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IP233 Hybrid Approach for Aortoiliac TASC C and D Lesions
Journal of Vascular Surgery
Abstracts
117S
Volume 65, Number 6S Conclusions: Many factors that patients with symptomatic PAD consider important and terms that they use to communicate are absent from consensus treatment guidelines. Areas of mismatch between patientand clinician-defined decision approaches and terminology represent opportunities for development of more patient-centered approaches to care and communication. Author Disclosures: D. Boone: Nothing to disclose; G. Burke: Nothing to disclose; M. A. Corriere: Nothing to disclose; D. Easterling: Nothing to disclose; E. Ip: Nothing to disclose; D. Keith: Nothing to disclose.
IP229. Proposal of a Multicentric-Based Score for Graft Patency in Below-knee Femoropopliteal Bypass With Heparin-Bonded ePTFE Graft in Patients With Critical Limb Ischemia Walter Dorigo,1 Gabriele Piffaretti,2 Raffaele Pulli,3 Paolo Ottavi,4 Patrizio Castelli,2 Carlo Pratesi1. 1University of Florence, Florence, Italy; 2Insubria University, Varese, Italy; 3University of Bari, Bari, Italy; 4 Terni Hospital, Terni, Italy Objectives: This study retrospectively created a predictive score for primary patency (PP) in patients with critical limb ischemia (CLI) operated on with the use of a heparin-bonded expanded polytetrafluoroethylene (ePTFE) bypass graft (Hb-ePTFE) in a large multicenter registry. Methods: Over a 13-year period, ending in December 2014, a Hb-ePTFE graft was implanted in 683 patients undergoing below-knee revascularization for CLI in seven Italian vascular hospitals. Data concerning these interventions were retrospectively collected in a multicenter registry with a dedicated database. Follow-up results were analyzed in terms of PP: univariate and multivariable analyses with Kaplan-Meier estimates were used to identify potential significant predictors of such end point at 3 years, and then a predictive risk score was constructed by dividing the b-coefficient of each significant predictor at multivariable analysis by 0.25 and by rounding off to the nearest integer value. A qualitative assessment of the Kaplan-Meier survival estimates for each integer score was performed, and subgroups of risk were stratified on the basis of the primary end point. Comparison between subgroups was performed with log-rank test. Results: Median duration of follow-up was 34 months (range, 1-123; standard deviation, 27.8 months). Overall, estimated 3-year PP rate was 51.3% (standard error, 0.02). At multivariate analysis, female gender, reintervention following the failure of previous open or endovascular intervention, and the need for distal tibial anastomosis were predictors of poorer PP. The integer score ranged from 0 to 6. Kaplan-Meier analysis for PP in each score group identified four subgroups with significant differences at 3 years: score 0 (PP, 63%), score 2 (PP, 49%; P ¼ .003, log-rank 6.1, in comparison with score 0), score 4 (PP, 39%; P ¼ .05, log-rank 2.2, in comparison with score 2), and score 6 (PP, 25%; P ¼ . 01, log-rank 2.7 in comparison with score 4). Conclusions: A category of patients with CLI treated with the indexed graft with excellent patency rates does exist, thus suggesting a primary role for Hb-ePTFE in such patients. A prospective validation of such a score is necessary. Author Disclosures: P. Castelli: Nothing to disclose; W. Dorigo: Nothing to disclose; P. Ottavi: Nothing to disclose; G. Piffaretti: Nothing to disclose; C. Pratesi: Nothing to disclose; R. Pulli: Nothing to disclose.
