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Analysis of Aortic Growth Rates in Uncomplicated Type B Dissection
Journal of Vascular Surgery
Abstracts
869
Volume 64, Number 3 Table. Complications after inferior vena cava (IVC) filter placement Permanent Retrievable (n ¼ 366) (n ¼ 240) Thrombotic
5 (2.0)
9 (2.4)
Thrombosis
4 (1.6)
6 (1.6)
PE
1 (0.4)
3 (0.8)
Device related
1 (0.4)
15 (4.0)
Symptomatic perforation
1 (0.4)
7 (1.9)
Migration
0
4 (1.0)
Fracture
0
Total complications
6 (2.5)
24 (6.5)
Number of filters with at least one complication
4 (1.6)
17 (4.6)
4 (1.0)
PE, Pulmonary embolism. Data are presented as number (%). retrievable filters compared with permanent filters are not clearly understood. The purpose of this study was to compare the complication rates between retrievable and permanent IVC filters. Methods: A retrospective review identified 606 IVC filters, of which 366 were retrievable and 240 were permanent, placed between January 2001 and July 2015. Patients with retrievable filters were compared with those with permanent filters with respect to demographics, filter model, indication for filter, and comorbidities as well as the number and types of complications. Filter complications were further subcategorized as thrombotic or device related. The percentage of filters that were eventually retrieved was also evaluated. Results: A total of 21 filters were identified with at least one complication for an overall filter complication rate of 3.4%. Of these, 17 were in patients who had retrievable filters (4.6%) and 4 were in patients with permanent filters (1.6%; Table). The most common complications identified were filter thrombosis and perforation of the vena cava. Thrombotic complications occurred at similar rates in both groups (2.4% vs 2.0%). Device-related complications were more common in patients with retrievable filters (4.0% vs 0.4%). Of the retrievable filters that were placed, only 48 (13.1%) were eventually retrieved. Conclusions: Retrievable filters are rarely retrieved and are associated with a higher rate of complications compared with permanent filters. This should be taken into account in deciding which filter is most appropriate for a patient. However, the overall complication rate for both types of filters is low, and IVC filters continue to be a viable option for protection in patients who have or are at risk for VTEs. Author Disclosures: N. A. Parker: None; A. Mohla: None; S. W. Kujath: Consulting Fee; Consultant Bard Peripheral Vascular; K. R. Stark: Consulting Fee; Consultant Bard Peripheral Vascular; J. E. Wilson: Consulting Fee; Consultant Bard Peripheral Vascular; R. J. Thomas: None; R. R. Carter: Consulting Fee; Consultant Bard Peripheral Vascular.
Results: A total of 108 patients were included. Average age of patients was 58.7 years. Median follow-up time was 3 months for the first CT scan and 32 months for the second. Disease-specific mortality was 5.6% (6 patients) at 30 days, 12% (13 patients) at 12 months, and 19.4% (21 patients) at >1-year follow-up. Overall mortality was 27.8%. Thirty-seven percent (40 patients) required operative intervention (18 open, 22 endovascular repair): 20 at 30 days, 12 at 12 months, and 8 patients at >1 year. Mean aortic growth rate was higher in the first time interval compared with the second: 0.88 vs 0.19 mm/month (P < .05) at the dissection flap, 1.01 vs 0.18 mm/month (P < .05) at the mid-descending aorta, and 0.65 vs 0.28 mm/month (P < .05) at the diaphragm. The growth rate at dissection area was higher in those requiring operation (P < .05). Age and number of comorbidities were associated with overall mortality. Thrombosis of the false lumen did not affect the mortality and intervention rate. Conclusions: During the study period, the overall aortic growth rate was not linear, with a more prominent initial phase. A relevant number of patients ultimately required interventions. Prospectively designed studies are needed to identify the subgroup of patients who may benefit from early intervention based on growth rate measurements. Author Disclosures: M. Aboul Hosn: None; P. Goffredo: None; J. Zavala: None; T. Kresowik: None; R. Nicholson: None; L. Pascarella: None.
