- Email: [email protected]
Outcomes of Tibial Endovascular Intervention in Patients with ESRD on Dialysis
10 Vascular and Endovascular Surgery Society 41st Annual Meeting
meeting in March from 2004 to 2015. In order to obtain accurate data, all surveys were kept anonymous. Methods: The fellows rated their endovascular, open, and vascular lab experiences as excellent, satisfactory, or mixed. They were queried into who taught them their endovascular skills, the quality of their didactics, and amount of small cases they did not learn from. 674 of 908 attendees (74%) completed the survey. Males made up 81% of those surveyed. 59% were between 31 and 35 years of age. Second-year (5+2) fellows made up 52% of those surveyed. Results: 84% were satisfied with their endovascular experience during their fellowship while 83% were satisfied with their open case experience. Interventional skills were mostly obtained from a vascular surgeon (93%), interventional radiologist (9%), cardiologist (1%), or a mixture (4%). The didactics were felt to be excellent, satisfactory, or to need some or much improvement in: 43%, 44%, 10% and 4% respectively. The distribution of non-learning cases was felt to be excellent, satisfactory, or to need some or much improvement in: 50%, 40%, 8%, and 2% respectively. However, only 68% felt their vascular laboratory experience was excellent or satisfactory. Only 35% actually performed vascular duplex exams, and only 47% felt comfortable managing a vascular laboratory. Comparing the data from 2004 and 2015, significant improvements were found with satisfaction with experience in endovascular cases, the percentage of endovascular cases taught by vascular surgeons, and overall program didactics. There were no significant differences in gender distribution, satisfaction with vascular lab experience, or comfort level in running a vascular laboratory. Conclusions: This survey highlights the self-assessment of vascular trainees and suggests that several significant issues exist in the minds of vascular trainees that have not been addressed. These represent opportunities for further improvement. http://dx.doi.org/10.1016/j.avsg.2017.03.125
OUTCOMES OF TIBIAL ENDOVASCULAR INTERVENTION IN PATIENTS WITH ESRD ON DIALYSIS Hallie E. Baer-Bositis, Georges M. Haider, Taylor D. Hicks, Lori L. Pounds, Matthew J. Sideman, and Mark G. Davies UT HSC San Antonio, San Antonio, TX. Background: Tibial interventions for critical limb ischemia are frequent in patients with ESRD presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient centered outcomes following tibial endovascular Intervention. Methods: A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (Rutherford 4 and 5) were identified. Patients
Annals of Vascular Surgery
Number of Limbs at Risk High Risk III score (%) Mortality (%) Morbidity (%) 5yr-CE (Mean±SEM %) 5yr-AFS (Mean±SEM %) 5yr-MALE (Mean±SEM %)
No ESRD
ESRD
P-Value
1212 18% 0.5% 3% 58±4 55±3 60±5
222 60% 3% 10% 19±8 18±9 11±6
d 0.01 0.01 0.01 0.001 0.001 0.001
were categorized by the presence or absence of ESRD. Patient orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation and absence of major amputation), amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated. Results: 1434 patients (56% male, average age 59 years) underwent tibial intervention for critical ischemia. Technical success was 99% with a mean of 2 vessels treated per patient and a mean pedal runoff score of 6. Overall MACE was equivalent at 90 days after the procedure. At 5 years, patients with ESRD had significantly lower CE, AFS and MALE at 5 years (Table). Conclusions: Patients with ESRD do not achieve satisfactory clinical efficacy and amputation free survival after tibial intervention. Defining such subgroups will allow stratification of the patients and appropriate application of interventions. http://dx.doi.org/10.1016/j.avsg.2017.03.126
SURGICAL INTERVENTION FOR PERIPHERAL ARTERY DISEASE DOES NOT IMPROVE PATIENT COMPLIANCE WITH RECOMMENDED MEDICAL THERAPY Tyler R. Halle, Jaime Benarroch-Gampel, Victoria Teodorescu, and Ravi R. Rajani Emory University School of Medicine, Atlanta, GA. Introduction and Objectives: Non-adherence to smoking cessation, antiplatelet and statin therapies in patients with peripheral artery disease (PAD) are associated with worse long-term outcomes. We hypothesized that patients who underwent invasive revascularization procedures would be more likely to adhere to these therapies than patients who were managed medically. Methods: Prospective surveys pertaining to medication and behavioral compliance of patients with symptomatic peripheral artery disease were performed. Specifically, adherence to smoking cessation, antiplatelet therapy,