IP231. Kidney Transplant Increases the Risk of Ipsilateral Critical Limb Ischemia Ziad Al Adas, Timothy Nypaver, Alex D. Shepard, Mitchell R. Weaver, Lauren Malinzak, Naushaba Khalid, Anita Patel, Loay Kabbani. Henry Ford Health System, Detroit, Mich Objectives: End-stage renal disease is a known risk factor for peripheral arterial disease (PAD). Hypertension, hyperlipidemia, and diabetes, which are highly prevalent in renal transplant candidates, are independent risk factors for atherosclerosis and PAD. Renal transplantation is an invasive arterial procedure that may have effects
on ipsilateral limb perfusion and/or progression of atherosclerotic disease. We hypothesized that the lower extremity ipsilateral to the side of the kidney transplant may be at increased risk for PAD complications. Methods: Our transplant database was retrospectively queried for all kidney transplant patients who underwent subsequent lower extremity revascularization or amputation procedures. Patients with concomitant pancreatic transplants or bilateral renal transplants were excluded. Patient demographics, comorbidities, and discharge medications were collected, and data analysis was conducted on SPSS 22.0 software (IBM Corp, Armonk, NY). Results: Between January 2004 and August 2016, 1214 patients received a renal transplant at our tertiary referral center. Of these, 25 patients (2%) had subsequent arterial revascularizations or amputations on either lower extremity. Average age was 55 years; 76% were male, 65% were African American, 92% had diabetes, 92% had hypertension, 44% had a history of coronary artery disease, and 72% were on aspirin or another antiplatelet agent. Eighteen patients had lower extremity vascular interventions (13 amputations and 5 revascularizations) ipsilateral to the transplanted kidney, and seven patients had contralateral vascular interventions (all amputations; P ¼ .043). The average interval between transplantation and subsequent vascular intervention was 27 months for the ipsilateral interventions and 39 months for the contralateral interventions (P ¼ .37). Conclusions: Kidney transplantation is associated with an increased risk of ipsilateral lower extremity PAD requiring surgical intervention. Further studies are necessary to determine whether this represents a “steal” phenomenon vs progression of atherosclerosis distal to the transplanted kidney. Renal transplant patients should be monitored closely for the development of ischemic symptoms in the lower extremity ipsilateral to the transplanted kidney. Author Disclosures: Z. Al Adas: Nothing to disclose; L. Kabbani: Nothing to disclose; N. Khalid: Nothing to disclose; L. Malinzak: Nothing to disclose; T. Nypaver: Nothing to disclose; A. Patel: Nothing to disclose; A. D. Shepard: Nothing to disclose; M. R. Weaver: Nothing to disclose.
IP233. Hybrid Approach for Aortoiliac TASC C and D Lesions Paola Wiesel, Noemi Ventrella, Michele Tedesco, Giovanni Mastrangelo, Domenico Angiletta, Raffaele Pulli. University of Bari, Bari, Italy Objectives: The recommended treatment of TASC (TransAtlantic InterSociety Consensus II) C and D iliac and femoral atherosclerotic disease is an open surgical approach, although in the last few years endovascular treatment is increasing. We hypothesized that a hybrid approach, combining iliac endovascular revascularization with common femoral artery endarterectomy, may improve long-term patency compared with angioplasty and stenting or with endarterectomy alone, reducing the morbidity rate. Methods: We reviewed our clinical series of patients who underwent an endovascular or hybrid treatment from June 2015 to October 2016 for occlusive aortoiliac disease. Patient demographics, comorbidities, operative details, and risk factors were analyzed. Early and midterm results (12 months) were recorded in terms of primary and secondary patency, amputation, and survival. All patients underwent a double-antiplatelet therapy or anticoagulation combined with one antiplatelet drug. Immediate data were analyzed using the c2 test, and the longterm results were analyzed using the Kaplan-Meyer curve and the logrank test. Results: During the index period, 37 patients with aortoiliac and femoral disease were treated: 25 (67.6%) underwent an endovascular treatment (group 1) and 12 (32.4%) a hybrid approach (group 2). TASC lesions were divided in 37% of C and 63% of D. In eight patients (20% endovascular and 25% hybrid) we performed a kissing stent of CIA, and nine patients (20% endovascular and 33.3% hybrid) also had a FSA percutaneous transluminal angioplasty. In only seven patients, all of them in the group 1, we performed a plane angioplasty, whereas in the remaining 30, we positioned 38 stents, 15 of them were covered stents and 23 were bare-metal stents. No intraoperative complications occurred. In group 1, three patients required an additional endovascular procedure for an early thrombosis,
118S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 and three patients had a major limb amputation. No major adverse events occurred in group 2. Thirty-day patency rate was 100% in the hybrid group and 88% in the endovascular group. During a follow-up of 12 months, primary patency rate was 66.7% (log-rank, 1.38; P ¼ not significant) in the endovascular group and 80% in the hybrid group. Conclusions: Hybrid-based iliac and femoral revascularization provides a minimally invasive approach to occlusive disease comparable with surgical bypasses and seems to have a better outcome when compared with endovascular treatment alone. Moreover, in group 1, the rate of additional intervention was lower and patency and limb salvage rates were higher in comparison with those achieved in group 2. Author Disclosures: D. Angiletta: Nothing to disclose; G. Mastrangelo: Nothing to disclose; R. Pulli: Nothing to disclose; M. Tedesco: Nothing to disclose; N. Ventrella: Nothing to disclose; P. Wiesel: Nothing to disclose.
