Biomedical subjects

Henry C Veldenz

Publications and source records attributed to Henry C Veldenz.

5 recordsLinked to original sources

PubMed2005

Carotid graft replacement: a durable option.

BACKGROUND: Carotid artery bifurcation reconstruction after endarterectomy has been refined over the years. Methods including primary closure, patch closure, and eversion endarterectomy have been proven to be durable. However, there are patients who require more complicated reconstructions in primary or recurrent disease management. Carotid replacement with a prosthetic interposition graft is potentially a durable option to reconstruct an artery that is technically unsuitable for primary or patch closure. METHODS: The charts of all carotid endarterectomies (n = 482) performed by the authors at our institution between January 1999 and December 2003 were retrospectively reviewed. Follow-up was performed in an Intersocietal Commission for the Accreditation of Vascular Laboratories-accredited vascular laboratory. Patients were divided into two main groups: carotid replacement with 6-mm expanded polytetrafluoroethylene (ePTFE) (REP) or standard endarterectomy (CEA) with or without patch closure. The decision for REP vs CEA (as well as the type of closure) was at the discretion of the surgeon according to an assessment of the end point, the distal internal carotid artery, and the quality and length of the endarterectomy segment. Interposition grafting with a 6-mm stretch of ePTFE from the transected common carotid to the transected internal carotid artery was performed in replacement reconstruction. The external carotid was ligated. Follow-up statistical analyses were performed with the Fisher exact test and analysis of variance for nominal values and t tests for continuous variables. Life table analyses were performed for patency and survival. RESULTS: Complete perioperative data were available for 478 of the 482 operations performed (including all REP cases) during the study. At least one duplex ultrasound scan in follow-up was documented in 84% (n = 402) of the patients. A total of 51 were in the REP group, and 427 received CEA (95.3% with patch closure). Preoperative demographics, preoperative symptoms, and degree of stenosis did not vary within the study groups. Three 30-day surgical deaths occurred. The perioperative stroke rate between groups was not statistically different (REP, 1/51 [1.9%]; CEA, 3/427 [0.70%]; P = .35). Long-term patency and stroke-free survival rates at 3 years exceeded 96% and did not vary significantly between groups. The presence of a patch in the CEA group had no influence on outcomes. Duplex follow-up scan averaged two studies for at least 14 months in each group. Significantly more REP cases were reoperative procedures. CONCLUSIONS: Carotid interposition reconstruction with an ePTFE graft is an acceptable alternative in cases in which the standard technique would be technically difficult or compromising to the endarterectomy closure. Carotid ePTFE interposition graft replacement seems to be safe and durable and to have no increased perioperative risk or altered intermediate-term outcomes.

Aged↗

PubMed2002

Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study.

BACKGROUND: Knee dislocation, which poses a significant risk for injury of the popliteal artery, prompts many surgeons to evaluate these patients with arteriography routinely. Our hypothesis was that physical examination alone (without arteriography) accurately confirms or excludes surgically significant vascular injuries associated with knee dislocation. METHODS: All patients diagnosed with a knee dislocation by an attending orthopedic surgeon between January 1990 and January 2000 were prospectively managed by protocol at our Level I trauma center according to their physical examination. Those with hard signs (active hemorrhage, expanding hematoma, absent pulse, distal ischemia, bruit/thrill) underwent arteriography followed immediately by surgical repair if indicated. Patients with no hard signs (negative physical examination) were admitted for 23 hours, underwent serial physical examination, and then followed as outpatients. RESULTS: There were 35 knee dislocations in 35 patients during this 10-year period. The average age was 31 years; 18 dislocations were on the right knee and 17 were on the left. Two patients died from closed head injuries and multisystem trauma. Eight patients were found to have hard signs (positive physical examination) either at presentation (six patients) or during their hospitalization after reduction of their dislocation (two patients). All eight patients demonstrated a loss of pulses only. Six of these patients showed occlusion of the popliteal artery on arteriography and underwent surgical repair without complication (five vein grafts, one primary repair), one demonstrated spasm of the popliteal artery, and one showed a normal artery that required no treatment. None of the 27 patients with negative physical examination during their hospitalization ever developed limb ischemia, needed an operation for vascular injury, or experienced limb loss. Sixteen patients were available for follow-up (46%). Twelve patients with negative physical examination (44%) were contacted (mean, 13 months; range, 2-35 months), and four of the eight patients with positive physical examination (50%) and surgical repair were contacted (mean, 19 months; range, 6-49 months). None of the patients in either group developed any vascular-related symptoms or suffered from a vascular repair complication over the follow-up interval. CONCLUSION: This limited series suggests that the presence or absence of an injury of the popliteal artery after knee dislocation can be safely and reliably predicted, with a 94.3% positive predictive value and 100% negative predictive value. Arteriography appears to be unnecessary when physical examination is negative but may avert negative vascular exploration when physical examination is positive. This approach substantially reduces cost and resource use without adverse impact on the patient.

