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Natural History of Aneurysmal Aortic Arch Branch Vessels in a Single Tertiary Referral Center
e18
Journal of Vascular Surgery
Abstracts
August 2017 with a long-term protective effect against MI and stroke. High-intensity statin use compared with standard use did not show an effect on stroke or MI at 30 and 90 days after CEA.
Table I. Demographics and perioperative outcomes
Author Disclosures: N. Arinze: None; T. Sachs: None; G. Patts: None; J. Kalish: None; A. Kuhnen: None; G. Kasotakis: None; J. Siracuse: None; A. Farber: None
Demographics and comorbidities
HYB (n ¼ 509)
BPV (n ¼ 445)
BYG (n ¼ 526)
P value
64.4 (328)
64.7 (288)
60.1 (316)
.229
.016
Gender Male Age groups
NESVS24. Natural History of Aneurysmal Aortic Arch Branch Vessels in a Single Tertiary Referral Center Adam J. Brownstein,1 Young Erben,1 Sareh Rajaee,1 Yupeng Li,2 John A. Rizzo,2 Vikram Lyall,1 Hamid Mojibian,1 Bulat Ziganshin,1 John Elefteriades1. 1Yale University, New Haven, CT; 2Population and Preventive Medicine, Stony Brook, NY Objective: Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AARBVs). The objectives of this study were to assess the natural history of AARBVs and the AARBV’s risk of rupture and to examine the outcomes of operative intervention. Methods: A retrospective review of the Yale radiologic database from 1999 to 2016 was performed. Only those patients with AARBV and a computed tomography scan were selected for review. Patient demographics, aneurysm characteristics, management, and follow-up information were collected. Results: There were 111 patients with 153 AARBVs identified; 79 were male (71%), with mean age of 70 years (range, 17-93 years). There were 65 brachiocephalic, 51 left subclavian, 33 right subclavian, and 4 common carotid artery aneurysms. On computed tomography, 68 (61%) had aortic aneurysms, 32 (29%) bovine arch, and 8 (7%) aortic dissections. Most were asymptomatic (105 [95%]); four had arm pain and one had chest pain, shortness of breath, and dysphagia, respectively. One patient presented with a ruptured brachiocephalic pseudoaneurysm (size, 6.5 cm). Nineteen (17%) patients underwent operative repair (OR); 92 (83%) were followed up with cross-sectional imaging (NOR). The overall mean vessel diameter was 2.22 6 0.96 cm. The diameter of OR and NOR was 3.94 6 1.61 cm and 1.97 6 0.46 cm, respectively (P < .00001). OR included 13 bypasses, 5 stent grafts, and 1 resection without reconstruction. Two patients developed postoperative hemorrhage requiring re-exploration. One patient required pseudoaneurysm repair 20 years after index operation. Mean follow-up was 52 6 51 months for NOR without any ruptures. Four patients underwent elective repair of AARBV because of either growth or other aortic operation. The growth rate was 0.04 6 0.10 cm/y. On multivariable regression analysis, age (P ¼ .011), the presence of ascending (P ¼ .011) or descending aortic aneurysms (P ¼.005), and a left subclavian artery aneurysm (P ¼ .038) were associated with higher growth rates, whereas height was associated with a lower growth rate (P ¼ .0005). Conclusions: Few patients with AARBVs require an operation. Operative intervention is safe and has a low index of complications. In the presence of other aortic abnormalities, open repair would be favored. When feasible, an endovascular option can be pursued. Given that we observed no true AARBV rupture, patients can be observed safely with imaging, accepting a growth rate of 0.04 6 0.10 cm/y. Author Disclosures: A. J. Brownstein: None; Y. Erben: None; S. Rajaee: None; Y. Li: None; J. A. Rizzo: None; V. Lyall: None; H. Mojibian: None; B. Ziganshin: None; J. Elefteriades: None
NESVS25. Hybrid Procedures Improve Perioperative Outcomes of Femoropopliteal Revascularization Compared with Bypass Saman Doroodgar Jorshery, Laura Skrip, Timur P. Sarac, Cassius Iyad Ochoa Chaar. Yale University School of Medicine, New Haven, CT Objective: Hybrid procedures have gained momentum as less invasive surgeries that can potentially improve patient outcomes. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compared the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization.
