Kaoru R Goshima

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Scholarly Contributions

Chapters

• Goshima, K. R. (2023). Overview of thoracic outlet syndrome. In UpToDate. https://www.uptodate.com/contents/search: Wolters Kluwer.
• Goshima, K. R. (2015). Primary (spontaneous) Upper Extremity Deep Vein Thromobsis. In Up To Date. uptodate.com.
• Goshima, K. R. (2018). Overview of the thoracic outlet syndrome. In UpToDate.
• Goshima, K. R. (2022). Overview of the thoracic outlet syndrome:. In Up To Date.
• Goshima, K. R. (2022). Primary (spontaneous) upper extremity deep vein thrombosis. In UpTo Date. Basow DS (Ed). UpToDate. Updated, April 20, 2020.
• Goshima, K. R. (2020). Overview of the thoracic outlet syndrome:. In Up To Date.
• Goshima, K. R. (2020). Primary (spontaneous) upper extremity deep vein thrombosis. In UpTo Date. Basow DS (Ed). UpToDate. Updated, April 20, 2020.
• Goshima, K. R. (2019). Overview of the thoracic outlet syndrome:. In UpToDate. Basow, DS (ED), Waltham, MA.
• Goshima, K. R. (2019). Primary (spontaneous) upper extremity deep vein thrombosis.. In UpToDate. Basow DS (Ed).
• Goshima, K. R. (2018). Primary (spontaneous) upper extremity deep vein thrombosis. In UpToDate.
• Goshima, K. R. (2017). Overview of Thoracic Outlet Syndromes. In Up To Date.
• Goshima, K. R. (2017). Primary (spontaneous) upper extremity deep vein thrombosis.. In UpToDate.
• Goshima, K. R., & Goshima, K. R. (2015). Overview of thoracic outlet syndromes. In Up To Date. uptodate.com.
• Goshima, K. R. (2014). Overview of thoracic outlet syndromes. In Up To Date. uptodate.com.
• Goshima, K. R. (2014). Primary (spontaneous) Upper Extremity Deep Vein Thromobsis. In Up To Date. uptodate.com.
• Mills, J. L., Goshima, K. R., & Wixon, C. (2006). Management of hand ischemic associated with arteriovenous hemodialysis access. In Mastery of Vascular and Endovascular Surgery.

Journals/Publications

• Wolf, S., Ashouri, Y., Succar, B., Hsu, C. H., Abuhakmeh, Y., Goshima, K., Devito, P., & Zhou, W. (2024). Follow-up compliance in patients undergoing abdominal aortic aneurysm repair at Veterans Affairs hospitals. Journal of vascular surgery, 80(1), 89-95.
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  The Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well-established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals.
• Patel, N., Tan, T. W., Weinkauf, C., Rice, A. H., Rottman, A. M., Pappalardo, J., Kraemer, C., Goshima, K., & Zhou, W. (2021). ECONOMIC VALUE OF PODIATRY SERVICE IN LIMB SALVAGE ALLIANCE. Journal of vascular surgery.
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  Over the last decade, multidisciplinary "toe and flow" programs have gained great popularity with proven benefits in limb salvage. Many vascular surgeons have incorporated podiatrists into their practices. The viability of this practice model requires close partnership, hospital support, and financial sustainability. We intend to examine the economic values of podiatrists in a busy safety-net hospital in the Southwest United States.
• Goshima, K. R., Palppparlardo, J., Patel, N., Rice, A., Rottman, A., Tan, T., Weinkauf, C., & Zhou, W. (2020).

