Fadi Elias

Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study.

Objective: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. Background: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. Methods: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. Results: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%–22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%–20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%–3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46–25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1–29.1) and without an ischemic feature (12.2%; 95% CI, 5.3–25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6–82.4). Conclusions: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

User-Centered Requirements Analysis and Design Solutions for Chronic Disease Self-management

An aging population and the attendant growth in the need to care for people with serious chronic illnesses has created a demand for online support systems that can assist older adults to self-manage their illnesses. This could play a role in relieving some of the load on the healthcare system. Determining user-centered requirements of older adults for such systems is different from usual requirements analysis because older adults have particular needs, depending upon their chronic illnesses, their ability to manage technology, their access to appropriate technologies, and their cognitive abilities. This paper discusses in detail the use of the persona-scenario approach to elicit these needs from outpatients, informal care givers, and physicians. It proposes several suitable interface designs, depending on outpatient ability to deal with the proposed systems.

Nontumescent-Based Versus Tumescent-Based Endovenous Therapies for Patients with Saphenofemoral Reflux and Varicose Veins: A Meta-Analysis

However, its use in obliterating perforating veins has not yet been examined. Here we report our series of ultrasound-guided direct cyanoacrylate injection into perforator veins for the management of chronic varicose veins. The objective of this study was to assess the clinical outcomes and complications after direct injection of cyanoacrylate-based adhesives into venous perforators. Methods: A retrospective analysis of patients undergoing varicose vein treatment with VenaSeal (Medtronic of Canada Ltd, Vancouver, BC) at Vancouver General Hospital between 2015 and 2018 was conducted. Patients were included if perforator veins were treated with direct injection of cyanoacrylate glue. Patients’ demographics, class of venous disease, and location of perforator veins were collected (Table I). Outcomes at short-term and midterm follow-up appointments were also analyzed (Table II). Results: A total of 18 patients with 19 legs and 22 perforator vein injections were included. The amount of cyanoacrylate injected per perforator was 0.2 mL. The average age of patients was 63 6 3 years, with 61% being female and a body mass index of 25 6 2 kg/m. Clinical, Etiology, Anatomy, and Pathophysiology classification and the location of perforators treated are shown in Table I. Immediate treatment success was noted in all 22 instances. Treatment success was 100% at short-term follow-up. There were three cases of superficial phlebitis noted that had resolved by midterm follow-up. There were no deep venous thromboses or other procedure-related complications noted at midterm follow-up. Conclusions: Ultrasound-guided direct perforator injection of cyanoacrylate glue is a safe and effective treatment for patients undergoing concurrent superficial vein ablation.

IP077. Novel Approach to Acute Limb Occlusion After EVAR With Pharmacomechanical Thrombectomy: Preliminary Analysis

Objectives: This preliminary study examined the technical efficacy and safety of treating acute limb occlusion after EVAR with pharmacomechanical thrombectomy (PMT) using the AngioJet rheolytic system. Methods: The technical aspects, success, and complications of the first seven consecutive patients presenting with acute limb occlusion after EVAR treated with PMT were analyzed. All patients underwent surgical femoral exposure to facilitate distal arterial control and limit distal embolization. Completion thrombectomy angiograms were reviewed to identify anatomical or structural causes for limb occlusion and subsequently treated accordingly. Technical success, distal embolization, major hemorrhagic complications, acute kidney injury, compartment syndrome, 30-day patency, and amputation-free survival were evaluated. Results: Six of seven patients (86%) presented with acute limb occlusion within 30 days of the original EVAR procedure. All patients were on antiplatelet therapy at time of presentation. Narrowing or kinking of the endograft limb was apparent on computed tomography scan in three patients (43%). An embolic etiology of limb occlusion was suspected in two patients (29%). The technical success rate with PMT treatment was 100%. All patients subsequently underwent EVAR limb stenting in the same procedure. There were no reported cases of distal embolization after PMT or major hemorrhagic complications. Two patients (29%) developed compartment syndrome after revascularization requiring lower leg fasciotomies. Furthermore, two patients (29%) developed acute kidney injury during their hospital admission. The 30-day patency and amputation-free survival rate for PMT was 100%. The overall mean length of stay in hospital for PMT treatment was 9.8 6 4.2 days. Conclusions: Early results of PMT with the AngioJet system represent a novel strategy for treating acute limb occlusion after EVAR that is safe and effective.