IP235. Predicting Inadequate Amputation Stump Healing in High-Risk Patients Using Laser-Assisted Fluorescence Angiography
Table. Spearman correlation analysis between Wound, Ischemia, and foot Infection (WIfI) scores and stump perfusion Variable
r
Wound score
0.81
.05
Eschar score
0.87
.02
Infection score
0.64
.1
Conclusions: Major lower extremity amputation in “high-risk” patients is associated with increased perioperative complications. Use of intraoperative LAFA, and a modified WIfI scoring algorithm that incorporates realtime perfusion variables, can help with early identification of patients who are at increased risk of stump-related complications. However, in our study early identification of these complications may have yielded higher readmission rates. Author Disclosures: G. S. De Silva: Nothing to disclose; K. Saffaf: Nothing to disclose; L. Sanchez: Bolton, Cook, Endologix, W. L. Gore and Medtronic: consulting fees (eg, advisory boards); M. A. Zayed: Nothing to disclose.
Gayan S. De Silva, Khalid Saffaf, Luis Sanchez, Mohamed A. Zayed. Washington University School of Medicine, St. Louis, Mo
IP237.
Objectives: Patients with peripheral arterial disease undergoing major lower extremity amputation are at risk of inadequate postoperative stump healing leading to readmission and reoperation. We hypothesized that in addition to the American College of Surgeons National Safety Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, intraoperative noninvasive laser-assisted fluorescence angiography (LAFA), can help identify patients who are at higher risk of developing postoperative complications. Methods: Over an 8-month period, we evaluated patients who underwent a below- or above-knee lower extremity amputation. Estimated and actual ACS NSQIP 30-day risk of postoperative complications was evaluated for all patients over a 4-week follow-up period using a twoway analysis of variance. A modified Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) scoring algorithm was used to evaluate the relationship between stump LAFA perfusion and healing using a Spearman correlation analysis (Table). Results: Eleven patients were identified during the study period as having significantly higher than average ACS NSQIP risk of perioperative complications, including risk of serious complication (29.9% 6 4.72%; P < .001), any complication (35.3% 6 6.93%; P < .001) readmission (22.9% 6 2.86%; P < .001), death (14.6% 6 4.52%; P < .001), and discharge to nursing facility (92.7% 6 1.33%; P < .001; Fig). Our results demonstrated lower serious complication rates of 9% (1/11), and 18% for any complication (2/11) within 30 days. Readmission rates within 30 days following amputation and LAFA were 18% (2/11), with 91% (10/11) discharged to a nursing facility. Ultimately, only one patient (1/11) required some sort of reoperative intervention after LAFA. There were no deaths during the study period. Using LAFA, areas in amputation stumps with poor perfusion along the suture line were more likely to develop inadequate healing, especially with respect to the eschar formation (r ¼ 0.87; P ¼ .02) and wound score (granulation tissue character) (r ¼ 0.81; P ¼ .05). There was no significant correlation between poor perfusion and infection (r ¼ 0.64; P ¼ .1). Amputation stumps with higher WIfI scores were indicative of inadequate would healing.
Natural History and Management of Renal Artery Aneurysms in a Single Tertiary Referral Center
Fig.