  Economic Value of Podiatry Service in a Limb Salvage Alliance

  . Journal of Vascular Surgery, 72(3), e327. doi:10.1016/j.jvs.2020.07.018
• Pandit, V., Lee, A., Zeeshan, M., Goshima, K., Tan, T. W., Jhajj, S., Trinidad, B., Weinkauf, C., & Zhou, W. (2020). Effect of frailty syndrome on the outcomes of patients with carotid stenosis. Journal of vascular surgery, 71(5), 1595-1600.
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  Frailty syndrome confers a greater risk of morbidity and mortality after operative interventions. The aim of the present study was to assess the effect of frailty on the outcomes after carotid interventions, including both carotid endarterectomy (CEA) and carotid artery stenting (CAS).
• Pandit, V., Zeeshan, M., Nelson, P. R., Hamidi, M., Jhajj, S., Lee, A., Trinidad, B., Goshima, K., Horst, V., Weinkauf, C., Zhou, W., & Tan, T. W. (2020). Frailty Syndrome in Patients with Carotid Disease: Simplifying How We Calculate Frailty. Annals of vascular surgery, 62, 159-165.
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  Frailty syndrome is an established predictor of adverse outcomes after carotid surgery. Recently, a modified 5-factor National Surgical Quality Improvement Program frailty index has been used; however, its utility in vascular procedures is unclear. The aim of our study was to compare the 5-factor modified frailty index (mFI-5) with the 11-factor modified frailty index (mFI-11) regarding value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission.
• Yanquez, F. J., Peterson, A., Weinkauf, C., Goshima, K. R., Zhou, W., Mohler, J., Ehsani, H., & Toosizadeh, N. (2020). Sensor-Based Upper-Extremity Frailty Assessment for the Vascular Surgery Risk Stratification. The Journal of surgical research, 246, 403-410.
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  Available methods for determining outcomes in vascular surgery patients are often subjective or not applicable in nonambulatory patients. The purpose of the present study was to assess the association between vascular surgery outcomes and a previously validated upper-extremity function (UEF) method, which incorporates wearable motion sensors for the physical frailty assessment.
• Goshima, K., Zhou, W., Hamidi, M. K., Hanna, K., Jhajj, S., Nelson, P. J., Pandit, V., Tan, T., Weinkauf, C., & Zeeshan, M. (2019).

  Association of Racial and Ethnical Disparities and Frailty in Geriatric Patients Undergoing Revascularization for Peripheral Arterial Disease

  . Journal of The American College of Surgeons, 229(4), S324. doi:10.1016/j.jamcollsurg.2019.08.709
• Pandit, V., Lee, A., Tan, T., Goshima, K. R., Jhajj, S., Trinidad, B., Weinkauf, C., & Zhou, W. (2019). Effect Of Frailty Syndrome On The Outcomes Of Patients With Carotid Stenosis. Journal of Vascular Surgery.
• Sabat, J., Hsu, C. H., Samra, N., Chu, Q., Weinkauf, C., Goshima, K., Zhou, W., & Tan, T. W. (2019). Length of Stay and ICU Stay Are Increased With Repair of Traumatic Superior Mesenteric Vein Injury. The Journal of surgical research, 242, 94-99.
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  Traumatic superior mesenteric vein (SMV) injury is rare, and the ideal treatment is controversial. We compared the outcomes of ligation versus repair of SMV injury using the National Trauma Databank.
• Yanquez, F. J., Peterson, A., Weinkauf, C., Goshima, K. R., Zhou, W., Mohler, J., Ehsani, H., & Toosizadeh, N. (2019). Sensor-Based Upper Extremity Frailty Assessment For The Vascular Surgery Risk Stratification. Journal of Surgical Research.
• Goshima, K. R. (2018). Diagnosis and Endovascular Management of Segmental Heel Ischemia.. International Journal of Clinical Cardiology, 5(117), 1-7. doi:10.23937/2378-2951/1410117
• Goshima, K. R., Zhou, W., Chiapaikeo, D., & Tan, T. (2018).

  PC176. Delayed Renal Artery Revascularization Can Be Associated With Complete Renal Recovery and Freedom From Dialysis

  . Journal of Vascular Surgery, 67(6), e220-e221. doi:10.1016/j.jvs.2018.03.332
• Weinkauf, C. C., Concha-Moore, K., Lindner, J. R., Marinelli, E. R., Hadinger, K. P., Bhattacharjee, S., Berman, S. S., Goshima, K., Leon, L. R., Matsunaga, T. O., & Unger, E. (2018). Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging. Journal of vascular surgery, 68(6S), 105S-113S.
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  Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging.
• Weinkauf, C., Concha-Moore, K., Linder, J. R., Marinelli, E. R., Hadinger, K. P., Bhattacharjee, S., Berman, S. S., Goshima, K. R., Leon, L. R., Matsunaga, T. O., & Unger, E. (2018). Endothelial Vascular Cell Adhesion Molecule 1 Is A Marker For High-Risk Carotid Plaques And Target For Ultrasound Molecular Imaging. J Vasc Surg.
• Goshima, K., Unger, E. C., Berman, S. S., Leon, L. R., Marinelli, E. R., Millius, R., & Weinkauf, C. C. (2016).

