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PC146. A National VQI Database Comparison of Hybrid and Open Repair for Aortoiliac-Femoral Occlusive Disease
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S
Author Disclosures: M. Archie: Nothing to disclose; M. Archie: Nothing to disclose; D. Chen: Nothing to disclose; P. F. Lawrence: Nothing to disclose; D. Lu: Nothing to disclose; L. McCoy: Nothing to disclose; T. Niu: Nothing to disclose.
Abstracts 197S
Table. Improvement in ambulatory status at long-term follow-up visit Status
Preoperative ambulation
Follow-up ambulation
Improved
Ambulatory
Ambulatory, ABI improved $0.15 Ambulatory
PC146. PC146 A National VQI Database Comparison of Hybrid and Open Repair for AortoiliacFemoral Occlusive Disease Marco Zavatta, MD1, Matthew W. Mell, MD, MS2. 1 University of Padua, Stanford, Calif; 2Stanford University School of Medicine, Stanford, Calif Objectives: This study analyzed the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair (endovascular treatment and open common femoral endarterectomy, ER-CFE) with open aortoiliac reconstruction and CFE (ORCFE). Methods: Using the National SVS-VQI database from 2006 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with aneurysmal disease or those with concomitant infrainguinal procedures were excluded. Main outcome variables were 30-day mortality, length of stay (LOS), primary 1-year mortality and patency, improvement in ankle-brachial index (ABI), need for secondary interventions, major amputations, and change in ambulatory status. Results: The cohort comprised 1324 patients receiving OR-CFE and 2524 receiving ER-CFE. Patients with ER-CFE were older (68 6 0.2 vs 63 6 0.3), and were more likely to have diabetes (36% vs 29%; P < .001) and heart failure (14% vs 9%; P < .001). Those receiving OR-CFE were more likely to have received a previous inflow procedure (25% vs 20%; P < .001). A greater number of arterial segments were treated for patients undergoing OR-CFE (5.2 6 1.6 vs 2.9 6 01.0; P < .001). ER-CFE was associated with lower 30-day mortality (2.3% vs 3.9%; P ¼ .004) and shorter LOS (median 3 vs 7 days; P < .001). Follow-up was available for 44.1% of the cohort (44.3% OR-CFE vs 44.0% ER-CFE; P ¼ NS). Those receiving ER-CFE had higher 1-year mortality (10.6% vs 6.2%; P ¼ .003), fewer reinterventions (7.2% vs 10.3%; P ¼ .31), and equivalent major amputation rate (3.3%). Patients with OR-CFE had greater improvement in follow-up ABI (0.40 6 0.4 vs 0.26 6 0.4; P < .001) and were more likely to achieve improved ambulatory status (82.0% vs 67.64%; P < .001; Table). Moreover, at follow-up, 18% of OR-CFE patients failed to improve ambulatory status compared to 33% of ER- CFE patients. Conclusions: For patients with aortoiliac-femoral occlusive disease, ER-CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, OR-CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk.
Ambulatory w/ assistance Wheelchair Ambulatory w/assistance Wheelchair Ambulatory Bedridden Wheelchair Bedridden Ambulatory w/assistance Bedridden Ambulatory Not improved
OR-CFE, % ER-CFE, % 72.33
56.40
7.71
9.21
0.40
0.45
1.38 0 0.20
1.01 0.22 0
0 17.98
0 32.71
ABI, Ankle-brachial index; ER-CFE, endovascular repair and common femoral endarterectomy; OR-CFE, open repair and common femoral endarterectomy.
Author Disclosures: M. W. Mell: Nothing to disclose; M. Zavatta: Nothing to disclose. PC148 PC148. Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice Jesse A. Columbo, MD, Brian W. Nolan, MD, MS, Ryland S. Stucke, MD, Eva M. Rzucidlo, MD, Karen L. Walker, MD, MS, Richard J. Powell, MD, Bjoern D. Suckow, MD, MS, David H. Stone, MD. DartmouthHitchcock Medical Center, Lebanon, NH Objectives: The perceived functional benefit of below-knee amputation (BKA) must be carefully weighed against the need for potential reinterventions among marginal candidates. Furthermore, the traditional bias towards preservation of the knee joint in the setting of an unknown ambulation probability may paradoxically expose patients to surgical reinterventions. This study sought to examine the contemporary functional outcomes of patients undergoing BKA in the endovascular era, and correlate results with preoperative transcutaneous oximetry (TcPO2) values. Methods: All patients who underwent BKA from January 2008 to December 2014 at Dartmouth-Hitchcock Medical Center were retrospectively reviewed. Patients who underwent amputation for trauma and venous disease were excluded. Demographics, comorbidities, ambulation status and TcPO2 values were recorded. Study end points included freedom from conversion to above-knee amputation (AKA), freedom from conversion to AKA or death, BKA healing, and ambulation. Statistical modeling was performed to determine associations with BKA failure. Results: Over the study interval, 130 limbs underwent BKA in 120 patients (68% male). Mean age was 65 years, 67% were diabetic, and 66% had a history of smoking. TcPO2 studies were obtained in 65% (n ¼ 85) of cases before amputation. A total of 38% (n ¼ 46) of all BKA patients went on to heal and ultimately ambulate. A total of 25% (n ¼ 33) of the BKA cohort required reintervention, 24 with conversion to AKA, and 9 with BKA revision. One-year freedom from conversion to AKA was 76% and
Author Disclosures: M. Archie: Nothing to disclose; M. Archie: Nothing to disclose; D. Chen: Nothing to disclose; P. F. Lawrence: Nothing to disclose; D. Lu: Nothing to disclose; L. McCoy: Nothing to disclose; T. Niu: Nothing to disclose.
