The Experts below are selected from a list of 219 Experts worldwide ranked by ideXlab platform
G.patrick Clagett - One of the best experts on this subject based on the ideXlab platform.
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Aortofemoral Bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?
Journal of vascular surgery, 2004Co-Authors: Mark R. Jackson, R. James Valentine, Ahsan T. Ali, Christopher Bell, J. Gregory Modrall, M.burress Welborn, Eva Scoggins, Victor J. D’addio, G.patrick ClagettAbstract:Abstract Purpose Previous studies have documented poor patency rates in "young" patients (age 55 years or younger) with premature atherosclerosis undergoing Aortofemoral Bypass (AFB) to treat aortoiliac occlusive disease. Given the high reported graft patency rates with superficial femoral vein (SFV) grafts performed because of aortic graft infection, we evaluated the role of SFV grafts for AFB as primary therapy for premature atherosclerosis in a case-control study. Methods Over 10 years 31 patients aged 55 year or younger underwent AFB with use of SFV (V-AFB). Case controls consisted of all patients 55 years of age or younger who underwent AFB with use of Dacron (D-AFB) during the same period (n = 80). In all cases this was the initial therapy (no repeat operations). The two groups were well matched for age, sex, weight, preoperative ankle-brachial index, and the comorbid conditions of smoking, coronary artery disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, and renal insufficiency. There were more patients with diabetes in the V-AFB group (34% vs 16%; P = .05). Patients in the V-AFB group had more advanced disease, and the surgical indication was more frequently critical ischemia compared with the D-AFB group (90% vs 46%; P Results There was only one perioperative death in each group. There were no differences in cardiac, pulmonary, or gastrointestinal complications. However, fasciotomy occurred more frequently with V-AFB (44% vs 1%; P P P = .013). There was also a trend for higher limb salvage at 5 years (90% vs 62%). Four graft infections occurred with D-AFB, and none with V-AFB ( P = .32). Conclusions AFB performed with SFV grafts is a far more durable operation than standard D-AFB in young patients with aortoiliac occlusive disease. However, V-AFB is far more likely to require lower extremity fasciotomy, and takes almost twice as long to perform.
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Aortic corset syndrome
Journal of Vascular Surgery, 1997Co-Authors: Ryan T. Hagino, R. James Valentine, G.patrick ClagettAbstract:Abstract The majority of proximal anastomotic complications of Aortofemoral Bypass grafts are related to the formation of pseudoaneurysms or true proximal aneurysmal dilation of the residual infrarenal aorta. The late development of occlusive disease at the proximal anastomosis is an extremely rare event. We report two patients in whom symptomatic stenoses developed involving the proximal anastomoses of Aortofemoral Bypass grafts originally placed for aortoiliac occlusive disease. Surgical exploration demonstrated the presence of a constricting prosthetic corset wrapped around the proximal suture line of each graft. Exuberant neointimal hyperplasia was responsible for both stenoses. (J Vasc Surg 1997;26:138-41.)
Robert Staffa - One of the best experts on this subject based on the ideXlab platform.
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Analysis of the learning curve of robot-assisted laparoscopic Aortofemoral Bypass
2014Co-Authors: Tomáš Novotný, Martin Dvořák, Robert StaffaAbstract:Introduction: Advanced minimally invasive surgery is typically associated with appreciable learning curves. Robotic operating systems are used to facilitate the most complex procedures. Minimally invasive vascular surgery of the aortoiliac region belongs to this group. The objective of our study was to evaluate the learning process of robot-assisted laparoscopic Aortofemoral Bypass for aortoiliac occlusive disease in a group of 63 patients. Materials/Methods: Between May 2006 and December 2011, 63 patients (48 men, 15 women) at a median age of 58 years (range, 44-75 years), underwent 63 robot-assisted laparoscopic Aortofemoral Bypass procedures. The process of learning was evaluated by the assessment of learning curves. For continuous variables, they were constructed using the cumulative average-time model and power function regression (operative, aortoiliac segment dissection, clamping and anastomosis time). For the evaluation of conversion rate (binary variable) we used a cumulative summation (CUSUM) technique. Results: We implanted 33 aortobifemoral and 30 Aortofemoral Bypasses. In 60 cases, we completed the procedure successfully using minimally invasive approach. We had to convert to open surgery three times. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time 65 minutes (range, 40-125 minutes), median aortoiliac segment dissection time 125 minutes (range, 45-315 minutes) and median operative time 270 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%. During the follow-up period (median 31 months; range, 6-72 months), we observed 3 early occlusions (5%) and 1 graft infection (2%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for proximal anastomosis creation, confirming the positive contribution of the robotic system. The operative time and aortoiliac segment dissection time learning curves were less steep, demonstrating the complexity of the whole procedure and laparoscopic retroperitoneal dissection as well. The reduction of the aortoiliac segment dissection time contributed the most to the overall procedure time improvement. The learning curve for clamping time was the flattest. Only the proximal anastomosis time contributed to its reduction, as expected. The conventional creation of distal anastomoses in the groin was constant. CUSUM analysis confirmed that we had achieved better a conversion rate than the set 5% after 31 procedures. Conclusions: One of the main difficulties of laparoscopic Bypass grafting, anastomosis creation, has been overcome using a robotic operating system and its learning curve is short. Therefore, the acceptable anastomosis and clamping time can be achieved easily even during the learning curve. The whole procedure remains an advanced endoscopic surgery and the retroperitoneal dissection is now its most challenging part. Previous laparoscopic experience and training is crucial for the successful application of this method. Totally robotic retroperitoneal dissection or development of laparoscopic retroperitoneal approach may lead to further operative time reduction. Robot-assisted laparoscopic aortoiliac Bypass grafting seems a safe method with a low complication rate.