<70 years
47.5 (242)
55.3 (246)
55.5 (292)
$70 years
52.5 (267)
44.7 (199)
44.5 (234)
White
85.7 (406)
86.4 (367)
84.3 (428)
Others
14.3 (68)
13.6 (58)
15.7 (80)
36.9 (188)
45.2 (201)
49.6 (261)
<.001
94.3 (480)
93.7 (417)
93.5 (487)
.851
5.7 (29)
6.3 (28)
6.5 (34)
Race
Current smoker
.648
Functional status before surgery Independent Dependent Currently on dialysis
5.5 (28)
5.4 (24)
6.1 (32)
.879
Open wound/ wound infection
19.6 (100)
29.9 (133)
27.2 (143)
.001
<.001
Procedural details Indication CLI
49.1 (250)
61.1 (272)
63.1 (332)
50.9 (259)
38.9 (173)
36.9 (194)
General
91.6 (466)
96 (427)
94.9 (499)
Others
8.4 (43)
4 (18)
5.1 (27)
Claudication Principal anesthesia technique
.01
ASA classification #3
81.3 (413)
73.8 (327)
74.7 (393)
$4
18.7 (95)
26.2 (116)
25.3 (133)
Total operation time
.01
193.96 6 77.227 259.35 6 103.449 194.64 6 80.347 <.001
Morbidities and outcomes Bleeding transfusions
16.9 (86)
22.9 (102)
24.1 (127)
.01
Any morbidity
23.8 (121)
31.2 (139)
35.7 (188)
<.001 .615
Mortality
2.8 (14)
1.8 (8)
2.5 (13)
Major amputation
1.2 (6)
0.4 (2)
1.5 (8)
.265
Reoperation
8.6 (44)
14.3 (75)
.017
Readmission Total length of hospital stay
11 (49)
10.4 (53)
13 (58)
17.1 (90)
4.07 6 6.785
6.2 6 6.05
5.8 6 5.69
.007 <.001
ASA, American Society of Anesthesiologists; BPG, bypass with nonvein graft; BPV, bypass with vein; CLI, critical limb ischemia; HYB, hybrid. Categorical variables are presented as % (No.). Continuous variables are presented as mean 6 standard deviation.
Methods: The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The c2 and analysis of variance tests with post hoc analysis were used. A multivariate logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality. SPSS statistical software (IBM Corp, Armonk, NY) was used. Results: There were 1480 patients in the analysis. Patients in the HYB group were older (P ¼ .016); this group had significantly fewer smokers (P < .001) and infected wounds (P ¼ .001), and the patients were more likely to have American Society of Anesthesiologists score #3 (P ¼ .01) and claudication (P < .01) compared with the BPV and BPG groups.
Journal of Vascular Surgery
Abstracts
August 2017 with a long-term protective effect against MI and stroke. High-intensity statin use compared with standard use did not show an effect on stroke or MI at 30 and 90 days after CEA.
Table I. Demographics and perioperative outcomes
Author Disclosures: N. Arinze: None; T. Sachs: None; G. Patts: None; J. Kalish: None; A. Kuhnen: None; G. Kasotakis: None; J. Siracuse: None; A. Farber: None
Demographics and comorbidities
HYB (n ¼ 509)
BPV (n ¼ 445)
BYG (n ¼ 526)
P value
64.4 (328)
64.7 (288)
60.1 (316)
.229
.016
Gender Male Age groups
NESVS24. Natural History of Aneurysmal Aortic Arch Branch Vessels in a Single Tertiary Referral Center Adam J. Brownstein,1 Young Erben,1 Sareh Rajaee,1 Yupeng Li,2 John A. Rizzo,2 Vikram Lyall,1 Hamid Mojibian,1 Bulat Ziganshin,1 John Elefteriades1. 1Yale University, New Haven, CT; 2Population and Preventive Medicine, Stony Brook, NY Objective: Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AARBVs). The objectives of this study were to assess the natural history of AARBVs and the AARBV’s risk of rupture and to examine the outcomes of operative intervention. Methods: A retrospective review of the Yale radiologic database from 1999 to 2016 was performed. Only those patients with AARBV and a computed tomography scan were selected for review. Patient demographics, aneurysm characteristics, management, and follow-up information were collected. Results: There were 111 patients with 153 AARBVs identified; 79 were male (71%), with mean age of 70 years (range, 17-93 years). There were 65 brachiocephalic, 51 left subclavian, 33 right subclavian, and 4 common carotid artery aneurysms. On computed tomography, 68 (61%) had aortic aneurysms, 32 (29%) bovine arch, and 8 (7%) aortic dissections. Most were asymptomatic (105 [95%]); four had arm pain and one had chest pain, shortness of breath, and dysphagia, respectively. One patient presented with a ruptured brachiocephalic pseudoaneurysm (size, 6.5 cm). Nineteen (17%) patients underwent