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Dive into the research topics where Omid Jazaeri is active.

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Featured researches published by Omid Jazaeri.


Circulation | 2015

The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease

Thomas T. Tsai; Thomas F. Rehring; R. Kevin Rogers; Susan Shetterly; Nicole Wagner; Rajan Gupta; Omid Jazaeri; Nasim Hedayati; W. Schuyler Jones; Manesh R. Patel; P. Michael Ho; Alan S. Go; David J. Magid

Background— Treatment for symptomatic peripheral artery disease includes lower extremity bypass surgery (LEB) and peripheral endovascular interventions (PVIs); however, limited comparative effectiveness data exist between the 2 therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia. Methods and Results— In a community-based clinical registry at 2 large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1, 2005 and December 31, 2011. Rates of target lesion revascularization were greater for PVI than for LEB in patients presenting with claudication (12.3±2.7% and 19.0±3.5% at 1 and 3 years versus 5.2±2.4% and 8.3±3.1%, log-rank P<0.001) and critical limb ischemia (19.1±4.8% and 31.6±6.3% at 1 and 3 years versus 10.8±2.5% and 16.0±3.2%, log-rank P<0.001). However, in comparison with PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% versus 11.9%, P<0.001). There were no differences in amputation rates between the 2 groups. Findings remained consistent in sensitivity analyses by using propensity methods to account for treatment selection. Conclusions— In patients with symptomatic peripheral artery disease, in comparison with LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations.


Seminars in Interventional Radiology | 2014

Overview of classification systems in peripheral artery disease.

Rulon L. Hardman; Omid Jazaeri; Jeniann A. Yi; Mitchell T. Smith; Rajan Gupta

Peripheral artery disease (PAD), secondary to atherosclerotic disease, is currently the leading cause of morbidity and mortality in the western world. While PAD is common, it is estimated that the majority of patients with PAD are undiagnosed and undertreated. The challenge to the treatment of PAD is to accurately diagnose the symptoms and determine treatment for each patient. The varied presentations of peripheral vascular disease have led to numerous classification schemes throughout the literature. Consistent grading of patients leads to both objective criteria for treating patients and a baseline for clinical follow-up. Reproducible classification systems are also important in clinical trials and when comparing medical, surgical, and endovascular treatment paradigms. This article reviews the various classification systems for PAD and advantages to each system.


American Heart Journal | 2015

Anatomic runoff score predicts cardiovascular outcomes in patients with lower extremity peripheral artery disease undergoing revascularization

W. Schuyler Jones; Manesh R. Patel; Thomas T. Tsai; Alan S. Go; Rajan Gupta; Nasim Hedayati; P. Michael Ho; Omid Jazaeri; Thomas F. Rehring; R. Kevin Rogers; Susan Shetterly; Nicole Wagner; David J. Magid

BACKGROUND Although the presence, extent, and severity of obstruction in patients with lower extremity peripheral artery disease (LE PAD) affect their functional status, quality of life, and treatment, it is not known if these factors are associated with future cardiovascular events. We empirically created an anatomic runoff score (ARS) to approximate the burden of LE PAD and determined its association with clinical outcomes. METHODS We evaluated all patients with LE PAD and bilateral angiography undergoing revascularization in a community-based clinical study. Primary clinical outcomes of interest were (1) a composite of all-cause death, myocardial infarction (MI), and stroke and (2) amputation-free survival. Cox proportional hazards models were created to identify predictors of clinical outcomes. RESULTS We evaluated 908 patients undergoing angiography, and a total of 260 (28.0%) patients reached the composite end point (45 MI, 63 stroke, and 152 death) during the study period. Anatomic runoff score ranged from 0 to 15 (mean 4.7; SD 2.5) with higher scores indicating a higher burden of disease, and an optimal cutpoint analysis classified patients into low ARS (<5) and high ARS (≥5). The unadjusted rates of the primary composite end point and amputation-free survival were nearly 2-fold higher in patients with a high ARS when compared with patients with a low ARS. The most significant predictors of the composite end point (death/MI/stroke) were age (δ 10 years; hazard ratio [HR] 1.53; CI 1.32-1.78; P < .001), diabetes mellitus (HR 1.65; CI 1.26-2.18; P < .001), glomerular filtration rate <30 (HR 2.23; CI 1.44-3.44; P < .001), statin use (HR 0.66; CI 0.48-0.88; P < .001), and ARS (δ 2 points; HR 1.21; CI 1.08-1.35; P < .001). CONCLUSIONS After adjustment for clinical factors, the LE PAD ARS was an independent predictor of future cardiovascular morbidity and mortality in a broadly representative patient population undergoing revascularization for symptomatic PAD. A clinically useful anatomic scoring system, if validated, may assist clinicians in risk stratification during the course of clinical decision making.