P
Adam J. Brownstein,1 Young Erben,2 Sareh Rajaee,1 Yupeng Li,2 John Rizzo,2 Hamid Mojibian,1 Bulat Ziganshin,1 John Elefteriades1. 1Yale University School of Medicine, New Haven, Conn; 2Stony Brook University Medical Center, Stony Brook, NY Objectives: Although renal artery aneurysms (RAA) are uncommon, several large reports have been published indicating their benign natural history. The objective of our study was to review our own single-center experience managing this disease entity. Methods: A retrospective review of the Yale radiology database from January 1999 to December 2016 was performed. Only patients with RAA and a computed tomography (CT) scan of the abdomen were selected for review. Patient demographics, aneurysm characteristics, management, postoperative complications, and follow-up data were collected. Results: We identified 241 patients (147 females [61%]) with 259 RAAs. Mean age was 69 years (range, 35-100 years). RAA was as an incidental finding 236 patients (98%). On CT, aneurysms were solitary in 224 (86%) and right sided in 159 (61%), and 64 patients (27%) had aneurysms elsewhere. The breakdown of RAA by location was as follows: renal bifurcation in 84 (32%), renal pelvis in 77 (30%), distal renal artery in 58 (22%), midrenal artery in 34 (13%), and proximal renal artery in 6 (2%). Only five patients were symptomatic and underwent operative repair (OR); all others were monitored with CT without an operation (NOR). Symptoms included flank pain in four and uncontrolled hypertension in one. The mean overall diameter of the RAAs was 1.22 6 0.49 cm. The diameter of OR and NOR was 1.84 6 0.55 cm and 1.21 6 0.48 cm, respectively (P ¼ .002). OR included four coil embolizations and one open resection. There were no renal function changes in any of these patients after the operation and no other complications. Mean follow-up was 41 6 35 months for patients in the NOR group; 18 of these RAAs were >2 cm, and none ruptured. On multivariate regression analysis, female gender (P ¼ .0001), smoking history (P ¼ .00007), the presence of RAA calcification (P ¼ .05), left-sided RAA (P ¼ .03), and main renal artery location (P ¼ .03) were inversely related to growth, whereas a
Fig.
Abstracts
117S
Volume 65, Number 6S Conclusions: Many factors that patients with symptomatic PAD consider important and terms that they use to communicate are absent from consensus treatment guidelines. Areas of mismatch between patientand clinician-defined decision approaches and terminology represent opportunities for development of more patient-centered approaches to care and communication. Author Disclosures: D. Boone: Nothing to disclose; G. Burke: Nothing to disclose; M. A. Corriere: Nothing to disclose; D. Easterling: Nothing to disclose; E. Ip: Nothing to disclose; D. Keith: Nothing to disclose.
IP229. Proposal of a Multicentric-Based Score for Graft Patency in Below-knee Femoropopliteal Bypass With Heparin-Bonded ePTFE Graft in Patients With Critical Limb Ischemia Walter Dorigo,1 Gabriele Piffaretti,2 Raffaele Pulli,3 Paolo Ottavi,4 Patrizio Castelli,2 Carlo Pratesi1. 1University of Florence, Florence, Italy; 2Insubria University, Varese, Italy; 3University of Bari, Bari, Italy; 4 Terni Hospital, Terni, Italy Objectives: This study retrospectively created a predictive score for primary patency (PP) in patients with critical limb ischemia (CLI) operated on with the use of a heparin-bonded expanded polytetrafluoroethylene (ePTFE) bypass graft (Hb-ePTFE) in a large multicenter registry. Methods: Over a 13-year period, ending in December 2014, a Hb-ePTFE graft was implanted in 683 patients undergoing below-knee revascularization for CLI in seven Italian vascular hospitals. Data concerning these interventions were retrospectively collected in a multicenter registry with a dedicated database. Follow-up results were analyzed in terms of PP: univariate and multivariable analyses with Kaplan-Meier estimates were used to identify potential significant predictors of such end point at 3 years, and then a predictive risk score was constructed by dividing the b-coefficient of each significant predictor at multivariable analysis by 0.25 and by rounding off to the nearest integer value. A qualitative assessment of