  Vascular Cell Adhesion Molecule 1 Is a Promising Target to Identify High-Risk Carotid Plaques Using Contrast-Enhanced Duplex Ultrasound

  . Journal of Vascular Surgery, 64(2), 549. doi:10.1016/j.jvs.2016.05.032
• Aziz, H., Branco, B. C., Braun, J., Hughes, J. D., Goshima, K. R., Trinidad-Hernandez, M., Hunter, G., & Mills, J. L. (2015). The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations. Journal of vascular surgery, 61(6), 1538-42.
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  Do-not-resuscitate (DNR) orders allow patients to communicate their wishes regarding cardiopulmonary resuscitation. Although DNR status may influence physician decision making regarding resuscitation, the effect of DNR status on outcomes of patients undergoing emergency vascular operation remains unknown. The aim of this study was to analyze the effect of DNR status on the outcomes of emergency vascular surgery.
• Echeverria, A. B., Branco, B. C., & Goshima, K. R. (2015).

  Outcomes of Endovascular Management of Acute Thoracic Aorta Emergencies in an Academic Level 1 Trauma Center

  . Journal of Vascular Surgery, 62(4), 1090. doi:10.1016/j.jvs.2015.08.006
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  BACKGROUND: Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience. METHODS: We retrospectively evaluated emergency descending thoracic aortic endovascular interventions performed at a single academic level 1 trauma center between January 2005 and August 2013 including all cases of traumatic aortic injury, ruptured descending thoracic aneurysm, penetrating atherosclerotic ulcer, aortoenteric fistula, and acute complicated type B dissection. Demographics, clinical data, and outcomes were extracted. Stepwise logistic regression was used to identify independent risk factors for death. RESULTS: During the study period, 51 patients underwent TEVAR; 22 cases (43.1%) were performed emergently (11 patients [50.0%] traumatic aortic injury; 4 [18.2%] ruptured descending thoracic aneurysm; 4 [18.2%] complicated type B dissection; 2 [9.1%] penetrating aortic ulcer; and 1 [4.5%] aortoenteric fistula). Overall, 72.7% (n 5 16) were male with a mean age of 54.8 6 15.9 years. Nineteen patients (86.4%) required only a single TEVAR procedure, whereas 2 (9.1%) required additional endovascular therapy, and 1 (4.5%) open thoracotomy. Four traumatic aortic injury patients required exploratory laparotomy for concomitant intra-abdominal injuries. During a mean hospital length of stay of 18.9 days (range, 1 to 76 days), 3 patients (13.6%) developed major complications. In-hospital mortality was 27.2%, consisting of 6 deaths from traumatic brain injury (1); exsanguination in the operating room before repair could be achieved (2); bowel ischemia (1) and multisystem organ failure (1); and family withdrawal of care (1). A stepwise logistic regression model identified 24-hour packed red blood cell requirements R4 units, admission mean arterial pressure ,60 mm Hg, and
• Schannen, A. P., Truchan, L., Goshima, K., Bentley, R., & DeSilva, G. L. (2015). Sural Versus Perforator Flaps for Distal Medial Leg Wounds. Orthopedics, 38(12), e1059-64.
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  Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. [Orthopedics. 2015; 38(12):e1059-e1064.].
• Branco, B. C., DuBose, J. J., Zhan, L. X., Hughes, J. D., Goshima, K. R., Rhee, P., & Mills, J. L. (2014). Trends and outcomes of endovascular therapy in the management of civilian vascular injuries. Journal of vascular surgery, 60(5), 1297-307, 1307.e1.
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  The rapid evolution of endovascular surgery has greatly expanded management options for a wide variety of vascular diseases. Endovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries.
• Echeverria, A. B., Branco, B. C., Goshima, K. R., Hughes, J. D., & Mills, J. L. (2014). Outcomes of endovascular management of acute thoracic aortic emergencies in an academic level 1 trauma center. American journal of surgery, 208(6), 974-80; discussion 979-80.
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  Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience.
• Schannen, A. P., Goshima, K., Latt, L. D., & Desilva, G. L. (2014). Simultaneous soft tissue coverage of both medial and lateral ankle wounds: Sural and rotational flap coverage after revision fixation in an infected diabetic ankle fracture. Journal of orthopaedics, 11(1), 19-22.
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  To describe a case of simultaneous medial and lateral soft tissue coverage for exposed orthopaedic implants in the setting of revision fixation of a non-united ankle fracture. This was achieved using a sural flap as well as a propeller flap.
• Armstrong, D. G., Bharara, M., White, M., Lepow, B., Bhatnagar, S., Fisher, T., Kimbriel, H. R., Walters, J., Goshima, K. R., Hughes, J., & Mills, J. L. (2012). The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot. Diabetes/metabolism research and reviews, 28(6), 514-8.
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  This study aimed to quantify the impact of an integrated diabetic foot surgical service on outcomes and changes in surgical volume and focus.
• Bui, T. D., Mills, J. L., Ihnat, D. M., Gruessner, A. C., Goshima, K. R., & Hughes, J. D. (2012). The natural history of duplex-detected stenosis after femoropopliteal endovascular therapy suggests questionable clinical utility of routine duplex surveillance. Journal of vascular surgery, 55(2), 346-52.
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  Duplex ultrasound (DU) surveillance (DUS) criteria for vein graft stenosis and thresholds for reintervention are well established. The natural history of DU-detected stenosis and the threshold criteria for reintervention in patients undergoing endovascular therapy (EVT) of the femoropopliteal system have yet to be determined. We report an analysis of routine DUS after infrainguinal EVT.
• Goshima, K. R., Mills, J. L., Armstrong, D. G., Bharara, M., Bhatnagar, S., Fisher, T. K., Hughes, J. D., Ihnat, D. M., Lepow, B., & White, M. L. (2011).