Seminars in Interventional Radiology | 2013

Preservation of Internal Iliac Arterial Flow during Endovascular Aortic Aneurysm Repair Using the “Sandwich” Technique

Mitchell T. Smith; Rajan Gupta; Omid Jazaeri; Paul J. Rochon; Charles E. Ray

Conventional endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA) requires adequate graft seal proximally in the infrarenal aorta and distally in the common or external iliac arteries. When possible, sealing in the common iliac artery is performed to maintain perfusion to the internal iliac artery. Approximately 40% of AAAs have associated common iliac artery aneurysms that would require an external iliac seal zone and ipsilateral internal iliac artery embolization to prevent a type II endoleak. Concurrent or staged internal iliac artery occlusion may result in pelvic ischemia, which commonly manifests as buttock claudication or, in men, impotence. Uncommon but more serious consequences include colonic and spinal artery ischemia. Coverage or embolization of a single internal iliac artery is generally well tolerated. There is a varied incidence (20 to 50%) of clinically significant buttock claudication that tends to improve over time resulting in ∼10% incidence of buttock claudication at 1 year with single hypogastric artery embolization. Published case series and individual reports of bilateral internal iliac artery embolization demonstrate that bilateral hypogastric occlusion appears safe, although there is an increased risk of serious complications that may be life threatening. Most physicians attempt to preserve flow to a single internal iliac artery whenever possible. Various methods have been described to preserve internal iliac artery flow during EVAR. Investigational iliac branched devices (not currently approved by the Food and Drug Administration [FDA]), hybrid surgical revascularization of the internal iliac artery, physician modification of existing endografts, and, more recently, parallel endografting with the “sandwich” technique are some of the ways flow can be preserved to the hypogastric artery. The sandwich endograft technique involves placing two endografts side by side into an existing iliac limb to create an off-the-shelf bifurcated component to preserve flow to both the internal iliac and external iliac arteries. This technique has been gaining acceptance as a viable method for preservation of flow to at least a single internal iliac artery allowing for expansion of anatomy suitable for EVAR with the use of commercially available endograft components, albeit in an off-label manner. The sandwich technique is applicable to a variety of endograft designs, although the steep bifurcation of most endografts requires axillary or brachial artery access to deliver a stent into the preserved internal iliac artery. The bifurcation-sparing nature of the Endologix AFX (Endologix, Irvine, CA) endograft allows for this technique to be performed from an entirely femoral approach and has become our preferred approach for internal iliac preservation during EVAR when the anatomy is appropriate.


Annals of Vascular Surgery | 2015

Vascular Injury Is Associated with Increased Mortality in Winter Sports Trauma

John C. Eun; Michael Bronsert; Kristine Hansen; Steven L. Moulton; Omid Jazaeri; Mark R. Nehler; Joshua I. Greenberg

BACKGROUND Trauma is the leading cause of injury and death for individuals aged 1-44 years. Up to 8% of the US population participates in winter sports, and although vascular injuries are uncommon in these activities, little is published in this area. We sought to identify the incidence, injury patterns, and outcomes of vascular injuries resulting from winter sports trauma. METHODS Patients with winter sports trauma and the subset with vascular injuries were identified by accessing the National Trauma Data Bank querying years 2007-2010. Patients with and without vascular injuries were then compared. Admission variables included transport time, emergency department hypotension (systolic blood pressure < 90), Glasgow Coma Scale ≤ 8, Injury Severity Score ≥ 25, fractures, solid organ injury, and vascular injury. Outcomes were analyzed and associations with vascular injuries were determined. RESULTS A total of 2,298 patients were identified with winter sports-related trauma and 28 (1.2%) had associated vascular injuries. Overall, the top 3 injuries were head trauma (16.7%), thoracic vertebral fractures (5.5%), and lumbar vertebral fractures (5.1%). The most common associated vascular injures were to the popliteal artery (17.7%), splenic artery (14.7%), and brachial blood vessels (14.7%). In the entire cohort, 1 patient (0.04%) suffered an amputation and 15 patients (0.7%) died. There were no amputations in the vascular injury group. Mortality was 0.6% in patients without a vascular injury compared with 7.1% of those with a vascular injury (P = 0.01). CONCLUSIONS Although vascular injury is an uncommon associated finding in winter sports trauma, it is associated with a significant increase in mortality. These findings highlight the need for rapid identification of traumatic vascular injuries, which predicts worse overall outcomes in this patient population.


