All Publications

  • Hybrid repair of an innominate artery pseudoaneurysm after blunt traumatic injury in a bovine arch JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES Satam, K., Sorondo, S., Paisley, M., Chandra, V. 2023; 9 (4)
  • Association of Baseline Chronic Kidney Disease Stage with Short- and Long-term Outcomes after Fenestrated Endovascular Aneurysm Repair. Annals of vascular surgery Dossabhoy, S. S., Sorondo, S. M., Fisher, A. T., Ho, V. T., Stern, J. R., Lee, J. T. 2023


    Fenestrated endovascular aneurysm repair (FEVAR) is a well-established treatment approach for juxtarenal and short neck infrarenal aortic aneurysms. Recommendations and clinical outcomes are lacking for offering FEVAR in patients with chronic kidney disease (CKD). We aimed to compare short and long-term outcomes for patients with none-to-mild versus moderate-to-severe CKD undergoing FEVAR.We retrospectively reviewed consecutive patients undergoing standard FEVAR with Cook devices at a single institution. The cohort was stratified by preoperative CKD stage none-to-mild or moderate-to-severe (CKD 1-2 and CKD 3-5, respectively). The primary outcome was postoperative acute kidney injury. Secondary outcomes included 30-day perioperative complications, 1- and 5-year rates of overall survival, dialysis, renal target artery patency, endoleak, and reintervention assessed by Kaplan-Meier method. Aneurysm sac regression, number of surveillance computed tomography scans, and CKD stage progression were assessed at latest follow up. Multivariate Cox proportional hazards modeling was used to evaluate the association of CKD stage 3 and stage 4-5 with all-cause mortality, controlling for differences in baseline characteristics.From 2012-2022, 184 patients (of which 82% were male) underwent FEVAR with the Cook ZFEN device (mean follow-up 34.3 months). Group CKD 3-5 comprised 77 patients (42%), was older (75.2 vs 73.0 years, P=.04), had increased preoperative creatinine (1.6 vs 0.9 mg/dL, P<.01) and demonstrated increased renal artery ostial calcification (37.7% vs 21.5%, P=.02) compared with Group CKD 1-2. Perioperatively, CKD 3-5 sustained higher estimated blood loss (342 vs 228 ml, P=.01), longer operative times (186 vs 162 min, P=.04), and longer length of stay (3 vs 2 days, P<.01). Kaplan-Meier 1- and 5-year survival estimates were lower for CKD 3-5 (82.3% vs 95.1%, P<.01 and 55.4% vs 70.8%, P=.02). Fewer CKD 3-5 patients remained free from chronic dialysis at 1 year (94.4% vs 100%, P=.015) and 5 years (84.7% vs 100%, P<.01). There were no significant differences in postoperative AKI rate (CKD 1-2 6.5% vs CKD 3-5 14.3%, P=.13), long-term renal artery patency, reinterventions, type I or III endoleak, mean sac regression, or total follow-up CT scans between groups. CKD stage progression occurred in 47 patients (31%) at latest follow-up but did not differ between stratified groups (P=.17). On multivariable modeling, age (HR 1.05, 95%CI 1.01-1.09, P=.02) and CKD stage 4-5 (HR 6.39, 95%CI 2.26-18.05, P<.01) were independently associated with mortality.Preoperative CKD status did not negatively impact the durability nor technical success related to aneurysm outcomes after FEVAR. Worsening CKD stage was associated with lower 1- and 5-year overall survival and freedom from dialysis after FEVAR with no statistically significant differences in 30-day or long-term technical aneurysm outcomes.

