Loma Linda University

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Ahmed Abou-Zamzam, MD
Head, Cardiovascular & Thoracic Surg, Vascular Division
School of Medicine
Professor, Cardiovascular & Thoracic Surg
School of Medicine
Publications    Scholarly Journals--Submitted
  • Chiriano, JC, Abou-Zamzam, AM Jr., Urayeneza, O, Zhang, W, and W. Cheng. "The role of the vascular surgeon in anterior retroperitoneal spine exposure: ensuring patient safety and preserving open surgical training.Submitted: Journal of Vascular Surgery. ( 11/2008 )
  Scholarly Journals--Published
  • Abou-Zamzam Jr.  Invited commentary on percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia. J Vasc Surg. 2010 Feb: 51(2):391 ( 2/2010 )
  • Eckermann JM, teruya TH, Bianchi C, Abou-Zamzam Jr. Arterial thrombosis and gangrene secondary to arachnidism.  Vascular. 2009 July - August; 17(4):239-42. ( 7/2009 - 8/2009 )
  • Chiriano J, Abou-Zamzam Jr., Urayeneza O, Zhang WW, Cheng W. The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J VAsc Surg. 2009 Jul; 50(1):148-51. Epub 2009 Feb 15. ( 7/2009 )
  • Chiriano J, Teruya TH, Zhang WW, Abou-Zamzam AM, Bianchi C. Treatment of superior mesenteric artery portal vein fistula with balloon-expandable stent graft. Ann Vasc Surg. 2009 Jan-Feb;23(1):99-102 ( 1/2009 - 2/2009 )
  • Teruya TH, Schaeffer D, Abou-Zamzam AM, Bianchi C. Arteriovenous graft with outflow in the proximal axillary vein. Ann Vasc Surg. 2009 Jan-Feb;23(1):95-8. Epub 2008 Sep 21. ( 1/2009 - 2/2009 )
  • Chiriano J, Molkara AM, Teruya TH, Abou-Zamzam AM. "Acute cholangitis secondary to hepatic artery aneurysm and acute aortic dissection: a case report." Surgical Rounds . September 2007 ( 11/2008 )
  • Zhang WW, David Killeen J, Chiriano J, Bianchi C, Teruya TH, Abou-Zamzam AM. "Management of symptomatic spontaaneous isolated visceral artery dissection: is emergent intervention mandatory?" Annals of Vascular Surgery (2008), Spetember 5. ( 9/2008 )
  • Teruya TH, Schaeffer D, Abou-Zamzam AM, Bianchi C. "Arteriovenous graft with outflow in the proximal axillary vein." Annals of Vascular Surgery (2008) September 20. ( 9/2008 )
  • Bianchi C, Ou HW, Bishop V., Zhang W. Molkara A, Teruya TH, Abou-Zamzam AM. "Carotid artery stenting in high-risk patients: midterm mortality analysis." Annals of Vascular Surgery 22.2 (2008) 185-189. ( 3/2008 )
  • Abou-Zamzam AM Jr., Zhang W, Wang N, Razzouk A. "Endovascular repair of a ruptured descending thoracic aortic aneurysm in a patient with an ascending aortic aneurysm: hybrid open arch reconstruction with simultaneous thoracic stent-graft deployment within elephant trunk." Annals of Vascular Surgery 22.2 (2008) 168-172 ( 3/2008 )
  • Zhang WW. Abou-Zamzam AM, Hashisho M, Killeen JD, Bianchi C, Teruya TH. "Staged endovascular stent grafts for concurrent mobile/ulcerated thrombi of thoracic and abdominal aorta causing recurrent spontaneous distal embolization." Journal of Vascular Surgery 47.1, (2008) 193-196 ( 1/2008 )
  • Chiriano J, Molkara AM, Teruya TH, Abou-Zamzam AM Jr. "Acute cholangitis secondary to hepatic artery aneurysm and acute aortic dissection: A case report." Surgical Rounds . (2007): -. ( 9/2007 )
  • Abou-Zamzam AM Jr., Gomez NR, Molkara A, Banta JE, Teruya TH, Killeen JD, Bianchi C. "A prospective analysis of critical limb ischemia: Factors leading to major primary amputation versus revascularization." Annals of Vascular Surgery 21.4 (2007): 458-463. ( 1/2007 )
  • Molkara AM, Abou-Zamzam AM Jr., Teruya TH, Bianchi C, Killeen JD. "Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain." Annals of Vascular Surgery . 20(6): 803-808, 2006. ( 11/2006 )
  • Molkara AM, Abou-Zamzam AM Jr, Teruya TH, Bianchi C, Killeen JD. "Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain." Annals of Vascular Surgery 20.6 (2006): 803-808. ( 11/2006 )
