Pre-existing Systolic Dysfunction is the Most Powerful Predictor of Failed Arteriovenous Fistula Maturation.

Background: Patients requiring hemodialysis access creation often have significant comorbid conditions, which may impact access maturation. Underlying cardiac dysfunction likely plays an important role in the maturation of arteriovenous fistulae (AVF). The effect of specific parameters of cardiac function on successful AVF creation has not previously been explored.

Rationale and design of a smartphone-enabled, home-based exercise program in patients with symptomatic peripheral arterial disease: The smart step randomized trial.

Background: Supervised exercise therapy (SET) is recommended in patients with symptomatic peripheral arterial disease (PAD) as first-line therapy, although patient adoption remains low. Home-based exercise therapy (HBET) delivered through smartphones may expand access. The feasibility of such programs, especially in low-resource settings, remains unknown.

Surgical Intervention for Peripheral Artery Disease Does Not Improve Patient Compliance with Recommended Medical Therapy.

Background: Nonadherence to smoking abstinence, antiplatelet therapy, and statin therapy in patients with peripheral artery disease (PAD) is associated with worse long-term outcomes. We hypothesized that patients who underwent invasive revascularization procedures would be more likely to adhere to these therapies than patients who were managed medically.

Methods: Prospective survey-based interviews pertaining to medication and behavioral compliance of patients with symptomatic PAD were performed.

Hemodialysis Vascular Access: Rising Costs as a Surrogate Marker for Patency and Function of Arteriovenous Fistulas.

Background: Establishment and maintenance of vascular access for hemodialysis is life-sustaining for patients needing renal-replacement therapy. Arteriovenous fistulas (AVFs) are the preferred type of access, but the costs associated with creation and maintenance are poorly characterized, especially with respect to patient characteristics.

Methods: A prospectively maintained registry has been established at The Mount Sinai Hospital for patients undergoing access procedures since 2007.

Inflow stenosis as a contributing factor in the etiology of AV access-induced ischemic steal.

Objective: To determine how frequent inflow stenosis is a contributing factor in the etiology of arteriovenous access-induced steal (AVAIS).

Methods: A retrospective review of hemodialysis patients who underwent interventions from October 1998 to December 2011 for AVAIS was conducted at Mount Sinai Hospital. Patients with grade 3 AVAIS and complete arch and upper extremity vascular imaging were included.

Chronic kidney disease and dialysis access in women.

Chronic kidney disease currently affects one in nine Americans and over 500,000 have progressed to failure requiring kidney replacement therapy, with nearly 45% being women. Clinical Practice Guidelines have been developed in an effort to synthesize the latest literature, particularly randomized controlled trials, to assist clinical decision making. Women have different levels of kidney function than men at the same level of serum creatinine and may also lose kidney function over time more slowly than men.

Peripheral arterial disease in women.

Peripheral arterial disease (PAD) affects a significant portion of the United States population, and much research has been conducted on identifying populations at risk for PAD, evaluating appropriate diagnostic modalities for PAD, studying the effect of risk factor reduction on PAD progression, and determining the best method of treatment for symptomatic PAD. However, most PAD research and clinical trials have focused on whole populations, or populations consisting mostly of men. Little data exist with respect to PAD in women.

Experience of HeRO dialysis graft placement in a challenging population.

Objective: To assess the outcomes of the hemodialysis reliable outflow (HeRO) device in a subset of hemodialysis access-challenged patients with central venous obstruction.

Methods: Retrospective analysis of a series of patients in 2 centers who underwent placement of the HeRO device between September 2009 and November 2010. Patients' demographics, access history, HeRO patency, and number of reinterventions were analyzed.

Carotid artery pseudo-occlusion: does end-diastolic velocity suggest need for treatment?

Objective: We reviewed our institution's experience with carotid artery pseudo-occlusion (CAPO), to investigate whether internal carotid artery (ICA) end-diastolic velocity (EDV) as measured by duplex ultrasonography, was a predictor of need for further intervention.

Methods: From February 2003 to January 2008, 7478 patients underwent duplex ultrasonographic evaluation of their carotid arteries. Diagnosis of CAPO included the appearance of a narrow flow jet (string sign) on power doppler images, low velocities in the ICA and additional criteria listed below.

Endovascular stent-graft repair of failed endovascular abdominal aortic aneurysm repair.

Despite high initial technical success, the long-term durability of endovascular abdominal aortic aneurysm repair (EVAR) continues to be a concern. Following EVAR, patients can experience endoleaks, device migration, device fractures, or aneurysm growth that may require intervention. The purpose of this study was to review all patients treated with secondary endovascular devices at our institution for failed EVAR procedures.

Endovascular treatment of visceral artery aneurysms.

Visceral artery aneurysms, although uncommon, can present with life-threatening hemorrhage. The increasing use of imaging studies has allowed for earlier identification and intervention of these aneurysms, thus avoiding the high morbidity and mortality associated with rupture. The treatment options for visceral artery aneurysms range from conventional open surgical repair to minimally invasive techniques using covered stents or embolization materials.

Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy.

Objective: Aneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome.

Methods: Patients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution's medical records and endovascular database.

Successful endovascular treatment of bleeding aortoenteric fistula: a case report.