    View details for DOI 10.1016/j.avsg.2023.07.102

    View details for PubMedID 37586562

  • Risk of Reintervention Is Lower for Carotid Endarterectomy Than Carotid Artery Stenting Adkar, S., Zheng, X., Sorondo, S., George, E. L., Stern, J. R. MOSBY-ELSEVIER. 2023: E52
  • A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair. Journal of vascular surgery cases and innovative techniques Stern, J. R., Tran, K., Dossabhoy, S. S., Sorondo, S. M., Lee, J. T. 2023; 9 (1): 101091


    Proximal endovascular reintervention after prior endovascular aortic repair (EVAR) or open abdominal aortic aneurysm repair (OR) can be challenging due to the short distance to the visceral branches. We present a novel solution to allow the use of the commercially available ZFEN device using a double-barrel, kissing-limb technique.Patients who underwent fenestrated repair for proximal failure after EVAR or OR were identified. The ZFEN device is deployed above the prior graft flow divider. Once the visceral branches are secured, kissing limbs are used to connect with the prior graft limbs. The distal diameter of the standard ZFEN is 24 mm, accommodating two 20 mm components according to the formula 2πDLIMB = πDZFEN + 2DZFEN.Of 235 patients who underwent repair using ZFEN from 2012 to 2021 at a single institution, 28 were treated for proximal failure of prior repairs, with 13 treated using the double-barrel technique (8 EVAR, 5 OR). The distance from the flow divider to the lowest renal artery was 67 ± 24.4 mm (range, 39-128 mm), and the distance to the superior mesenteric artery (SMA) was 87 ± 30.5 mm (range, 60-164 mm). Technical success was 100%. Seven patients had standard ZFEN builds (2 renal small fenestrations, SMA large fen/scallop). The minimum distance to the lowest renal artery and SMA to accommodate a standard ZFEN build was 56 and 60 mm, respectively. Four patients required adjunctive snorkel grafts and two required laser fenestrations. Two patients had gutter leaks at 1 month that self-resolved; one patient developed a late type 1a endoleak. Freedom from reintervention was 90%, 72%, and 48% at 1, 2, and 3 years, respectively.This double-barrel technique allows for distal seal of commercial ZFEN devices into prior open or endovascular repairs with good technical success. Long-term outcomes remain to be quantified.

    View details for DOI 10.1016/j.jvscit.2022.101091

    View details for PubMedID 36747609

    View details for PubMedCentralID PMC9898739

  • Large Fenestrations Versus Scallops for the SMA During Fenestrated EVAR: Does it Matter? Annals of vascular surgery Sorondo, S. M., Ss, D., K, T., Vt, H., Jr, S., J, L. 2022


    FEVAR is an established customized treatment for aortic aneurysms with three current commercially available configurations for the superior mesenteric artery (SMA) - a single-wide scallop, large fenestration, or small fenestration, with the scallop or large fenestration most utilized. Outcomes comparing SMA single-wide scallops to large fenestrations with the ZFEN device are scarce. As large fenestrations have the benefit of extending the proximal seal zone compared to scalloped configurations, we sought to determine the differences in seal zone and sac regression outcomes between the two SMA configurations.We retrospectively reviewed our prospectively maintained complex EVAR database and included all patients treated with the Cook ZFEN device with an SMA scallop or large fenestration configuration at its most proximal build. All first post-operative CT scans (1-30 days) were analyzed on TeraRecon to determine precise proximal seal zone lengths, and standard follow-up anatomic and clinical metrics were tabulated.A total of 234 consecutive ZFEN patients from 2012-2021 were reviewed, and 137 had either a scallop or large fenestration for the SMA as the proximal-most configuration (72 scallops and 65 large fenestrations) with imaging available for analysis. Mean follow-up was 35 months. Mean proximal seal zone length was 19.5±7.9 mm for scallop vs 41.7±14.4 mm for large fenestration groups (P<.001). There was no difference in sac regression between scallop and large fenestration at one year (10.1±10.9 mm vs 11.0±12.1, P = 0.63). Overall, 30-day mortality (1.3% vs 2.5%, P=.51) and all-cause three-year mortality (72.5% vs 81.7%, P=.77) were not significantly different. Reinterventions within 30 days were primarily secondary to renal artery branch occlusions, with only one patient in the scallop group requiring reintervention for an SMA branch occlusion.Despite attaining longer proximal seal lengths, large SMA fenestrations were not associated with a difference in sac regression compared to scalloped SMA configurations at one-year follow up. There were no significant differences in reinterventions or overall long-term survival between the two SMA strategies.

