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Michael C Dalsing

Publications and source records attributed to Michael C Dalsing.

13 recordsLinked to original sources
PubMed2007

Results of the national pilot screening program for venous disease by the American Venous Forum.

OBJECTIVE: This report describes the pilot of a free comprehensive national screening program for venous disease. METHODS: The screening process consisted of a venous thromboembolism (VTE) risk assessment, abbreviated duplex examination for venous obstruction and reflux, inspection for signs of chronic venous insufficiency (CVI), and an exit interview. Physicians coordinating the screenings were members of the American Venous Forum. RESULTS: Seventeen institutions screened 476 people (mean, 28 per site; range, 6 to 71). Mean age was 60 years (range, 40 to 91 years), with 78% women and 68% with a body mass index of > or =25. If placed in a situation conducive for VTE, 22 participants (5%) were low risk, 87 (18%) were moderate risk, 186 (39%) were high risk, and 179 (38%) were at very high risk. In 26 people (6%), one or more segments had venous obstruction, and 190 (40%) had one or more segments of venous reflux in the lower extremities. Varicose veins were present in 32%, edema without skin changes in 11%, skin changes attributable to venous disease in 8%, and healed or active venous stasis ulcer in 1.3% (CEAP classification 2, 3, 4, 5, and 6, respectively). Increasing age and increasing deep venous thrombosis risk score significantly correlated with increasing clinical classification, r = 0.09, P = .04, and r = 0.16, P = .0004, respectively. Those participants with reflux in one or more segments were significantly more likely to have a higher clinical classification compared with those with no reflux (P = .0001). CONCLUSION: The first comprehensive national screening for venous disease was performed. Participants were informed of their risk for VTE if placed in a situation conducive to VTE, screened for evidence of obstruction, reflux, and CVI, and empowered to share their results with their primary care provider.

Adult↗
PubMed2006

Discretionary carotid patch angioplasty leads to good results.

BACKGROUND: This study evaluated the type and need for angioplasty in 253 consecutive carotid endarterectomies. METHODS: Polyester knitted gelatin sealed patch (DP) and polytetrafluoroethylene (PTFE) patches were used in, respectively, 159 and 29 patients, with 65 vessels closed primarily (no patch [NP]). RESULTS: Surgical results, estimated blood loss, and surgical time were similar in each group. Postoperative hematomas occurred in 6 DP and 3 NP patients. There were 3 strokes in the DP group. Long-term duplex evaluation was possible in 201 patients. The number of patients who had less than 15%, 15% to 50%, 50% to 79%, 80% to 99%, 100%, or an ungraded degree of narrowing were as follows for each group: DP, 117, 2, 5, 0, 1, and 2; PTFE, 18, 1, 1, 0, 0; and NP, 53, 0, 0, 0, 1. Statistical analysis failed to show any difference between groups postoperatively or in long-term follow-up evaluation. CONCLUSIONS: It appears that selective patching is safe and effective in male patients who undergo carotid endarterectomy. The type of patch material also is inconsequential. Patch type and its use should be at the surgeon's discretion.

Aged↗
PubMed2005

Open surgical repair of children less than 13 years old with lower extremity vascular injury.

PURPOSE: We sought to review the diagnosis and treatment of children with lower extremity vascular injury. METHODS: We performed a query of our vascular surgery database from 1996 through 2002 to determine those with lower extremity vascular injuries requiring surgery who were also less than 13 years of age. Patient demographics, presentation, cause, surgical specifics, and outcome were sought. RESULTS: Six children (2 girls and 4 boys) with an average age of 6.8 years (range, 2-9 years) were found. The causes were 3 blunt injuries, 2 iatrogenic injuries, and 1 penetrating injury. Associated injuries were common. There were 3 femoral and 3 popliteal artery injuries. Two were pseudoaneurysms (common femoral and popliteal artery), and 4 were acute occlusions, of which 3 experienced a delay in diagnosis. There was one primary below-knee amputation. Four reverse vein bypasses were performed, and one vein patch repair of a pseudoaneurysm was performed. Generally, 7 to 9 O interrupted Prolene (Ethicon, Inc, Somerville, NJ) repairs were performed. A delay in diagnosis (2 blunt injuries) resulted in 2 major amputations and 1 insensate foot. Four reconstructions are functioning with viable limbs (follow-up, 5-49 months). An associated brain injury resulted in the only death. CONCLUSIONS: Vascular blunt injury is especially insidious in children. However, an aggressive approach of vascular repair, even extensive bypasses with reverse vein, will allow limb salvage in the absence of a diagnostic delay.

