Postoperative complications after common femoral endarterectomy

Nguyen, Bao Ngoc; Amdur, Richard L.; Abugideiri, Mustafa; Rahbar, Rodeen; Neville, Richard F.; Sidawy, Anton N.

doi:10.1016/j.jvs.2015.01.024

Cited by 100 publications

(93 citation statements)

References 9 publications

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“…[6] For comparison, a second study using a similar NSQIP sample to Nguyen et al, but excluding emergent cases, reported a 1.5% thirty-day mortality following isolated common femoral endarterectomy. [7] The later study did not identify proportion with rest pain and as mentioned above could not identify the proportion with CLI.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study from the National Surgical Quality Improvement Program (NSQIP) evaluating isolated common femoral endarterectomy reported a 3.4% thirty-day mortality. [6] Siracuse et al, using NSQIP data from 2007–2010, found a thirty-day mortality rate of 1.5% for isolated common femoral endarterectomy but differed from the former in that it did not include emergent cases. [7] It is likely that many of the patients getting isolated common femoral endarterectomy, especially in the emergent setting, were too sick for a more extensive procedure, such as bypass.…”

Section: Introductionmentioning

confidence: 99%

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Effect of adjunct femoral endarterectomy in lower extremity bypass on perioperative and 1-year outcomes

Soden

Zettervall

Shean

et al. 2017

Journal of Vascular Surgery

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Introduction Isolated common femoral endarterectomy was recently reported to have a thirty-day mortality of 3.4%. The impact of adjunctive femoral endarterectomy at the time of lower extremity bypass is not well described and therefore the purpose of this study is to determine its associated perioperative and long-term risk. Methods Patients undergoing initial lower extremity bypass in the VSGNE from 2003–2015 were identified. After univariate analysis, multivariable logistic regression was used to identify the independent association of endarterectomy with adverse perioperative events. Kaplan-Meier and Cox hazard models were utilized for 1-year analysis. Results After exclusions 4496 patients were identified as undergoing infrainguinal bypass (33% with endarterectomy). There was no difference in proportion with chronic limb-threatening ischemia (CLI)(68% vs. 67%, P=.24), or tissue loss (of those with CLI: 65% vs. 63%, P=.34), between the adjunctive endarterectomy group and bypass alone, respectively. Patients undergoing adjunctive endarterectomy were older (mean 68yr vs. 67yr, P=.02), more likely white (95% vs. 93%, P=.02), smokers (91% vs. 87%, P=.001), and more often had prior CABG/PCI (34% vs. 31%, P=.02). The endarterectomy cohort had similar 30-day mortality (CLI: 2.6% vs. 2.9%, P=.60; Claudication: 0.2% vs. 0.4%, P=1.0) despite longer operative time (median 268min vs. 210min, P<.001) and increased blood loss (median 250cc vs. 180cc, P<.001). Patients with CLI undergoing adjunctive endarterectomy had more in-hospital MIs (6.2% vs. 3.8%, P=.003) and transfusions (11% vs. 6.8%, P<.001). At one-year this group had a suggestion of improved freedom from major amputation (91% vs. 87%, P=.049) and AFS (80% vs. 76%, P=.03) that did not reach significance after adjustment. For patients with claudication and adjunctive endarterectomy rates of MI (2.4% vs. 0.9%, P=.02), renal dysfunction (3.6% vs.1.4%, P=.01), SSI (5.0% vs. 2.6%, P=.02), and transfusion (4.6% vs. 1.8%, P=.002) were higher. After adjustment, all patients undergoing adjunctive endarterectomy were at increased risk of MI (OR 1.6, 95%CI 1.1–2.2), SSI (1.5, 1.1–2.0), and bleeding requiring transfusion (1.8, 1.4–2.3). There were no differences in one-year survival for either CLI or claudication groups and no difference in all one-year endpoints, for patients with claudication. Conclusion Adjunctive femoral endarterectomy with bypass is safe, with no difference in perioperative or 1-year mortality compared to bypass. However, surgeons should be aware that adjunctive endarterectomy is associated with increased risk of bleeding, surgical site infection, and myocardial infarction, likely from these patients’ disease burden and presumed more extensive atherosclerosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of adjunct femoral endarterectomy in lower extremity bypass on perioperative and 1-year outcomes