Journal of Bone and Joint Surgery, American Volume | 2013

Cryoamputation as a Lifesaving Intervention

Justin T. Newman; Omid Jazaeri; Bennie Lindeque

Emergency amputation of ischemic or infected limbs in critically ill patients is associated with substantial morbidity and mortality. Cryoamputation involves a physiologic amputation, effectively isolating the offending limb without actual amputation, as a lifesaving, temporizing measure in the subset of patients who cannot undergo a surgical amputation1,2. A physiologic amputation should be considered in disaster scenarios or with those patients who are experiencing systemic toxicity from the offending limb but whose current condition or extraneous circumstances do not permit a surgical amputation. Cryoamputation involves the application of an occlusive tourniquet to isolate the affected extremity, with subsequent cooling with use of dry ice (frozen carbon dioxide), common ice, or special cooling systems. This allows for patients to be medically optimized prior to undergoing a formal amputation. This approach may be valuable even in situations when long-term survival is not anticipated. The benefit of this technique is that it allows a high-risk emergency amputation to be performed in an elective fashion after medical optimization. We present a case of cryoamputation and review the literature on this subject. We are not aware of any prior report of this technique in the orthopaedic literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. The Orthopaedic Surgery Service was emergently consulted by the Vascular Surgery Service to assist with bilateral transfemoral amputation. A fifty-six-year-old man with a history of multiple bypass procedures presented with acute-on-chronic worsening of severe peripheral vascular disease in the setting of a hypercoagulable state. At the time of our initial consultation, the patient had bilateral lower limbs that were cool to the touch and insensate to the level of the proximal part of the thigh. The case was complicated by prior bilateral total hip arthroplasty with prosthesis …


Journal of Vascular Surgery | 2018

Isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac vein injury

Gregory A. Magee; Jayun Cho; Kazuhide Matsushima; Aaron Strumwasser; Kenji Inaba; Omid Jazaeri; Charles J. Fox; Demetrios Demetriades

Objective The incidence of morbidity and mortality for iliac vascular injuries in the literature are likely overestimated owing to associated injuries. Data for isolated iliac vascular injuries are very limited. No large studies have reported the incidence of morbidity for repair versus ligation of isolated iliac vein injuries. Methods Patients in the National Trauma Data Bank (NTDB; 2007‐2012) with at least one iliac vascular injury were analyzed. Isolated iliac vessels were defined as cases with Abbreviated Injury Scale severity score of greater than 3 for extraabdominal injuries and an Organ Injury Scale grade of greater than 3 for intraabdominal injuries. Results Overall, 6262 iliac vascular injuries (2809 penetrating, 3453 blunt) were identified in 271,076 patients with abdominal trauma (2.3%). There were 3379 patients (1841 penetrating, 1538 blunt) with isolated iliac vascular injuries (1.2%) and 557 patients (514 penetrating, 43 blunt) with combined iliac artery and vein injuries (0.2%). The 30‐day mortality rate was 16.5% for isolated iliac vein injury, 19.3% for isolated iliac artery injury, and 48.7% for combined isolated iliac artery and vein injury. The 30‐day mortality rate was 23.4% for isolated iliac vascular injuries compared with 39.0% for nonisolated iliac vascular injuries (P < .001). Patients with isolated iliac vein injuries had morbidity rates of deep venous thrombosis (repair, 14.6%; ligation, 14.1%; P = .875), pulmonary embolism (repair, 1.8%; ligation, 0.5%; P = .38), fasciotomy (repair, 9.3%; ligation, 14.6%; P = .094), amputation (repair, 1.8%; ligation, 2.6%; P = .738), acute kidney injury (repair, 5.8%; ligation, 4.7%; P = .627). Multivariate logistic regression demonstrated that ligation of isolated iliac vein injuries had an odds ratio of 2.2 for mortality compared with repair (95% confidence interval, 1.08‐4.66). Conclusions Isolated iliac vascular injuries are associated with a high incidence of mortality, especially for combined venous and arterial injury, but mortality is significantly lower than in patients with nonisolated iliac vascular injuries. In patients with isolated iliac vein injuries, mortality was higher in patients who underwent ligation compared with repair; however, the rates of deep venous thrombosis, pulmonary embolism, fasciotomy, amputation, and acute kidney injury were not different between the treatment groups. These data lend credence to the assessment that repair of iliac vein injuries is preferable to ligation whenever feasible.