  The Impact and Outcomes of Establishing an Integrated Interdisciplinary Team to Care for Patients with Diabetic Foot Ulcers

  . Journal of Vascular Surgery, 54(2), 594. doi:10.1016/j.jvs.2011.05.084
• Pacanowski, J., Higa, G., Jeck, D. T., Goshima, K. R., & Leon Jr, L. R. (2010). Vertebral artery aneuryms and cervical arteriovenous fistulae in patients with neurofibromatosis.. Vascular, Vascular. 2010 May-Jun;18(3):166-77..
• Goshima, K. R., Hughes, J. D., & Leon, L. R. (2009).

  Aortic stent-graft explantation in a kidney transplant recipient.

  . Annals of vascular surgery, 23(4), 535.e21-6. doi:10.1016/j.avsg.2008.08.017
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  AAA repair in renal transplant recipients has generated a variety of methods of managing the allograft. Endovascular techniques have been successfully employed in this patient population. Due to inherent limitations of present endovascular methods, occasional stent-graft excision must be performed. We present a case of aortic stent-graft excision in a renal transplant recipient using a pump-oxygenator to maintain allograft perfusion.
• Lauvao, L. S., Ihnat, D. M., Goshima, K. R., Chavez, L., Gruessner, A. C., & Mills, J. L. (2009). Vein diameter is the major predictor of fistula maturation. Journal of vascular surgery, 49(6), 1499-504.
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  Preoperative duplex ultrasound mapping of veins and arteries has been widely advocated to maximize the creation of native arteriovenous fistula (AVF) for hemodialysis access, but reliable diameter criteria have not been established. We sought to determine patient and anatomic variables predictive of fistula maturation in patients receiving their initial permanent hemodialysis access.
• Leon, L. R., & Goshima, K. R. (2009).

  Delayed superficial femoral artery stent erosion and pseudoaneurysm following endovascular therapy for occlusive disease.

