Annals of vascular surgery最新文献

{"title":"Revisiting Equity in Healthcare Spending: Variation in Reimbursement for Aortic Procedures from the Perspective of Medicare Payments.","authors":"Tess Cremers, Gordon Morewood, Bill Moser, Abul Kashem, Lawrence Oresanya, Samuel Han, Yoshiya Toyoda, Suyog Mokashi","doi":"10.1016/j.avsg.2024.12.069","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.12.069","url":null,"abstract":"<p><strong>Objective: </strong>Medicare insures over 65 million Americans and is a primary driver of private insurance reimbursement rates. However, public data shows Medicare reimbursement for comparatively complex procedures such as aortic aneurysm repair is disproportionate. Medicare reimbursement rates are multifactorial and highly localized, yet little is known about nationwide trends. Therefore, we sought to compare Medicare reimbursement for aortic surgery by geographic region and state poverty level.</p><p><strong>Methods: </strong>Fee charged, total payment received, and Medicare payment data for aortic procedures comes from publicly available datasets. Geographic regions were determined using Center for Disease Control designations, and state level poverty statistics were obtained from published Census Bureau data. Mean fee charged, total, and Medicare payments were compared by poverty and geographic subgroup.</p><p><strong>Results: </strong>States with the highest poverty levels received significantly lower Medicare payments when compared to states with lower poverty levels. Medicare and total payments for aortic procedures varied significantly by geographic region with Midwest and Southern states receiving lower Medicare and total payments relative to the Northeast and West. Further geographic division revealed lower Medicare payments to North Central, East South-Central, and West South-Central states with correspondingly lower total payments. Total payments were highest in the Pacific West.</p><p><strong>Conclusions: </strong>Aortic procedures are disproportionately reimbursed from Medicare. Our results suggest that states with the highest poverty levels were paid strikingly less than other regions for complex aortic procedures. Payments also varied regionally, with Midwestern and Southern providers receiving lower reimbursement than their Northeastern and Western counterparts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Acute Cerebrovascular Accidents following Cardiovascular Surgical Procedures: A Comprehensive 17-year study involving 24,412 patients at a leading Tertiary care institution in the United Kingdom.","authors":"Mai Shehab, Eduardo Urgesi, Sarvananthan Sajiram, Abdallah Abbas, Wael I Awad","doi":"10.1016/j.avsg.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.01.004","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study is to quantify the incidence of stroke following cardiac surgery over 17 years at our centre. Additionally, we evaluated the potential risk factors leading to postoperative stroke in these patients.</p><p><strong>Methods: </strong>Patient characteristics and perioperative data were collected for 24,412 patients undergoing surgery at our centre between January 2005 and December 2021. We identified the patients who developed postoperative stroke and assessed potential risk factors. Chi-Squared and Mann-Whitney U tests were used for inter-group comparisons. Independent risk factors were evaluated by univariate logistic regression analysis.</p><p><strong>Results: </strong>In our cohort, we identified 346 patients (1.4%) with postoperative stroke. After adjusting for possible confounders, the following were significant risk factors: previous cardiac surgery (OR:1.6; 95% CI:1.2-2.2; p= 0.004), EuroSCORE II of 1-1.9 (OR:2.1; CI:1-4.2; p= 0.048), 2-4.9 (OR:3.3; CI:1.7-6.6; p= 0.001), 5-9.9 (OR:3.6; CI:1.7-7.5; p= 0.001) and ≥10 (OR:3.4; CI:1.6-7.5; p= 0.002), EuroSCORE Additive of 5-9 (OR:2.4; CI:1.2-4.7; p= 0.013) and ≥10 (OR:2.7; CI:1.2-6.2; p= 0.020), requiring new postoperative haemofiltration/dialysis (OR:4.0; CI:2.9-5.5, p<0.001), Stanford type A dissections (OR:2.3; CI:1.1-4.7; p= 0.020), returning to theatre for bleeding/tamponade (OR:3.2; CI:2.2-4.6; p<0.001).