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PC128. Medical Management for Uncomplicated Isolated Abdominal Aortic Dissection
JOURNAL OF VASCULAR SURGERY June Supplement 2015
152S Abstracts
or not treated (n ¼ 1980) with ACEI/ARB. Outcomes included perioperative need for intravenous medications for blood pressure (IVBPmed), length of stay (LOS), major adverse cardiac events (MACE), transient ischemic attack (TIA) or stroke, and death. One-year myocardial infarction (MI), TIA/stroke, restenosis, reintervention, and death rates were examined in a subset of 826 patients. Results: ACEI/ARB users were more likely to be male (64% vs 59%, P ¼ .001), to have diabetes (41% vs 28%, P < .0001), hypertension (HTN) (97% vs 82%, P < .0001), coronary artery disease (31% vs 25%, P ¼ .0001), congestive heart failure (10% vs 8%, P ¼ .02) and to use aspirin (92% vs 88%, P ¼ .0002) and statins (89% vs 85%, P ¼ .001). No significant differences were identified in hypotension requiring IVBPmed (12% vs 11%, P ¼ .28). ACEI/ARB usage was associated with HTN requiring IVBPmed (13% vs 10%, P ¼ .008). In-hospital outcomes were similar: MACE (3% vs 2%, P ¼ .09), TIA/stroke (1% vs 2%, P ¼ .51), death (0.3% vs 0.3%, P ¼ .86), and LOS (1.7 days vs 1.9 days, P ¼ .36). There were no significant differences in 1-year rates of MI (0.4% vs 0.99%, P ¼ .42), TIA/stroke (2% vs 3%, P ¼ .51), restenosis (2% vs 2%, P ¼ 1.00), reintervention (0.3% vs 0.9%, P ¼ .25), or death (0.3% vs 0.7%, P ¼ .41) between ACEI/ARB and non-ACEI/ARB groups, respectively. Conclusions: ACEI/ARB use was associated with increased use of IVBPmed for HTN, but other outcomes were similar. The use of ACEI/ARB appears safe in the perioperative period surrounding CEA. Author Disclosures: A. M. Steely: Nothing to disclose; P. W. Callas: Nothing to disclose; D. J. Bertges: Nothing to disclose. PC128. Medical Management for Uncomplicated Isolated Abdominal Aortic Dissection Harleen K. Sandhu1, Kristofer M. Charlton-Ouw2, Monica K. Tamil2, Charles C. Miller1, Sherene Shalhub3, Ali Azizzadeh4, Anthony L. Estrera4, Hazim J. Safi4. 1 University of Texas Health Science Center at Houston, Houston, Tex; 2University of Texas Medical School at Houston, Houston, Tex; 3University of Washington, Seattle, Washington; 4University of Texas, Memorial Hermann, Houston, Tex Objectives: We compare our experience with management of isolated abdominal aortic dissection (IAAD) and acute thoracic type B aortic dissection (ATBAD). Methods: We reviewed patients with IAAD from 1998 to 2014, excluding iatrogenic and traumatic dissections. All patients were managed with anti-impulse therapy. Indications for surgery were rupture, aortic expansion, malperfusion, or intractable pain. Survival was analyzed by Kaplan-Meier and Cox regression. Results: We treated 33 patients (67% male; mean age 59 years) with IAAD. Presentation was acute in 18 (55%), symptomatic in 28 (85%), aneurysm in 16 (49%), and penetrating aortic ulcer in 3 (10%). IAAD was mostly infrarenal (97%), with iliac involvement in 37% (11 of 30). Seven (21%) required surgery (5 open and 2 endovascular), with no in-hospital mortality. Over a mean 114 months of follow-up, eight were readmitted with two reinterventions.
Fig.
Overall and reintervention-free survival at 10 years for medical vs surgical management in IAAD was 90% and 82% vs 67% and 67% (P ¼ .282 and P ¼ .633), respectively. Compared with patients with ATBAD, the need for surgery in IAAD was not different (4 of 18 [22%] vs 108 of 397 [27%]) but was associated with higher mortality (HR 1.9, P < .001). Survival between surgically managed and uncomplicated medically managed acute IAAD vs ATBAD was significantly different (Fig). Conclusions: Medical management of uncomplicated IAAD demonstrated excellent long-term survival. Patients with IAAD had improved survival compared with those with ATBAD. Author Disclosures: H. K. Sandhu: Nothing to disclose; K. M. Charlton-Ouw: Nothing to disclose; M. K. Tamil: Nothing to disclose; C. C. Miller: Nothing to disclose; S. Shalhub: Nothing to disclose; A. Azizzadeh: Gore, Medtronic, consulting fee; A. L. Estrera: Gore, consulting fee, Maquet, speakers bureau; H. J. Safi: Nothing to disclose.