  . Vascular and endovascular surgery, 43(5), 502-8. doi:10.1177/1538574409333367
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  A 78 year-old male with multiple serious medical comorbidities was diagnosed with a pseudoaneurysm of the proximal superficial femoral artery. He had undergone successful superficial femoral artery (SFA) stenting for limb salvage four months previously and a Duplex ultrasound had confirmed adequacy of the endovascular procedure two months after its execution. This was successfully treated with placement of a covered-stent at the proximal SFA and a balloon-expandable stent at the origin of the deep femoral artery. Unfortunately the patient expired six weeks after the last endovascular intervention, likely due to procedural-unrelated causes. We postulate delayed stent erosion of a proximal atherosclerotic SFA, causing the pseudoaneurysm. This is the first report of such a case in the literature.
• Leon, L. R., Glazer, E. S., Hughes, J. D., Bui, T. D., Psalms, S. B., & Goshima, K. R. (2009). Aortoiliac aneurysm repair in kidney transplant recipients. Vascular and endovascular surgery, 43(1), 30-45.
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  A potential problem during endovascular aortic aneurysm repair (EVAR) or open repair in renal allograft patients is ischemia of the transplanted kidney. In this study, kidney transplant patients who underwent aortic aneurysm repair in our institution were added to similar cases extracted from the literature to represent the basis of this work. Comparisons between patients treated with open surgery versus EVAR were performed in terms of renal function. In the EVAR group, most aneurysms were infrarenal, and 84% were treated with modular bifurcated devices. Protective kidney allograft perfusion measures were not used. The pre- and postoperative Cr was 1.69 and 1.73 mg/dL, respectively (P = .412). All EVAR patients had good outcomes. Complications included 8 endoleaks and 1 limb ischemia case. Three patients died from aortic repair-unrelated reasons. In the open group, the pre-and postoperative Cr was 1.45 and 1.37 mg/dL, respectively (P = .055). Most cases were infrarenal and mostly treated by aortobiiliac bypasses. In 16%, no adjuvant allograft perfusion was provided. In the rest, temporary axillofemoral bypasses were used most often. Most outcomes were favorable (57%). Reported procedural-related complications included arterial embolism, wound infection, and pneumonia. Deaths were reported in 5 occasions (none allograft failure dependent). No differences in Cr between EVAR and open techniques (P = .13) were seen. Aneurysm repair in kidney transplant recipients is associated with excellent renal preservation. Adverse outcomes were all allograft failure independent in both groups. EVAR without special allograft protection measures seems to be equally effective as open surgery with or without adjuvant kidney transplant perfusion.
• Bui, T. D., Glazer, E. S., Goshima, K. R., Hughes, J. D., Leon, L. R., & Psalms, S. B. (2008).