the Kaplan-Meier survival estimates for each integer score was performed, and subgroups of risk were stratified on the basis of the primary end point. Comparison between subgroups was performed with log-rank test. Results: Median duration of follow-up was 34 months (range, 1-123; standard deviation, 27.8 months). Overall, estimated 3-year PP rate was 51.3% (standard error, 0.02). At multivariate analysis, female gender, reintervention following the failure of previous open or endovascular intervention, and the need for distal tibial anastomosis were predictors of poorer PP. The integer score ranged from 0 to 6. Kaplan-Meier analysis for PP in each score group identified four subgroups with significant differences at 3 years: score 0 (PP, 63%), score 2 (PP, 49%; P ¼ .003, log-rank 6.1, in comparison with score 0), score 4 (PP, 39%; P ¼ .05, log-rank 2.2, in comparison with score 2), and score 6 (PP, 25%; P ¼ . 01, log-rank 2.7 in comparison with score 4). Conclusions: A category of patients with CLI treated with the indexed graft with excellent patency rates does exist, thus suggesting a primary role for Hb-ePTFE in such patients. A prospective validation of such a score is necessary. Author Disclosures: P. Castelli: Nothing to disclose; W. Dorigo: Nothing to disclose; P. Ottavi: Nothing to disclose; G. Piffaretti: Nothing to disclose; C. Pratesi: Nothing to disclose; R. Pulli: Nothing to disclose.
IP231. Kidney Transplant Increases the Risk of Ipsilateral Critical Limb Ischemia Ziad Al Adas, Timothy Nypaver, Alex D. Shepard, Mitchell R. Weaver, Lauren Malinzak, Naushaba Khalid, Anita Patel, Loay Kabbani. Henry Ford Health System, Detroit, Mich Objectives: End-stage renal disease is a known risk factor for peripheral arterial disease (PAD). Hypertension, hyperlipidemia, and diabetes, which are highly prevalent in renal transplant candidates, are independent risk factors for atherosclerosis and PAD. Renal transplantation is an invasive arterial procedure that may have effects
on ipsilateral limb perfusion and/or progression of atherosclerotic disease. We hypothesized that the lower extremity ipsilateral to the side of the kidney transplant may be at increased risk for PAD complications. Methods: Our transplant database was retrospectively queried for all kidney transplant patients who underwent subsequent lower extremity revascularization or amputation procedures. Patients with concomitant pancreatic transplants or bilateral renal transplants were excluded. Patient demographics, comorbidities, and discharge medications were collected, and data analysis was conducted on SPSS 22.0 software (IBM Corp, Armonk, NY). Results: Between January 2004 and August 2016, 1214 patients received a renal transplant at our tertiary referral center. Of these, 25 patients (2%) had subsequent arterial revascularizations or amputations on either lower extremity. Average age was 55 years; 76% were male, 65% were African American, 92% had diabetes, 92% had hypertension, 44% had a history of coronary artery disease, and 72% were on aspirin or another antiplatelet agent. Eighteen patients had lower extremity vascular interventions (13 amputations and 5 revascularizations) ipsilateral to the transplanted kidney, and seven patients had contralateral vascular interventions (all amputations; P ¼ .043). The average interval between transplantation and subsequent vascular intervention was 27 months for the ipsilateral interventions and 39 months for the contralateral interventions (P ¼ .37). Conclusions: Kidney transplantation is associated with an increased risk of ipsilateral lower extremity PAD requiring surgical intervention. Further studies are necessary to determine whether this represents a “steal” phenomenon vs progression of atherosclerosis distal to the transplanted kidney. Renal transplant patients should be monitored closely for the development of ischemic symptoms in the lower extremity ipsilateral to the transplanted kidney. Author Disclosures: Z. Al Adas: Nothing to disclose; L. Kabbani: Nothing to disclose; N. Khalid: Nothing to disclose; L. Malinzak: Nothing to disclose; T. Nypaver: Nothing to disclose; A. Patel: Nothing to disclose; A. D. Shepard: Nothing to disclose; M. R. Weaver: Nothing to disclose.