  • Ballard JL, Abou-Zamzam AM Jr, Teruya TH, Harward TR, Flanigan DP.. "Retroperitoneal aortic aneurysm repair: long-term follow-up regarding wound complications and erectile dysfunction.." Annals of Vascular Surgery 20.2 (2006): 195-199. ( 3/2006 )
    The long-term impact of retroperitoneal aortic exposure regarding wound complications in all patients and erectile dysfunction in men was studied in a consecutive group of 107 patients (81 males and 26 females). Postoperative wound complications were classified into the following groups: none, flank bulge, hernia, and chronic pain. Patient demographic features including body mass index (BMI) were statistically analyzed in relation to the incidence of long-term wound problems. Information regarding erectile dysfunction was obtained before surgery in all men and stratified into three groups after surgery: no change, inability to consistently obtain an erection, and retrograde ejaculation. Mean patient follow-up was 2.9 years (range 1-4.36, median 2.8). Flank bulge was the only long-term wound complication, and this was noted in nine patients (8%). The incidence of true hernia and chronic pain was 0%. BMI >28 was the only factor that positively impacted the incidence of wound complications (p < 0.0001). Erectile dysfunction prior to surgery was noted in 37 men (46%), while 44 (54%) reported normal erectile function. Erectile function improved after surgery in one patient but remained unchanged in the rest. Postoperative retrograde ejaculation occurred with a frequency of 9% (four of 45 patients). Retroperitoneal abdominal aortic aneurysm (rAAA) exposure with incision based on the twelfth rib tip and rectus abdominis muscle sparing results in an overall low incidence of long-term wound complications. Postoperative flank bulge is associated with patient BMI >28. In addition, erectile function is not worsened by infrarenal autonomic nerve sparing rAAA exposure. However, a small percentage of potent men will experience postoperative retrograde ejaculation.
  • Retamozo M, Teruya TH, Abou-Zamzam AM, Ballard JL.. "Aorto-left renal artery bypass as an adjunct to suprarenal abdominal aortic aneurysm repair.." Annals of Vascular Surgery 19.5 (2005): 599-604. ( 9/2005 )
    Renal ischemia remains a vexing issue in the repair of suprarenal abdominal aortic aneurysms (SR-AAAs). Multiple reconstruction methods have been described, including fish-mouth anastomoses, renal artery reimplantation, and aortorenal interposition grafts. We present an alternative method of SR-AAA repair that minimizes renal ischemia time. We describe our approach in two patients with SR-AAAs. Both patients had normal preoperative renal function. Maximal aneurysm diameters were 6.0 and 7.4 cm. In each case, the abdominal aorta was exposed via the retroperitoneal approach and the supraceliac aorta was dissected from the surrounding tissue. A partially occluding side-biting aortic clamp was placed at this level to facilitate placement of a synthetic 6 mm interposition graft that was sewn in an end-to-side fashion to the suprarenal aorta first. These grafts were then sewn end-to-end to the left renal artery, completing the aorto-left renal bypass. Left renal ischemia times were 12 and 14 min. The aneurysm was then repaired with a beveled proximal anastomosis, accommodating the right renal artery orifice. Both patients had minimal postoperative renal dysfunction, with peak creatinine levels of 1.9 and 1.4 mg/dl. At discharge, both patients had a creatinine level of 1.1 mg/dl. Urinary output remained normal throughout the hospital stays, and neither patient required dialysis. Retroperitoneal aortic exposure with preliminary aorto-left renal artery bypass is an effective method of treating SR-AAAs. Proximal anastomosis can be done with less urgency and minimal right renal ischemia, by revascularizing the left kidney first.
