- Email: [email protected]
1-Year Experience With Acute Aortic Dissection
Abstracts Accepted for Presentation during the Florida Vascular Society’s, 29th Annual Scientific Sessions Meeting April 28-May 1, 2016, Four Season’s Disney Resort-Orlando, Florida Bypass To The Ankle And Foot Paul Citrin Florida Medical Clinic, Zephyrhills, FL.
Introduction and Objectives: The objective of this study is to review the technique and results of bypass surgery to the ankle and foot. I will present some cases from this group of patients to illustrate my techniques for surgical intervention for limb salvage. Methods: 36 bypasses were performed to the ankle, posterior tibial artery (PTA) 17, and foot, dorsal pedal artery (DPA) 19, for limb salvage, in the 6-year period from 1/1/10 to 12/31/15, by a single surgeon. 35 patients had pre-operative toe pressures of 0-38 mmHg. Postoperative toe pressures at one month were 46-169 mm Hg in patients with patent bypasses. 1 patient presented with a transmetatarsal amputation stump that healed after DPA bypass and couldn’t have toe pressures recorded. Vein conduits included reversed saphenous (RSV)-13, nonreversed saphenous (NRSV)-16, composite saphenous/saphenous (CSS)-2, composite basilic/ saphenous (CBS)-2, reversed cephalic (RC)-2 and reversed basilic (RB)-1. Results: There were 6 graft occlusions from 1 day to 14 months. 1 occlusion resulted in a BKA and the other was replaced with a new PTA bypass to heal a wound following a great toe amputation. 1 patient with a patent bypass required BKA due to diabetic foot infection. There were 7 patients with ESRF. Other comorbidities included diabetes, cardiac, pulmonary and metabolic problems in this high risk group. No patient died in the first 30 days after surgery but there were 7 deaths from 6 months to 3 years postoperatively. Some incisional wound issues required antibiotics, debridements and wound care. No wound issue caused graft failure. Conclusion: Bypass to the ankle and foot can provide blood flow to the foot to attain limb salvage. In this era of
2
endovascular interventions for revascularization there are still patients that will benefit from open surgery. http://dx.doi.org/10.1016/j.avsg.2016.10.010
1-Year Experience With Acute Aortic Dissection Sean D. O’Donnell Memorial Regional Hospital, Hollywood, Florida. Introduction and Objectives: Acute aortic dissection is the most frequent aortic emergency. The management can be challenging for the treatment team and the institution. The management of aortic dissection has been evolving with newly available technologies. We reviewed our experience with Type A and B dissections to evaluate our treatment guidelines and explore opportunities for improvement. Methods: STS and VQI databases were reviewed in addition to our EMR records for patients with primary diagnosis of aortic dissection. Records were reviewed for demographics, mortality, morbidity, treatment and complications. Results: 52 admissions for aortic dissection were identified. Thirty-one patients had acute aortic dissections. The average age was 55.6 with 18 females and 13 males. There were 21 type A dissections and 10 type B. Mortality for the Type A dissections was 14.3% and 30% for the Type B. The mortality in type B dissections included 66.7% for surgically treated patients, 16.7% for medically treated and 0% for endovascular treatment. There were complications in 61.35 % of all patients. This included 6% with stroke and 6% with paraplegia. There were no lower extremity lower extremity or visceral ischemic events in either the Type A or B dissections. Conclusions: Acute aortic dissection is a challenging condition that results in significant morbidity and mortality. Mortality for type B dissections is higher in surgically treated
Volume 38, January 2017
Abstracts accepted for presentation during the Florida Vascular Society’s, 29th Annual Scientific Sessions Meeting 3
patients than for medical or endovascular treatment. Treatment protocols and guidelines may improve management.