PC130. Increased Primary Care Provider (PCP) Referrals to a Vascular Surgery Practice That Actively Manages Statin Therapy Improves Their Patients’ Compliance With American Heart Association (AHA) Guidelines and Decreases Their LDL Levels Naren Gupta1, Helene Garcon1, Joseph D. Raffetto2, Sarah K. White2, Summer A. Mattera2, James T. McPhee1. 1VA Boston Health System, Harvard Medical School, Boston, Mass; 2VA Boston Health System, Harvard Medical School, West Roxbury, Mass Objectives: Vascular surgeons are often hesitant to actively manage statin therapy, deferring to primary care providers (PCPs) or other providers. Starting in October 2011, we implemented a protocol to actively manage statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) in accordance with American Heart Association guidelines, and to communicate any changes in statin therapy that we
152S Abstracts
or not treated (n ¼ 1980) with ACEI/ARB. Outcomes included perioperative need for intravenous medications for blood pressure (IVBPmed), length of stay (LOS), major adverse cardiac events (MACE), transient ischemic attack (TIA) or stroke, and death. One-year myocardial infarction (MI), TIA/stroke, restenosis, reintervention, and death rates were examined in a subset of 826 patients. Results: ACEI/ARB users were more likely to be male (64% vs 59%, P ¼ .001), to have diabetes (41% vs 28%, P < .0001), hypertension (HTN) (97% vs 82%, P < .0001), coronary artery disease (31% vs 25%, P ¼ .0001), congestive heart failure (10% vs 8%, P ¼ .02) and to use aspirin (92% vs 88%, P ¼ .0002) and statins (89% vs 85%, P ¼ .001). No significant differences were identified in hypotension requiring IVBPmed (12% vs 11%, P ¼ .28). ACEI/ARB usage was associated with HTN requiring IVBPmed (13% vs 10%, P ¼ .008). In-hospital outcomes were similar: MACE (3% vs 2%, P ¼ .09), TIA/stroke (1% vs 2%, P ¼ .51), death (0.3% vs 0.3%, P ¼ .86), and LOS (1.7 days vs 1.9 days, P ¼ .36). There were no significant differences in 1-year rates of MI (0.4% vs 0.99%, P ¼ .42), TIA/stroke (2% vs 3%, P ¼ .51), restenosis (2% vs 2%, P ¼ 1.00), reintervention (0.3% vs 0.9%, P ¼ .25), or death (0.3% vs 0.7%, P ¼ .41) between ACEI/ARB and non-ACEI/ARB groups, respectively. Conclusions: ACEI/ARB use was associated with increased use of IVBPmed for HTN, but other outcomes were similar. The use of ACEI/ARB appears safe in the perioperative period surrounding CEA. Author Disclosures: A. M. Steely: Nothing to disclose; P. W. Callas: Nothing to disclose; D. J. Bertges: Nothing to disclose. PC128. Medical Management for Uncomplicated Isolated Abdominal Aortic Dissection Harleen K. Sandhu1, Kristofer M. Charlton-Ouw2, Monica K. Tamil2, Charles C. Miller1, Sherene Shalhub3, Ali Azizzadeh4, Anthony L. Estrera4, Hazim J. Safi4. 1 University of Texas Health Science Center at Houston, Houston, Tex; 2University of Texas Medical School at Houston, Houston, Tex; 3University of Washington, Seattle, Washington; 4University of Texas, Memorial Hermann, Houston, Tex Objectives: We compare our experience with management of isolated abdominal aortic dissection (IAAD) and acute thoracic type B aortic dissection (ATBAD). Methods: We reviewed patients with IAAD from 1998 to 2014, excluding iatrogenic and traumatic dissections. All patients were managed with anti-impulse therapy. Indications for surgery were rupture, aortic expansion, malperfusion, or intractable pain. Survival was analyzed by Kaplan-Meier and Cox regression. Results: We treated 33 patients (67% male; mean age 59 years) with IAAD. Presentation was acute in 18 (55%), symptomatic in 28 (85%), aneurysm in 16 (49%), and penetrating aortic ulcer in 3 (10%). IAAD was mostly infrarenal (97%), with iliac involvement in 37% (11 of 30). Seven (21%) required surgery (5 open and 2 endovascular), with no in-hospital mortality. Over a mean 114 months of follow-up, eight were readmitted with two reinterventions.
Fig.
Overall and reintervention-free survival at 10 years for medical vs surgical management in IAAD was 90% and 82% vs 67% and 67% (P ¼ .282 and P ¼ .633), respectively. Compared with patients with ATBAD, the need for surgery in IAAD was not different (4 of 18 [22%] vs 108 of 397 [27%]) but was associated with higher mortality (HR 1.9, P < .001). Survival between surgically managed and uncomplicated medically managed acute IAAD vs ATBAD was significantly different (Fig). Conclusions: Medical management of uncomplicated IAAD demonstrated excellent long-term survival. Patients with IAAD had improved survival compared with those with ATBAD. Author Disclosures: H. K. Sandhu: Nothing to disclose; K. M. Charlton-Ouw: Nothing to disclose; M. K. Tamil: Nothing to disclose; C. C. Miller: Nothing to disclose; S. Shalhub: Nothing to disclose; A. Azizzadeh: Gore, Medtronic, consulting fee; A. L. Estrera: Gore, consulting fee, Maquet, speakers bureau; H. J. Safi: Nothing to disclose.
PC130. Increased Primary Care Provider (PCP) Referrals to a Vascular Surgery Practice That Actively Manages Statin Therapy Improves Their Patients’ Compliance With American Heart Association (AHA) Guidelines and Decreases Their LDL Levels Naren Gupta1, Helene Garcon1, Joseph D. Raffetto2, Sarah K. White2, Summer A. Mattera2, James T. McPhee1. 1VA Boston Health System, Harvard Medical School, Boston, Mass; 2VA Boston Health System, Harvard Medical School, West Roxbury, Mass Objectives: Vascular surgeons are often hesitant to actively manage statin therapy, deferring to primary care providers (PCPs) or other providers. Starting in October 2011, we implemented a protocol to actively manage statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) in accordance with American Heart Association guidelines, and to communicate any changes in statin therapy that we