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SS23 Long-Term Patency of Venous and Synthetic Conduits for Ipsilateral Internal Carotid Artery Bypass
Journal of Vascular Surgery
Abstracts
135S
Volume 65, Number 6S Table I. Femoral-popliteal atherectomy downstream utilization (Current Procedural Terminology code 37225) 1-month Service
6-month
12-month
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Any peripheral diagnostic angiography (cath, MR, CT)
5.0
2.6
24.8
Any peripheral vascular endovascular intervention
8.8
3.6
32.8
17.4
37.8
29.6
22.4
40.1
Peripheral vascular bypass
0.4
0.5
1.5
2.6
2.7
31.6 3.8
Any amputation
0.4
1.2
2.3
3.9
2.7
4.8
Major amputation
0.4
0.6
1.5
2.0
1.9
2.9
CT, Computed tomography; HOPD, hospital outpatient department; MR, magnetic resonance.
Table II. Tibial-peroneal atherectomy downstream utilization (Current Procedural Terminology code 37229) 1-month Service
6-month
12-month
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Any peripheral diagnostic angiography (cath, MR, CT)
5.9
1.4
29.2
17.2
37.1
24.0
Any peripheral vascular endovascular intervention
8.9
5.9
35.6
26.7
44.6
34.8
Peripheral vascular bypass
0
0.5
1.5
1.8
2.0
1.8
Any amputation
1.0
2.3
3.0
7.2
4.4
10.4
Major amputation
1.0
0.9
2.0
4.1
3.0
7.2
CT, Computed tomography; HOPD, hospital outpatient department; MR, magnetic resonance.
when done for claudication results in outcomes worse than the natural history of the disease. Author Disclosures: B. Contos: Nothing to disclose; D. Mukherjee: Nothing to disclose.
VS07. Surgical Release by Myotomy and Arterial Repair of Familial Type 3 Popliteal Entrapment Yehuda G. Wolf, Yefim Rabinovich, Natalie Noam, Josef Levi, Alberto Saltiel, Alexander Chaikov, Ido Druckmann, Galia Rosen. Tel Aviv Sourasky Medical Center, Mevaseret Zion, Israel Objectives: The video demonstrates the anatomical relations and the important steps in the surgical treatment of type 3 popliteal entrapment. This is the second leg treated in this young adult. It concludes with this anomaly shown on magnetic resonance imaging in four of the patient’s male relatives. http://www.conferenceabstracts.com/uploads/cfp2/attachments/ZRFDQ HCR/ZRFDQHCR–285491-1-ANY (1).mp4
Objectives: Ipsilateral internal carotid artery bypass has been successfully used to treat aneurysms, infection, tumor, and occlusive disease. The purpose of this study was to evaluate the long-term outcomes of autogenous and prosthetic conduits used for ipsilateral internal carotid artery bypass. Methods: A retrospective review of a single institution registry was performed to identify patients with ipsilateral carotid artery bypass. Demographics, complications, and patency were recorded and compared using c2, Fisher exact, and log-rank analysis. Results: From 1994 to 2016, 105 patients underwent ipsilateral carotid artery bypass (86 prosthetic, 19 veins). The venous bypass group (VBG) and prosthetic bypass group (PBG) were different in terms of gender (8 men and 11 women vs 58 men and 28 women; P ¼.038) but were similar in age (mean VGB: 63 years; range, 18-80; PBG: 68 years; range, 33-88; P ¼ .052). Mean follow-up was 53 months (range, 1 month-15 years). Diabetes, pulmonary disease, hypercholesterolemia, and tobacco use was not statistically significant between groups. Indications were different between groups, with more PBG used for occlusive disease and more VBG used for infection, aneurysm, trauma, and tumor (Fisher exact test P ¼ .004). There were 81 prosthetic bypasses performed for occlusive disease which was
Author Disclosures: A. Chaikov: Nothing to disclose; I. Druckmann: Nothing to disclose; J. Levi: Nothing to disclose; N. Noam: Nothing to disclose; Y. Rabinovich: Nothing to disclose; G. Rosen: Nothing to disclose; A. Saltiel: Nothing to disclose; Y. G. Wolf: Nothing to disclose.