Soden

Zettervall

Shean

et al. 2017

Journal of Vascular Surgery

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“…In line with our study, Nguyen et al recently reported in a large series that the risks of death following femoral endarterectomy, albeit as an isolated intervention, are not insignificant. 22 In addition, Hobo et al determined that surgical intervention for PAD, which included femoral endarterectomy, was associated with increased perioperative mortality. 6 The need for femoral endarterectomy is a reflection of extensive PAD, which is a well-established risk for adverse outcomes following surgery.…”

Section: Discussionmentioning

confidence: 99%

The impact of concomitant procedures during endovascular abdominal aortic aneurysm repair on perioperative outcomes

Ultee

Zettervall

Soden

et al. 2016

Journal of Vascular Surgery

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Introduction Concomitant procedures during endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) are performed to either facilitate endograft delivery, simultaneously treat unrelated conditions, or to resolve intraoperative pitfalls. The frequency and perioperative impact of these procedures are not well described. This study aims to assess the frequency and perioperative impact of various concomitant procedures performed at the time of EVAR Methods We included all elective EVARs in the Vascular Study Group of New England between January 2003 and November 2014, and identified those with and those without concomitant procedures. Multivariable logistic regression analysis was used to establish the independent association between concomitant procedures and perioperative outcomes. Results 4033 patients were included in the study, with 1168 (29.0%) patients undergoing one or more additional procedure. Independent risk factors for 30-day mortality were concomitant femoral endarterectomy (OR: 4.8, 95% CI: 2.1–11.2) and renal angioplasty or stenting (3.1, 1.2–8.3). Postoperative bowel ischemia was associated with hypogastric embolization (3.8, 1.1–13.4) and iliac angioplasty or stenting (3.5, 1.3–9.6). Leg ischemia was associated with unplanned graft extension (2.3, 1.02–5.0), other artery reconstruction (5.2, 1.8–15.1), thrombo-embolectomy (5.2, 1.3–20.8), and repair of arterial injury (4.6, 1.2–18.3). Risk factors for deterioration of renal function were ilio-femoral bypass (3.9, 1.3–12.2), other artery reconstruction (2.7, 1.3–5.8), renal angioplasty or stenting (2.5, 1.3–4.6), and repair of arterial injury (4.5, 1.6–12.2). Myocardial infarction was associated with femoro-femoral bypass (3.9, 1.7–8.7), other artery reconstruction (3.9, 1.6–9.2) and repair of arterial injury (6.1, 1.8–21.0). Wound complications were predicted by femoro-femoral bypass (13.4, 5.8–31.1). Conclusions Concomitant procedures during EVAR are associated with increased postoperative morbidity and mortality. The need for performing concomitant procedures should be carefully considered. The morbidity associated with intraoperative complications highlights the importance of avoidance of arterial injury and thrombo-embolic events where possible.

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“…However, a recent study of patients undergoing CFA endarterectomy demonstrated 30-day mortality and wound complication rates of 3.4% and 8%, respectively 44. Endovascular approaches to CFA revascularisation offer a minimally invasive alternative in patients who are not candidates for surgical endarterectomy.…”

Section: Treatmentmentioning

confidence: 99%

Contemporary evaluation and management of lower extremity peripheral artery disease

Foley

Armstrong

Waldo

2016

Heart

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Peripheral artery disease (PAD) includes atherosclerosis of the aorta and lower extremities. Affecting a large segment of the population, PAD is associated with impaired functional capacity and reduced quality of life as well as an increased risk of stroke, myocardial infarction and cardiovascular death. The evaluation of PAD begins with the physical examination, incorporating non-invasive testing such as ankle-brachial indices to confirm the diagnosis. Therapeutic interventions are aimed at alleviating symptoms while preserving limb integrity and reducing overall cardiovascular risk. With this in mind, risk factor modification with exercise and medical therapy are the mainstays of treatment for many patients with PAD. Persistent symptoms or non-healing wounds should prompt more aggressive therapies with endovascular or surgical revascularisation. The following manuscript provides a comprehensive review on the contemporary evaluation and management of PAD.

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Postoperative complications after common femoral endarterectomy

Cited by 100 publications

References 9 publications

Effect of adjunct femoral endarterectomy in lower extremity bypass on perioperative and 1-year outcomes

Effect of adjunct femoral endarterectomy in lower extremity bypass on perioperative and 1-year outcomes

The impact of concomitant procedures during endovascular abdominal aortic aneurysm repair on perioperative outcomes

Contemporary evaluation and management of lower extremity peripheral artery disease

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