Type A
Treatments
Complications (%)
Ascending/arch repair Ascending repair only Repair with valve Hybrid Medical
9 8 2 1 1
Medical Surgical Endovascular
6 3 1
Type B
Overall
61.3
Pulmonary Renal Cardiac Stroke Paraplegia Wound
22 19 9 6 6 6
Overall
19.4
Mortality (%)
Type A Type B
14.3 30.0 Surgery 66.7
All Type I Medical 16.7
Endo 0
http://dx.doi.org/10.1016/j.avsg.2016.10.011
Fast-Track Endovascular Aneurysm Repair: Rationale and Design of The Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry Hiranya A. Rajasinghe The Vascular Group of Naples, Naples, FL. Introduction and Objectives: Considerable technological advancements have recently been made with endovascular stent grafts for the treatment of abdominal aortic aneurysm (AAA). However, there is opportunity to further improve the efficiency of endovascular aneurysm repair (EVAR), which may yield better patient outcomes and lower perioperative treatment costs. Methods: The Least Invasive Fast-Track EVAR (LIFE) registry was developed to determine the clinical utility and cost effectiveness of the Ovation Prime stent graft when used under least invasive conditions using a defined fasttrack protocol. The LIFE study is a prospective multicenter post-market registry of the ultra-low profile (14F) Ovation Prime stent graft when used in the treatment of patients
with AAA using a fast-track protocol, consisting of appropriate patient selection, bilateral percutaneous access, avoidance of general anesthesia and intensive care unit admission, and next-day discharge. A total of 250 subjects will be enrolled at up to 40 sites in the United States. The first subject in this study was enrolled in October 2014 and enrollment is anticipated to continue through mid-2016. Results: The primary endpoint of the LIFE registry is the incidence of major adverse events (MAE) through 30 days follow-up. All adverse events are adjudicated by a Clinical Events Committee. Secondary endpoints of the LIFE registry include operative details, technical success, procedure- and device-related complications, patient convalescence, and ability to successfully complete all components of the fast-track protocol. Patients will be followed in the LIFE registry for 30 days post-treatment. Conclusions: The recent development of ultra low-profile stent grafts enables EVAR using least invasive methods. A structured fast-track EVAR protocol may yield clinical and cost benefits versus standard EVAR. http://dx.doi.org/10.1016/j.avsg.2016.10.012
Novel Technique for Renal Protection during Thoracoabdominal Aneurysm Repair Libby Watch, Howard Katzman, Abilio Coello, Athanassios Tsoukas, Michele Taubman, and Ignacio Rua Miami Vascular Specialists, Miami, Florida. We describe a novel technique for renal protection during open repair of a Type IV thoracoabdominal aortic aneurysm. Previously described techniques for renal protection include cold perfusion, octopus catheters with left heart bypass and temporary axillo-femoral bypass combined with cardiopulmonary bypass. Our technique provides continuous antegrade perfusion to the kidneys and SMA without use of cardiopulmonary bypass. In some instances, this can be performed without using the axillary artery for inflow to the SMA, kidneys and lower extremities. http://dx.doi.org/10.1016/j.avsg.2016.10.013
Inclusion of Pulmonary Embolism Response in a Level I Vascular Emergency Program: A Good Fit in a Collaborative, Multidisciplinary System
Introduction and Objectives: The objective of this study is to review the technique and results of bypass surgery to the ankle and foot. I will present some cases from this group of patients to illustrate my techniques for surgical intervention for limb salvage. Methods: 36 bypasses were performed to the ankle, posterior tibial artery (PTA) 17, and foot, dorsal pedal artery (DPA) 19, for limb salvage, in the 6-year period from 1/1/10 to 12/31/15, by a single surgeon. 35 patients had pre-operative toe pressures of 0-38 mmHg. Postoperative toe pressures at one month were 46-169 mm Hg in patients with patent bypasses. 1 patient presented with a transmetatarsal amputation stump that healed after DPA bypass and couldn’t have toe pressures recorded. Vein conduits included reversed saphenous (RSV)-13, nonreversed saphenous (NRSV)-16, composite saphenous/saphenous (CSS)-2, composite basilic/ saphenous (CBS)-2, reversed cephalic (RC)-2 and reversed basilic (RB)-1. Results: There were 6 graft occlusions from 1 day to 14 months. 1 occlusion resulted in a BKA and the other was replaced with a new PTA bypass to heal a wound following a great toe amputation. 1 patient with a patent bypass required BKA due to diabetic foot infection. There were 7 patients with ESRF. Other comorbidities included diabetes, cardiac, pulmonary and metabolic problems in this high risk group. No patient died in the first 30 days after surgery but there were 7 deaths from 6 months to 3 years postoperatively. Some incisional wound issues required antibiotics, debridements and wound care. No wound issue caused graft failure. Conclusion: Bypass to the ankle and foot can provide blood flow to the foot to attain limb salvage. In this era of
2
endovascular interventions for revascularization there are still patients that will benefit from open surgery. http://dx.doi.org/10.1016/j.avsg.2016.10.010
1-Year Experience With Acute Aortic Dissection Sean D. O’Donnell Memorial Regional Hospital, Hollywood, Florida. Introduction and Objectives: Acute aortic dissection is the most frequent aortic emergency. The management can be challenging for the treatment team and the institution. The management of aortic dissection has been evolving with newly available technologies. We reviewed our experience with Type A and B dissections to evaluate our treatment guidelines and explore opportunities for improvement. Methods: STS and VQI databases were reviewed in addition to our EMR records for patients with primary diagnosis of aortic dissection. Records were reviewed for demographics, mortality, morbidity, treatment and complications. Results: 52 admissions for aortic dissection were identified. Thirty-one patients had acute aortic dissections. The average age was 55.6 with 18 females and 13 males. There were 21 type A dissections and 10 type B. Mortality for the Type A dissections was 14.3% and 30% for the Type B. The mortality in type B dissections included 66.7% for surgically treated patients, 16.7% for medically treated and 0% for endovascular treatment. There were complications in 61.35 % of all patients. This included 6% with stroke and 6% with paraplegia. There were no lower extremity lower extremity or visceral ischemic events in either the Type A or B dissections. Conclusions: Acute aortic dissection is a challenging condition that results in significant morbidity and mortality. Mortality for type B dissections is higher in surgically treated
Volume 38, January 2017
Abstracts accepted for presentation during the Florida Vascular Society’s, 29th Annual Scientific Sessions Meeting 3
patients than for medical or endovascular treatment. Treatment protocols and guidelines may improve management.