S5: PLENARY SESSION 5 SS23. Long-Term Patency of Venous and Synthetic Conduits for Ipsilateral Internal Carotid Artery Bypass Andre Ramdon, Krishna Martinez-Singh, Jeffrey Hnath, Benjamin Chang, R. Clement Darling III. Albany Medical College, Albany, NY
Fig.
136S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 asymptomatic stenosis (41 [51%]). The perioperative complications were few and similar between groups (bleeding, infection, immediate occlusion, and stroke). Patency rates, as determined by duplex ultrasound imaging, were similar at 1 year (100% VBG vs 99% PBG; P ¼ .434). The 5- to 10-year patency was also similar between groups (84% VBG vs 88% PBG; P ¼ .434; Fig). Conclusions: Ipsilateral internal carotid artery bypass performed for a variety of indications using prosthetic and venous conduits have demonstrated excellent short-term results. Both types of conduit in this series have demonstrated continued durability over long-term follow-up.
Author Disclosures: B. Chang: Nothing to disclose; R. Darling, III: Nothing to disclose; J. Hnath: Nothing to disclose; K. Martinez-Singh: Nothing to disclose; A. Ramdon: Nothing to disclose.
SS24. Cryopreserved Vein vs Autologous Vein in Portomesenteric Reconstruction During Oncologic Surgery
Table I. Comparison of characteristics and outcomes in two types of conduit Variable Age (years)
CryoVeina (n ¼ 22)
64.9 6 8.2
63.0 6 14.8
15 (57.7)
10 (45.5)
11 (42.3)
12 (54.5)
Gender Male Female
P valueb .583 .398
Diabetes
12 (48.2)
3 (13.6)
Hypertension
11 (42.3)
13 (59.1)
.247
Obesity
7 (26.9)
4 (18.2)
.473
Never smoked
11 (42.3)
10 (45.5)
Former smoker
11 (42.3)
10 (45.5)
Current smoker
4 (15.4)
2 (9.0)
Tobacco use
.015
.849
Kidney failure
2 (7.7)
1 (4.5)
Pulmonary disease
8 (30.8)
5 (22.7)
Tumor stage
Olamide Alabi, Enjae Jung, Timothy Liem, Gregory Landry, Gregory Moneta, Erica Mitchell. Oregon Health & Science University, Portland, Ore Objectives: In 2016, pancreatic cancer became the third leading cause of cancer-related death in the United States. While 5-year survival rates remain in the single digits, surgical resection offers the only potential for cure and can increase survival tenfold. As such, patients with portomesenteric vein involvement benefit from surgical resection with portomesenteric vein reconstruction (PVR). Studies demonstrate the feasibility of PVR with femoral and/or saphenous vein conduits; however, femoral vein (FV) harvest is associated with increased risk of deep vein thrombosis (DVT) and wound complications. Cryopreserved FV may be a reasonable alternative avoiding such morbidity. We sought to compare outcomes of autogenous vs cryopreserved FV conduit in patients undergoing PVR during pancreaticoduodenectomy. Methods: This was a retrospective review of our National Surgical Quality Improvement Program database for all patients undergoing pancreaticoduodenectomy with PVR from January 2010 to July 2016. Patient demographics (age, sex, and comorbidities) and tumor stage and pathology records were assessed. Postoperative complications, conduit patency, and perioperative mortality were compared between autogenous and cryopreserved vein groups. Results: A total of 48 patients, 26 autogenous and 22 cryopreserved vein, underwent PVR. Demographics were similar between groups, although the autogenous vein group consisted of significantly more patients with diabetes (48% vs 14%; P ¼ .015). Median follow-up was 6.7 months. Median survival was 24 months between both