Clinical Diagnostic Criteria and Pretreatment Patient-Reported Outcomes Measures in a Prospective Cohort of Patients With Neurogenic Thoracic Outlet Syndrome Joshua A. Balderman, MD, Katherine Holzem, Ahmmad A. Abuirqeba, Beverly J. Field, PhD, Michael M. Bottros, MD, Lauren N. McLaughlin, RN, Chandu Vemuri, MD, Robert W. Thompson, MD. Vascular Surgery, Washington University, St. Louis, Mo Objective: The objective of this study was to assess relationships between clinical diagnostic criteria (CDC) and pretreatment patient-reported outcomes measures (PROMs) in a prospective 6-month cohort of patients with neurogenic thoracic outlet syndrome (NTOS). Methods: Between July 1, 2015, and December 31, 2015, our group saw 183 new patient referrals, with 150 (82.0%) meeting predefined CDC for NTOS. Seven PROMs were obtained across five domains: pain severity (McGill pain score, Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale), depression (Zung Self-Rating Depression Scale), functional disability (Quick Disabilities of the Arm, Shoulder, and Hand; Cervical Brachial Symptom Questionnaire), and quality of life (12-Item Short Form Health Survey physical and mental). Associations between individual CDC and PROMs were analyzed using Pearson correlation statistics. Results: Mean (6 standard error) age of patients was 37.1 6 1.1 years (range, 12-66), and 107 (71.3%) were women. Twelve (8.0%) had a cervical
Analysis of Aortic Growth Rates in Uncomplicated Type B Dissection Maen Aboul Hosn, MD, Paolo Goffredo, MD, Jeffrey Zavala, Timothy Kresowik, MD, Rachael Nicholson, MD, Luigi Pascarella, MD. University of Iowa Hospital and Clinics, Iowa City, Iowa Objective: Uncomplicated type B dissections have historically been treated medically with hemodynamic control. Early progression of the disease and late aneurysmal dilation have been considered indications for intervention. The aim of this study was to analyze growth rate patterns of type B dissections based on computed tomography (CT) measurements over time. Methods: We conducted a retrospective review of patients with acute type B dissection from 2008 to 2014 who had at least two follow-up CT scans. Patients with rapid progression requiring interventions were also included. Using M2S software (M2S, Lebanon, NH), we calculated the mean centerline diameter of the true and false lumens at three different sites of the descending aorta. Growth rate was calculated as the change in maximal diameter between the first, interval, and last available CT scans. Primary outcome was to compare the growth rate pattern between the two time intervals. Secondary outcomes included early and delayed aortic intervention and overall mortality.
Fig. PCS vs CDC, East, and QuickDASH. CDCs, Clinical diagnostic criteria; EAST, elevated arm stress test; PCS, Pain Catastrophizing Scale; QuickDASH, Quick Disabilities of the Arm, Shoulder, and Hand.
Abstracts
869
Volume 64, Number 3 Table. Complications after inferior vena cava (IVC) filter placement Permanent Retrievable (n ¼ 366) (n ¼ 240) Thrombotic
5 (2.0)
9 (2.4)
Thrombosis
4 (1.6)
6 (1.6)
PE
1 (0.4)
3 (0.8)
Device related
1 (0.4)
15 (4.0)
Symptomatic perforation
1 (0.4)
7 (1.9)
Migration
0
4 (1.0)
Fracture
0
Total complications
6 (2.5)
24 (6.5)
Number of filters with at least one complication
4 (1.6)
17 (4.6)
4 (1.0)
PE, Pulmonary embolism. Data are presented as number (%). retrievable filters compared with permanent filters are not clearly understood. The purpose of this study was to compare the complication rates between retrievable and permanent IVC filters. Methods: A retrospective review identified 606 IVC filters, of which 366 were retrievable and 240 were permanent, placed between January 2001 and July 2015. Patients with retrievable filters were compared with those with permanent filters with respect to demographics, filter model, indication for filter, and comorbidities as well as the number and types of complications. Filter complications were further subcategorized as thrombotic or device related. The percentage of filters that were eventually retrieved was also evaluated. Results: A total of 21 filters were identified with at least one complication for an overall filter complication rate of 3.4%. Of these, 17 were in patients who had retrievable filters (4.6%) and 4 were in patients with permanent filters (1.6%; Table). The most common complications identified were filter thrombosis and perforation of the vena cava. Thrombotic complications occurred at similar rates in both groups (2.4% vs 2.0%). Device-related complications were more common in patients with retrievable filters (4.0% vs 0.4%). Of the retrievable filters that were placed, only 48 (13.1%) were eventually retrieved. Conclusions: Retrievable filters are rarely retrieved and are associated with a higher rate of complications compared with permanent filters. This should be taken into account in deciding which filter is most appropriate for a patient. However, the overall complication rate for both types of filters is low, and IVC filters continue to be a viable option for protection in patients who have or are at risk for VTEs. Author Disclosures: N. A. Parker: None; A. Mohla: None; S. W. Kujath: Consulting Fee; Consultant Bard Peripheral Vascular; K. R. Stark: Consulting Fee; Consultant Bard Peripheral Vascular; J. E. Wilson: Consulting Fee; Consultant Bard Peripheral Vascular; R. J. Thomas: None; R. R. Carter: Consulting Fee; Consultant Bard Peripheral Vascular.
