Biomedical subjects
Todd E Rasmussen
Publications and source records attributed to Todd E Rasmussen.
Endovascular assisted in situ bypass grafting: a simplified technique for saphenous vein side branch occlusion.
The in situ bypass procedure for lower extremity limb salvage requires a long continuous incision or multiple interrupted incisions over the greater saphenous vein to ligate the saphenous vein side branches. This can result in wound complications that frequently prolong hospital stay and threaten the graft. In an effort to reduce the incidence of wound complications, alternate methods of occluding the vein side branches have been used. One method is to deliver coils under angioscopic vision into the saphenous vein side branches. This report details a simplified technique that uses widely available catheter-based equipment to perform saphenous vein side branch occlusion under fluoroscopic guidance.
Intraoperative use of a new angle-independent Doppler system to measure arterial velocities after carotid endarterectomy.
OBJECTIVE: The purpose of this study was to assess the intraoperative use of a new angle-independent ultrasound scan device (EchoFlow [EF]) in measurement of carotid artery velocities after endarterectomy. Specifically, the purpose was to determine the reproducibility of velocity measurements obtained with EF and to compare these measurements with the velocity measurements obtained with duplex ultrasound scan. METHODS: Velocity measurements of the common, internal, and external carotid arteries were performed by the operative surgeon with EF in 65 consecutive patients after carotid endarterectomy (36 female, 29 male; mean age, 71 years). Three velocity measurements were obtained from each of the arteries with EF and compared with the velocity measurements obtained with duplex ultrasound scan performed by a radiologist. RESULTS: Velocity measurements obtained with the EF device were reproducible in the common, internal, and external carotid arteries (intrapatient correlation coefficients, 0.95, 0.96, and 0.95, respectively). Seventy-five percent of common, 88% of internal, and 78% of external carotid velocity measurements obtained with the angle-independent ultrasound scan device were within 25 cm/s of the velocities measured with duplex ultrasound scan. The mean differences in velocity measurements between EF and duplex scan were -12 cm/s in the common, -8 cm/s in the internal, and -11 cm/s in the external carotid arteries. Differences between the EF device and duplex scan velocity measurements correlated with increasing arterial velocities in each of the three arteries measured (P <.05). CONCLUSION: Reproducible measurements of carotid artery velocity may be obtained with a new angle-independent Doppler system after endarterectomy. Most measurements obtained with the EF system are clinically comparable with those obtained with standard duplex ultrasound scan. This novel low-cost device may be useful in the intraoperative assessment of hemodynamic adequacy of carotid endarterectomy.
Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study.
OBJECTIVE: The objectives of this study were the comparison of patients who needed mesh closure of the abdomen with patients who underwent standard abdominal closure after ruptured abdominal aortic aneurysm repair and the determination of the impact of timing of mesh closure on multiple organ failure (MOF) and mortality. METHODS: We performed a case-control study of patients who needed mesh-based abdominal closure (n = 45) as compared with patients who underwent primary closure (n = 90) after ruptured abdominal aortic aneurysm repair. RESULTS: Before surgery, the patients who needed mesh abdominal closure had more blood loss (8 g versus 12 g of hemoglobin; P <.05), had prolonged hypotension (18 minutes versus 3 minutes; P <.01), and more frequently needed cardiopulmonary resuscitation (31% versus 2%; P <.01) than did the patients who underwent primary closure. During surgery, the patients who needed mesh closure also had more severe acidosis (base deficit, 14 versus 7; P <.01), had profound hypothermia (32 degrees C versus 35 degrees C; P <.01), and needed more fluid resuscitation (4.0 L/h versus 2.7 L/h; P <.01). With this adverse clinical profile, the patients who needed mesh closure had a higher mortality rate than did the patients who underwent primary closure (56% versus 9%; P <.01). However, the patients who underwent mesh closure at the initial operation (n = 35) had lower MOF scores (P <.05), a lower mortality rate (51% versus 70%), and were less likely to die from MOF (11% versus 70%; P <.05) than the patients who underwent mesh closure after a second operation in the postoperative period for abdominal compartment syndrome (n = 10). CONCLUSION: This study reports the largest experience of mesh-based abdominal closure after ruptured abdominal aortic aneurysm repair and defines clinical predictors for patients who need to undergo this technique. Recognition of these predictors and initial use of mesh closure minimize abdominal compartment syndrome and reduce the rate of mortality as the result of MOF.