groups. Tumor stage did not differ significantly between groups. Conduit patency (Fig 1) and overall survival (Fig 2) did not differ between groups. While surgical site infection rates did not differ between the groups (7% v 0%; P ¼ .493), there was a significantly higher rate of perioperative DVT in the autogenous vein group (57% v 14%; P ¼ .002). These DVTs were notably more likely to be proximal to the site of FV harvest. There were no conduit infections in either group. Univariate analysis demonstrated autogenous vein conduit and diabetes mellitus were independent predictors of perioperative DVT. Conclusions: Patients undergoing oncologic pancreatic resection with PVR do not have significantly different patency or survival rates regardless of the conduit used. Since autogenous vein harvest is associated with significantly higher rates of perioperative DVT, cryopreserved vein should be considered for all PVR in pancreatic
Autologousa (n ¼ 26)
1.000 .532 .763
IB
0
1 (4.8)
IIA
6 (23.1)
5 (23.8)
IIB
19 (73.1)
13 (61.9)
III
1 (3.8)
1 (4.8)
IV
0
1 (4.8)
10 (38.5)
2 (9.1)
.019 .166
Preoperative use Antiplatelet Anticoagulation Therapeutic
0
2 (9.1)
Prophylactic
24 (92.3)
20 (90.9)
17 (65.4)
20 (90.9)
.036
8 (30.8)
2 (9.1)
.084
<30 days
15 (57.7)
3 (13.6)
.002
>30 days
5 (19.2)
1 (4.5)
Postoperative use Antiplatelet Anticoagulation Therapeutic Deep vein thrombosis
Proximal Distal No deep vein thrombosis
.199 <.0001
Site of deep vein thrombosis 8 (30.8)
0
10 (38.5)
0
8 (30.7)
22 (100)
Absence of wound infection Midline
20 (76.9)
18 (81.8)
Leg wound <30 days
24 (92.3)
22 (100)
.493
22.5 6 16.8
16.6 6 13.7
.200
12 (54.6)
.051
Hospital length of hospital (days) Survival at last follow-up
7 (26.9)
.735
Continuous variables are summarized as mean 6 standard deviation, and categoric variables are summarized as frequency (%). b Continuous variables are compared using Student t-test, and frequencies are compared using c2 or Fisher exact test as appropriate. Bold values are statistically significant (P < .05). a
resection as it avoids the morbidity associated with autogenous vein harvest.
Abstracts
135S
Volume 65, Number 6S Table I. Femoral-popliteal atherectomy downstream utilization (Current Procedural Terminology code 37225) 1-month Service
6-month
12-month
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Any peripheral diagnostic angiography (cath, MR, CT)
5.0
2.6
24.8
Any peripheral vascular endovascular intervention
8.8
3.6
32.8
17.4
37.8
29.6
22.4
40.1
Peripheral vascular bypass
0.4
0.5
1.5
2.6
2.7
31.6 3.8
Any amputation
0.4
1.2
2.3
3.9
2.7
4.8
Major amputation
0.4
0.6
1.5
2.0
1.9
2.9
CT, Computed tomography; HOPD, hospital outpatient department; MR, magnetic resonance.
Table II. Tibial-peroneal atherectomy downstream utilization (Current Procedural Terminology code 37229) 1-month Service
6-month
12-month
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Office (%)
HOPD (%)
Any peripheral diagnostic angiography (cath, MR, CT)
5.9
1.4
29.2
17.2
37.1
24.0
Any peripheral vascular endovascular intervention
8.9
5.9
35.6
26.7
44.6
34.8
Peripheral vascular bypass
0
0.5
1.5
1.8
2.0
1.8
Any amputation
1.0
2.3
3.0
7.2
4.4
10.4
Major amputation
1.0
0.9
2.0
4.1
3.0
7.2
CT, Computed tomography; HOPD, hospital outpatient department; MR, magnetic resonance.
when done for claudication results in outcomes worse than the natural history of the disease. Author Disclosures: B. Contos: Nothing to disclose; D. Mukherjee: Nothing to disclose.