operative repair (OR); 92 (83%) were followed up with cross-sectional imaging (NOR). The overall mean vessel diameter was 2.22 6 0.96 cm. The diameter of OR and NOR was 3.94 6 1.61 cm and 1.97 6 0.46 cm, respectively (P < .00001). OR included 13 bypasses, 5 stent grafts, and 1 resection without reconstruction. Two patients developed postoperative hemorrhage requiring re-exploration. One patient required pseudoaneurysm repair 20 years after index operation. Mean follow-up was 52 6 51 months for NOR without any ruptures. Four patients underwent elective repair of AARBV because of either growth or other aortic operation. The growth rate was 0.04 6 0.10 cm/y. On multivariable regression analysis, age (P ¼ .011), the presence of ascending (P ¼ .011) or descending aortic aneurysms (P ¼.005), and a left subclavian artery aneurysm (P ¼ .038) were associated with higher growth rates, whereas height was associated with a lower growth rate (P ¼ .0005). Conclusions: Few patients with AARBVs require an operation. Operative intervention is safe and has a low index of complications. In the presence of other aortic abnormalities, open repair would be favored. When feasible, an endovascular option can be pursued. Given that we observed no true AARBV rupture, patients can be observed safely with imaging, accepting a growth rate of 0.04 6 0.10 cm/y. Author Disclosures: A. J. Brownstein: None; Y. Erben: None; S. Rajaee: None; Y. Li: None; J. A. Rizzo: None; V. Lyall: None; H. Mojibian: None; B. Ziganshin: None; J. Elefteriades: None
NESVS25. Hybrid Procedures Improve Perioperative Outcomes of Femoropopliteal Revascularization Compared with Bypass Saman Doroodgar Jorshery, Laura Skrip, Timur P. Sarac, Cassius Iyad Ochoa Chaar. Yale University School of Medicine, New Haven, CT Objective: Hybrid procedures have gained momentum as less invasive surgeries that can potentially improve patient outcomes. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compared the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization.
<70 years
47.5 (242)
55.3 (246)
55.5 (292)
$70 years
52.5 (267)
44.7 (199)
44.5 (234)
White
85.7 (406)
86.4 (367)
84.3 (428)
Others
14.3 (68)
13.6 (58)
15.7 (80)
36.9 (188)
45.2 (201)
49.6 (261)
<.001
94.3 (480)
93.7 (417)
93.5 (487)
.851
5.7 (29)
6.3 (28)
6.5 (34)
Race
Current smoker
.648
Functional status before surgery Independent Dependent Currently on dialysis
5.5 (28)
5.4 (24)
6.1 (32)
.879
Open wound/ wound infection
19.6 (100)
29.9 (133)
27.2 (143)
.001
<.001
Procedural details Indication CLI
49.1 (250)
61.1 (272)
63.1 (332)
50.9 (259)
38.9 (173)
36.9 (194)
General
91.6 (466)
96 (427)
94.9 (499)
Others
8.4 (43)
4 (18)
5.1 (27)
Claudication Principal anesthesia technique
.01
ASA classification #3
81.3 (413)
73.8 (327)
74.7 (393)
$4
18.7 (95)
26.2 (116)
25.3 (133)
Total operation time
.01
193.96 6 77.227 259.35 6 103.449 194.64 6 80.347 <.001
Morbidities and outcomes Bleeding transfusions
16.9 (86)
22.9 (102)
24.1 (127)
.01
Any morbidity
23.8 (121)
31.2 (139)
35.7 (188)
<.001 .615
Mortality
2.8 (14)
1.8 (8)
2.5 (13)
Major amputation
1.2 (6)
0.4 (2)
1.5 (8)
.265
Reoperation
8.6 (44)
14.3 (75)
.017
Readmission Total length of hospital stay
11 (49)
10.4 (53)
13 (58)
17.1 (90)
4.07 6 6.785
6.2 6 6.05
5.8 6 5.69
.007 <.001
ASA, American Society of Anesthesiologists; BPG, bypass with nonvein graft; BPV, bypass with vein; CLI, critical limb ischemia; HYB, hybrid. Categorical variables are presented as % (No.). Continuous variables are presented as mean 6 standard deviation.
Methods: The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The c2 and analysis of variance tests with post hoc analysis were used. A multivariate logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality. SPSS statistical software (IBM Corp, Armonk, NY) was used. Results: There were 1480 patients in the analysis. Patients in the HYB group were older (P ¼ .016); this group had significantly fewer smokers (P < .001) and infected wounds (P ¼ .001), and the patients were more likely to have American Society of Anesthesiologists score #3 (P ¼ .01) and claudication (P < .01) compared with the BPV and BPG groups.