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The learning curve of robot-assisted laparoscopic Aortofemoral Bypass grafting for aortoiliac occlusive disease.
Journal of vascular surgery, 2010Co-Authors: Tomáš Novotný, Martin Dvořák, Robert StaffaAbstract:Background Since the end of the 20th century, robot-assisted surgery has been finding its role among other minimally invasive methods. Vascular surgery seems to be another specialty in which the benefits of this technology can be expected. Our objective was to assess the learning curve of robot-assisted laparoscopic Aortofemoral Bypass grafting for aortoiliac occlusive disease in a group of 40 patients. Methods Between May 2006 and January 2010, 40 patients (32 men, 8 women), who were a median age of 58 years (range, 48-75 years), underwent 40 robot-assisted laparoscopic Aortofemoral reconstructions. Learning curve estimations were used for anastomosis, clamping, and operative time assessment. For conversion rate evaluation, the cumulative summation (CUSUM) technique was used. Statistical analysis comparing the first and second half of our group, and unilateral-to-bilateral reconstructions were performed. Results We created 21 Aortofemoral and 19 aortobifemoral Bypasses. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time was 60 minutes (range, 40-95 minutes), and median operative time was 295 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%, and no graft or wound infection or cardiopulmonary or hepatorenal complications were observed. During the median 18-month follow-up (range, 2-48 months), three early graft occlusions occurred (7%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for robotic proximal anastomosis creation with anastomosis and clamping time reduction. The operative time learning curve was flat, confirming the procedure's complexity. There were two conversions to open surgery. CUSUM analysis confirmed that an acceptable conversion rate set at 5% was achieved. Comparing the first and second half of our group, all recorded times showed statistically significant improvements. Differences between unilateral and bilateral reconstructions were not statistically significant. Conclusions Our results show that the success rate of robot-assisted laparoscopic Aortofemoral Bypass grafting is high and the complication rate is low. Anastomosis creation, one of the main difficulties of laparoscopic Bypass grafting, has been overcome using the robotic operating system and its learning curve is short. However, the endoscopic dissection of the aortoiliac segment remains the most difficult part of the operation and should be addressed in further development of the method to reduce the operative times. Long-term results and potential benefits of this minimally invasive method have to be verified by randomized controlled clinical trials.
R. James Valentine - One of the best experts on this subject based on the ideXlab platform.
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Aortofemoral Bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?
Journal of vascular surgery, 2004Co-Authors: Mark R. Jackson, R. James Valentine, Ahsan T. Ali, Christopher Bell, J. Gregory Modrall, M.burress Welborn, Eva Scoggins, Victor J. D’addio, G.patrick ClagettAbstract:Abstract Purpose Previous studies have documented poor patency rates in "young" patients (age 55 years or younger) with premature atherosclerosis undergoing Aortofemoral Bypass (AFB) to treat aortoiliac occlusive disease. Given the high reported graft patency rates with superficial femoral vein (SFV) grafts performed because of aortic graft infection, we evaluated the role of SFV grafts for AFB as primary therapy for premature atherosclerosis in a case-control study. Methods Over 10 years 31 patients aged 55 year or younger underwent AFB with use of SFV (V-AFB). Case controls consisted of all patients 55 years of age or younger who underwent AFB with use of Dacron (D-AFB) during the same period (n = 80). In all cases this was the initial therapy (no repeat operations). The two groups were well matched for age, sex, weight, preoperative ankle-brachial index, and the comorbid conditions of smoking, coronary artery disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, and renal insufficiency. There were more patients with diabetes in the V-AFB group (34% vs 16%; P = .05). Patients in the V-AFB group had more advanced disease, and the surgical indication was more frequently critical ischemia compared with the D-AFB group (90% vs 46%; P Results There was only one perioperative death in each group. There were no differences in cardiac, pulmonary, or gastrointestinal complications. However, fasciotomy occurred more frequently with V-AFB (44% vs 1%; P P P = .013). There was also a trend for higher limb salvage at 5 years (90% vs 62%). Four graft infections occurred with D-AFB, and none with V-AFB ( P = .32). Conclusions AFB performed with SFV grafts is a far more durable operation than standard D-AFB in young patients with aortoiliac occlusive disease. However, V-AFB is far more likely to require lower extremity fasciotomy, and takes almost twice as long to perform.