Results: A total of 108 patients were included. Average age of patients was 58.7 years. Median follow-up time was 3 months for the first CT scan and 32 months for the second. Disease-specific mortality was 5.6% (6 patients) at 30 days, 12% (13 patients) at 12 months, and 19.4% (21 patients) at >1-year follow-up. Overall mortality was 27.8%. Thirty-seven percent (40 patients) required operative intervention (18 open, 22 endovascular repair): 20 at 30 days, 12 at 12 months, and 8 patients at >1 year. Mean aortic growth rate was higher in the first time interval compared with the second: 0.88 vs 0.19 mm/month (P < .05) at the dissection flap, 1.01 vs 0.18 mm/month (P < .05) at the mid-descending aorta, and 0.65 vs 0.28 mm/month (P < .05) at the diaphragm. The growth rate at dissection area was higher in those requiring operation (P < .05). Age and number of comorbidities were associated with overall mortality. Thrombosis of the false lumen did not affect the mortality and intervention rate. Conclusions: During the study period, the overall aortic growth rate was not linear, with a more prominent initial phase. A relevant number of patients ultimately required interventions. Prospectively designed studies are needed to identify the subgroup of patients who may benefit from early intervention based on growth rate measurements. Author Disclosures: M. Aboul Hosn: None; P. Goffredo: None; J. Zavala: None; T. Kresowik: None; R. Nicholson: None; L. Pascarella: None.
Clinical Diagnostic Criteria and Pretreatment Patient-Reported Outcomes Measures in a Prospective Cohort of Patients With Neurogenic Thoracic Outlet Syndrome Joshua A. Balderman, MD, Katherine Holzem, Ahmmad A. Abuirqeba, Beverly J. Field, PhD, Michael M. Bottros, MD, Lauren N. McLaughlin, RN, Chandu Vemuri, MD, Robert W. Thompson, MD. Vascular Surgery, Washington University, St. Louis, Mo Objective: The objective of this study was to assess relationships between clinical diagnostic criteria (CDC) and pretreatment patient-reported outcomes measures (PROMs) in a prospective 6-month cohort of patients with neurogenic thoracic outlet syndrome (NTOS). Methods: Between July 1, 2015, and December 31, 2015, our group saw 183 new patient referrals, with 150 (82.0%) meeting predefined CDC for NTOS. Seven PROMs were obtained across five domains: pain severity (McGill pain score, Brief Pain Inventory), pain catastrophizing (Pain Catastrophizing Scale), depression (Zung Self-Rating Depression Scale), functional disability (Quick Disabilities of the Arm, Shoulder, and Hand; Cervical Brachial Symptom Questionnaire), and quality of life (12-Item Short Form Health Survey physical and mental). Associations between individual CDC and PROMs were analyzed using Pearson correlation statistics. Results: Mean (6 standard error) age of patients was 37.1 6 1.1 years (range, 12-66), and 107 (71.3%) were women. Twelve (8.0%) had a cervical
Analysis of Aortic Growth Rates in Uncomplicated Type B Dissection Maen Aboul Hosn, MD, Paolo Goffredo, MD, Jeffrey Zavala, Timothy Kresowik, MD, Rachael Nicholson, MD, Luigi Pascarella, MD. University of Iowa Hospital and Clinics, Iowa City, Iowa Objective: Uncomplicated type B dissections have historically been treated medically with hemodynamic control. Early progression of the disease and late aneurysmal dilation have been considered indications for intervention. The aim of this study was to analyze growth rate patterns of type B dissections based on computed tomography (CT) measurements over time. Methods: We conducted a retrospective review of patients with acute type B dissection from 2008 to 2014 who had at least two follow-up CT scans. Patients with rapid progression requiring interventions were also included. Using M2S software (M2S, Lebanon, NH), we calculated the mean centerline diameter of the true and false lumens at three different sites of the descending aorta. Growth rate was calculated as the change in maximal diameter between the first, interval, and last available CT scans. Primary outcome was to compare the growth rate pattern between the two time intervals. Secondary outcomes included early and delayed aortic intervention and overall mortality.
Fig. PCS vs CDC, East, and QuickDASH. CDCs, Clinical diagnostic criteria; EAST, elevated arm stress test; PCS, Pain Catastrophizing Scale; QuickDASH, Quick Disabilities of the Arm, Shoulder, and Hand.