  Aortoiliac Aneurysm Repair in Kidney Transplant Recipients

  . Vascular and Endovascular Surgery, 43(1), 30-45. doi:10.1177/1538574408322654
• Goshima, K. R., Mills, J. L., Awari, K., Pike, S. L., & Hughes, J. D. (2008). Measure what matters: institutional outcome data are superior to the use of surrogate markers to define "center of excellence" for abdominal aortic aneurysm repair. Annals of vascular surgery, 22(3), 328-34.
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  Outcome analysis is increasingly being used to develop health-care policy and direct patient referral. For example, the Leapfrog Group health-care quality initiative has proposed "evidence-based hospital" referral criteria for specific procedures including elective abdominal aortic aneurysm repair (AAA-R). These criteria include an annual hospital AAA operative volume exceeding 50 cases and provision of intensive care unit (ICU) care by board-certified intensivists. Outcomes after AAA-R are reportedly influenced by presentation (intact vs. ruptured), operative approach (endovascular vs. open, transperitoneal vs. retroperitoneal), surgeon subspecialty, case volume (hospital and surgeon), and provision of postoperative care by an intensivist. The purpose of this study was to compare our single-center results with those of high-volume centers to assess the validity of the concept that surrogate markers, such as case volume or intensivist involvement, can be used to estimate procedural outcome. A retrospective review was performed of AAA-Rs at one low-volume academic medical center from January 1994 to March 2005. Demographic data, aneurysm diameter and location, operative indications, and repair approach were documented. Postoperative complications, mortality rates, and hospital and ICU length of stay (LOS) were noted and compared to established benchmarks. During the study period, 270 patients underwent AAA-R (annual mean = 27 hospital cases and 13.4 cases/attending vascular surgeon). ICU care was provided by a dedicated vascular surgery service without routine intensivist involvement. Open, elective, infrarenal AAA-R was performed in 161 patients (60%), with a 2.5% hospital mortality rate (30-day, 3.1%). Thirty-three (12%) patients underwent elective endovascular aneurysm repair (EVAR), with no mortality. Both ICU (3.7 vs. 1.4 days, p = 0.03) and hospital (9.2 vs. 2.8 days, p = 0.002) LOS were significantly reduced after EVAR compared to open repair. Hospital LOS was significantly lower after open retroperitoneal repair compared to transperitoneal repair (6.1 vs. 10.3 days, p = 0.001). Thirty-five patients (13%) underwent ruptured AAA-R, with only 34.3% mortality (in-hospital and 30-day). Forty-one patients (15%) underwent repair of complex aortic aneurysms, with 14.1% mortality. There are increasing societal and economic pressures to direct patient referrals to "centers of excellence" for specific surgical procedures. Although our institution meets neither of the Leapfrog Group's proposed criteria, our mortality and LOS for both intact and ruptured infrarenal AAA-R are equivalent or superior to published benchmarks for high-volume hospitals. Individual institutional outcome results such as these suggest that patient referral and care should be based upon actual, carefully verified outcome data rather than utilization of surrogate markers such as case volume and subspecialist involvement in postoperative care.
• Ihnat, D. M., Duong, S. T., Taylor, Z. C., Leon, L. R., Mills, J. L., Goshima, K. R., Echeverri, J. A., & Arslan, B. (2008). Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. Journal of vascular surgery, 47(5), 967-74.
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  A recent randomized trial suggested nitinol self-expanding stents (SES) were associated with reduced restenosis rates compared with simple percutaneous transluminal angioplasty (PTA). We evaluated our results with superficial femoral artery (SFA) SES to determine whether TransAtlantic InterSociety Consensus (TASC) classification, indication for intervention, patient risk factors, or Society of Vascular Surgery (SVS) runoff score correlated with patency and clinical outcome, and to evaluate if bare nitinol stents or expanded polytetrafluoroethylene (ePTFE) covered stent placement adversely impacts the tibial artery runoff.
• Lauvao, L. S., Goshima, K. R., Leon, L. R., Nolan, P. E., & Hughes, J. D. (2008). Superficial femoral artery thrombosis as a cause for distal embolism in primary antiphospholipid syndrome. Journal of vascular surgery, 48(2), 472-7.
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  Antiphospholipid syndrome is a diagnosis with the clinical manifestations of thromboses in the presence of an antiphospholipid antibody. A 25-year-old man with a history of deep venous thrombosis, pulmonary emboli, and myocardial infarction, and receiving long-term anticoagulation with warfarin, all due to primary antiphospholipid syndrome, presented with blue toe syndrome from a primary superficial femoral artery thrombus. He was anticoagulated with fondaparinux in addition to dipyridamole and aspirin perioperatively. The area of thrombus was resected and reconstructed using a cephalic vein interposition graft. This report reviews antiphospholipid syndrome and identifies potential questions and problems relating to a rare clinical presentation.
• Mills, J. L., Duong, S. T., Leon, L. R., Goshima, K. R., Ihnat, D. M., Wendel, C. S., & Gruessner, A. (2008). Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. Journal of vascular surgery, 47(6), 1141-9.
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  It has been suggested that endovascular aneurysm repair (EVAR) in concert with serial contrast-enhanced computed tomography (CT) surveillance adversely impacts renal function. Our primary objectives were to assess serial renal function in patients undergoing EVAR and open repair (OR) and to evaluate the relative effects of method of repair on renal function.