Aortoenteric fistula (AEF) is an infrequent but disastrous complication of open abdominal aortic repair. Left untreated, it has a 100% fatality rate. The traditional approaches to the repair of secondary AEF (SAEF) are associated with average mortality rates of 21-59% and numerous major complications.

Experience with endovascular abdominal aortic aneurysm repair in nonagenarians.

Purpose: To report a single-institution experience with endovascular abdominal aortic aneurysm (AAA) repair (EVAR) in nonagenarians.

Methods: A retrospective review was performed of all patients >90 years old undergoing EVAR over an 8-year period at a major academic medical center. The patient population was investigated for the presence of various comorbidities, initial aneurysm size, successful aneurysm exclusion, perioperative complications, disposition, endoleaks, secondary interventions, and overall survival.

Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening.

Patients admitted to in-patient rehabilitation programs have an increased risk for developing deep venous thrombosis (DVT). However, the utility of screening for lower extremity DVT using duplex ultrasound in this high-risk population is not well characterized. The purpose of this study is to identify whether or not screening lower-extremity duplex exams are indicated in this high-risk population.

Abdominal aortic aneurysm sac shrinkage after endovascular aneurysm repair: correlation with chronic sac pressure measurement.

Objectives: Abdominal aortic aneurysm (AAA) sac shrinkage after endovascular aneurysm repair (EVAR) is considered to be evidence of clinical success. Exclusion of the sac from systemic pressure is the likely cause of shrinkage. We report our continuing clinical experience with the use of a permanently implantable, ultrasound-activated remote pressure transducer to measure intrasac pressure and its correlation with changes in sac diameter over time.

Aortic arch and descending thoracic aortic aneurysms: experience with stent grafting for second-stage "elephant trunk" repair.

Reconstruction of aortic arch and descending thoracic aortic aneurysms (TAAs) is technically challenging and associated with significant morbidity and mortality. We report our experience with extensive TAAs using a two-stage "elephant trunk" repair, with the second stage completed using an endovascular stent graft (ESG). Over 6 years, 111 patients underwent ESG treatment of TAAs at Mount Sinai Medical Center.

The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: results after a mean of 15 months follow-up.

Background: Endovascular stent-graft (ESG) repair of abdominal aortic aneurysm (AAA) has emerged as an alternative to open surgery. The role of ESG in patients with challenging medical and anatomic problems remains an area of general debate. This study reviews an experience with stent grafts to treat patients with AAA and atheromatous embolization syndrome (AES) presenting with chronic distal embolization (CDE).

First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms.

Objectives: Endovascular stent graft repair of abdominal aortic aneurysms (AAAs) prevents rupture by excluding the aneurysm sac from systemic arterial pressure. Current surveillance protocols after endovascular aneurysm repair (EVAR) follow secondary markers of sac pressurization, namely, endoleak and sac enlargement. We report the first clinical experience with the use of a permanently implantable, ultrasound-activated remote pressure transducer to measure intrasac pressure after EVAR.

Detailed protocol of ischemia and the use of noninvasive vascular laboratory testing in diabetic foot ulcers.

Diabetic foot ulcers are frequently complicated by the presence of arterial occlusive disease (PAD). It is often difficult to assess the severity of ischemia by history and physical examination alone; a combination of different types of noninvasive laboratory testing may be necessary. Pulse-volume recordings and segmental pressures should be routinely obtained.

The role of surgical revascularization in the management of diabetic foot wounds.

Diabetic foot wounds affect an estimated 15% of all patients with diabetes. These wounds are typically multifactorial in origin. Neuropathy of the foot and impaired wound healing are frequently associated with peripheral arterial occlusive disease.

Endovascular treatment of abdominal aortic aneurysms.

Minimally invasive endovascular techniques for the treatment of abdominal aortic aneurysm have significantly reduced its morbidity compared to that following standard surgical repair. Moreover, patients with extensive comorbid medical illnesses, for whom standard operative repair is contraindicated may be successfully treated using endovascular means. The full limitations and indications for use of endovascular grafts have not yet been fully defined.

Duplex ultrasonography and its impact on providing endograft surveillance.

Increasingly, aortic aneurysms are being repaired using endoluminal grafting techniques. Complications of such surgery include persistent endoleaks, continued growth of the aneurysm and migration or thrombosis of the device. Consequently, patients undergoing endovascular repair must be under rigorous surveillance postoperatively.

Endovascular stent graft repair of abdominal and thoracic aortic aneurysms: a ten-year experience with 817 patients.

Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients.

Summary And Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair.

Rat epigastric flow-through flap as a modulated arteriovenous fistula: model for the radial artery flow-through flap in distal arterial bypass.

The authors describe a rat flap model that is useful for flow studies. It is an epigastric flow-through flap that mimics the clinical use of a radial artery flow-through (RAFT) flap that has been used as an adjunct to a distal lower extremity arterial bypass graft to improve patency when there is potential high outflow resistance. The hypotheses were that this RAFT flap serves two purposes: 1) it allows additional blood flow through the skin flap and drainage via the vena comitans to increase the blood flow through the bypass graft and help to maintain bypass graft patency; and 2) it acts as a modulating arteriovenous fistula in which the additional flow through the vena comitans of the flow-through flap fluctuates with distal arterial outflow resistance.