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Multiple studies have demonstrated the efficacy of transcranial Doppler (TCD)-directed dextran therapy during carotid endarterectomy (CEA). In our recent review of 6641 CEAs performed within the auspices of the Vascular Study Group of New England, we found perioperative infusion of dextran was not correlated with lower stroke rates but rather was associated with increased postoperative cardiac complications, including myocardial infarction and congestive heart failure. We concluded that there was limited clinical utility for the routine use of dextran during CEA.
Source: Journal of Vascular Surgery - October 1, 2013 Category: Surgery Authors: Tze-Woei Tan, Alik Farber Tags: Letters to the Editor Source Type: research

The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality
The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED).Methods: We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not. Outcomes included perioperative death, stroke, myocardial infarction (MI), congestive heart failure (CHF), hospital l...
Source: Journal of Vascular Surgery - September 3, 2013 Category: Surgery Authors: Tze-Woei Tan, Mohammad H. Eslami, Jeffrey A. Kalish, Robert T. Eberhardt, Gheorghe Doros, Philip P. Goodney, Jack L. Cronenwett, Alik Farber, Vascular Study Group of New England Tags: Clinical research studies Source Type: research

Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival
We examined factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.Methods: Prospectively collected data from 4114 isolated CEAs performed for asymptomatic stenosis across 24 centers in the Vascular Study Group of New England between 2003 and 2011 were used for this analysis. Late survival was determined with the Social Security Death Index. Cox proportional hazard models were used to identify risk factors for mortality within the first 5 years after CEA and to calculate a risk score for predicting 5-year survival.Results: Overall 3- and 5-year survival af...
Source: Journal of Vascular Surgery - March 13, 2013 Category: Surgery Authors: Jessica B. Wallaert, Jack L. Cronenwett, Daniel J. Bertges, Andres Schanzer, Brian W. Nolan, Randall De Martino, Jens Eldrup-Jorgensen, Philip P. Goodney, Vascular Study Group of New England Tags: Clinical research studies Source Type: research

The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry
Objective: The Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.Methods: We analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death,...
Source: Journal of Vascular Surgery - February 13, 2013 Category: Surgery Authors: Marc L. Schermerhorn, Margriet Fokkema, Philip Goodney, Ellen D. Dillavou, Jeffrey Jim, Christopher T. Kenwood, Flora S. Siami, Rodney A. White, SVS Outcomes Committee Tags: Clinical research studies Source Type: research