• Leon, L. R., Mills, J. L., Psalms, S. B., Goshima, K., Duong, S. T., & Ukatu, C. (2007). A novel hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stent grafting and femorofemoral bypass grafting. Journal of vascular surgery, 45(6), 1244-8.
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  A progressively enlarging left common iliac artery aneurysm developed in a 72-year-old man 7 years after open abdominal aortic aneurysm repair with a bifurcated Dacron graft. Because both the right hypogastric and inferior mesenteric arteries had been ligated at the initial operation, preservation of left hypogastric flow was critical to avoid pelvic or intestinal ischemia. He was a poor open surgical candidate owing to obesity, a hostile abdomen, and multiple medical comorbidities. Therefore, a novel hybrid approach was used consisting of left transbrachial selective left hypogastric artery catheterization, followed by deployment of two, overlapping, antegrade, covered stent grafts extending from the proximal left graft limb into the left hypogastric artery. A right-to-left femorofemoral crossover bypass was added to perfuse the left lower extremity and was performed in end-to-end fashion to the left common femoral artery to exclude and prevent retrograde flow into the iliac aneurysm. Also presented are potential procedural pitfalls and a detailed review of open, endovascular and hybrid options to preserve hypogastric flow when treating iliac aneurysms in complex, high-risk patients.
• Goshima, K., & Mills, J. L. (2005). Commentary. De novo femoropopliteal stenoses: endovascular gamma irradiation following angioplasty--angiographic and clinical follow-up in a prospective randomized controlled trial. Perspectives in vascular surgery and endovascular therapy, 17(1), 69-70.
• Patel, S. T., Mills, J. L., Tynan-Cuisinier, G., Goshima, K. R., Westerband, A., & Hughes, J. D. (2005). The limitations of magnetic resonance angiography in the diagnosis of renal artery stenosis: comparative analysis with conventional arteriography. Journal of vascular surgery, 41(3), 462-8.
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  Gadolinium-enhanced magnetic resonance angiography (MRA) is commonly used as a screening modality for the detection of renal artery stenosis. However, evidence supporting its utility in clinical practice is lacking; few rigorous studies have compared MRA with contrast arteriography (CA). After making anecdotal clinical observations that MRA sometimes overestimated the degree of renal artery stenosis, we decided to determine the interobserver variability, sensitivity, specificity, and diagnostic accuracy of MRA compared with CA.
• Goshima, K. R., Mills, J. L., & Hughes, J. D. (2004). A new look at outcomes after infrainguinal bypass surgery: traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage. Journal of vascular surgery, 39(2), 330-5.
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  Graft patency, limb salvage, and mortality are the traditional means of assessing the outcome of infrainguinal bypass surgery (IBS). However, these measures underestimate patient morbidity and fail to consider the entire spectrum of treatment required to restore the patients to their premorbid state. The aim of this study was to quantify the efforts required to achieve limb salvage by assessing three nontraditional outcomes: (1). index limb reoperation rate in 3 months, (2). hospital readmission rate in the first 6 months after IBS, and (3). wound-healing time.
• Margenthaler, J. A., Meier, J. D., Virgo, K. S., Johnson, D. Y., Goshima, K., Chan, D., Handler, B. S., & Johnson, F. E. (2003). Geographic variation in posttreatment surveillance intensity for patients with cutaneous melanoma. American journal of surgery, 186(2), 194-200.
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  We investigated whether geographic determinants could account for variation in posttreatment melanoma surveillance intensity among plastic surgeons.
• Margenthaler, J. A., Johnson, D. Y., Virgo, K. S., Fosko, S. W., Chan, D., Goshima, K., Handler, B. S., & Johnson, F. E. (2002). Evaluation of patients with clinically suspected melanoma recurrence: current practice patterns of plastic surgeons. International journal of oncology, 21(3), 591-6.
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  The optimal extent-of-disease evaluation for patients with clinically suspected melanoma recurrence is not known. The available modalities are numerous and many are expensive. We documented the extent of work-up carried out by plastic surgeons when their patients with melanoma develop clinical recurrence. A custom-designed questionnaire was mailed to a random sample (n=3,032) of the 4,320 members of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Subjects were asked which specific laboratory tests and imaging studies they would order for a patient with initial T2N0M0 disease treated with curative intent who later presented with either regional nodal metastases or pulmonary metastases. We measured the variability in practice patterns among surgeons and estimated the effects of physician age, U.S. census region, health maintenance organization (HMO) penetration rates, and type of recurrence (regional versus systemic) on work-up intensity. Of the 1,142 questionnaires completed (38%), 395 (35%) were evaluable. Non-evaluability was usually due to lack of melanoma patient follow-up in surgeons' practices. Lesion biopsy, chest X-ray, complete blood count, liver function tests, and computed tomography were frequently used, but there was no consensus for most modalities. More tests, particularly computed tomography, were utilized for evaluating systemic recurrence than for regional recurrence (p

