Andrew J. Seiwert

Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair.

BACKGROUND Shrinking health care resources impose a requirement to evaluate new technology for cost as well as clinical effectiveness. We studied an initial clinical experience with endograft treatment (EAG) of abdominal aortic aneurysm (AAA) at the beginning of an endovascular program in comparison with open surgical repair (OSR), which had been in use for decades. METHODS From March 1997 to April 1998, the utilization of hospital resources, actual cost, clinical descriptors, and treatment outcomes were recorded for two contemporaneous groups, each having 16 consecutive patients with AAA, treated with either EAG or OSR. Subjects were not randomized; EAG treatment was based on predetermined exclusion/inclusion criteria. Statistical comparison was by either Fishers exact test or the Wilcoxon rank sum test. RESULTS There were no differences between OSR and EAG in age, gender, AAA size, smoking status, diabetes, ischemic heart disease, history of coronary artery bypass grafts, previous vascular surgery, or other comorbidity. There were no deaths in either group. Patients treated by EAG procedure had significantly lower length of hospital stay, length of stay in intensive care unit, time in operating room, and cost of operating room without graft (P <0.05). Cost of operating room with graft was less in OSR group (P <0.001). In-hospital imaging costs specific to the EAG procedure were

Carotid arterial ultrasound scan imaging: A direct approach to stenosis measurement

1,370.45 +/-

Chronic venous insufficiency due to great saphenous vein incompetence treated with radiofrequency ablation: an effective and safe procedure in the elderly.

66.92 (range

Fate of great saphenous vein after radio-frequency ablation: detailed ultrasound imaging.

911.58 to

Factors Related to Short Length of Stay After Carotid Endarterectomy

1,826.76). Total costs were not significantly different between the OSR and EAG,

Emergent carotid endarterectomy versus stenting in acute stroke patients with tandem occlusion

12,714.19 +/-

PC100. First Experience of Creating a Secondary Hemodialysis Access Using a Modified MILLER Technique

1,115.52 and

Cilostazol May Improve Maturation Rates and Durability of Vascular Access for Hemodialysis

12,904.99 +/-

Ultrasound findings after radiofrequency ablation of the great saphenous vein: Descriptive analysis

494.69, respectively (P = 0.26). CONCLUSIONS Total hospital cost is not different for the two treatments studied despite differences in experience with their use. Endograft treatment utilizes significantly less hospital resources than open surgical repair. The endograft prosthesis contributes a significant cost increment that may decline with expanded use.

Regarding “Deep venous thrombosis after radiofrequency ablation of greater saphenous vein”

PURPOSE Management decisions regarding carotid artery disease are critically dependent on stenosis but have been made difficult because of conflicting methods used to determine such stenosis. The increasing use of duplex ultrasound scanning has conventionally depended on Doppler velocity measurement, an indirect method for calculating carotid stenosis. Recent technical advances have improved the quality of B-mode/color-flow ultrasound scan imaging (USI). We tested prospectively whether USI was clinically effective as the primary criterion for estimating carotid stenosis. METHODS Transverse and longitudinal USI, Doppler velocity, and arteriography data were obtained sequentially and independently for 713 carotid bifurcations. The internal carotid artery (ICA) residual lumen, the local outer diameter at the stenotic site, and the diameter distal to the bulb were measured in a representative USI longitudinal section. The peak systolic velocity and the end diastolic velocity (EDV) were measured at the stenosis. Local stenosis as determined with USI was compared with the x-ray arteriographic clinical radiology interpretation (XRI). As the primary method, radiologists compared the residual lumen with the distal ICA diameter, as recommended by the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study. Analysis was by means of the USI positive predictive value (PPV) and negative predictive value (NPV) of the XRI findings, with the assumption that 80%, 70%, and 60% local stenosis with USI related to 70%, 60%, and 50% stenosis with XRI, respectively. RESULTS All 56 ICA occlusions as determined with USI were confirmed with XRI. When the USI showed 80% to 99% stenosis, the PPV of the XRI showing 70% to 99% stenosis was 94% (116/123). Two ICAs that were shown to be severely diseased with USI appeared to be occluded with XRI. For <50% stenosis shown with USI, the prediction of <50% stenosis shown with XRI was 94% (253/269). For borderline stenosis in the 50% to 79% range with USI, the addition of velocity criteria to USI data improved both the PPV and the NPV. In the range of 70% to 79% stenosis with USI, the PPV improved from 82% (76/93) to 91% (53/58) for the subgroup with an EDV of more than 80 cm/s. For the range of 60% to 69% stenosis with USI, the PPV improved from 75% (71/95) to 95% (21/22) for the subgroup with an EDV of more than 80 cm/s. In the range of 50% to 59% stenosis with USI, the NPV improved from 69% (53/77) to 93% (14/15) for the subset with a peak systolic velocity of less than 100 cm/s. CONCLUSION On the basis of the USI data alone, a prediction of arteriographic findings was possible at the 95% level for occlusion and severe stenosis and for ruling out hemodynamically significant stenosis. The addition of velocity data improved prediction in borderline degrees of stenosis. USI was effective for quantifying clinically significant degrees of stenosis.