</p><p><strong>Conclusions: </strong>The incidence of stroke following surgery is low with many predisposing factors. Nevertheless, identifying patients at increased risk of stroke may enhance informed consent, preoperative planning, and perioperative strategies.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-emptive Endovascular Repair for Uncomplicated Type B Dissection - Is this an Option?","authors":"Nikolaos Papatheodorou, Nikolaos Tsilimparis, Sven Peterss, David Khangholi, Nikolaos Konstantinou, Maximilian Pichlmaier, Jan Stana","doi":"10.1016/j.avsg.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.01.003","url":null,"abstract":"<p><p>Type B aortic dissection (TBAD) primarily affects men aged 60-65, with hypertension in over 80% of cases. The gold standard for the treatment of uncomplicated acute TBAD is Best Medical Therapy (BMT), which focused on controlling blood pressure and heart rate. However, Thoracic Endovascular Aortic Repair (TEVAR) has gained attention over the years, especially for complicated TBAD cases, by covering the primary entry tear, lowering false lumen pressure, and promoting aortic remodeling. TBAD can be classified according to the onset of symptoms into acute, subacute and chronic stages, with different intervention implications at each stage. Studies such as the ADSORB and INSTEAD trials have shown the benefits of TEVAR over BMT, particularly in promoting aortic remodeling and reducing long-term aorta-related mortality. However, these trials noted no significant difference in immediate mortality. TEVAR timing is crucial, as early intervention in the acute phase can lead to higher complication rates due to higher intimal fragility. As a result, the subacute phase offers a balance, allowing beneficial remodeling with a lower complication rate.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variant Aortic Anatomy with High Aortoiliac Bifurcation and Crossing of Iliac Vessels in an Asymptomatic 10-Year-Old Female","authors":"Gautam Agarwal MD,&nbsp;Fairouz Chibane MD,&nbsp;Danielle Frischmann MSN,&nbsp;Michaela Cushing BS","doi":"10.1016/j.avsg.2024.09.009","DOIUrl":"10.1016/j.avsg.2024.09.009","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Page 545"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"**Influential Factors in Post-Admission Imaging Surveillance for Uncomplicated Type B Aortic Dissection","authors":"Jonathan Krebs MD,&nbsp;Liam Kugler BS,&nbsp;Chelsea Viscardi MD,&nbsp;Brian Fazzone MD,&nbsp;Zain Shahid MD,&nbsp;Martin Back MD, MS,&nbsp;Salvatore Scali MD,&nbsp;Samir Shah MD,&nbsp;Gilbert Upchurch MD,&nbsp;Michol Cooper MD,&nbsp;Griffin Stinson BS","doi":"10.1016/j.avsg.2024.09.007","DOIUrl":"10.1016/j.avsg.2024.09.007","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 540-542"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Small Artery Disease (SAD) and Medial Arterial Calcification (MAC) Scores on Chronic Wound and Amputation Healing: Can It Tell Us More?","authors":"Saranya Sundaram ,&nbsp;Christian Barksdale ,&nbsp;Stephanie Rodriguez ,&nbsp;Mathew D. Wooster","doi":"10.1016/j.avsg.2024.07.089","DOIUrl":"10.1016/j.avsg.2024.07.089","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In 2021, Ferraresi et al. created a novel scoring system based on the impact of small artery disease (SAD) and medial arterial calcification (MAC) on wound healing. SAD and MAC scores functioned similar to Wound, Ischemia, and foot Infection (WIfI) but with minimal resource expenditure. Despite its potential, few studies have expanded on the original dataset. We aim to validate SAD’s impact and MAC's impact on wound healing outcomes and determine their utility in relation to current predictive models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Single-institution retrospective review was used to identify amputations for chronic (&gt;1 month) podiatric wounds between 2015 and 2020. Foot X-ray (MAC) or angiography (SAD) &lt; 6 months of index procedure was required. Primary outcomes included major amputation, wound healing, major adverse limb events, and amputation-free survival (AFS). Statistical analysis included chi-squared, 1-way analysis of variance, nonparametric correlation, Kaplan-Meier, Cox regression, and Akaike/Bayesian Inclusion Criteria model comparison.