Predictors of serious morbidity and mortality after endovascular repair of aortoiliac lesions

Thomas, A. Taylor; Leitman, I. Michael

doi:10.1016/j.surg.2018.04.028

Cited by 5 publications

(32 citation statements)

References 19 publications

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“…In one of the most extensive multicenter experiences Sixt et al 32 reported that nicotine abuse was one of the most significant factors associated with restenosis. In a review of the American College of Surgeons National Surgical Quality Improvement Program, Thomas et al 34 documented that smoking and chronic use of steroids were significant predictors of reintervention, which is frequently associated with loss of patency. Thus, we advocate the inclusion of COPD as a variable in evaluating patency.…”

Section: Discussionmentioning

confidence: 99%

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

et al. 2019

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Purpose: To report the results of endovascular treatment of iliac and complex aortoiliac occlusive disease (AIOD) in a multicenter Italian registry. Materials and Methods: A retrospective, multicenter, observational cohort study analyzed 713 patients (mean age 68±10 years; 539 men) with isolated iliac and complex aortoiliac lesions treated with primary stenting between January 2015 and December 2017. Indications for treatment were claudication in 406 (57%) patients and critical limb ischemia in 307 (43%). According to the TransAtlantic Inter-Society Consensus II (TASC) classification, the lesions were categorized as type A (104, 15%), type B (171, 24%), type C (170, 24%), and type D (268, 37%). Early (<30 days) endpoints included mortality, thrombosis, and major complications. Late major outcomes were primary and secondary patency and freedom from reintervention as estimated by Kaplan-Meier analysis; estimates are given with the 95% confidence intervals (CIs). Associations between baseline variables and primary patency were sought with multivariate analysis; the results are presented as the hazard ratio (HR) and 95% CI. Results: Technical success was achieved in 708 (99%) lesions; in-hospital mortality was 0.6% (n=4). The median follow-up was 11 months (range 0–42). The estimated primary patency rate was 96% (95% CI 94% to 97%) at 1 year and 94% (95% CI 91% to 96%) at 2 years. The estimated secondary patency was 99% (95% CI 97% to 99%) at 1 year and 98% (95% CI 95% to 99%) at 2 years. The estimated freedom from reintervention was 98% (95% CI 96% to 99%) at 1 year and 97% (95% CI 94% to 98.5%) at 2 years. Cox regression analysis demonstrated that the application of a covered stent was associated with an increased need for reintervention (HR 1.4, 95% CI 1.10 to 1.74, p=0.005). Chronic obstructive pulmonary disease was associated with decreased primary patency (HR 3.7, 95% CI 1.25 to 10.8, p=0.018). Conclusion: Endovascular intervention with primary stent placement for aortoiliac occlusive disease achieved satisfactory 2-year patency regardless of the complexity of the lesion. Almost all TASC lesions should be considered for primary endovascular intervention if suitable.

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Section: Discussionmentioning

confidence: 99%

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

et al. 2019

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“…The Google Scholar database search yielded 205,000 results; however, after reviewing the results on the first 20 web pages, the author identified no additional studies for inclusion. After removing duplicate records and screening the remaining titles and abstracts for relevancy, the author read the full text of the relevant articles and determined that 11 articles met the inclusion criteria 19‐29 . Figure 1 provides detailed information regarding the searching and screening process.…”

Section: Methodsmentioning

confidence: 99%

Patient Smoking Status and Postoperative Outcomes: An Integrative Literature Review of Studies Using the ACS NSQIP Data Set

Devlin¹,

Smeltzer²,

Yost³

2023

AORN Journal

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Tobacco use is associated with poor surgical outcomes and is the leading cause of preventable morbidity and mortality in the United States. Because of the risk for postoperative complications, researchers continue to examine the association between surgical patients' smoking status and adverse outcomes. This quantitative integrative review synthesizes evidence on the relationship between smoking status and postoperative outcomes according to information in the American College of Surgeons National Surgical Quality Improvement Program data set. The included studies involved 10 procedures and the evaluated outcomes comprise surgical complications (eg, surgical site infection), medical complications (eg, sepsis), and transitions in care (eg, discharge destination). The review results are mixed and are not generalizable because only two studies specified smoking status as a primary variable of interest. To develop policies for perioperative patient smoking cessation, perioperative nurses require additional research results on the relationships between smoking status and standardized variables.

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“…A szövődmények kialakulásának szempontjából, így a műtét utáni hospitali- záció hosszának tekintetében, főleg a posztoperatív első hónapban az endovascularis beavatkozás előnyösebb. Az összmorbiditás és -mortalitás a nyitott műtét esetében lényegesen rosszabb eredményeket mutat [22][23][24][25][26][27]. Bár a bypass hosszú távú eredményei elfogadhatók, súlyos komplikációk gyakrabban fordulnak elő.…”

Section: Megbeszélésunclassified

“…Ezeket a tényezőket mindenképpen figyelembe kell venni a terápiás modalitás megválasztásakor [28]. Az endovascularis intervenció után a posztoperatív első hónapban Thomas és Leitman 2018. évi publikációja szerint a nyílt seb jelenléte, a dohányzás, a beavatkozást megelőző időszakban zajló szteroidterápia, a diabetes, a női nem, a magas szérumlipid-és fehérvérsejt-koncentráció és az alacsony szérumalbuminszint a leginkább meghatározó rizikófaktorok [22]. Az irodalmi adatok alapján TASC II.…”

