Biomedical subjects

David J Minion

Publications and source records attributed to David J Minion.

10 recordsLinked to original sources

PubMed2006

The endowedge and kilt techniques to achieve additional juxtarenal seal during deployment of the Gore Excluder endoprosthesis.

The proximal 4 mm of the Gore Excluder endoprosthesis are scalloped. Our purpose is to describe our initial experience of a novel technique, referred to as the "endowedge," that takes advantage of this scalloped configuration in aneurysms with short proximal necks. The technique utilizes a balloon in the renal artery to aid alignment of a scallop and allow additional juxtarenal seal. A retrospective review of aneurysms treated with the endowedge technique at our institution was initiated. Renal balloons were placed via the brachial approach. Excluder endografts were deployed by flowering the first one or two rings, then advancing upward against the inflated balloon during completion of deployment. In patients with dumbbell-shaped morphology, an aortic cuff was deployed in the distal seal zone prior to the main body (kilt technique). Eight patients were identified, three of whom underwent an adjuvant kilt procedure. Average preoperative proximal neck length was 8.5 mm (range 6-12). Average additional juxtarenal seal was 2.3 mm. Mean follow-up was 5 months (range 2.5 weeks to 9 months). There were no type I endoleaks. There were two type II endoleaks. Average aneurysm size decreased from 6.0 to 5.5 cm. No aneurysm has enlarged or ruptured. We conclude that the endowedge technique allows additional juxtarenal seal during endograft placement. Our early results suggest that this technique may allow for safe treatment of aneurysms with short necks.

Aged↗

PubMed2006

Technique of slow deployment of Gore Excluder endograft improves accuracy of placement.

The standard deployment of Gore Excluder endoprostheses involves rapid pulling of the deployment knob once the graft is thought to be properly positioned. We describe an alternative technique that involves the slow pulling of the deployment knob. The key features of this technique include anticipating the asymmetric flowering of the graft that occurs toward the contralateral limb, prompt correction of any graft malpositioning, and maintaining the slow deployment until the contralateral gate is released. Our experience with this technique demonstrates that it is accurate, safe, and reduces the need for proximal extension cuffs.

Angioplasty↗

PubMed2006

Peripheral atherectomy in TransAtlantic InterSociety Consensus type C femoropopliteal lesions for limb salvage.

BACKGROUND: The optimal therapy for TransAtlantic Societal Consensus (TASC) type C femoropopliteal lesions remains a critical issue in the treatment of infrainguinal occlusive disease. The purpose of this study was to evaluate the outcome of limbs with TASC C femoropopliteal lesions and critical limb ischemia treated with the FoxHollow SilverHawk atherectomy catheter. METHODS: From September 2004 to September 2005, 18 consecutive femoropopliteal procedures performed in 17 limbs in 16 patients were reviewed. Demographic data, baseline angiographic findings, and indications for the procedures were recorded. Clinical outcomes including symptom resolution and limb salvage were determined for the 17 primary procedures. Hemodynamic improvement was compared by using the paired Student t test. Stenosis-free patency was determined by the Kaplan-Meier method. RESULTS: The mean age was 72.5 years (range, 47-88 years). Fifty percent of the patients had four or more of the following risk factors: hypertension, diabetes, tobacco use, hyperlipidemia, renal insufficiency, and coronary artery disease. The indication was tissue loss in 13 limbs and rest pain in 4. All patients had a second level of disease, either inflow or tibial/pedal, which was treated concurrently when appropriate. Initial resolution of symptoms was achieved in 12 limbs, and partial healing was achieved in 2 others. Early amputation was necessary in the remaining three patients, but this was likely due to severe inframalleolar disease and advanced forefoot ischemia at the time of presentation. Five patients have remained symptom-free without restenosis at a mean follow-up of 6 months. Two patients have required late amputation for hemodynamic failure. The ankle-brachial index improved from 0.39 +/- 0.08 (mean +/- SEM) before surgery to 0.75 +/- 0.08 in the immediate postoperative period (P = .02). However, it returned toward baseline at 6 months after surgery, with a mean of 0.48 +/- 0.07. Stenosis-free patency of the femoropopliteal segment was 22% at 12 months. CONCLUSIONS: Peripheral atherectomy can achieve good early clinical and hemodynamic success in patients with TASC C lesions and critical limb ischemia. However, mid-term restenosis rates are high in this challenging cohort of patients.

Arterial Occlusive Diseases↗

PubMed2005

Revision using distal inflow: a novel approach to dialysis-associated steal syndrome.

Current access-preserving treatment options for dialysis-associated steal syndrome (DASS) include fistula lengthening or banding and distal revascularization interval ligation (DRIL). We describe a novel technique for the treatment of DASS that we have termed revision using distal inflow (RUDI). Briefly, the technique involves ligation of the fistula at its origin followed by reestablishment of the fistula via bypass from a more distal arterial source to the venous limb. Four patients with brachial artery-based arteriovenous fistula and DASS underwent RUDI as described above using either the proximal radial or ulnar artery as inflow and vein as conduit. Patients were diagnosed with DASS based on the clinical findings of pain, pallor, loss of radial pulse, and sensorimotor dysfunction after creation of an AVF. Noninvasive vascular studies confirmed diminished finger pressures that improved with compression of the fistula. All patients experienced rapid resolution of their symptoms, although one patient complained of mild residual parasthesias. Follow-up ranging from 4 to 14 months has revealed patent functional fistulas. These initial results demonstrate that RUDI can be an effective treatment of DASS. By design, RUDI incorporates many of the advantages of established access-preserving procedures. That is, by using a smaller distal artery as inflow, RUDI lengthens the fistula, decreases the radius, and preserves antegrade flow in the brachial artery. In contrast to DRIL, it is the fistula, not the native arterial supply, that is placed at risk by ligation and revascularization. Consequently, we believe that RUDI may become the procedure of choice for DASS after brachial artery-based fistulas.

