Portland Veterans Administration Hospital

Portland, OR, United States

Portland Veterans Administration Hospital

Portland, OR, United States

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Crowner J.,University of North Carolina at Chapel Hill | Marston W.,University of North Carolina at Chapel Hill | Almeida J.,Miami Vein Center | McLafferty R.,Portland Veterans Administration Hospital | Passman M.,University of Alabama at Birmingham
Journal of Vascular Surgery: Venous and Lymphatic Disorders | Year: 2014

Objective Iliocaval venous obstruction (ICVO) includes a wide spectrum of iliac vein and vena cava obstructive patterns but anatomic classification is lacking, making comparisons of treatment modalities difficult. The purpose of this study was to propose an anatomic classification for ICVO based on patterns of venous obstruction and to correlate severity to clinically relevant outcomes. Methods A multi-institutional retrospective evaluation of patients with ICVO who underwent venous stenting procedures was performed to identify anatomic patterns of iliocaval obstruction. The sites of venous disease were categorized on the basis of computed tomography or magnetic resonance venography supplemented by contrast venography or intravascular ultrasound. Proposed anatomic classification was defined as follows: type I, stenosis of a single venous segment; type II, stenosis of multiple venous segments; type III, occlusion of a single venous segment; and type IV, occlusion of multiple venous segments. Anatomic segments included in the classification scheme were defined as inferior vena cava, common iliac vein, external iliac vein, and common femoral vein. All patients underwent attempted stenting to re-establish normal iliocaval outflow. Outcomes, including initial procedural success and rethrombosis rates within 6 months, were determined for each type of ICVO. Results A consecutive 120 patients with ICVO underwent venography and attempted intervention. The type of ICVO was well distributed across all categories, with type I involvement identified in 42.5% of cases, type II in 19.2%, type III in 13.3%, and type IV in 25%. Procedural success was achieved significantly more often in types I and II ICVO (P =.02). Stent reocclusion was more frequent in type IV ICVO (26.7%) than in type I (7.8%) or type II ICVO (4.3%) (P =.009). Conclusions On the basis of a proposed anatomic classification, the diversity of ICVO may be stratified according to the severity of venous involvement. The anatomic classification was found to correlate to the technical success and short-term patency of venous intervention. Prospective evaluation is required to further validate the utility of this new anatomic classification system. © 2014 by the Society for Vascular Surgery.


PubMed | Miami Vein Center, University of North Carolina at Chapel Hill, University of Alabama at Birmingham and Portland Veterans Administration Hospital
Type: Journal Article | Journal: Journal of vascular surgery. Venous and lymphatic disorders | Year: 2016

Iliocaval venous obstruction (ICVO) includes a wide spectrum of iliac vein and vena cava obstructive patterns but anatomic classification is lacking, making comparisons of treatment modalities difficult. The purpose of this study was to propose an anatomic classification for ICVO based on patterns of venous obstruction and to correlate severity to clinically relevant outcomes.A multi-institutional retrospective evaluation of patients with ICVO who underwent venous stenting procedures was performed to identify anatomic patterns of iliocaval obstruction. The sites of venous disease were categorized on the basis of computed tomography or magnetic resonance venography supplemented by contrast venography or intravascular ultrasound. Proposed anatomic classification was defined as follows: type I, stenosis of a single venous segment; type II, stenosis of multiple venous segments; type III, occlusion of a single venous segment; and type IV, occlusion ofmultiple venous segments. Anatomic segments included in the classification scheme were defined as inferior vena cava, common iliac vein, external iliac vein, and common femoral vein. All patients underwent attempted stenting to re-establish normal iliocaval outflow. Outcomes, including initial procedural success and rethrombosis rates within 6months, were determined for each type of ICVO.A consecutive 120 patients with ICVO underwent venography and attempted intervention. The type of ICVO was well distributed across all categories, with type I involvement identified in 42.5% of cases, type II in 19.2%, type III in 13.3%, and type IV in 25%. Procedural success was achieved significantly more often in types I and II ICVO (P= .02). Stent reocclusion was more frequent in type IV ICVO (26.7%) than in type I (7.8%) or type II ICVO (4.3%) (P= .009).On the basis of a proposed anatomic classification, the diversity of ICVO may be stratified according to the severity of venous involvement. The anatomic classification was found to correlate to the technical success and short-term patency of venous intervention. Prospective evaluation is required to further validate the utility of this new anatomic classification system.


Ross D.A.,Portland Veterans Administration Hospital | Ross D.A.,Oregon Health And Science University
Minimally Invasive Surgery | Year: 2014

The object of the study was to review the author's large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n = 1231) were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases). There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery. © 2014 Donald A. Ross.


Mendez G.,Oregon Health And Science University | Ozpinar A.,Oregon Health And Science University | Raskin J.,Oregon Health And Science University | Gultekin S.H.,Oregon Health And Science University | And 2 more authors.
Surgical Neurology International | Year: 2014

Background: Diagnosis of glioblastoma multiforme (GBM) includes a heterogeneous group of tumors. We describe two cases with histopathologically and molecularly similar tumors, but very different outcomes. We attempt to illustrate the need for improved prognostic markers for GBM.Copyright:Case Description: Two patients with similar molecular profiles were retrospectively identified. The following markers were assessed: O6-methylguanine DNA methyltransferase (MGMT) methylation, isocitrate dehydrogenase (IDH) 1 and 2 status, epidermal growth factor receptor (EGFR) amplification, phosphatase and tensin homolog (PTEN) status, Ki-67, p53, and 1p/19q status. Each patient was assigned a Karnofsky performance score at presentation. Case 1 (62-year-old male) was a right temporal lobe glioblastoma with a molecular profile of amplified EGFR, normal PTEN, no IDH1/2 mutation, 28.7% MGMT promoter methylation, 5-20% Ki-67, 1p deletion, and 19q intact. The patient underwent resection followed by radiation therapy and 2 years of chemotherapy, and was asymptomatic and tumor free 5 years post diagnosis. Tumor eventually recurred and the patient expired 72 months after initial diagnosis. Case 2 (63-year-old male) was a right frontal white matter mass consistent with glioblastoma with a molecular profile of amplified EGFR, absent PTEN, no IDH1/2 mutation, 9.9% MGMT promoter methylation, 5-10% Ki-67, and 1p/19q status inconclusive. A radical subtotal resection was performed; however, 2 weeks later symptoms had returned. Subsequent imaging revealed a tumor larger than at diagnosis. The patient expired 3 months after initial diagnosis.Conclusion: The need for formulating more robust means to classify GBM tumor subtypes is paramount. Standard histopathologic and molecular analyses are costly and did not provide either of these patients with a realistic appraisal of their prognosis. Individualized whole genome testing similar to that being reported for medulloblastoma and other tumors may be preferable to the array of tests as currently utilized. © 2014 Mendez G.

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