Human leukocyte antigen class II immune response genes, female gender, and cigarette smoking as risk and modulating factors in abdominal aortic aneurysms.
OBJECTIVE: Aortic inflammation and the genes that regulate the immune response play an important role in abdominal aortic aneurysm pathogenesis. However, the modulating effects of such genetic and other environmental factors on the severity on aneurysm inflammation is not known. The objective of this study was to determine the influence of the human leukocyte antigen (HLA) class II genes, gender, and environmental factors on degree of abdominal aortic aneurysm tissue inflammation. METHODS: Aneurysm specimens were obtained at the time of operation from 96 consecutive patients who underwent abdominal aortic aneurysm repair and were graded for degree of histologic inflammation. Multivariate analysis was used to determine the association of genetic and environmental factors with degree of inflammation and to determine the HLA-associated disease risk for aneurysm. RESULTS: Active cigarette smoking and female gender were independently associated with high-grade tissue inflammation identified histologically (odds ratio [OR], confidence interval [CI]: 5.6, 1.6 to 19.3; and 6.0, 1.4 to 26.2, respectively), and a specific HLA allele (DR B1(*)01) was inversely associated with inflammation (OR, CI: 0.2, 0.04 to 0.7). Overall, the HLA-DR B1(*)02 and B1(*)04 alleles were significantly associated with disease risk, more than doubling risk for abdominal aortic aneurysm (OR, CI: 2.5, 1.4 to 4.3; and 2.1, 1.2 to 3.7, respectively). CONCLUSION: Active cigarette smoking and female gender are significant disease-modulating factors associated with increased abdominal aortic aneurysm inflammation. In addition, the HLA class II immune response genes possess both disease modulating and disease risk properties, which may be useful in early aneurysm detection and surveillance.
Motor scooter handlebar syndrome.
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Ehlers-Danlos syndrome type IV and a novel mutation of the type III procollagen gene as a cause of abdominal apoplexy.
Abdominal apoplexy is a clinical entity characterized by spontaneous intraperitoneal hemorrhage from rupture of a visceral vessel. We describe a 34-year-old man who presented with abdominal apoplexy due to rupture of an ileocolic aneurysm. Subsequent biochemical and genetic analysis confirmed the diagnosis of Ehlers-Danlos syndrome type IV based on abnormal production of type III procollagen and a novel mutation in the COL3A1 gene. Patients presenting with abdominal apoplexy should undergo a thorough examination so that the underlying vascular pathology can be identified.
Review of standards for competence in catheter-based endovascular procedures: a resource and strategy for the interventional vascular surgeon.
The field of peripheral vascular disease management is evolving. As such, vascular surgeons can no longer be complacent and expect to be included in the rapidly expanding practice of endovascular intervention. If not engaged, vascular surgeons risk losing not only the patients who have largely driven this evolution but also their role as leaders in the management of vascular disease. Therefore vascular surgeons and vascular surgical training programs find themselves in an awkward and sometimes confrontational circumstance attempting to gain experience and training in catheter-based procedures. Individual societies, both surgical and nonsurgical, have put forth competence standards for catheter-based procedures. However these standards are not always consistent and the definition of competence is often a heated debate. In addition, combining the acquisition of endovascular skills with the multitude of available endovascular training experiences, didactic and "hands-on," is not well coordinated. The objectives of this review are to summarize the literature as it relates to catheter-based endovascular competence, including publications from nonsurgical catheter-based specialties, and to place the acquisition of basic endovascular skills in context with the available endovascular courses in a stepwise strategy. A final objective is to provide a literature-based resource that outlines specific phases in the development of interventional vascular surgeons and training programs as they advance into the arena of catheter-based endovascular therapies.