Biomedical subjects

Philip S k Paty

Publications and source records attributed to Philip S k Paty.

3 recordsLinked to original sources

PubMed2003

Gender-related differences in outcome: an analysis of 5880 infrainguinal arterial reconstructions.

OBJECTIVE: Few will debate that infrainguinal arterial reconstruction increases limb salvage. However, numerous reports describe a difference in results in coronary and peripheral arterial reconstructions between men and women. In this study, we analyze the outcome of infrainguinal bypasses performed over 30 years and stratify the results by gender. METHODS: We reviewed our vascular registry from 1968 to 1999 for all infrainguinal arterial reconstructions. Demographics, indications, and adverse outcomes were analyzed. Patency, limb salvage, and survival rates were determined with life-table analysis. The chi2, log-rank, and Student t tests were used to determine statistical significance. RESULTS: Five thousand eight hundred eighty procedures were performed, with 2161 in women (37%). Women were significantly older (71 versus 66 years), more often diabetic (53% versus 50%), and less often smokers (27% versus 44%) and more often had surgery for limb salvage (89.8% versus 81.0%). Mortality, complications, and need for revision did not differ. Primary patency rate was 44% versus 47%, secondary patency rate was 55% versus 58%, and survival rate was 39% versus 34% in men and women, respectively, at 10 years (all P >.05). Limb salvage rate in women exceeded that in men (93% versus 88%) at 10 years. Subgroup analysis by conduit also revealed no difference in patency. CONCLUSION: Infrainguinal arterial reconstruction can be performed safely with comparable results in women and men. Although women may present older and more often for limb salvage, outcomes do not appear to be adversely affected.

Adolescent↗

PubMed2002

Composite sequential arterial reconstruction for limb salvage.

OBJECTIVE: Autogenous vein is the conduit of choice in patients presenting for infrainguinal arterial reconstruction. Venous conduit may be limited because of inadequacy or prior utilization. Our group and others use prosthetics to maximize limb salvage with moderate results. However, in cases where patients present with an isolated popliteal segment that may extend below the knee, we have performed prosthetic bypasses to this above-knee segment and then used a venous reconstruction from the native arterial circulation to a more distal outflow tract. In this report, we will analyze our results using this type of reconstruction in patients who present for limb salvage with no all-autogenous option. METHOD: From 1992 to 2000, 27 patients presented for limb salvage with an isolated popliteal artery and inadequate vein for continuous bypass. There were 106 patients in this period without an isolated popliteal segment or adequate vein who underwent prosthetic bypass with distal vein cuff or arteriovenous fistula. The vascular registry and patient charts were reviewed for indication, demographics, and type of composite reconstruction. Outcomes were calculated with use of life table methods and compared by log rank analysis. RESULTS: Demographics revealed 16 (59%) men, 16 (59%) patients with diabetes, and 4 (15%) smokers with a mean age of 71 years (range, 51-87 years). The venous reconstructions had the inflow taken from the distal native popliteal artery in 26 (above knee in 8 and below knee in 18) and the peroneal artery in one. The outflow involved the below-knee popliteal in one (4%), a tibial in 23 (85%), and the dorsalis pedis artery in 3 (11%). Morbidity included bleeding (4%), wound infection (4%), and limb loss (4%). Mortality occurred in one patient (4%), and no revisions were required in follow-up. Six late failures were identified, one of which resulted in amputation. Primary patency and limb salvage were 80% and 88% at 1 year, respectively. For comparison, our results using prosthetic with vein cuff had a 1-year primary patency of 52% and limb salvage of 92% (P = NS), whereas prosthetic with an arteriovenous fistula was 73% and 84%, respectively (P = NS). CONCLUSIONS: Composite sequential reconstruction using an isolated popliteal segment as inflow for the distal reconstruction is an acceptable option in patients presenting for limb salvage reconstruction with limited venous conduit. This type of reconstruction, when available, may be a better option than pure prosthetic with or without a vein cuff or arteriovenous fistula.

Adult↗

PubMed2002

Combined coronary artery bypass with carotid endarterectomy: do women have worse outcomes?

OBJECTIVE: Women undergoing coronary artery bypass grafting (CABG) have higher mortality and morbidity in numerous studies. Although controversial, similar results have been seen in women undergoing carotid endarterectomy. We examined the results of combined eversion CEA/CABG by one group to analyze if the outcome is different between men and women in this setting. METHOD: The records of all patients undergoing combined eversion CEA/CABG were reviewed from our vascular registry between January 1992 and January 2001. Indications, demographics, morbidity, and mortality were retrieved. These results were compared on the basis of gender as well as to patients undergoing CEA alone. Significance was assessed using Theta(2) analysis. RESULTS: There were 563 combined eversion CEA/CABG procedures performed over the 9-year study period: 324 in men and 239 in women. Asymptomatic >70% stenosis was seen in 275 (85%) male patients and 215 (90%) female patients (P = not significant [NS]). Stroke was found in four men vs three women (1.2% vs 1.3%, P = NS), whereas death occurred in 13 men and five women (4.0% vs 2.1%, P = NS). Thirty-day stroke/mortality was 4.9% in men vs 3.3% in women (P = NS). During the same period, patients undergoing CEA alone were subject to a stroke-mortality rate of 1.6% in men and 1.2% in women (P = NS). CONCLUSION: This series demonstrated no difference in outcome among patients undergoing combined eversion CEA/CABG procedures on the basis of gender. Although the results demonstrate a significantly higher mortality and morbidity in patients undergoing combined procedures when compared to carotid surgery alone, the combined procedures can be performed safely in both genders. The large number of asymptomatic patients in both the combined and solo procedures may have positively influenced these results.

Adult↗