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 136 limbs, 67 received SAD scores (0–2) and 128 received MAC scores (0–2). SAD cohorts exhibited similar comorbidity profiles with exception of coronary disease, heart failure, and chronic kidney disease. MAC cohorts were notably disparate in prevalence of multiple conditions. High mean SAD/MAC scores were seen in severe (3-vessel) below-ankle disease (&lt;em&gt;P&lt;/em&gt; = 0.001∗ [SAD], &lt;em&gt;P&lt;/em&gt; = 0.041∗ [MAC]). Both SAD and MAC correlated with lower mean toe pressure (&lt;em&gt;P&lt;/em&gt; = 0.043∗ [SAD], &lt;em&gt;P&lt;/em&gt; ≤ 0.001∗ [MAC]), while only MAC correlated with higher overall WIfI score (&lt;em&gt;P&lt;/em&gt; = 0.029∗). No significant procedural differences were noted. However, higher readmission rates (73.9% [2] vs. 46.9% [0], &lt;em&gt;P&lt;/em&gt; = 0.014∗) and all-cause mortality (65.2% [2] vs. 26.0% [0], &lt;em&gt;P&lt;/em&gt; = 0.002∗) were noted with higher MAC. Survival analysis revealed higher 1-year major amputation rates (&lt;em&gt;P&lt;/em&gt; = 0.036∗), impaired wound healing (&lt;em&gt;P&lt;/em&gt; &lt; 0.001∗), and lower AFS (&lt;em&gt;P&lt;/em&gt; = 0.001∗) with increasing MAC severity. Additionally, MAC-2 patients underwent amputation at faster rates than MAC-0 patients (hazard ratio 5.25, 95% confidence interval [1.82, 9.77]) with longer times to wound healing (hazard ratio 0.21, 95% confidence interval [0.08, 0.53]). Model comparison suggested a combination of WIfI and MAC could improve accuracy of predicted time to major amputation, wound healing, and AFS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;MAC scoring showed significant promise both as individual predictor and adjunct to current predictive models of long-term wound healing outcomes. Routine use of MAC scoring in chronic limb-threatening ischemia evaluation, especially when noninvasive testing is unavailable, could promote timely referral for intervention and efficient resource utilization in limited-resource or critical care settin","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 260-275"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Controlling Nutritional Status Score With Mortality in Patients With Chronic Limb-Threatening Ischemia Following Endovascular Revascularization","authors":"Zhanjiang Cao,&nbsp;Zipeng Li,&nbsp;Xiaohua Yu,&nbsp;Yiwen Li,&nbsp;Jiazheng Li,&nbsp;Luhuan Bai,&nbsp;Weiwei Wu","doi":"10.1016/j.avsg.2024.07.103","DOIUrl":"10.1016/j.avsg.2024.07.103","url":null,"abstract":"<div><h3>Background</h3><div>Chronic limb-threatening ischemia (CLTI) represents the severest manifestation of peripheral artery disease. Malnutrition is closely associated with poor clinical outcomes in patients with chronic diseases. The Controlling Nutritional Status (CONUT) score is a tool to evaluate the systemic inflammation and nutritional status. This study aimed to investigate the association of baseline CONUT score with mortality in patients with CLTI following endovascular revascularization.</div></div><div><h3>Methods</h3><div>A single-center retrospective analysis of patients with CLTI undergoing endovascular revascularization between January 2015 and December 2022 was performed. Preoperative nutritional status was evaluated using CONUT score, which was calculated using the serum albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. A CONUT score ≥5 indicates moderate or severe malnutrition. The Kaplan-Meier and multivariate Cox proportional hazards regression were used for survival analysis and to evaluate the risk factors associated with mortality.