Child↗
PubMed2004

Short-stay carotid endarterectomy in a tertiary-care Veterans Administration hospital.

BACKGROUND: This study focused on 200 carotid endarterectomies (CEA) performed at our Veterans Administration Hospital (VAH) to determine whether 1-day hospitalization after CEA is safe and the degree to which it can be achieved. METHODS: Over 36 months, 200 CEAs were performed for asymptomatic stenosis (n = 104), transient ischemic attacks (n = 68), and stroke (n = 28). General anesthesia was used in 189 procedures. RESULTS: The hospital stay was 1 day for 132 procedures and more than 1 day in 68 CEAs. The average stay was 1.69 +/- 1.5 days. After surgery there were 3 strokes, 5 hematomas that required evacuation, and 5 myocardial infarctions. There were no deaths. Four patients were readmitted in the 1-day and the greater than 1-day stay groups. History of myocardial infarction, renal insufficiency, longer operative time, and complications correlated with a greater than 1-day stay (P <0.05). CONCLUSION: A 1-day hospital stay is safe and practical in a VAH setting, resulting in good clinical outcomes.

Aged↗
PubMed2003

Mesenteric ischemia affects young adults with predisposition.

An 8-year retrospective review of Indiana University Hospital records consisting of any patient age 18 to 40 years old who presented with arterial mesenteric ischemia was performed. Three patients were identified that met our criteria. The first patient was discovered to have a protein C deficiency. The second patient was afflicted with afibrinoginemia, a protein C and an antithrombin III deficiency. The third patient had been previously diagnosed with Takayasu's arteritis and had an elevated ESR. Each patient had a protracted course of symptoms before mesenteric disease was considered, confirmed by angiography, and treated by arterial bypass with/without bowel resection. All patients survived and are currently asymptomatic at an average of 2 years postoperatively. Mesenteric ischemia in patients under the age of 40, especially in the absence of cocaine use, is rare and often causes a delay in diagnosis and appropriate treatment. The high incidence of hypercoagulable states in our study cases suggests the need for a search for such disorders and the possible need for long-term anticoagulation therapy as a deterrent to recurrence.

Adult↗
PubMed2003

Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice.

PURPOSE: Saphenous nerve injury has long been recognized as a risk of greater saphenous vein stripping, and it has been suggested by some authors as a reason to avoid stripping below the knee. The rate of injury reported in the literature is extremely variable, with no study adequately addressing the effect of these injuries on patient quality of life. We undertook this study to measure the prevalence of these injuries and quantify their impact on quality of life. METHODS: A cross-sectional study of patients who had undergone primary greater saphenous vein stripping to the ankle was performed. Patients who had undergone this procedure, performed in a downward manner by a single surgeon over a 12-year period, were contacted and asked to return for a follow-up examination. Subjects completed the Aberdeen Varicose Vein Symptom Severity Score as well as a questionnaire designed to identify symptoms of saphenous nerve injury and any effects on quality of life. They were then evaluated for saphenous nerve deficits with simple neurologic tests. Charts were reviewed to determine preoperative CEAP classification. Results were analyzed for statistically significant differences between groups. RESULTS: Out of 111 patients (127 legs) who had undergone the procedure, 38 (34%) agreed to participate in the study. Three of these patients were ultimately excluded because of an inability to obtain a reliable neurologic examination of the legs, leaving 35 patients with a total of 45 legs operated. Participants did not differ from the potential study population in demographic data, follow-up interval, or preoperative CEAP classification. Median time since operation was 4.5 years (range, 8 months to 10.75 years). Overall, 40% of patients reported symptoms consistent with saphenous nerve injury at some time after operation, but these symptoms affected quality of life in only 6.7%. Symptoms persisted at evaluation in 17.8%, and only one patient (2.3%) reported any negative effect on quality of life at the time of examination. Saphenous nerve deficits were identified in 58% of patients. Patients with deficits had no statistically significant differences from those without deficits in terms of demographic data, follow-up interval, preoperative CEAP class, or Aberdeen score. CONCLUSIONS: Signs and symptoms of saphenous nerve injury are common at long-term follow-up after greater saphenous vein stripping to the ankle. However, there appears to be little, if any, significant resultant morbidity. The risk of saphenous nerve injury should therefore not be considered a reason to avoid stripping of the greater saphenous vein to the ankle.