VS07. Surgical Release by Myotomy and Arterial Repair of Familial Type 3 Popliteal Entrapment Yehuda G. Wolf, Yefim Rabinovich, Natalie Noam, Josef Levi, Alberto Saltiel, Alexander Chaikov, Ido Druckmann, Galia Rosen. Tel Aviv Sourasky Medical Center, Mevaseret Zion, Israel Objectives: The video demonstrates the anatomical relations and the important steps in the surgical treatment of type 3 popliteal entrapment. This is the second leg treated in this young adult. It concludes with this anomaly shown on magnetic resonance imaging in four of the patient’s male relatives. http://www.conferenceabstracts.com/uploads/cfp2/attachments/ZRFDQ HCR/ZRFDQHCR–285491-1-ANY (1).mp4
Objectives: Ipsilateral internal carotid artery bypass has been successfully used to treat aneurysms, infection, tumor, and occlusive disease. The purpose of this study was to evaluate the long-term outcomes of autogenous and prosthetic conduits used for ipsilateral internal carotid artery bypass. Methods: A retrospective review of a single institution registry was performed to identify patients with ipsilateral carotid artery bypass. Demographics, complications, and patency were recorded and compared using c2, Fisher exact, and log-rank analysis. Results: From 1994 to 2016, 105 patients underwent ipsilateral carotid artery bypass (86 prosthetic, 19 veins). The venous bypass group (VBG) and prosthetic bypass group (PBG) were different in terms of gender (8 men and 11 women vs 58 men and 28 women; P ¼.038) but were similar in age (mean VGB: 63 years; range, 18-80; PBG: 68 years; range, 33-88; P ¼ .052). Mean follow-up was 53 months (range, 1 month-15 years). Diabetes, pulmonary disease, hypercholesterolemia, and tobacco use was not statistically significant between groups. Indications were different between groups, with more PBG used for occlusive disease and more VBG used for infection, aneurysm, trauma, and tumor (Fisher exact test P ¼ .004). There were 81 prosthetic bypasses performed for occlusive disease which was
Author Disclosures: A. Chaikov: Nothing to disclose; I. Druckmann: Nothing to disclose; J. Levi: Nothing to disclose; N. Noam: Nothing to disclose; Y. Rabinovich: Nothing to disclose; G. Rosen: Nothing to disclose; A. Saltiel: Nothing to disclose; Y. G. Wolf: Nothing to disclose.
S5: PLENARY SESSION 5 SS23. Long-Term Patency of Venous and Synthetic Conduits for Ipsilateral Internal Carotid Artery Bypass Andre Ramdon, Krishna Martinez-Singh, Jeffrey Hnath, Benjamin Chang, R. Clement Darling III. Albany Medical College, Albany, NY
Fig.
136S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 asymptomatic stenosis (41 [51%]). The perioperative complications were few and similar between groups (bleeding, infection, immediate occlusion, and stroke). Patency rates, as determined by duplex ultrasound imaging, were similar at 1 year (100% VBG vs 99% PBG; P ¼ .434). The 5- to 10-year patency was also similar between groups (84% VBG vs 88% PBG; P ¼ .434; Fig). Conclusions: Ipsilateral internal carotid artery bypass performed for a variety of indications using prosthetic and venous conduits have demonstrated excellent short-term results. Both types of conduit in this series have demonstrated continued durability over long-term follow-up.
Author Disclosures: B. Chang: Nothing to disclose; R. Darling, III: Nothing to disclose; J. Hnath: Nothing to disclose; K. Martinez-Singh: Nothing to disclose; A. Ramdon: Nothing to disclose.