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Aortic corset syndrome
Journal of Vascular Surgery, 1997Co-Authors: Ryan T. Hagino, R. James Valentine, G.patrick ClagettAbstract:Abstract The majority of proximal anastomotic complications of Aortofemoral Bypass grafts are related to the formation of pseudoaneurysms or true proximal aneurysmal dilation of the residual infrarenal aorta. The late development of occlusive disease at the proximal anastomosis is an extremely rare event. We report two patients in whom symptomatic stenoses developed involving the proximal anastomoses of Aortofemoral Bypass grafts originally placed for aortoiliac occlusive disease. Surgical exploration demonstrated the presence of a constricting prosthetic corset wrapped around the proximal suture line of each graft. Exuberant neointimal hyperplasia was responsible for both stenoses. (J Vasc Surg 1997;26:138-41.)
Mark R. Jackson - One of the best experts on this subject based on the ideXlab platform.
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Aortofemoral Bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?
Journal of vascular surgery, 2004Co-Authors: Mark R. Jackson, R. James Valentine, Ahsan T. Ali, Christopher Bell, J. Gregory Modrall, M.burress Welborn, Eva Scoggins, Victor J. D’addio, G.patrick ClagettAbstract:Abstract Purpose Previous studies have documented poor patency rates in "young" patients (age 55 years or younger) with premature atherosclerosis undergoing Aortofemoral Bypass (AFB) to treat aortoiliac occlusive disease. Given the high reported graft patency rates with superficial femoral vein (SFV) grafts performed because of aortic graft infection, we evaluated the role of SFV grafts for AFB as primary therapy for premature atherosclerosis in a case-control study. Methods Over 10 years 31 patients aged 55 year or younger underwent AFB with use of SFV (V-AFB). Case controls consisted of all patients 55 years of age or younger who underwent AFB with use of Dacron (D-AFB) during the same period (n = 80). In all cases this was the initial therapy (no repeat operations). The two groups were well matched for age, sex, weight, preoperative ankle-brachial index, and the comorbid conditions of smoking, coronary artery disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, and renal insufficiency. There were more patients with diabetes in the V-AFB group (34% vs 16%; P = .05). Patients in the V-AFB group had more advanced disease, and the surgical indication was more frequently critical ischemia compared with the D-AFB group (90% vs 46%; P Results There was only one perioperative death in each group. There were no differences in cardiac, pulmonary, or gastrointestinal complications. However, fasciotomy occurred more frequently with V-AFB (44% vs 1%; P P P = .013). There was also a trend for higher limb salvage at 5 years (90% vs 62%). Four graft infections occurred with D-AFB, and none with V-AFB ( P = .32). Conclusions AFB performed with SFV grafts is a far more durable operation than standard D-AFB in young patients with aortoiliac occlusive disease. However, V-AFB is far more likely to require lower extremity fasciotomy, and takes almost twice as long to perform.
Tomáš Novotný - One of the best experts on this subject based on the ideXlab platform.