    View details for DOI 10.1016/j.avsg.2022.07.013

    View details for PubMedID 36058451

  • Female sex is independently associated with reduced inpatient mortality after endovascular repair of blunt thoracic aortic injury. Journal of vascular surgery Ho, V. T., Sorondo, S., Forrester, J. D., George, E. L., Tran, K., Lee, J. T., Garcia-Toca, M., Stern, J. R. 2022


    Female sex has been associated with decreased mortality following blunt trauma, but whether sex influences outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown.In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative (VQI) registry was queried from 2013-2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and chi-squared tests were performed, followed by multivariate logistic regression for variables associated with inpatient mortality.211 (26.2%) of 806 patients were female. Female patients were older (47.9 vs. 41.8 years, p<0.0001) and less likely to smoke (38.3% vs. 48.2%, p=0.044). Most patients presented with grade III BTAI (54.5% female, 53.6% male,), followed by grade IV (19.0% female, 19.5% male). Mean Injury Severity Scores (30.9 + 20.3 female, 30.5 + 18.8 male) and regional Abbreviated Injury Score did not vary by sex. Postoperatively, female patients were less likely to die as inpatients (3.8% vs 7.9% , p=0.042) and to be discharged home (41.4% vs. 52.2%, p=0.008). On multivariate logistic regression, female sex (OR 0.05, p=0.002) was associated with reduced inpatient mortality. Advanced age (OR 1.06, p< 0.001), postoperative transfusion (OR 1.05, p=0.043), increased Injury Severity Score (OR 1.03, p=0.039), postoperative stroke (OR 9.09, p= 0.016), postoperative myocardial infarction (OR 9.9, p=0.017), and left subclavian coverage (OR 2.7, p= 0.029) were associated with inpatient death.Female sex is associated with lower odds of inpatient mortality following TEVAR for BTAI, independent of age, injury severity, BTAI grade, and postoperative complications. Further study of the influence of sex on post-discharge outcomes is needed.

    View details for DOI 10.1016/j.jvs.2022.07.178

    View details for PubMedID 35944732

  • Reintervention Does Not Impact Long-term Survival After Fenestrated Endovascular Aneurysm Repair. Journal of vascular surgery Dossabhoy, S. S., Sorondo, S. M., Tran, K., Stern, J. R., Dalman, R. L., Lee, J. T. 2022


    OBJECTIVES: Fenestrated endovascular aneurysm repair (FEVAR) is increasingly used in the treatment of juxtarenal aortic aneurysms and short-neck infrarenal aneurysms. Reinterventions (REIs) occur frequently, contributing to patient morbidity and resource utilization. We sought to determine if REIs impact long-term survival after FEVAR.METHODS: A single-institution retrospective review of all Cook ZFEN repairs was performed. Patients with ≥6 months follow-up and without adjunctive branch modifications were included. REI was defined as any aneurysm, device, target branch, or access-related intervention after the index procedure. REIs were categorized by early (<30 days) or late (≥30 days), indication (branch, endoleak, limb, access-related, or other), and target branch/device component. Patients were stratified into REI vs No REI and Branch REI vs Non-Branch REI.RESULTS: Of 219 consecutive ZFEN from 2012-2021, 158 patients met inclusion criteria. Forty-one (26%) patients underwent a total of 51 REIs (10 early, 41 late) over a mean follow-up of 33.9 months. The most common indication for REI was branch-related 61% (31/51), with the renal arteries most frequently affected 51% (26/51). The only differences found in baseline, aneurysm, or device characteristics were a higher mean SVS comorbidity score (9.6 vs 7.9, P=.04) and larger suprarenal neck angle (23.3 vs 17.1 degrees, P=.04) in No REI, while REI had larger mean proximal seal zone diameter (26.3 vs 25.1 mm, P=.03) and device diameter (31.9 vs 30.0 mm, P=.002) than No REI. Technical success and operative characteristics were similar between groups, except for longer mean fluoroscopy time (74.9 vs 60.8 min, P=.01) and longer median length of stay (2 vs 2 days, P=.006) in REI. While the rate of early major adverse events (<30 days) was higher in REI (24.4% vs 6.0%, P=.001), 30-day mortality was not statistically different (4.9% vs 0.9%, P=.10). On Kaplan-Meier analysis, freedom from REI at 1- and 5-years was 85.7% and 62.6%, respectively, in the overall cohort. There was no difference in estimated 5-year survival between REI and No REI (62.8% vs 63.5%, log-rank P=.87) and Branch REI and Non-Branch REI (71.8% vs 49.9%, log-rank P=.16). In multivariate analysis, REI did not predict mortality; age, the SVS comorbidity score, and preoperative maximum aneurysm diameter each increased the hazard of death (HR 1.07 95% CI 1.02-1.12, P=.007; HR 1.10, 95% CI 1.01-1.18, P=.02; HR 1.05, 95% CI 1.02-1.08, P=.003 respectively).CONCLUSIONS: Following ZFEN, 26% of patients required a total of 51 REIs with most occurring ≥30 days and 61% being branch-related, with no influence on 5-year survival. Age, comorbidity, and baseline aneurysm diameter independently predicted mortality. FEVAR mandates lifelong surveillance and protocols to maintain branch patency. Despite their relative frequency, REIs do not influence 5-year post-procedural survival.