IP233. Hybrid Approach for Aortoiliac TASC C and D Lesions Paola Wiesel, Noemi Ventrella, Michele Tedesco, Giovanni Mastrangelo, Domenico Angiletta, Raffaele Pulli. University of Bari, Bari, Italy Objectives: The recommended treatment of TASC (TransAtlantic InterSociety Consensus II) C and D iliac and femoral atherosclerotic disease is an open surgical approach, although in the last few years endovascular treatment is increasing. We hypothesized that a hybrid approach, combining iliac endovascular revascularization with common femoral artery endarterectomy, may improve long-term patency compared with angioplasty and stenting or with endarterectomy alone, reducing the morbidity rate. Methods: We reviewed our clinical series of patients who underwent an endovascular or hybrid treatment from June 2015 to October 2016 for occlusive aortoiliac disease. Patient demographics, comorbidities, operative details, and risk factors were analyzed. Early and midterm results (12 months) were recorded in terms of primary and secondary patency, amputation, and survival. All patients underwent a double-antiplatelet therapy or anticoagulation combined with one antiplatelet drug. Immediate data were analyzed using the c2 test, and the longterm results were analyzed using the Kaplan-Meyer curve and the logrank test. Results: During the index period, 37 patients with aortoiliac and femoral disease were treated: 25 (67.6%) underwent an endovascular treatment (group 1) and 12 (32.4%) a hybrid approach (group 2). TASC lesions were divided in 37% of C and 63% of D. In eight patients (20% endovascular and 25% hybrid) we performed a kissing stent of CIA, and nine patients (20% endovascular and 33.3% hybrid) also had a FSA percutaneous transluminal angioplasty. In only seven patients, all of them in the group 1, we performed a plane angioplasty, whereas in the remaining 30, we positioned 38 stents, 15 of them were covered stents and 23 were bare-metal stents. No intraoperative complications occurred. In group 1, three patients required an additional endovascular procedure for an early thrombosis,
118S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 and three patients had a major limb amputation. No major adverse events occurred in group 2. Thirty-day patency rate was 100% in the hybrid group and 88% in the endovascular group. During a follow-up of 12 months, primary patency rate was 66.7% (log-rank, 1.38; P ¼ not significant) in the endovascular group and 80% in the hybrid group. Conclusions: Hybrid-based iliac and femoral revascularization provides a minimally invasive approach to occlusive disease comparable with surgical bypasses and seems to have a better outcome when compared with endovascular treatment alone. Moreover, in group 1, the rate of additional intervention was lower and patency and limb salvage rates were higher in comparison with those achieved in group 2. Author Disclosures: D. Angiletta: Nothing to disclose; G. Mastrangelo: Nothing to disclose; R. Pulli: Nothing to disclose; M. Tedesco: Nothing to disclose; N. Ventrella: Nothing to disclose; P. Wiesel: Nothing to disclose.
IP235. Predicting Inadequate Amputation Stump Healing in High-Risk Patients Using Laser-Assisted Fluorescence Angiography
Table. Spearman correlation analysis between Wound, Ischemia, and foot Infection (WIfI) scores and stump perfusion Variable
r
Wound score
0.81
.05
Eschar score
0.87
.02
Infection score
0.64
.1
Conclusions: Major lower extremity amputation in “high-risk” patients is associated with increased perioperative complications. Use of intraoperative LAFA, and a modified WIfI scoring algorithm that incorporates realtime perfusion variables, can help with early identification of patients who are at increased risk of stump-related complications. However, in our study early identification of these complications may have yielded higher readmission rates. Author Disclosures: G. S. De Silva: Nothing to disclose; K. Saffaf: Nothing to disclose; L. Sanchez: Bolton, Cook, Endologix, W. L. Gore and Medtronic: consulting fees (eg, advisory boards); M. A. Zayed: Nothing to disclose.
Gayan S. De Silva, Khalid Saffaf, Luis Sanchez, Mohamed A. Zayed. Washington University School of Medicine, St. Louis, Mo
IP237.