  • Ballard JL, Reiss J, Abou-Zamzam AM, Teruya TH, Bianchi C.. "Two-graft repair of very proximal superior mesenteric artery aneurysms: a technical note.." Annals of Vascular Surgery 19.4 (2005): 465-469. ( 7/2005 )
    Visceral artery aneurysms are found in only 0.2% of the general population. Among these, aneurysms of the superior mesenteric artery (SMA) are very unusual and account for only 5.5 % to 8 %. Risk of rupture or embolization is the impetus for their definitive treatment and this should be performed in acceptable candidates. These aneurysms are typically located distal to the origin of the SMA and this situation lends itself to interposition grafting as a means of both aneurysm repair and reestablishment of prograde SMA blood flow. However, SMA origin aneurysms that arise directly from the abdominal aorta add a degree of complexity because the vascular reconstruction must include the diseased visceral aorta as well as the SMA. In this article we report successful operative treatment of large aneurysms at the origin of the superior mesenteric artery using a two-graft technique in two elderly patients
  • Chiriano J, Abou-Zamzam AM Jr, Teruya TH, Ballard JL. "Delayed development of a traumatic superior mesenteric arteriovenous fistula following multiple gunshot wounds to the abdomen.." Annals of Vascular Surgery 19.4 (2005): 470-473. ( 7/2005 )
    Traumatic visceral arteriovenous fistulae are rare and pose a diagnostic and therapeutic challenge. We present the case of a 20-year-old male who sustained multiple gunshot wounds to the abdomen, injuring the inferior vena cava, duodenum, stomach, and small bowel. The patient was taken emergently to the operating room for repair of his injuries, which required primary small bowel repair, duodenal repair, and inferior vena cava ligation due to exigent hemorrhage. At the initial operation there was a normal pulse in the superior mesenteric artery at the base of the small bowel mesentery, with no evidence of hematoma or thrill in the small bowel mesentery. The patient was subsequently returned to the operating room several times for bowel exploration and abdominal wall closure with mesh. Ten days after his initial injury, the patient was noted to have an abdominal bruit on physical exam. Arteriography demonstrated a fistula between the proximal superior mesenteric artery and vein with significant portal hypertension. The patient underwent surgical repair of the superior mesenteric artery and vein with closure of the fistula. The patient had no further complications and was discharged from the hospital 1 month later, after abdominal wall skin grafting, in good condition. The patient remains in good health 12 months later. Continued vigilance and careful physical examination are important in the identification of delayed vascular injuries and allow timely treatment and avoidance of untoward long-term sequelae.
  • Teruya TH, Bianchi C, Abou-Zamzam AM, Ballard JL.. "Endovascular treatment of a blunt traumatic abdominal aortic injury with a commercially available stent graft.." Annals of Vascular Surgery 19.4 (2005): 474-478. ( 7/2005 )
    Abdominal aortic injuries are rarely encountered in blunt abdominal trauma. The traditional treatment of these injuries has been surgical exploration and repair. Endografts are commonly used in the repair of abdominal aortic aneurysms. We present a case of a blunt abdominal aortic injury treated successfully with a commercially available endograft. A 26-year-old male was involved in a rollover motor vehicle collision. Evaluation revealed an aortic injury as well as a concomitant small bowel injury. No treatment of the aorta was undertaken initially; however, on 6-month follow-up, the patient developed bilateral hip and buttock claudication. Computed tomography and aortography revealed two areas of stenosis with an associated pseudoaneurysm. The patient was treated with three 22 mm AneuRx (Medtronic, Sunnyvale, CA) aortic extender cuffs. Balloon angioplasty of the stenosis was also performed. The patient's symptoms resolved, and he was well at 9 months postprocedure. We report the use of aortic extender cuffs to treat a blunt abdominal aortic injury. The potential to treat these injuries with aortic extender cuffs emergently or electively at any institution represents an advance in the management of vascular trauma.
