Biomedical subjects

Mark R Sarfati

Publications and source records attributed to Mark R Sarfati.

6 recordsLinked to original sources

PubMed2006

A ruptured pancreaticoduodenal artery aneurysm repaired by combined endovascular and open techniques.

Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for <2% of all visceral aneurysms. An association with celiac artery stenosis has been reported. Many present with rupture, and a high mortality can be expected. Treatment is therefore challenging. Arterial ligation, anuerysmectomy, or bypass has been the mainstay of treatment. We recently treated a patient (who had no celiac axis) with a ruptured PDA aneurysm with combined open and endovascular techniques. A 46-year-old man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.

Aneurysm, Ruptured↗

PubMed2006

Pneumococcal aortitis: a difficult preoperative diagnosis.

Primary infections of the aorta are rare. We recently treated a patient who was given a diagnosis of noninfectious aortitis after an extensive work-up, but after clinical deterioration, was found to have a pneumococcal mycotic aneurysm at the time of surgery. The difficulty in distinguishing microbial aortitis from noninfectious chronic periaortitis is discussed as well as the need for frequent surveillance imaging of the aorta if immunosuppression is used to treat the latter entity. The infected aortoiliac segment was ultimately repaired with autologous femoral veins.

Aged↗

PubMed2006

Meeting AHA/ACC secondary prevention goals in a vascular surgery practice: an opportunity we cannot afford to miss.

OBJECTIVE: In an effort to reduce cardiovascular mortality, patients with atherosclerotic arterial disease should undergo risk factor modification according to the American Heart Association/American College of Cardiology (AHA/ACC) Secondary Prevention Guidelines (hereafter, Guideline). We assessed compliance with the Guideline in a group of patients seen in a vascular surgery practice. METHODS: We evaluated 200 consecutive patients with lower-extremity occlusive disease, cerebrovascular disease, or abdominal aortic aneurysm seen by a university-based vascular surgery practice. The subjects were patients who had been seen previously in our clinic (ESTABLISHED) and new referrals (NEW). Data pertinent to each of the nine AHA/ACC Guideline goals were collected from patient interviews, medication histories, and laboratory records. Compliance with each of the Guideline goals was evaluated. Differences in compliance between ESTABLISHED and NEW patient groups were also compared. We also recorded whether a patient had a previous endovascular or open surgical vascular intervention (EVENT or NO EVENT). Differences in compliance between the EVENT and NO EVENT groups were compared. RESULTS: Most patients did not achieve the secondary prevention goals recommended in the Guideline. Patients who had a prior vascular intervention (EVENT) were significantly more likely to achieve goals for low-density lipoprotein level (43% vs 23%), and for statin (71% vs 39%), beta-blocker (46% vs 27%), angiotensin-converting enzyme inhibitor (53% vs. 35%), and antiplatelet agent (85% vs. 68%) use (P < .05). ESTABLISHED patients were significantly more likely than NEW patients to have a prior EVENT (87% vs 47%, P < .0005). ESTABLISHED patients were significantly more likely than NEW patients to achieve goals for low-density lipoprotein level, beta-blocker, and statin use; however, these differences were likely due to the higher proportion of EVENT patients in the ESTABLISHED group. CONCLUSION: Compliance with the Guideline is suboptimal in patients with atherosclerotic arterial disease. Secondary prevention goals were more often achieved in the EVENT patient group, suggesting that a vascular intervention may lead to increased patient and physician awareness and compliance with the Guideline. A targeted effort towards risk factor modification in patients with atherosclerotic arterial disease could improve compliance with the Guideline and reduce cardiovascular mortality.

Aged↗

PubMed2004

Severe coagulopathy following intraoperative use of topical thrombin.

This report describes a case of severe coagulopathy and bleeding related to the intraoperative use of topically applied thrombin. Commercial thrombin preparations contaminated with bovine factor V have been shown to stimulate the production of antibodies directed against factor V. These antibodies can cause coagulopathy. Our patient developed antibodies against factor V after intraoperative exposure to topical thrombin. The resulting antibody-mediated depletion of factor V caused a severe and refractory coagulopathy. Vascular surgeons should be aware that the use of topical bovine thrombin can cause severe coagulopathy.

Administration, Topical↗

PubMed2003

Has the changing nature of vascular surgery adversely affected scholarly activity.

OBJECTIVE: Because of reduced reimbursement and introduction of endovascular techniques into practice, vascular surgeons have increased clinical commitments. Therefore we hypothesized that the scholarly productivity of vascular surgeons has decreased. Study design An author-based Medline search was carried out for members of the Society for Vascular Surgery (SVS). The search included the period from 1985 to 1989 (era 1) for members in 1990, and from 1995 to 1999 (era 2) for members in 2000. Citations were assigned a type: basic science, clinical, case report, letter, or other; and a topic: cardiac, vascular, endovascular, transplantation, or miscellaneous. The main outcome measures were the proportion of members who published in each era and the rates of publication among authors. RESULTS: For era 1, 7069 citations were identified for 529 members, and for era 2, 6823 citations were identified for 615 members. Four hundred forty-two members were cited in era 1 (84%), compared with 443 (72%) in era 2 (P =.01). A significantly smaller proportion of members published clinical research, case reports, and other publications, but not basic science or letters. Excluding unpublished members, there was a median of 11 total publications per author in each era. There were significant reductions in the proportion of members publishing papers related to cardiac (from 36% to 21%), transplantation (8% to 4%), and miscellaneous (43% to 31%) topics, and a significant increase in papers related to endovascular topics (from 19% to 28%) from era 1 to era 2. Moreover, there was a significant increase in median number of vascular (from 5 to 8) and endovascular (1 to 2) papers per published member. Further, the proportion of vascular and endovascular citations compared with total citations increased from 44% to 56% in era 1 and from 3% to 10% in era 2. On a yearly basis, there was a steady decrease in the number of citations throughout era 2, whereas the number of citations in era 1 was relatively constant. CONCLUSIONS: Academic productivity was maintained for individual members who published across both eras, but a smaller proportion of the SVS membership published in era 2. There was also a progressive reduction in the number of publications during the 1990s.

General Surgery↗

PubMed2002

Common femoral artery injury secondary to bicycle handlebar trauma.

Blunt trauma from bicycle handlebars is associated with well-described injuries of the abdominal viscera. These injuries result from the forceful compression of the relatively immobile abdominal organs between the handlebar end and the vertebral bodies. The common femoral artery is also immobile as it passes anterior to the superior pubic ramus, rendering this vessel susceptible to a similar mechanism of injury. We have treated two children who sustained thrombosis of the common femoral artery caused by bicycle handlebar trauma. The lack of familiarity with this uncommon mode of injury may contribute to delayed diagnosis and increased morbidity. We therefore wish to draw attention to this mechanism of injury.

Adolescent↗