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James T Lee

Publications and source records attributed to James T Lee.

7 recordsLinked to original sources
PubMed2003

Accuracy of three-dimensional simulation in the sizing of aortic endoluminal devices.

The purpose of this study is to examine the accuracy of a 3D simulation generated by inclusion of various intensity-selected portions of spiral CT data into a proprietary software program (Preview, Medical Media Systems, MMS) in preoperative and postoperative assessment of the anatomical features of abdominal aortic aneurysm (AAA). The accuracy of this software was measured against two other modalities-intravascular ultrasound (IVUS) and axial CT scan-using the IVUS as the reference. Eighty-five patients were included; 43 underwent AAA endovascular exclusion with Talent devices, and 42 with Aneurx devices. Measurement of proximal neck diameter was performed using IVUS, Preview software, and axial CT scan with manual calipers. Measurement of the AAA maximum diameter was performed using Preview software and axial CT scan; 253 measurements in the 85 patients were included. These measurements were compared by means of both linear regression and Bland-Altman agreement analysis. Our results showed that the 95% confidence interval between the Preview software and mean IVUS measurement of proximal AAA neck (3.1 and 2.5) is narrow enough for the software to be used in sizing AAA. This would be especially important for having the properly sized devices available preoperatively. The Preview software tended to be more accurate than CT scans although it was not statistically significant.

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PubMed2003

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Antibiotic Prophylaxis↗
PubMed2002

Endovascular exclusion of abdominal aortic pathology in patients with concomitant malignancy.

The advent of endoluminal aortic repair has gained increasing popularity as an alternative to traditional open surgery in the setting of multiple comorbid disease states. This study analyzes a single center experience of excluding aortic disease in patients with concomitant malignancy. As part of a Federal Drug Administration FDA-approved trial, 318 patients underwent aortic stent-graft repair between June 1996 and February 2001. During that period five patients with advanced-stage neoplasia were treated. Endovascular management of symptomatic abdominal aortic aneurysms (AAA) with a mean diameter of 7.8 cm (range, 6-10 cm), was performed in four patients. In the fifth patient, a custom-made aortic prosthesis was utilized to exclude a paraanastamotic abdominal aneurysm (PAAA) from a previous open AAA repair. Malignancies included esophageal, lung, renal, prostate, and urinary bladder cancers. A mean follow-up of 10.1 months was available. Successful endoluminal repair was accomplished in all five patients with minimal in-hospital morbidity. Mean length of stay was 3.4 days. There were no device-related mortalities and no persistent endoleaks detected for the duration of follow-up. Aneurysm sac enlargement was not seen in any of the patients and complete resolution of the PAAA was noted at one year. Exclusion of AAA and other aortic pathology in patients with an associated malignancy can be performed with a relatively low procedure-related morbidity and mortality. In this population, stent-graft repair remains an individualized option with a multidisciplinary team necessary to explore this therapeutic approach.

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PubMed2002

Iliac vessel injuries.

Trauma to the iliac vasculature continues to pose a significant challenge to management. In several large series, mortality for penetrating injuries is reported as approaching 40%. Uncontrollable hemorrhage originating from an anatomically inaccessible source and multiple associated injuries often contribute to this high mortality rate. This article discusses the current existing management strategies and the controversial role of PTFE in vascular reconstruction within a contaminated field. Concomitant injuries to the enteric viscera and genitourinary system are also addressed. Postoperative management including anticoagulation and the complications of liberal fasciotomy are mentioned. The evolving role of endovascular therapy as an adjunctive modality in the armamentarium of the trauma surgeon is also presented briefly.

Abdominal Injuries↗
PubMed2002

Endovascular management of blunt traumatic renal artery dissection.

PURPOSE: To describe the importance of accurate diagnosis and successful emergent endovascular repair of intimal injury to the renal artery from sudden deceleration. CASE REPORT: A 22-year-old man was evaluated after jumping head first out of a fourth floor window. Gross hematuria was detected at the initial assessment. Contrast-enhanced computed tomography (CT) revealed diminished uptake in the right kidney. Arteriographic examination of the renal artery demonstrated 2 areas of intimal disruption, which a team of physicians decided to treat with angioplasty and stent placement owing to the associated intracranial injuries. Two balloon-expandable stents were successfully deployed to exclude the intimal defects. Once the associated injuries were also addressed, the patient made an uneventful recovery. CONCLUSIONS; Management of blunt traumatic injuries to the renal vasculature involves timely assessment to maximize preservation of renal function. In the setting of multiple concomitant injuries, recent experience supports the consideration of endoluminal intervention for traumatic renal artery dissections.

Adult↗
PubMed2002

Stent-graft migration following endovascular repair of aneurysms with large proximal necks: anatomical risk factors and long-term sequelae.

PURPOSE: To evaluate the outcome of aortic endografts deployed in large infrarenal necks and to identify any association of preoperative aneurysm characteristics and postoperative morphological changes with the incidence of neck dilatation and device migration in this patient subset. METHODS: The records of 47 patients (41 men; mean age 74, range 55-84) with large aortic neck diameters treated with Talent stent-grafts from 1998 to 2001 were reviewed. Patients with anatomical criteria that precluded aneurysm exclusion with currently available devices were preferentially selected. Mean baseline aneurysm morphology included 27.6-mm (range 18-33.4) suprarenal and 28.1-mm (range 24-34) infrarenal neck diameters; the infrarenal neck length was 26 +/- 16 mm with angulation of 37 degrees +/- 18 degrees. Computed tomographic (CT) angiograms up to 3 years were analyzed using specialized interactive software; migration was defined as >1-cm change in the distance from the lower renal artery to the top of the device. Pre- and postoperative morphological characteristics of the aneurysm were compared between patients with and without migration. RESULTS: Of the 45 patients successfully treated, 40 had complete CT data for analysis. During a mean 17-month follow-up, 7 (17.5%) of the 40 devices exhibited distal migration. Six patients required secondary procedures; 5 were in the migration cohort. No preoperative anatomical characteristic or degree of neck dilatation over time was predictive of stent-graft migration. Aneurysm sac regression was significant at 1 (-0.09 +/- 4.90 mm) and 2 (-1.48 +/- 2.56 mm) years in endografts without migration (p<0.001). Distal endograft migration >1 cm predicted the need for secondary interventions (p<0.001), with 83% sensitivity and 94% specificity. CONCLUSIONS: Endovascular repair is successful in patients with large infrarenal necks and complex neck morphology. Changes in aneurysm remodeling over time were similar to reported observations in patients with more favorable neck criteria. Although no anatomical factor associated with migration could be identified from this analysis, distal displacement >1 cm correlated with the need for a secondary intervention.

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