  • Komorowska-Timek, E, Teruya TH, Abou-Zamzam, AM Jr., Papa D, and JL Ballard. "Treatment of radial and ulnar artery pseudoaneurysms using percutaneous thrombin injection." J Hand Surg 29A.5 (2004): 936-942. ( 9/2004 )
    Pseudoaneurysm formation is a recognized complication of arterial catheterization or traumatic arterial disruption, which may lead to considerable morbidity. Ultrasound-guided thrombin injection has been shown to be effective in the treatment of peripheral pseudoaneurysms; however, its application in the management of radial or ulnar artery pseudoaneurysms has not been well established. Arterial thrombosis and distal embolization are concerns when treating a pseudoaneurysm involving a small vessel. We performed successful ultrasound-guided thrombin injection of a 3-cm radial artery and a 2.5-cm ulnar artery pseudoaneurysm resulting from arterial catheterization and missed arterial trauma, respectively. Radial artery recannalization occurred 28 days after the procedure whereas the ulnar artery remained patent throughout the observation period.
  • Gambaro, E, Abou-Zamzam, AM Jr., Teruay TH, Hopewell, WJ, Bianchi, C, and JL Ballard. "Ischemic colitis following translumbar thrombin injection for treatment of endoleak." Annals of Vascular Surgery, 18(1): 74-78, 2004. ( 0/2004 )
  • Ballard, JL, Abou-Zamzam, AM Jr., Teruya TH, Bianchi, C, and FF Petersen. "Quality of life before and after endovascular and retroperitoneal adbominal aortic aneurysm repair: a prospective study." Journal of Vascular Surgery, 39(4):797-803, 2004. ( 0/2004 )
  • Abou-Zamzam, AM Jr., "Detection and treatment of peripheral arterial occlusive disease." Journal of Clinical Outcomes Management, 11(5):1-13, 2004. ( 0/2004 )
  • Abou-Zamzam, AM Jr., Teruya TH, Killeen JD, and JL Ballard. "Major lower extremity amputation in an academic vascular center." Annals of Vascular Surgery, 17(1): 86-90, 2003. ( 0/2003 )
  • Ballard, JL, Bianchi C., Abou-Zamzam, AM Jr., Teruya, TH, and M. Abu-Assal. "Anterior retroperitoneal lumbosacral spine exposure: operative technique and results." Annals of Vascular Surgery, 17(2): 137-142, 2003. ( 0/2003 )
  • Teruya, TH, Ayerdi, J, Solis, M, Abou-Zamzam, AM Jr., Ballard JL, and KJ Hodgson. "Treatment of type-III endoleak with an aorto-uniliac stent graft." Annals of Vascular Surgery, 17(2):123-128, 2003. ( 0/2003 )
  • Abou-Zamzam, AM Jr., Bianchi C, Mazraany, W, Teruya TH, Hopewell, J, Vannix, RS, and JL Ballard. "Aorto-enteric fistula development following endovascular abdominal aortic aneurysm repair: a case report." Annals of Vascular Surgery, 17(2) 119-122, 2003. ( 0/2003 )
  • Bianchi, C, Ballard JL, Abou-Zamzam, AM, Jr., and TH Teruya. "Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: results and critical analysis." Journal of Vascular Surgery, 38(1):67-71, 2003. ( 0/2003 )
  • Teruya, TH, Abou-Zamzam, AM Jr., Limm W, and L. Wong. "Symptomatic subclavian vein stenosis and occlusion in hemodialysis patients with transvenous pacemakers." Annals of Vascular Surgery, 17(5): 526-529, 2003. ( 0/2003 )