Adult↗
PubMed2002

Impaired collateral artery development in spontaneously hypertensive rats.

OBJECTIVE: To determine whether collateral artery development is impaired in spontaneously hypertensive (SHR) relative to normotensive (WKY) rats. METHODS: Sequential mesenteric arteries were ligated to create a collateral pathway responsible for the perfusion of approximately 50 first-order arterioles. Collateral development was assessed by measurement of in vivo arterial diameter before and 1 week after ligation. Histological and morphometric measurements were made from cross-sectional preparations of these arteries to evaluate intimal and medial cell numbers and medial area. eNOS expression was evaluated with Western blotting. RESULTS: One week after arterial ligation, collateral diameter was increased more in WKY than SHR both absolutely (137 +/- 9.1 versus 99 +/- 8.6 microm) and relative to same-animal controls (38 +/- 5.5% versus 13 +/- 7.1%). At the time of model creation, blood flow was elevated to comparable levels in both WKY and SHR, and wall shear rate in the SHR collateral was greater than both the SHR control and WKY collateral arteries. Endothelial cell number in arterial cross-section was increased in collaterals by 80% in WKY and only 22% in the SHR. eNOS expression was increased in the WKY (128%) but not in the SHR collateral. CONCLUSIONS: For equivalent arterial occlusion, the data demonstrate that collateral development is suppressed in the SHR as indicated by luminal expansion. This impairment of luminal expansion is associated with a decreased endothelial proliferation and the lack of an increase in eNOS expression.

Adaptation, Physiological↗
PubMed2002

Impaired collateral development in mature rats.

The effect of maturation on collateral development of resistance arteries was investigated. Three to four sequential mesenteric arteries were ligated to create collateral pathways in anesthetized young (approximately 200 g) and mature (approximately 600 g) rats. Blood flow was similarly elevated in collaterals of young and mature animals. In vivo inner arterial diameter was increased only within young collaterals (33 +/- 7%, P < 0.001). Increases in number of intimal nuclei (57 +/- 10% vs. 52 +/- 14%) and cross-sectional medial area (33 +/- 13% vs. 38 +/- 5%) were similar between young and mature collaterals. Relative to the same animal controls, collateral endothelial nitric oxide synthase mRNA was increased as much in mature as in young rats. Proteomic analysis revealed significant differences in protein expression with maturation between control arteries as well as flow-loaded collateral vessels. The results indicate that, whereas intimal and medial remodeling events were similar in collaterals of young and mature rats, luminal expansion occurred only in young rats. Alteration in arterial protein expression with maturation and altered responses to stimuli for collateral development may contribute to this impairment.

Aging↗
PubMedDate not supplied

The Ehlers-Danlos specter revisited.