Section: Megbeszélésunclassified

Az aortobiiliacalis occlusiv érbetegség miatt végzett aortobifemoralis bypass műtétek hosszú távú eredményeinek elemzése

Pomozi

Lengyel

Osztrogonacz

et al. 2021

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Összefoglaló. Bevezetés: A diffúz aortobiiliacalis érszakasz occlusiv betegségének kezelésére alkalmazott aortobifemoralis bypass szerepe csökken az endovascularis műtétek térnyerése miatt. Célkitűzés: A vizsgálat célja volt a modern invazív kezelés korszakában a perioperatív és a hosszú távú eredmények elemzése aortobiiliacalis bypass után, melyek összehasonlíthatók az endovascularis megoldások eredményeivel. Módszerek: A retrospektív, egycentrumú vizsgálat során a Semmelweis Egyetem Városmajori Szív- és Érgyógyászati Klinikájának Érsebészeti és Endovaszkuláris Tanszékén 2006. 01. 01. és 2017. 12. 31. között occlusiv aortoiliacalis atherosclerosis miatt primer aortobifemoralis bypass műtéten átesett 419 beteg (átlagéletkor: 62,2 év, SD: ± 8,22; 224 férfi, 53%) adatait elemeztük. Eredmények: A posztoperatív 30 napon belüli mortalitás 5,01%, a késői mortalitás 10,98% és 29,59% volt 12, illetve 60 hónap után. A betegek 12,57%-ánál történt korai reoperáció, késői reoperáció 32 (8%) betegnél vált szükségessé. A graft elsődleges nyitva maradása 88,65% és 81,15% volt 12, illetve 60 hónap után. 21 betegnél történt amputáció (6,29%); 57,14%-ban femoralis, 35,71%-ban cruralis szinten, 7,14%-ban a boka szintje alatt. Az amputációkra 35,71%-ban a bypasst követő 30 napon belül, további 35,71%-ban 2 éven belül került sor. Az esetek 35,63%-ában lépett fel egyéb szövődmény; a leggyakoribbak: műtétet igénylő posztoperatív hernia (6,89%), cardiovascularis szövődmény (4,19%), lágyéki nyirokcsorgás vagy sebgyógyulási zavar (4,79%). Következtetés: Eredményeink alapján e betegcsoportban az aortobifemoralis bypass elfogadható, de nem jelentéktelen perioperatív halálozással és magas morbiditással jár. A graft hosszú távú nyitva maradása jó, de az újabb érműtét mind rövid, mind hosszú távon relatíve gyakori. A kevésbé invazív technikák eredményeinek összehasonlítása indokolt a hosszú szakaszú (TASC C, D) elváltozások esetén. Orv Hetil. 2021; 162(3): 99–105. Summary. Introduction: The role of aorto-bifemoral bypass in the treatment of diffuse aorto-biiliac occlusive disease decreases in the era of endovascular surgery. Objective: The aim of the study was to analyse the early and long-term postoperative results of aorto-bifemoral bypass in a recent time period. These results may be used as a baseline to compare the results of endovascular procedures. Methods: In a retrospective, single-center study, the data of 419 patients (mean age: 62.2 years, SD: ± 8.22; 224 men, 53%) who underwent primary aorto-bifemoral bypass due to occlusive aorto-iliac atherosclerosis from 01. 01. 2006 to 31. 12. 2017 at the Department of Vascular and Endovascular Surgery of Semmelweis University Heart and Vascular Center were analysed. Results: Postoperative mortality within 30 days was 5.01%, late mortality was 10.98% and 29.59% after 12 and 60 months, respectively. 12.57% of the patients needed early reoperation and late reoperation was required in 32 cases (8%). The primary graft patency was 88.65% and 81.15% after 12 and 60 months, respectively. 21 patients underwent amputation (6.29%); 57.14% at the femoral level, 35.71% at the crural level and 7.14% below the ankle level. Amputations were performed in 35.71% of the cases within 30 days after the bypass and an additional 35.71% within 2 years. Other complications occurred in 35.63% of the cases; the most common causes were postoperative hernia requiring surgery (6.89%), cardiovascular complication (4.19%) and inguinal wound healing disorders (4.79%). Conclusion: Based on our results, aorto-bifemoral bypass surgery is associated with acceptable but not insignificant perioperative mortality and high morbidity in this group of patients. The graft patency is favourable in the long term, however, additional vascular reintervention is common in short and long term as well. Short- and long-term results of percutaneous endovascular techniques in diffuse aorto-biiliac disease (TASC C and D lesions) are suggested to be compared to these recent results of open surgery. Orv Hetil. 2021; 162(3): 99–105.

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Predictors of serious morbidity and mortality after endovascular repair of aortoiliac lesions

Cited by 5 publications

References 19 publications

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

Patient Smoking Status and Postoperative Outcomes: An Integrative Literature Review of Studies Using the ACS NSQIP Data Set

Az aortobiiliacalis occlusiv érbetegség miatt végzett aortobifemoralis bypass műtétek hosszú távú eredményeinek elemzése

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