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Analysis of the learning curve of robot-assisted laparoscopic Aortofemoral Bypass
2014Co-Authors: Tomáš Novotný, Martin Dvořák, Robert StaffaAbstract:Introduction: Advanced minimally invasive surgery is typically associated with appreciable learning curves. Robotic operating systems are used to facilitate the most complex procedures. Minimally invasive vascular surgery of the aortoiliac region belongs to this group. The objective of our study was to evaluate the learning process of robot-assisted laparoscopic Aortofemoral Bypass for aortoiliac occlusive disease in a group of 63 patients. Materials/Methods: Between May 2006 and December 2011, 63 patients (48 men, 15 women) at a median age of 58 years (range, 44-75 years), underwent 63 robot-assisted laparoscopic Aortofemoral Bypass procedures. The process of learning was evaluated by the assessment of learning curves. For continuous variables, they were constructed using the cumulative average-time model and power function regression (operative, aortoiliac segment dissection, clamping and anastomosis time). For the evaluation of conversion rate (binary variable) we used a cumulative summation (CUSUM) technique. Results: We implanted 33 aortobifemoral and 30 Aortofemoral Bypasses. In 60 cases, we completed the procedure successfully using minimally invasive approach. We had to convert to open surgery three times. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time 65 minutes (range, 40-125 minutes), median aortoiliac segment dissection time 125 minutes (range, 45-315 minutes) and median operative time 270 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%. During the follow-up period (median 31 months; range, 6-72 months), we observed 3 early occlusions (5%) and 1 graft infection (2%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for proximal anastomosis creation, confirming the positive contribution of the robotic system. The operative time and aortoiliac segment dissection time learning curves were less steep, demonstrating the complexity of the whole procedure and laparoscopic retroperitoneal dissection as well. The reduction of the aortoiliac segment dissection time contributed the most to the overall procedure time improvement. The learning curve for clamping time was the flattest. Only the proximal anastomosis time contributed to its reduction, as expected. The conventional creation of distal anastomoses in the groin was constant. CUSUM analysis confirmed that we had achieved better a conversion rate than the set 5% after 31 procedures. Conclusions: One of the main difficulties of laparoscopic Bypass grafting, anastomosis creation, has been overcome using a robotic operating system and its learning curve is short. Therefore, the acceptable anastomosis and clamping time can be achieved easily even during the learning curve. The whole procedure remains an advanced endoscopic surgery and the retroperitoneal dissection is now its most challenging part. Previous laparoscopic experience and training is crucial for the successful application of this method. Totally robotic retroperitoneal dissection or development of laparoscopic retroperitoneal approach may lead to further operative time reduction. Robot-assisted laparoscopic aortoiliac Bypass grafting seems a safe method with a low complication rate.
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The learning curve of robot-assisted laparoscopic Aortofemoral Bypass grafting for aortoiliac occlusive disease.
Journal of vascular surgery, 2010Co-Authors: Tomáš Novotný, Martin Dvořák, Robert StaffaAbstract:Background Since the end of the 20th century, robot-assisted surgery has been finding its role among other minimally invasive methods. Vascular surgery seems to be another specialty in which the benefits of this technology can be expected. Our objective was to assess the learning curve of robot-assisted laparoscopic Aortofemoral Bypass grafting for aortoiliac occlusive disease in a group of 40 patients. Methods Between May 2006 and January 2010, 40 patients (32 men, 8 women), who were a median age of 58 years (range, 48-75 years), underwent 40 robot-assisted laparoscopic Aortofemoral reconstructions. Learning curve estimations were used for anastomosis, clamping, and operative time assessment. For conversion rate evaluation, the cumulative summation (CUSUM) technique was used. Statistical analysis comparing the first and second half of our group, and unilateral-to-bilateral reconstructions were performed. Results We created 21 Aortofemoral and 19 aortobifemoral Bypasses. The median proximal anastomosis time was 23 minutes (range, 18-50 minutes), median clamping time was 60 minutes (range, 40-95 minutes), and median operative time was 295 minutes (range, 180-475 minutes). The 30-day mortality rate was 0%, and no graft or wound infection or cardiopulmonary or hepatorenal complications were observed. During the median 18-month follow-up (range, 2-48 months), three early graft occlusions occurred (7%). After reoperations, the secondary patency of reconstructions was 100%. Data showed a typical short learning curve for robotic proximal anastomosis creation with anastomosis and clamping time reduction. The operative time learning curve was flat, confirming the procedure's complexity. There were two conversions to open surgery. CUSUM analysis confirmed that an acceptable conversion rate set at 5% was achieved. Comparing the first and second half of our group, all recorded times showed statistically significant improvements. Differences between unilateral and bilateral reconstructions were not statistically significant. Conclusions Our results show that the success rate of robot-assisted laparoscopic Aortofemoral Bypass grafting is high and the complication rate is low. Anastomosis creation, one of the main difficulties of laparoscopic Bypass grafting, has been overcome using the robotic operating system and its learning curve is short. However, the endoscopic dissection of the aortoiliac segment remains the most difficult part of the operation and should be addressed in further development of the method to reduce the operative times. Long-term results and potential benefits of this minimally invasive method have to be verified by randomized controlled clinical trials.