Journal of Vascular Surgery | 2017

VESS15. Association of Variant Arch Anatomy With Type B Aortic Dissection and Hemodynamic Mechanisms

Sherene Shalhub; Michal Schäfer; Jason Reynolds; Niten Singh; Matthew Sweet; Benjamin W. Starnes; Thomas Hatsukami; Omid Jazaeri; Ferdia Bolster

nonrecommended AVF was created (AVG, 36; AVF, 17). Excluded were 25 patients who were lost to follow-up, died early, or never started dialysis. The functional maturation rate for AVF recommended by the VAPS was 78% (matured, 75; failed, 21). At least one intervention was required in 29% (22 of 75) of matured fistulas required to achieve maturation. The maturation rate for AVF not recommended by the VAPS was 62% (matured, 8; failed, 5). Conclusions: The VAPS mobile app is an easy to use tool that selects the most appropriate vascular access procedure for patient-specific clinical situations based on evidence-based literature and expert opinion. AVF nonmaturation rates using the VAPS may compare favorably to the 30% to 60% nonmaturation rates reported by contemporary series. The VAPS mobile app will improve outcomes by standardizing vascular access procedure selection and by guiding the surgeon toward AVF in situations where AVF are likely to be successful and toward AVG in situations where AVF failure is likely.


Journal of Vascular Surgery | 2017

Reduced shear stress and associated aortic deformation in the thoracic aorta of patients with chronic obstructive pulmonary disease

Michal Schäfer; Vitaly O. Kheyfets; Alex J. Barker; Kurt R. Stenmark; Kendall S. Hunter; P. Mason McClatchey; J. Kern Buckner; T. Brett Reece; Omid Jazaeri; Brett Fenster

Objective: Central aortic stiffness and chronic obstructive pulmonary disease (COPD) are associated with increased incidence of devastating aortopathies. However, the exact mechanism leading to elevated aortic stiffness in patients with COPD is unknown. The purpose of this study was to quantify flow and shear hemodynamic indices, known markers of vascular remodeling, in the thoracic aorta of patients with mild to moderate COPD (n = 16) and to compare these results with an age‐matched control group (n = 10). Methods: Four‐dimensional flow magnetic resonance imaging has been applied to measure hemodynamic wall shear stress (WSS) at four specific planes along the ascending aorta, aortic arch, and proximal descending aorta for all subjects. Peak systolic WSS and time‐averaged WSS, which respectively reflect magnitude and temporal shear variability, were calculated at standardized planes. Aortic deformation was measured by means of relative area change (RAC) at the midlevel of the ascending and descending aorta. Results: Compared with controls, patients with COPD had significantly reduced RAC in the mid ascending aorta (9% vs 18%; P < .0001) and descending aorta (15% vs 19%; P = .0206). Peak systolic WSS in COPD patients was significantly reduced in all considered planes, with the most dramatic difference occurring in the descending aorta (0.46 vs 0.86 N/m2; P < .0001). Peak systolic WSS and time‐averaged WSS were both significantly correlated with aortic RAC at each evaluated plane. Conclusions: Reduced flow shear metrics assessed at specific aortic regions correlated with RAC, a marker of aortic stiffness. Reduced hemodynamic WSS may then contribute to central aortic stiffening and perpetuate the risk for development of severe aortopathy. Clinical Relevance: Central aortic stiffness and chronic obstructive pulmonary disease are associated with increased incidence of devastating aortopathies including aneurysmal degeneration, aortic dissections, development of atherosclerosis, and overall increased cardiovascular morbidity and mortality. The exact mechanism leading to elevated aortic stiffness in patients with chronic obstructive pulmonary disease is yet to be determined. Hemodynamic forces can actively modulate endothelial cell alignment, extracellular matrix composition, vascular tone, and inflammation present in the wall of the aorta. In this study, we observed reduced flow shear assessed at specific aortic regions correlated with relative area strain, a marker of aortic stiffness.


Journal of Vascular Surgery | 2016

Usefulness of Four-Dimensional Flow Cardiac Magnetic Resonance for Evaluation of Aortic Dissection

Omid Jazaeri; Gregory Magee; Michal Schaefer; Ross Volpe; Adam Rocker; Ryan Arce; Kendall Hunter

variables but retaining the frailty domains (nutrition, social, physical function) performed just as well (AUC 1⁄4 0.76; Fig). Addition of procedure-specific mortality risk further improved model performance (AUC 1⁄4 0.77). The final model showed that open aortic procedures, thoracic endovascular aortic repair, and renal insufficiency carried the greatest risk for 9-month mortality. A nomogram summing points for each frailty element and procedure-based risk allows estimation of 9-month mortality (Fig). Conclusions: A model using only seven VQI frailty-related data elements and procedure-based risk estimates 9-month mortality after arterial reconstruction. Frailty assessment may improve preoperative decision-making, especially in considering risk/benefit of procedures for claudication or asymptomatic disease.

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Rajan Gupta

University of Colorado Denver

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Nasim Hedayati

University of California

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Gregory A. Magee

University of Southern California

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Mark R. Nehler

University of Colorado Denver

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