed a retrospective review of consecutive patients presenting with retinal ischemia who subsequently underwent carotid intervention from January 2018 to December 2022. Patients were classified into three groups (group I: amaurosis fugax/vascular transient monocular vision loss, group II: ocular ischemic syndrome [OIS], and group III: central/branch retinal artery occlusion).

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Objective: Aneurysm neck anatomy in ruptured abdominal aortic aneurysms (rAAAs) is often complex, limiting the feasibility of endovascular repair (EVAR). The objective of this study was to compare the outcomes of EVAR and open surgical repair (OSR) for treatment of rAAAs in patients with hostile neck anatomy (HNA). The secondary aim was to review the clinical characteristics and anatomic risk factors predictive of mortality.

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Article Synopsis
  • Treating atherosclerotic occlusive disease in the infrarenal aorta is challenging, with traditional open surgery posing high risks for morbidity and mortality.
  • The American College of Cardiology (ACC)/American Heart Association (AHA) classification helps assess patient risk, especially benefiting high-risk patients through advancements in endovascular technologies.
  • Minimally invasive methods, such as chimney-CERAB, have been effectively used to treat patients with aortoiliac occlusive disease while preserving key blood vessels like the inferior mesenteric artery.
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  • The study evaluates the performance of the Human Acellular Vessel (HAV), a new biologic option for arterial reconstructions, compared to the traditional great saphenous vein (GSV) in patients with advanced peripheral arterial disease (PAD).
  • Researchers compared outcomes in 34 patients using HAV to 88 historical patients who underwent bypass with GSV, noting demographic similarities but differences in health conditions and clinical stages.
  • Results showed that while the HAV group had a shorter operative time, the rates of major amputation-free survival and overall survival were similar between both groups, highlighting the need for further investigation.
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Introduction: Genomic characterization of serous ovarian carcinoma (SOC), which includes low-grade serous carcinoma (LGSC) and high-grade serous carcinoma (HGSC), remains necessary to improve efficacy of platinum-based chemotherapy. The aim of this study was to investigate the genomic variations in these SOC groups, also in relation to chemoresponse.

Methods: Forty-five samples of SOC were retrospectively analyzed by next-generation sequencing on DNA/RNA extracts from formalin-fixed, paraffin-embedded (FFPE) tumor samples obtained at diagnosis.

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Article Synopsis
  • Ocular ischemic syndrome (OIS) is a rare but serious condition linked to carotid artery blockage, leading to potential permanent vision loss and requiring early multidisciplinary treatment for better outcomes.
  • A review of 33 studies involving 479 patients found that most patients experienced improved or stable vision after interventions like carotid endarterectomy (CEA) and carotid artery stenting (CAS), with very few complications reported.
  • The research emphasizes the need for increased awareness and early diagnosis of OIS to enhance treatment effectiveness, suggesting a collaborative approach between vascular and eye specialists to improve patient outcomes.
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Article Synopsis
  • Endoscopic vein harvest is a technique for creating brachial-basilic arteriovenous fistulas, and its use is not widespread despite its benefits, particularly in patients with obesity.
  • A study evaluated this method in 11 patients, mostly overweight or obese, finding a 100% technical success rate and a maturation rate of 100%, with all dialysis-required patients successfully accessing their fistulas.
  • At the one-year mark, patency rates were impressive, sitting at 90% for primary assisted and 100% for secondary, highlighting that this approach is effective even for patients with medical challenges like hypertension and diabetes.
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Article Synopsis
  • Patients with chronic limb-threatening ischemia (CLTI) face high amputation risks when they lack a usable great saphenous vein for bypass surgery; the study investigates the use of the Human Acellular Vessel (HAV) to address this.* -
  • The HAV is a synthetic vascular conduit made from human cells and a dissolvable scaffold, designed to be nonimmunogenic, and was tested in a clinical study approved by the FDA for patients unable to use their own veins for arterial bypass.* -
  • In a trial involving 29 patients with severe CLTI, the HAV achieved 100% technical success in surgeries, resulting in an 86% limb salvage rate, although there was a 7% mortality
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Autologous vein is the optimal conduit for peripheral arterial bypass surgery, a standard recently highlighted by findings from the BEST-CLI trial. The Human Acellular Vessel is a novel biologic conduit produced using regenerative medicine technologies with structural and mechanical properties like a human blood vessel. Not yet approved by the United States Food and Drug Administration, the Human Acellular Vessel is being studied as an alternative bypass conduit in patients with peripheral arterial disease, vascular injury, and those in need of arteriovenous access for hemodialysis.