Abstracts 197S
Table. Improvement in ambulatory status at long-term follow-up visit Status
Preoperative ambulation
Follow-up ambulation
Improved
Ambulatory
Ambulatory, ABI improved $0.15 Ambulatory
PC146. PC146 A National VQI Database Comparison of Hybrid and Open Repair for AortoiliacFemoral Occlusive Disease Marco Zavatta, MD1, Matthew W. Mell, MD, MS2. 1 University of Padua, Stanford, Calif; 2Stanford University School of Medicine, Stanford, Calif Objectives: This study analyzed the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair (endovascular treatment and open common femoral endarterectomy, ER-CFE) with open aortoiliac reconstruction and CFE (ORCFE). Methods: Using the National SVS-VQI database from 2006 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with aneurysmal disease or those with concomitant infrainguinal procedures were excluded. Main outcome variables were 30-day mortality, length of stay (LOS), primary 1-year mortality and patency, improvement in ankle-brachial index (ABI), need for secondary interventions, major amputations, and change in ambulatory status. Results: The cohort comprised 1324 patients receiving OR-CFE and 2524 receiving ER-CFE. Patients with ER-CFE were older (68 6 0.2 vs 63 6 0.3), and were more likely to have diabetes (36% vs 29%; P < .001) and heart failure (14% vs 9%; P < .001). Those receiving OR-CFE were more likely to have received a previous inflow procedure (25% vs 20%; P < .001). A greater number of arterial segments were treated for patients undergoing OR-CFE (5.2 6 1.6 vs 2.9 6 01.0; P < .001). ER-CFE was associated with lower 30-day mortality (2.3% vs 3.9%; P ¼ .004) and shorter LOS (median 3 vs 7 days; P < .001). Follow-up was available for 44.1% of the cohort (44.3% OR-CFE vs 44.0% ER-CFE; P ¼ NS). Those receiving ER-CFE had higher 1-year mortality (10.6% vs 6.2%; P ¼ .003), fewer reinterventions (7.2% vs 10.3%; P ¼ .31), and equivalent major amputation rate (3.3%). Patients with OR-CFE had greater improvement in follow-up ABI (0.40 6 0.4 vs 0.26 6 0.4; P < .001) and were more likely to achieve improved ambulatory status (82.0% vs 67.64%; P < .001; Table). Moreover, at follow-up, 18% of OR-CFE patients failed to improve ambulatory status compared to 33% of ER- CFE patients. Conclusions: For patients with aortoiliac-femoral occlusive disease, ER-CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, OR-CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk.
Ambulatory w/ assistance Wheelchair Ambulatory w/assistance Wheelchair Ambulatory Bedridden Wheelchair Bedridden Ambulatory w/assistance Bedridden Ambulatory Not improved
OR-CFE, % ER-CFE, % 72.33
56.40
7.71
9.21
0.40
0.45
1.38 0 0.20
1.01 0.22 0
0 17.98
0 32.71
ABI, Ankle-brachial index; ER-CFE, endovascular repair and common femoral endarterectomy; OR-CFE, open repair and common femoral endarterectomy.
Author Disclosures: M. W. Mell: Nothing to disclose; M. Zavatta: Nothing to disclose. PC148 PC148. Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice Jesse A. Columbo, MD, Brian W. Nolan, MD, MS, Ryland S. Stucke, MD, Eva M. Rzucidlo, MD, Karen L. Walker, MD, MS, Richard J. Powell, MD, Bjoern D. Suckow, MD, MS, David H. Stone, MD. DartmouthHitchcock Medical Center, Lebanon, NH Objectives: The perceived functional benefit of below-knee amputation (BKA) must be carefully weighed against the need for potential reinterventions among marginal candidates. Furthermore, the traditional bias towards preservation of the knee joint in the setting of an unknown ambulation probability may paradoxically expose patients to surgical reinterventions. This study sought to examine the contemporary functional outcomes of patients undergoing BKA in the endovascular era, and correlate results with preoperative transcutaneous oximetry (TcPO2) values. Methods: All patients who underwent BKA from January 2008 to December 2014 at Dartmouth-Hitchcock Medical Center were retrospectively reviewed. Patients who underwent amputation for trauma and venous disease were excluded. Demographics, comorbidities, ambulation status and TcPO2 values were recorded. Study end points included freedom from conversion to above-knee amputation (AKA), freedom from conversion to AKA or death, BKA healing, and ambulation. Statistical modeling was performed to determine associations with BKA failure. Results: Over the study interval, 130 limbs underwent BKA in 120 patients (68% male). Mean age was 65 years, 67% were diabetic, and 66% had a history of smoking. TcPO2 studies were obtained in 65% (n ¼ 85) of cases before amputation. A total of 38% (n ¼ 46) of all BKA patients went on to heal and ultimately ambulate. A total of 25% (n ¼ 33) of the BKA cohort required reintervention, 24 with conversion to AKA, and 9 with BKA revision. One-year freedom from conversion to AKA was 76% and