Adult↗

PubMed2004

Surveillance venous duplex is not clinically useful after total joint arthroplasty when effective deep venous thrombosis prophylaxis is used.

The early detection of deep venous thrombosis (DVT) and treatment with systemic anticoagulation to prevent pulmonary embolism (PE) are essential in the management of patients undergoing total joint arthroplasty (TJA). However, improvements in prophylactic measures have significantly decreased the occurrence of DVT in these patients. The purpose of this study was to determine whether routine postoperative duplex surveillance for DVT remains clinically useful. The medical records of all patients undergoing total knee or total hip arthroplasty between October 1997 and January 2002 at a University Hospital and its Veterans Affairs (VA) affiliate were reviewed. The type of operation and occurrence of complications (e.g., DVT, PE, and hemorrhage) were noted. All patients were treated postoperatively with both enoxaparin 30 mg b.i.d. and bilateral lower extremity sequential compression devices (SCDs). A venous duplex scan was performed prior to discharge. Three hundred ninety-eight patients underwent 441 TJAs for 149 hips and 292 knees. The average age was 65 years (range, 23-95). Venous duplex scans were performed within 1 week (median, 4 days) of operation. Initial inpatient scans revealed acute, ipsilateral DVT in five patients (1.3%). Three patients experienced documented PE-one as an inpatient and two after hospital discharge; both outpatients had negative inhospital duplex scans. One of the 398 patients did not have a duplex scan as an inpatient and returned 6 weeks later with a popliteal DVT. Complications included one upper gastrointestinal hemorrhage, and one patient died postoperatively of unknown causes. These data demonstrate that routine postoperative venous duplex scans rarely found DVT (5 of 398 patients) after TJA when effective prophylaxis was used. Furthermore, surveillance scanning did not enable reliable prediction of PE. Therefore, we conclude that postoperative inpatient surveillance duplex scans for DVT provide very minimal benefit and that a routine screening program is not clinically useful for patients managed with effective DVT prophylaxis.

Adult↗

PubMed2004

Surgical management of peripancreatic arterial aneurysms.

Peripancreatic artery aneurysms--gastroduodenal (GDA) and pancreaticoduodenal (PDA)--are highly unusual. We report 4 such aneurysms and have collated reports of true peripancreatic artery aneurysms based on an extensive review of the English literature. From this review, patient characteristics, clinical behavior, outcome and management strategies are assessed.

Adult↗

PubMed2003

Endovascular exclusion of a postendarterectomy carotid pseudoaneurysm.

Carotid pseudoaneurysms are rare occurrences. They often result from trauma, but can also present following carotid endarterectomy. Treating such pseudoaneurysms can be difficult due to previous surgery and limited access to the high internal carotid artery. A case involving a postendarterectomy carotid pseudoaneurysm treated via a femoral approach with a covered stent using endoluminal techniques is presented.

Aged↗

PubMed2003

Pseudoaneurysm of the lateral plantar artery after foot laceration.

Two children with lateral plantar artery pseudoaneurysms are presented. Both cases were associated with a plantar laceration and were successfully treated with ligation. Only one other report of a lateral plantar artery pseudoaneurysm was found in the literature; no reports involving the medial plantar artery have been reported. A cadaver dissection supports the hypothesis that the lateral plantar artery is more superficially located and therefore more vulnerable to injury compared with the medial plantar artery. Clinicians treating patients with lacerations of the foot should be aware that an arterial injury may be present, even in the absence of active bleeding.

Aneurysm, False↗

PubMed2003

Endovascular repair of external iliac artery occlusion after hip prosthesis migration.

PURPOSE: To report emergent endovascular intervention to restore lower extremity arterial patency after migration of a hip prosthesis caused thrombosis of the external iliac artery (EIA). CASE REPORT: Nine months following left hip revision arthroplasty, a 66-year-old woman presented to the Emergency Department with the complaints of an acutely painful left lower extremity for over 6 hours. Imaging showed the metallic acetabular portion of the hip prosthesis in the iliac fossa, with severe external compression of the EIA. After thrombolysis to remove clot from the EIA, an 8x60-mm self-expanding Smart stent was deployed in the left EIA from a contralateral access. The procedure was successful, and the patient was discharged. An infected wound from a compartment fasciotomy delayed revision of the hip prosthesis. Nine weeks after stenting, the patient returned with a cold, pulseless left limb; a femorofemoral bypass was constructed to restore perfusion. CONCLUSIONS: While stent placement restored flow for 9 weeks after the initial ischemic event, the recurrent thrombosis could have been prevented by earlier revision of the migrated prosthesis.

Aged↗

PubMed2002

Are multiple objective measures of student performance necessary?

BACKGROUND: This study examines the effect of using multiple modalities to evaluate medical students. METHODS: Thirty-four students were evaluated by a complex model utilizing National Board of Medical Examiners (NBME) shelf examination, Objective Structured Clinical Examination (OSCE), Computer Patient Simulation (CPS), faculty and peer evaluation. Results were compared with a traditional model based on NBME and faculty evaluation alone. RESULTS: Reliability (coefficient alpha) of the complex and traditional models were 0.72 and 0.47, respectively. Item correlations suggested that NBME was most discriminating (r = 0.75), followed by OSCE (r = 0.52), peer evaluation (r = 0.43), CPS (r = 0.39), and faculty evaluation (r = 0.32). Rank order correlation (Spearman's rho) between scores calculated using each model was 0.87. CONCLUSIONS: Although the complex model has improved reliability, both models rank students similarly. However, neither model fully captures and reflects the information provided by each of the specific evaluation methods.

Adult↗