Proceedings Publications

• Khan, R., Choudhary, G., Goshima, K. R., Hughes, J. D., & Winegar, B. (2016, October). Time-Resolved MRA and MR Perfusion Findings Following Carotid Revascularization: Ipsilateral MCA Hyperperfusion Manifesting as Contralateral MCA Hypoperfusion. Case. In Western Neuroradiological Society 48th Annual Meeting, Austin, Texas.

Presentations

• Goshima, K. R. (2023, November). Ergonomics. Vascular Surgery Teaching Conference. College of Medicine / Sarver Heart Conf Rm.

Poster Presentations

• Krielach, A. M., D'Andrea, M., Clark, B., & Goshima, K. R. (2024, April). Limitations of Body Mass Index (BMI) and Bowel Gas Among Patients Referred for Renal Artery Duplex (RAD). . College of Medicine Research Day. Tucson, AZ: College of Medicine.
• Goshima, K. R. (2006, Spring). Role of Endovascular Therapy in the Management of Critical Limb Ischemia. Society for Clinical Vascular Surgery Annual Meeting. Las Vegas, Nevada: Society for Clinical Vascular Surgery.

Case Studies

• León, L. R., & Goshima, K. R. (2016. Delayed superficial femoral artery stent erosion and pseudoaneurysm following endovascular therapy for occlusive disease(pp 502-8).
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  A 78 year-old male with multiple serious medical comorbidities was diagnosed with a pseudoaneurysm of the proximal superficial femoral artery. He had undergone successful superficial femoral artery (SFA) stenting for limb salvage four months previously and a Duplex ultrasound had confirmed adequacy of the endovascular procedure two months after its execution. This was successfully treated with placement of a covered-stent at the proximal SFA and a balloon-expandable stent at the origin of the deep femoral artery. Unfortunately the patient expired six weeks after the last endovascular intervention, likely due to procedural-unrelated causes. We postulate delayed stent erosion of a proximal atherosclerotic SFA, causing the pseudoaneurysm. This is the first report of such a case in the literature.
• Higa, G., Pacanowski, J. P., Jeck, D. T., Goshima, K. R., & León, L. R. (2010. Vertebral artery aneurysms and cervical arteriovenous fistulae in patients with neurofibromatosis 1(pp 166-77).
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  Vascular involvement in the setting of neurofibromatosis type 1(NF1) has been well described. However, the coexistence of NF1 with vertebral artery (VA) aneurysms and arteriovenous fistulae (AVFs) is a rare occurrence. A 60-year-old female with NF1 and other severe comorbidities presented with acute respiratory insufficiency caused by a ruptured large VA aneurysm and an associated AVF that required emergent intubation and eventual repair through endovascular techniques that resolved her symptoms. A detailed description of this case and a comprehensive review of the literature are also presented.
• Hughes, J. D., Leon, L. R., & Goshima, K. R. (2009. Aortic stent-graft explantation in a kidney transplant recipient(pp 535.e21-6).
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  AAA repair in renal transplant recipients has generated a variety of methods of managing the allograft. Endovascular techniques have been successfully employed in this patient population. Due to inherent limitations of present endovascular methods, occasional stent-graft excision must be performed. We present a case of aortic stent-graft excision in a renal transplant recipient using a pump-oxygenator to maintain allograft perfusion.
• Luis, L. R., Kaoru, G. R., Shemuel, P. B., & Mills, J. L. (2008. Lower extremity glomus tumors: comprehensive review for surgeons(pp 326-32).
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  The diagnosis of a lower extremity glomus tumor (GT) is often delayed owing to the lack of awareness and low level of suspicion by the treating physician. GT is thought to arise from cutaneous arteriovenous connections, often involving the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. Surgical excision of GT is often curative and provides significant symptomatic relief. There is a paucity of information in regard to GT in general, especially among vascular surgeons. The aim of this report is to make the surgical community more aware of this disease entity based on the analysis of our own experience and review of the literature.

Others

• Goshima, K. R. (2023, September). Invited Disscuant:  Revascularization Offers no Long-term
  Benefit to Patients with Intermittent Claudication: 5-year Results
  of Patient-Reported Outcomes. Western Vascular Annual Meeting.
• Goshima, K. R. (2017, June). Carotid Artery, Atherosclerotic - Symptomatic (Vascular Fellowship Level). VSCORE.