  • Ballard, JL, Romano, M, Abou-Zamzam, AM Jr., and TH Teruya. "Carotid artery patch angioplasty: impact and outcome." Annals of Vascular Surgery, 16(1): 12-16, 2002. ( 0/2002 )
  • Ballard, JL, Abou-Zamzam, AM Jr., and TH Teruya. "Type III and IV thoracoabdominal aortic aneurysm repair: results of a trifurcated/two-graft technique." Journal of Vascular Surgery, 36(2): 211-216, 2002 ( 0/2002 )
  • Abou-Zamzam, AM Jr., Moneta GL, Landry GJ, Yeager, RA, Edwards, JM, McConnell, DB, Taylor, LM Jr., and JM Porter. "Carotid surgery following previous carotid endarterectomy is safe and effective." Vascular and Endovascular Surgery. 36:263-270, 2002. ( 0/2002 )
  • Lovelace T, Moneta GL, Abou-Zamzam AM Jr., Edwards JE, Yeager RA, Landry GJ, Taylor LM Jr., and JM Porter. "Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%." Journal of Vascular Surgery. 33(1):56-61, 2001. ( 0/2001 )
  • Abou-Zamzam AM Jr., and JL Ballard. "Management of sterile para-anastomotic aneurysms of the aorta." Seminars in Vascular Surgery. 14(4):282-291, 2001. ( 0/2001 )
  • Teruya, TH, Abou-Zamzam AM Jr., and JL Ballard. "Inflammatory abdominal aortic aneurysm trated by endovascular stent grafting: a case report." Vascular Surgery. 35(5):391-395, 2001. ( 0/2001 )
  • Abou-Zamzam, AM Jr., Moneta, GL, Edwards JM, Yeager RA, Taylor LM Jr., and JM Porter. "Is a single preoperative duplex exam sufficient for planning bilateral carotid endarterectomy?" Journal of Vascular Surgery. 31(2): 282-288, 2000. ( 0/2000 )
  • Foley MI, Moneta GL, Abou-Zamzam AM Jr., Edwards JM, Taylor LM Jr., Yeager RA, and JM Porter. "Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia." Journal of Vascular Surgery, 32(1): 37-47, 2000. ( 0/2000 )
  • Nicoloff AD, Abou-Zamzam AM Jr., Landry GJ, Moneta GL, Taylor LM Jr., and JM Porter. "Functional outcome of surgery for limb salvage." Advances in Vascular Surgery, 8:97-107, 2000. ( 0/2000 )
  • Chiriano, J.C., Abou-Zamzam, A.M. Jr., Nguyen, K., Zhang W., Killeen, J.D., Molkara, A.M., Bianchi, C., and T.H. Teruya.  Preoperative carotid duplex findings predict carotid stump pressures during carotid endartectomy in symptomatic but not asymptomatic patients.  Annals of Vascular Surgery.  24 (8): 1038-44 2010.  ( 8/2010 - Present )
  • Chiriano, J.C., Killeen, J.D., Molkara, A.M., Bianchi, C., and A.M. Abou-Zamzam Jr. Rupture of an abdominal aortic aneurysm following nonaccidental blunt abdominal trauma.  Vascular, 18 (5): 303-6, 2010. ( 0/2010 - Present )
  • Chiriano, J.C., Bianchi, C., Teruya, T.H., Mills, B., Bishop, V., and A.M. Abou-Zamzam, Jr. Management of lower extremity wounds in patients with peripheral arterial disease: a stratified conservative approach.  Annals of Vascular Surgery, 24 (8): 1110-6 2010. ( 0/2010 - Present )
  Books and Chapters
  • Zhang W and Abou-Zamzam Jr. Lower extremity Amputation, in Vascular Surgery, 7th ed., Rutherford (ed.), Philadelphia, Elsevier Saunders, 2010. ( 3/2010 )
  • Abou-Zamzam AM Jr.. Vascular Surgery, Sixth Edition. Philadelphia, PA: Elsevier Saunders, 2005. 2452 - 2459 ( 5/2005 )