    View details for DOI 10.1016/j.jvs.2022.04.050

    View details for PubMedID 35709854

  • Anatomic factors contributing to external iliac artery endofibrosis in high performance athletes. Annals of vascular surgery Fisher, A. T., Tran, K., Dossabhoy, S. S., Sorondo, S., Fereydooni, A., Lee, J. T. 2022


    External iliac artery endofibrosis (EIAE) classically presents in cyclists with intimal thickening of the affected arteries. We investigated possible anatomical predisposing factors including psoas muscle hypertrophy, arterial tortuosity, inguinal ligament compression, and arterial kinking via case-control comparison of symptomatic and contralateral limbs.All patients with unilateral EIAE treated surgically at our institution were reviewed. Each patient's symptomatic side was compared with their contralateral side using paired t-tests. Psoas hypertrophy was quantified by transverse cross-sectional area (CSA) at L4, L5, and S1 vertebral levels, and inguinal ligament compression was measured as anterior-posterior distance between inguinal ligament and underlying bone. Tortuosity index for diseased segments and arterial kinking were measured on TeraRecon.Of 33 patients operated on for EIAE from 2004-2021, 27 with available imaging presented with unilateral disease, more commonly left-sided (63%). Most (96%) had external iliac involvement and 26% had ≥2 segments affected: 19% common iliac artery, 15% common femoral artery. The symptomatic limb had greater mean L5 psoas CSA (1450 mm2 vs. 1396 mm2, mean difference 54 mm2, P=0.039). There were no significant differences in L4 or S1 psoas hypertrophy, tortuosity, inguinal ligament compression, or arterial kinking. 63% underwent patch angioplasty and 85% underwent additional inguinal ligament release. 84% reported postoperative satisfaction, which was associated with greater difference in psoas hypertrophy at L4 (p=0.022).Psoas muscle hypertrophy is most pronounced at L5 and is associated with symptomatic EIAE. Preferential hypertrophy of the affected side correlates with improved outcomes, suggesting psoas muscle hypertrophy as a marker of disease severity.

