Validation of Diagnoses of Peripheral Arterial Disease from the Danish National Patient Registry

Eur J Vasc Endovasc Surg (2017) 53, e13ee18

Abstracts from the Annual Meeting of the Danish Vascular Surgery Society 2016 Validation of Diagnoses of Peripheral Arterial Disease from the Danish National Patient Registry A.N. Lasota Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark

Objectives: To validate the diagnoses of peripheral arterial disease (PAD) in the legs obtained from National registries in Denmark. Design: We identified 1,471 potential cases of PAD in the Danish National Patient Registry among 57,053 middle-aged participants from the Danish Diet, Cancer and Health cohort study. Validation was performed by reviewing all medical records using pre-specified criteria for a diagnosis of PAD. Results: The overall positive predictive value (PPV) of PAD diagnoses was 73.5% [95% CI 71.2e75.7%]. The PPV of diagnoses given in departments of vascular surgery was significantly higher than diagnoses given in other departments: 75.0% [CI 72.5e77.4%] vs. 66.5% [CI 60.6e72.0%], respectively. The PPV difference was 8.5% [CI 2.3e14.7%]. In a substudy, we evaluated 141 potential cases of PAD also registered in the Danish National Vascular Registry and found a PPV of 94.3% [CI 89.0e97.2%] for these diagnoses. Conclusions: More than 25% of the diagnoses of PAD notified in the Danish National Patient Registry was not valid, stressing the importance of validation when using register information to identify potential cases of PAD for research purposes. In contrast, diagnoses obtained from the Danish National Vascular Registry had a high validity and can be used without further validation. Follow-up of Fascial Suture After Endovascular Aneurysm Repair Evaluated with Duplex Ultrasound K. Fredholm 1,*, K.K. Bredahl 1, L. Lönn H. Sillesen 1,3, J.P. Eiberg 1,3,4

1,2,3

, K.C. Vogt 1,

1 Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark 2 Department of Interventional Radiology, Rigshospitalet, University of Copenhagen, Denmark 3 Faculty of Health and Medical Sciences, University of Copenhagen, Denmark 4 Copenhagen Academy for Medical Education and Simulation, Denmark

Introduction: Fascial suture is an alternative technique for femoral artery access site hemostasis after endovascular aneurysm repair (EVAR)1. The aim of the study was to report the incidence and clinical outcome of access related vascular injury and subsequent intervention using the fascial suture technique. Methods: Between February 1st 2011 and July 31st 2014, all patients who underwent EVAR with attempted fascial suture technique described by Larzon et al. were included prospectively2. Exclusion criteria were a planned cut-down

due to intended femoral-femoral bypass or planned infrainguinal vascular reconstruction, use of closure device or if the surgeon refrained from fascial suture technique due to heavy calcification or body habitus. The access arteries were investigated with duplex ultrasound pre-operatively and at the three months follow up clinical visit. A local > 200% increase in peak systolic velocity was defined as a significant stenosis. Patients’ preprocedural computed tomography angiography of the iliofemoral access vessels were also included in the imaging analysis. Online medical records were used to identify primary failures, reoperations and re-hospitalization related to femoral artery access site within three months. Results: During the study period, 245 patients underwent EVAR of which three procedures were unilateral, and thus, 487 femoral accesses were recruited. Exclusion criteria were met in 177 (36 %), thus, 310 femoral accesses in 168 patients were eligible for further analysis. Peri-operatively, attempted fascia suture succeeded in 283 (91%) and failed in 27 femoral accesses (9%) due to bleeding (n ¼ 18) and thrombosis (n ¼ 9) necessitating cut-down without compromising function of the limb (Table 1). Before discharge major bleedings necessitated re-operation in four patients, one underwent thrombectomy of the common femoral artery. Then, between discharge and the three months follow-up, one patient suffered from acute limb ischemia and was treated successfully with a cross-over bypass. Finally, the three month duplex ultrasound scan demonstrated pseudo-aneurysm in 13 patients of which one needed thrombin injection and 12 were treated conservatively and in a median follow-up period of 36 (12e 48) months, none of these led to re-interventions (Table 1). Access site stenosis was not observed. Conclusion: Fascial suture technique in EVAR is associated with a low major vascular complication rate (<1%) and excellent clinical outcomes. Pseudo-aneurysm formation and access site stenosis are infrequent and can be managed conservatively which in concordance with a recent study2. Table 1. Access related complications after fascia suture technique (n ¼ 310). Variable Peri-operative (n ¼ 27) Bleeding leading to cut-down Thrombosis leading to cut-down Post-operative - major complications (n ¼ 7) Major bleeding necessitating cut-down Thrombosis leading to open repair Wound infection requiring surgical drainage

No. (%) 18(6) 9(3) 4(1) 1(<1) 0(0) Continued