Ehlers-Danlos type IV is a major concern to vascular surgeons because it is often associated with spontaneous hemorrhage from arteries containing decreased type III collagen. Five members of a family with Ehlers-Danlos type IV and a review of another family of five with Ehlers-Danlos type IV are reported. Evaluation of the recent family included clinical evaluation as well as assay of collagen production. The age range of the three involved females and two males was 7 to 52 years. The father of the affected family had a spontaneous colon perforation at age 39. His son, at age 27, had a spontaneous rupture of the iliac artery. Revascularization was accomplished with difficulty. His daughter had a large cerebral bleed. Two granddaughters, ages 7, have not had any bleeding or aneurysmal events. The amount of type III collagen was only 10% of normal in the patient with the iliac artery rupture. The three females all exhibited similarly low levels of type III collagen. The father's type III collagen level was not sufficiently low to confirm Ehlers-Danlos type IV, although he had a spontaneous colon perforation. In the other Ehlers-Danlos type IV family of five, the three surviving members had type III collagen levels as low as 5% of normal. Two family members died after spontaneous iliac rupture at ages 24 and 33. Both families exhibited an autosomal dominant inheritance pattern. Ehlers-Danlos type IV remains a challenging problem for vascular surgeons. It is transmitted as an autosomal dominant inheritance with a high degree of penetrance. Spontaneous arterial and intestinal perforations should alert the clinician to the possibility of Ehlers-Danlos type IV. Patients should be evaluated noninvasively. Arterial repairs may not be successful in these patients because the vessels are extremely friable. Assays of collagen production are advisable in establishing the diagnosis.

Adolescent↗
PubMedDate not supplied

Collateral growth in the peripheral circulation: a review.

Arterial occlusive diseases are a major cause of morbidity and death in the United States. The enlargement of pre-existing vessels, which bypass the site of arterial occlusion, provide a natural way for the body to compensate for such obstructions. Individuals differ in their capacity to develop collateral vessels. In recent years much attention has been focused upon therapy to promote collateral development, primarily using individual growth factors. Such studies have had mixed results. Persistent controversies exist regarding the initiating stimuli, the processes involved in enlargement, the specific vessels that should be targeted, and the most appropriate terminology. Consequently, it is now recognized that more research is needed to extend our knowledge of the complex process of collateral growth. This basic science review addresses five questions essential in understanding current problems in collateral growth research and the development of therapeutic interventions.

Animals↗
PubMedDate not supplied

Endovascular vs open AAA repair: does size matter?

Since the natural tendency of the aorta is to increase in diameter and tortuosity with age and since abdominal aortic aneurysms (AAAs) increase in diameter and length over time, encroaching on the renal and hypogastric orifices, early repair of AAAs (when > or =4.0 cm) may allow greater applicability of the endovascular option because of more favorable aortoiliac morphology. Patients who present at an older age with larger AAAs should be more likely to be anatomically excluded from endovascular AAA repair. Over a 42-month period, 317 consecutive patients referred with aortoiliac aneurysms (infrarenal AAA > or =4.0 cm) were evaluated by one of the authors (SGL) for endovascular vs open repair based on computed tomography (CT) and angiographic imaging. The 10 anatomic exclusion criteria were those applicable to the Zenith endograft (Cook, Inc), which currently is the most anatomically inclusive of the aortic endografts in commercial use in the United States. Based on their aortoiliac morphology, 212 patients were excluded from endovascular repair and 105 were included as acceptable anatomic candidates. Age, AAA size, and the reason(s) for exclusion were recorded for each patient. By use of Student's t test and logistic and linear regression analyses, the groups were compared by age, AAA size, and age + size. There was no significant difference in patient age or AAA size distribution between the group of patients excluded from endovascular repair based on aortoiliac morphology compared to those who met the inclusion criteria. Patients with small AAAs (4.0-5.4 cm) had similar age distribution as those with large (> or =5.5 cm) AAAs. The majority of patients (87%) were excluded based on proximal aortic neck morphology. The presence of aortoiliac morphology that precludes endovascular repair is independent of patient age or AAA size at presentation. A patient presenting with a small (4.0-5.4 cm) AAA is not more likely to be a candidate for endovascular repair than a patient with a large AAA.

Aged↗