Objectives: Patients with peripheral arterial disease undergoing major lower extremity amputation are at risk of inadequate postoperative stump healing leading to readmission and reoperation. We hypothesized that in addition to the American College of Surgeons National Safety Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, intraoperative noninvasive laser-assisted fluorescence angiography (LAFA), can help identify patients who are at higher risk of developing postoperative complications. Methods: Over an 8-month period, we evaluated patients who underwent a below- or above-knee lower extremity amputation. Estimated and actual ACS NSQIP 30-day risk of postoperative complications was evaluated for all patients over a 4-week follow-up period using a twoway analysis of variance. A modified Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) scoring algorithm was used to evaluate the relationship between stump LAFA perfusion and healing using a Spearman correlation analysis (Table). Results: Eleven patients were identified during the study period as having significantly higher than average ACS NSQIP risk of perioperative complications, including risk of serious complication (29.9% 6 4.72%; P < .001), any complication (35.3% 6 6.93%; P < .001) readmission (22.9% 6 2.86%; P < .001), death (14.6% 6 4.52%; P < .001), and discharge to nursing facility (92.7% 6 1.33%; P < .001; Fig). Our results demonstrated lower serious complication rates of 9% (1/11), and 18% for any complication (2/11) within 30 days. Readmission rates within 30 days following amputation and LAFA were 18% (2/11), with 91% (10/11) discharged to a nursing facility. Ultimately, only one patient (1/11) required some sort of reoperative intervention after LAFA. There were no deaths during the study period. Using LAFA, areas in amputation stumps with poor perfusion along the suture line were more likely to develop inadequate healing, especially with respect to the eschar formation (r ¼ 0.87; P ¼ .02) and wound score (granulation tissue character) (r ¼ 0.81; P ¼ .05). There was no significant correlation between poor perfusion and infection (r ¼ 0.64; P ¼ .1). Amputation stumps with higher WIfI scores were indicative of inadequate would healing.
Natural History and Management of Renal Artery Aneurysms in a Single Tertiary Referral Center
Fig.
P
Adam J. Brownstein,1 Young Erben,2 Sareh Rajaee,1 Yupeng Li,2 John Rizzo,2 Hamid Mojibian,1 Bulat Ziganshin,1 John Elefteriades1. 1Yale University School of Medicine, New Haven, Conn; 2Stony Brook University Medical Center, Stony Brook, NY Objectives: Although renal artery aneurysms (RAA) are uncommon, several large reports have been published indicating their benign natural history. The objective of our study was to review our own single-center experience managing this disease entity. Methods: A retrospective review of the Yale radiology database from January 1999 to December 2016 was performed. Only patients with RAA and a computed tomography (CT) scan of the abdomen were selected for review. Patient demographics, aneurysm characteristics, management, postoperative complications, and follow-up data were collected. Results: We identified 241 patients (147 females [61%]) with 259 RAAs. Mean age was 69 years (range, 35-100 years). RAA was as an incidental finding 236 patients (98%). On CT, aneurysms were solitary in 224 (86%) and right sided in 159 (61%), and 64 patients (27%) had aneurysms elsewhere. The breakdown of RAA by location was as follows: renal bifurcation in 84 (32%), renal pelvis in 77 (30%), distal renal artery in 58 (22%), midrenal artery in 34 (13%), and proximal renal artery in 6 (2%). Only five patients were symptomatic and underwent operative repair (OR); all others were monitored with CT without an operation (NOR). Symptoms included flank pain in four and uncontrolled hypertension in one. The mean overall diameter of the RAAs was 1.22 6 0.49 cm. The diameter of OR and NOR was 1.84 6 0.55 cm and 1.21 6 0.48 cm, respectively (P ¼ .002). OR included four coil embolizations and one open resection. There were no renal function changes in any of these patients after the operation and no other complications. Mean follow-up was 41 6 35 months for patients in the NOR group; 18 of these RAAs were >2 cm, and none ruptured. On multivariate regression analysis, female gender (P ¼ .0001), smoking history (P ¼ .00007), the presence of RAA calcification (P ¼ .05), left-sided RAA (P ¼ .03), and main renal artery location (P ¼ .03) were inversely related to growth, whereas a
Fig.