meeting in March from 2004 to 2015. In order to obtain accurate data, all surveys were kept anonymous. Methods: The fellows rated their endovascular, open, and vascular lab experiences as excellent, satisfactory, or mixed. They were queried into who taught them their endovascular skills, the quality of their didactics, and amount of small cases they did not learn from. 674 of 908 attendees (74%) completed the survey. Males made up 81% of those surveyed. 59% were between 31 and 35 years of age. Second-year (5+2) fellows made up 52% of those surveyed. Results: 84% were satisfied with their endovascular experience during their fellowship while 83% were satisfied with their open case experience. Interventional skills were mostly obtained from a vascular surgeon (93%), interventional radiologist (9%), cardiologist (1%), or a mixture (4%). The didactics were felt to be excellent, satisfactory, or to need some or much improvement in: 43%, 44%, 10% and 4% respectively. The distribution of non-learning cases was felt to be excellent, satisfactory, or to need some or much improvement in: 50%, 40%, 8%, and 2% respectively. However, only 68% felt their vascular laboratory experience was excellent or satisfactory. Only 35% actually performed vascular duplex exams, and only 47% felt comfortable managing a vascular laboratory. Comparing the data from 2004 and 2015, significant improvements were found with satisfaction with experience in endovascular cases, the percentage of endovascular cases taught by vascular surgeons, and overall program didactics. There were no significant differences in gender distribution, satisfaction with vascular lab experience, or comfort level in running a vascular laboratory. Conclusions: This survey highlights the self-assessment of vascular trainees and suggests that several significant issues exist in the minds of vascular trainees that have not been addressed. These represent opportunities for further improvement. http://dx.doi.org/10.1016/j.avsg.2017.03.125
OUTCOMES OF TIBIAL ENDOVASCULAR INTERVENTION IN PATIENTS WITH ESRD ON DIALYSIS Hallie E. Baer-Bositis, Georges M. Haider, Taylor D. Hicks, Lori L. Pounds, Matthew J. Sideman, and Mark G. Davies UT HSC San Antonio, San Antonio, TX. Background: Tibial interventions for critical limb ischemia are frequent in patients with ESRD presenting with critical ischemia. The aim of this study was to examine impact of ESRD on the patient centered outcomes following tibial endovascular Intervention. Methods: A database of patients undergoing lower extremity endovascular interventions between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (Rutherford 4 and 5) were identified. Patients
Annals of Vascular Surgery
Number of Limbs at Risk High Risk III score (%) Mortality (%) Morbidity (%) 5yr-CE (Mean±SEM %) 5yr-AFS (Mean±SEM %) 5yr-MALE (Mean±SEM %)
No ESRD
ESRD
P-Value
1212 18% 0.5% 3% 58±4 55±3 60±5
222 60% 3% 10% 19±8 18±9 11±6
d 0.01 0.01 0.01 0.001 0.001 0.001
were categorized by the presence or absence of ESRD. Patient orientated outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation and absence of major amputation), amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated. Results: 1434 patients (56% male, average age 59 years) underwent tibial intervention for critical ischemia. Technical success was 99% with a mean of 2 vessels treated per patient and a mean pedal runoff score of 6. Overall MACE was equivalent at 90 days after the procedure. At 5 years, patients with ESRD had significantly lower CE, AFS and MALE at 5 years (Table). Conclusions: Patients with ESRD do not achieve satisfactory clinical efficacy and amputation free survival after tibial intervention. Defining such subgroups will allow stratification of the patients and appropriate application of interventions. http://dx.doi.org/10.1016/j.avsg.2017.03.126
SURGICAL INTERVENTION FOR PERIPHERAL ARTERY DISEASE DOES NOT IMPROVE PATIENT COMPLIANCE WITH RECOMMENDED MEDICAL THERAPY Tyler R. Halle, Jaime Benarroch-Gampel, Victoria Teodorescu, and Ravi R. Rajani Emory University School of Medicine, Atlanta, GA. Introduction and Objectives: Non-adherence to smoking cessation, antiplatelet and statin therapies in patients with peripheral artery disease (PAD) are associated with worse long-term outcomes. We hypothesized that patients who underwent invasive revascularization procedures would be more likely to adhere to these therapies than patients who were managed medically. Methods: Prospective surveys pertaining to medication and behavioral compliance of patients with symptomatic peripheral artery disease were performed. Specifically, adherence to smoking cessation, antiplatelet therapy,