SS24. Cryopreserved Vein vs Autologous Vein in Portomesenteric Reconstruction During Oncologic Surgery
Table I. Comparison of characteristics and outcomes in two types of conduit Variable Age (years)
CryoVeina (n ¼ 22)
64.9 6 8.2
63.0 6 14.8
15 (57.7)
10 (45.5)
11 (42.3)
12 (54.5)
Gender Male Female
P valueb .583 .398
Diabetes
12 (48.2)
3 (13.6)
Hypertension
11 (42.3)
13 (59.1)
.247
Obesity
7 (26.9)
4 (18.2)
.473
Never smoked
11 (42.3)
10 (45.5)
Former smoker
11 (42.3)
10 (45.5)
Current smoker
4 (15.4)
2 (9.0)
Tobacco use
.015
.849
Kidney failure
2 (7.7)
1 (4.5)
Pulmonary disease
8 (30.8)
5 (22.7)
Tumor stage
Olamide Alabi, Enjae Jung, Timothy Liem, Gregory Landry, Gregory Moneta, Erica Mitchell. Oregon Health & Science University, Portland, Ore Objectives: In 2016, pancreatic cancer became the third leading cause of cancer-related death in the United States. While 5-year survival rates remain in the single digits, surgical resection offers the only potential for cure and can increase survival tenfold. As such, patients with portomesenteric vein involvement benefit from surgical resection with portomesenteric vein reconstruction (PVR). Studies demonstrate the feasibility of PVR with femoral and/or saphenous vein conduits; however, femoral vein (FV) harvest is associated with increased risk of deep vein thrombosis (DVT) and wound complications. Cryopreserved FV may be a reasonable alternative avoiding such morbidity. We sought to compare outcomes of autogenous vs cryopreserved FV conduit in patients undergoing PVR during pancreaticoduodenectomy. Methods: This was a retrospective review of our National Surgical Quality Improvement Program database for all patients undergoing pancreaticoduodenectomy with PVR from January 2010 to July 2016. Patient demographics (age, sex, and comorbidities) and tumor stage and pathology records were assessed. Postoperative complications, conduit patency, and perioperative mortality were compared between autogenous and cryopreserved vein groups. Results: A total of 48 patients, 26 autogenous and 22 cryopreserved vein, underwent PVR. Demographics were similar between groups, although the autogenous vein group consisted of significantly more patients with diabetes (48% vs 14%; P ¼ .015). Median follow-up was 6.7 months. Median survival was 24 months between both groups. Tumor stage did not differ significantly between groups. Conduit patency (Fig 1) and overall survival (Fig 2) did not differ between groups. While surgical site infection rates did not differ between the groups (7% v 0%; P ¼ .493), there was a significantly higher rate of perioperative DVT in the autogenous vein group (57% v 14%; P ¼ .002). These DVTs were notably more likely to be proximal to the site of FV harvest. There were no conduit infections in either group. Univariate analysis demonstrated autogenous vein conduit and diabetes mellitus were independent predictors of perioperative DVT. Conclusions: Patients undergoing oncologic pancreatic resection with PVR do not have significantly different patency or survival rates regardless of the conduit used. Since autogenous vein harvest is associated with significantly higher rates of perioperative DVT, cryopreserved vein should be considered for all PVR in pancreatic
Autologousa (n ¼ 26)
1.000 .532 .763
IB
0
1 (4.8)
IIA
6 (23.1)
5 (23.8)
IIB
19 (73.1)
13 (61.9)
III
1 (3.8)
1 (4.8)
IV
0
1 (4.8)
10 (38.5)
2 (9.1)
.019 .166
Preoperative use Antiplatelet Anticoagulation Therapeutic
0
2 (9.1)
Prophylactic
24 (92.3)
20 (90.9)
17 (65.4)
20 (90.9)
.036
8 (30.8)
2 (9.1)
.084
<30 days
15 (57.7)
3 (13.6)
.002
>30 days
5 (19.2)
1 (4.5)
Postoperative use Antiplatelet Anticoagulation Therapeutic Deep vein thrombosis
Proximal Distal No deep vein thrombosis
.199 <.0001
Site of deep vein thrombosis 8 (30.8)
0
10 (38.5)
0
8 (30.7)
22 (100)
Absence of wound infection Midline
20 (76.9)
18 (81.8)
Leg wound <30 days
24 (92.3)
22 (100)
.493
22.5 6 16.8
16.6 6 13.7
.200
12 (54.6)
.051
Hospital length of hospital (days) Survival at last follow-up
7 (26.9)
.735
Continuous variables are summarized as mean 6 standard deviation, and categoric variables are summarized as frequency (%). b Continuous variables are compared using Student t-test, and frequencies are compared using c2 or Fisher exact test as appropriate. Bold values are statistically significant (P < .05). a
resection as it avoids the morbidity associated with autogenous vein harvest.