Angiography↗

PubMed2002

Two careers in one: an analysis of the earning power of certification in surgical critical care.

BACKGROUND: The core of general surgery supports multiple disciplines, each of which entails similar operative care for different diseases. The purpose of this study was to compare variations of practice patterns of four general surgeons to define the general surgical core that each shared in common, and to determine the effect of subspecialization in surgical critical care on the scope of practice and efficiency of revenue production. METHODS: The charges and collections of four members of the same surgical faculty were analyzed for the 6 months beginning July 1, 2000. Three members practiced general surgery with additional specialization in surgical oncology, surgical endoscopy, and trauma/critical care. The fourth covered all aspects of general surgery, including in-house trauma call, but not surgical critical care. Data were stratified by Current Procedural Terminology code and categorized as operative, bedside care (which included minor procedures), and evaluation/consultation care. Scope of practice was defined as the proportion of operative cases represented by the 10 most frequently performed procedures. General surgical core was defined as those cases that were preformed by all four surgeons at the same frequency. Efficiency of revenue generation was defined as collection rate for these procedures divided by the established, budgeted collection rate for each practitioner. All results were compared using chi(2) with significance accepted at p < 0.05. RESULTS: Fifteen operative procedures were performed with equal frequency by each surgeon and represented a broad spectrum of surgical disease. These procedures constituted a similar proportion of operative practice for all specialists (mean, 45.2%; 90% confidence limit, 3.5%), yet occupied 70% of the trauma surgeon's 10 most frequent surgical procedures versus 36% for the surgical oncology and surgical endoscopy. Charges generated by the provision of surgical critical care, especially in bedside procedures commonly performed in the intensive care unit, exceeded all of the other three surgeons and equaled the revenue generated by operative care. Although overall revenue-generating efficiency was less for the trauma surgeons (57% of eventual collections vs. 67%, chi(2) p = 0.1), immediate reimbursement for critical care was higher than for any other clinical services. CONCLUSION: These data demonstrate that subspecialization in surgical critical care provides valid additional earning capacity to surgical practitioners. Reimbursement is at least as good as for traditional operative care, and fees generated can actually exceed revenue from operative care. With impending decreases in global reimbursement, and attempts to unbundle operative fees, this additional capability becomes an important consideration in potential career choice, as well as a major component in the fiscal stability of trauma programs.

Critical Care↗

PubMedDate not supplied

Endovascular grafts.

Explore the source record for details and available documents.

Journal Article↗

PubMedDate not supplied

Impaired residents: identification and intervention.

PURPOSE: To describe the effect of a psychologist on faculty staff supporting impaired residents to successful program completion in general surgery. METHODS: Since 1996, the Department of Surgery has had a staff psychologist on faculty who works closely with the Trauma service. Duties include provision of patient and family therapies (representing a revenue-generating activity for the department), in-services for staff stress management, research, and community education activities. As resident performance issues have arisen, the psychologist has been instrumental in early identification of and referral for underlying issues affecting resident behavior. RESULTS: From 1996 to October 2001, 12 residents (2 with multiple referrals) have been identified with significant psychological issues impairing performance. The various psychological problems include depression, anger control issues, and addictions; required interventions have included referrals for therapeutic counseling, recommendations for career change, and therapeutic counseling combined with pharmacotherapy. Fellow residents referred 4 of the 12 residents to the psychologist for possible evaluation, and the remaining 8 had referral initiated by performance concerns. CONCLUSIONS: Significant psychological problems can impair resident performance and possible training program completion. Early identification and intervention by a professional psychologist on faculty can provide support for increased opportunity to complete residency training.

Anger↗