Type A
Treatments
Complications (%)
Ascending/arch repair Ascending repair only Repair with valve Hybrid Medical
9 8 2 1 1
Medical Surgical Endovascular
6 3 1
Type B
Overall
61.3
Pulmonary Renal Cardiac Stroke Paraplegia Wound
22 19 9 6 6 6
Overall
19.4
Mortality (%)
Type A Type B
14.3 30.0 Surgery 66.7
All Type I Medical 16.7
Endo 0
http://dx.doi.org/10.1016/j.avsg.2016.10.011
Fast-Track Endovascular Aneurysm Repair: Rationale and Design of The Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry Hiranya A. Rajasinghe The Vascular Group of Naples, Naples, FL. Introduction and Objectives: Considerable technological advancements have recently been made with endovascular stent grafts for the treatment of abdominal aortic aneurysm (AAA). However, there is opportunity to further improve the efficiency of endovascular aneurysm repair (EVAR), which may yield better patient outcomes and lower perioperative treatment costs. Methods: The Least Invasive Fast-Track EVAR (LIFE) registry was developed to determine the clinical utility and cost effectiveness of the Ovation Prime stent graft when used under least invasive conditions using a defined fasttrack protocol. The LIFE study is a prospective multicenter post-market registry of the ultra-low profile (14F) Ovation Prime stent graft when used in the treatment of patients
with AAA using a fast-track protocol, consisting of appropriate patient selection, bilateral percutaneous access, avoidance of general anesthesia and intensive care unit admission, and next-day discharge. A total of 250 subjects will be enrolled at up to 40 sites in the United States. The first subject in this study was enrolled in October 2014 and enrollment is anticipated to continue through mid-2016. Results: The primary endpoint of the LIFE registry is the incidence of major adverse events (MAE) through 30 days follow-up. All adverse events are adjudicated by a Clinical Events Committee. Secondary endpoints of the LIFE registry include operative details, technical success, procedure- and device-related complications, patient convalescence, and ability to successfully complete all components of the fast-track protocol. Patients will be followed in the LIFE registry for 30 days post-treatment. Conclusions: The recent development of ultra low-profile stent grafts enables EVAR using least invasive methods. A structured fast-track EVAR protocol may yield clinical and cost benefits versus standard EVAR. http://dx.doi.org/10.1016/j.avsg.2016.10.012
Novel Technique for Renal Protection during Thoracoabdominal Aneurysm Repair Libby Watch, Howard Katzman, Abilio Coello, Athanassios Tsoukas, Michele Taubman, and Ignacio Rua Miami Vascular Specialists, Miami, Florida. We describe a novel technique for renal protection during open repair of a Type IV thoracoabdominal aortic aneurysm. Previously described techniques for renal protection include cold perfusion, octopus catheters with left heart bypass and temporary axillo-femoral bypass combined with cardiopulmonary bypass. Our technique provides continuous antegrade perfusion to the kidneys and SMA without use of cardiopulmonary bypass. In some instances, this can be performed without using the axillary artery for inflow to the SMA, kidneys and lower extremities. http://dx.doi.org/10.1016/j.avsg.2016.10.013
Inclusion of Pulmonary Embolism Response in a Level I Vascular Emergency Program: A Good Fit in a Collaborative, Multidisciplinary System