    View details for DOI 10.1016/j.avsg.2022.05.011

    View details for PubMedID 35654289

  • Reintervention Does Not Increase Long-term Mortality After Fenestrated Endovascular Aneurysm Repair Dossabhoy, S. S., Sorondo, S. M., Tran, K., Stern, J. R., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E399-E400
  • Reintervention Does Not Increase Long-term Mortality After Fenestrated Endovascular Aneurysm Repair Dossabhoy, S. S., Sorondo, S. M., Tran, K., Stern, J. R., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E227
  • Bicycle Exercise Ankle-Brachial Index Recovery Time as a Novel Metric for Evaluating the Hemodynamic Significance of External Iliac Endofibrosis in Competitive Cyclists Tran, K., Dossabhoy, S., Sorondo, S., Lee, J. T. MOSBY-ELSEVIER. 2021: E50
  • Interview Experience, Postinterview Communication, and Gender-Based Differences in the Integrated Vascular Surgery Residency Match Fereydooni, A., Ramirez, J. L., Morrow, K. L., Sorondo, S., Lee, J. T., Coleman, D. M., Chandra, V. MOSBY-ELSEVIER. 2021: E46
  • Interview Experience, Post-interview Communication and Gender-based Differences in the Integrated Vascular Surgery Residency Match. Journal of vascular surgery Fereydooni, A., Ramirez, J. L., Morrow, K. L., Sorondo, S., Lee, J. T., Coleman, D. M., Chandra, V. 2021


    Integrated vascular surgery residency (IVSR) applicant perspective about the Match process has been rarely studied, yet has important implications on trainee recruitment. We sought to better understand the nature of the interview process, and post-interview communication and its impact on students' ranking choices.A voluntary and anonymous survey was sent to students who matched to IVSR in 2020, inquiring about interviews, post-interview communications and factors influencing students' rank-lists.70 of the 73 matched students completed the survey (96% response rate; 23 female and 47 male). Applicants reported they were asked questions about other programs of interest (81.4%), top choice programs (65.7%), marital-status (32.9%), family-planning (7.1%) and religion (1.4%) during interviews. Female applicants were more frequently asked questions about family-planning (17.4% vs 2.1%; P<.01) and marital-status (52.5% vs 23.4%; P <.01) compared to male applicants. After interviews, 92.9% of applicants notified their top choice program of their ranking preference. 61.4% of applicants received post-interview communication with regards to ranking from at least one program, initiated by program directors in 81.3% of instances. Among these applicants, 58.1% reported that the post-interview communication had an impact on their rank-list and 46.5% matched at a program by which they were contacted. 5.7% of applicants were asked by a program to reveal their ranking of the program and 11.4% were promised by a program to be ranked first if the applicant reciprocally ranked them first. Female and male applicants weighed program culture, operative volume, mentorship and prestige equally in making their rank-list. Male applicants weighed the sub-internship experience more significantly; however, female applicants weighed the sub-internship experience, personal relationships in certain cities, dedicated professional development years and large female representation in the program more heavily (P<.02).This study provides insight into the interview experience and impactful factors for the vascular surgery match. Both female and male applicants were asked a high number of questions about personal matters unrelated to medical school performance. Female applicants, however, experienced a higher proportion of these instances, particularly regarding family-planning. These findings demonstrate the factors that are important to applicants in the match process and raises awareness of potential challenges in the interview and recruitment process.

    View details for DOI 10.1016/j.jvs.2021.05.060

    View details for PubMedID 34197947

  • Bicycle exercise ankle brachial index recovery time as a novel metric for evaluating the hemodynamic significance of external iliac endofibrosis in competitive cyclists. Journal of vascular surgery cases and innovative techniques Tran, K., Dossabhoy, S. S., Sorondo, S., Lee, J. T. 2021; 7 (4): 681-685


    Subtle radiographic findings can increase the challenge of diagnosing external iliac artery endofibrosis. We evaluated a new metric, the bicycle exercise ankle brachial index recovery time (BART), in a cohort of cyclists with symptomatic external iliac artery endofibrosis. BART was defined as the time required in minutes for the ankle brachial index to return to 0.9 after a period of exercise. Surgical correction resulted in an improvement in BART postoperatively (4.5 ± 4.1 vs 9.1 ± 4.3 minutes; P < .001), with improved values correlating with better patient satisfaction. Documentation of the BARTs before and after surgical treatment provides an additional measure of postoperative hemodynamic improvement.

    View details for DOI 10.1016/j.jvscit.2021.08.013

    View details for PubMedID 34746530

    View details for PubMedCentralID PMC8556481