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Objective: To report outcomes of the human acellular vessel (HAV) implanted for limb salvage through the Food and Drug Administration (FDA) Expanded Access Program for patients with chronic limb-threatening ischemia with no autologous conduit.

Methods: The HAV is a bioengineered vascular conduit designed with human vascular smooth muscle cells. The product is under regulatory study.

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Vascular compression syndromes (VCS) are rare diseases, but they may cause significant symptoms interfering with the quality of life (QoL) of patients who are often in their younger age. Given their infrequent occurrence, multiform clinical and anatomical presentation, and absence of dedicated guidelines from scientific societies, further knowledge of these conditions is required to investigate and treat them using modern imaging and surgical (open or endovascular) techniques. This consensus document will focus on known VCS, affecting the arterial and venous system.

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Background: Treatment algorithms for subclavian vein (SCV) effort thrombosis (Paget-Schroetter syndrome- PSS) are multiple, ranging from thrombolysis (TL) with immediate or delayed thoracic outlet decompression (TOD) to conservative treatment with anticoagulation alone. We follow a regimen of TL/pharmacomechanical thrombectomy (PMT) followed by TOD with first rib resection, scalenectomy, venolysis, and selective venoplasty (open or endovascular) performed electively at a time convenient for the patient. Oral anticoagulants are prescribed for 3 months or longer based upon response.

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Article Synopsis
  • * An innovative treatment was performed using a vascular staple device and a 6-mm endovascular balloon to fix a cephalic vein aneurysm and improve venous outflow.
  • * The patient saw immediate relief from symptoms post-surgery, enabling prompt access to his arteriovenous fistula for dialysis, which remained functional after 12 months.
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Article Synopsis
  • - The study examines the use of flap reconstruction for groin wounds after vascular procedures in patients with peripheral vascular disease, analyzing data from 1998 to 2021 to understand outcomes and complications.
  • - A total of 270 flaps were performed on 237 patients, with a significant portion experiencing complications, mainly wound infections, although flap coverage successfully prevented graft removals in nearly all cases.
  • - The research concludes that flap coverage for groin wounds is generally safe and effective in preserving vascular grafts, with rectus femoris and sartorius flaps being the most commonly used and showing good results.
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  • This study aimed to analyze malpractice claims related to aortic pathologies and to explore any changes in litigation rates with the rise of endovascular therapy from 2000 to 2017.* -
  • Out of 268 reviewed cases, aortic aneurysms and dissections were the most common issues; results showed a majority of verdicts favored defendants, with litigation being more prevalent in the Midwest and Northeast.* -
  • Although overall litigation has decreased, claims related to endovascular procedures are increasing, highlighting the need for physicians to be aware of legal risks as new treatment methods develop.*
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Superior vena cava (SVC) syndrome refers to the clinical manifestations of cerebral venous hypertension secondary to obstruction of the SVC and/or the innominate veins. The most common cause of SVC syndrome is malignancy like small cell lung cancer and non-Hodgkin lymphoma, but there is an increasing trend of benign etiologies secondary to thrombosis due to central lines/ pacemakers or mediastinal fibrosis. Supportive measures include head elevation, diuresis, supplemental oxygen, and steroids.

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Objective: The aim of the present study was to evaluate the presentation trends, intervention, and survival of patients who had been treated for late abdominal aortic aneurysm rupture (LAR) after open repair (OR) or endovascular aortic aneurysm repair (EVAR).

Methods: We reviewed the clinical data from a single-center, retrospective database for patients treated for LAR from 2000 to 2020. The end points were the 30-day mortality, major postoperative complication, and survival.

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Article Synopsis
  • - The position paper from the IUA Youth Committee and experts reviews treatment methods for patients with chronic limb-threatening ischemia (CLTI) who lack standard revascularization options.
  • - It emphasizes the importance of effectively managing "no-option" CLTI patients, focusing on wound care and rehabilitation.
  • - The ultimate goal is to improve the quality of life for these patients through tailored therapeutic approaches.
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