</div></div><div><h3>Results</h3><div>Among 232 enrolled patients, 20.7% had moderate or severe malnutrition defined by the CONUT score. During a median follow-up of 2.1 (interquartile ranges, 1.0–3.5) years, 87 (37.5%) patients died. The 3-year overall survival rate in patients with CLTI who underwent endovascular revascularization was 63.7%. The high CONUT (≥5) group had significantly worse 3-year overall survival (42.0% vs. 68.8%, <em>P</em> = 0.004) and limb salvage (73.3% vs. 84.1%, <em>P</em> = 0.005) rates than the low CONUT (&lt;5) group. Multivariate analysis showed that high CONUT score was significantly associated with increased risk for mortality in patients with CLTI after endovascular revascularization (hazard ratio, 1.687; 95% confidence interval, 1.031–2.759; <em>P</em> = 0.037).</div></div><div><h3>Conclusions</h3><div>The present study indicated that moderate or severe malnutrition defined by the CONUT score was significantly associated with increased mortality in patients with CLTI following endovascular revascularization. Future study is required to evaluate the efficacy of nutritional intervention in these patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 386-394"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ability of Activated Clotting Time Measurements to Monitor Unfractionated Heparin Activity During NonCardiac Arterial Procedures","authors":"Max Hoebink ,&nbsp;Thomas A.H. Steunenberg ,&nbsp;Liliane C. Roosendaal ,&nbsp;Arno M. Wiersema ,&nbsp;Henrike M. Hamer ,&nbsp;Kak Khee Yeung ,&nbsp;Vincent Jongkind","doi":"10.1016/j.avsg.2024.10.003","DOIUrl":"10.1016/j.avsg.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Activated clotting time (ACT) measurements are frequently used to monitor unfractionated heparin activity during noncardiac arterial procedures (NCAP). Accuracy of ACT-guided heparinization is mandatory to prevent heparin under and overdosing, thereby minimizing thrombo-embolic complications (TECs) and bleeding risk. The main objective of this study was to investigate accuracy of ACT to monitor heparin activity during NCAP using the Hemostasis Management System Plus (HMS) with high-range (HR) cartridges. ACT values were compared with anti-Xa measurements, regarded as the standard test to measure active heparin.</div></div><div><h3>Methods</h3><div>This was a single-center, prospective, observational cohort study. Perioperative blood samples of patients undergoing NCAP between December 2022 and September 2023 were used to perform bedside ACT measurements and anti-Xa assays in the clinical laboratory. Primary outcome was the association between ACT and anti-Xa measurements. TEC, mortality, and bleeding complications within 30 days postoperatively or during primary admission were also scored.</div></div><div><h3>Results</h3><div>196 pairs of ACT and anti-Xa measurements were performed in 34 patients. Strong correlation was observed between anti-Xa and ACT measurements (Pearson’s correlation coefficient = 0.84, 95% CI = 0.79–0.87, <em>P</em> &lt; 0.001). Apart from anti-Xa, no additional variables were associated with ACT in multivariate linear regression analyses (regression coefficient β = 36.7, 95% CI = 33.3–40.1, <em>P</em> &lt; 0.001). Bleeding complications occurred in 29% of the patients, while both TEC and mortality were observed in one patient.</div></div><div><h3>Conclusions</h3><div>Strong correlation and an independent association were observed between heparin activity measured by anti-Xa and ACT using the HMS Plus.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 460-468"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Regional Market Competition and Early Femoropopliteal Interventions for Claudication","authors":"Chen Dun ,&nbsp;M. Libby Weaver ,&nbsp;Sanuja Bose ,&nbsp;David P. Stonko ,&nbsp;Midori White ,&nbsp;Katherine M. McDermott ,&nbsp;James H. Black III ,&nbsp;Corey A. Kalbaugh ,&nbsp;Martin A. Makary ,&nbsp;Caitlin W. Hicks","doi":"10.1016/j.avsg.2024.09.047","DOIUrl":"10.1016/j.avsg.2024.09.047","url":null,"abstract":"<div><h3>Background</h3><div>Regional market competition is known to impact practice patterns in surgical care. We aimed to investigate the association of regional market competition with the utilization of early peripheral vascular interventions (PVIs) for the treatment of claudication, and the subsequent impact on clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 100% Medicare fee-for-service claims data from January 2019 to December 2021 to identify patients with a new diagnosis of claudication. We calculated the Herfindahl-Hirschman Index for all sites of service performing PVI according to Health Service Area. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of regional market competition with early (&lt;6 months) PVI for claudication, and progression to chronic limb-threatening ischemia, repeat PVI, and major amputation.</div></div><div><h3>Results</h3><div>We identified 300,492 patients with a new diagnosis of claudication (mean age 73.8 years, 51.6% male, 11.1% Black), of which 6.1% underwent an early PVI for claudication. Most patients (72.4%) were treated in low-competition markets. After adjusting for patient characteristics, patients treated in moderate-competition markets had the highest odds of receiving an early PVI. Regional market competition was not associated with conversion to chronic limb-threatening ischemia or repeat PVI (<em>P</em> &gt; 0.05), but patients treated in high- (adjusted hazard ratio [aHR] 0.70, 95% confidence interval [CI] 0.56–0.86) and moderate- (aHR 0.82, 95% CI 0.69–0.92) competition markets had lower hazards of major amputation compared to patients treated in low-competition markets. Early PVI was significantly associated with worse clinical outcomes after adjusting for all factors including market competition (all, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>There is a complex interplay between regional market competition, early PVI utilization, and subsequent clinical outcomes for patients with claudication. Early PVI continues to demonstrate a strong association with unfavorable clinical outcomes even when accounting for market competition.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 424-433"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular and Hybrid Interventions for Aortoiliac Occlusive Disease in Patients with Intermittent Claudication","authors":"Levester Kirksey,&nbsp;Khaled I. Alnahhal,&nbsp;Ahmed A. Sorour,&nbsp;Fachreza Aryo Damara,&nbsp;Andrew Smith,&nbsp;Christopher Smolock,&nbsp;Jarrad W. Rowse,&nbsp;Jon G. Quatromoni,&nbsp;Francis J. Caputo,&nbsp;Sean P. Lyden","doi":"10.1016/j.avsg.2024.09.063","DOIUrl":"10.1016/j.avsg.2024.09.063","url":null,"abstract":"<div><h3>Background</h3><div>Significant practice variability exists regarding the management of intermittent claudication (IC) across anatomic segments. We sought to answer the question of whether the safety, efficacy, and durability outcomes of an endovascular approach with or without common femoral endarterectomy for complex aortoiliac occlusive disease (AIOD) justify a surgical approach in patients presenting with IC.</div></div><div><h3>Methods</h3><div>A retrospective single-center review of all patients who were treated using an endovascular approach for AIOD with or without common femoral artery endarterectomy (CFE) from 2010 to 2020 was conducted. The review was limited to those with symptoms of IC. Patient- and limb-level preoperative presentations were reviewed. The outcomes were postoperative complications and patency rates in addition to freedom from re-intervention. Subgroup analyses were conducted to compare patients who underwent endovascular and hybrid procedures.</div></div><div><h3>Results</h3><div>A total of 245 limbs in 180 consecutive patients were analyzed. The mean age was 65 years, and 61% were males. Of 176 patients, 101 (57%) had trans-atlantic inter-society consensus (TASC) class D and 18 (10%) had class C. Eleven limbs (7.4%) had access site complications, 12 (7.9%) had surgical wound complications, and below-the-knee amputation was observed in 2 limbs (0.82%) (2 patients). Two (1.0%) patients had perioperative myocardial infarction (MI), 1 (0.5%) stroke, 1 (0.5%) AKI that progressed to dialysis, and no 30-day mortality. Rutherford's classification was improved during the follow-up period. The 1-, 2-, and 5-year primary patency rates were 94%, 77%, and 58%; primary-assisted patency rates were 98%, 91%, and 79%, respectively; and secondary patency rates were 100% for all follow-up periods. Patients who had concurrent CFE were likely to have hypertension, hyperlipidemia, and anatomically more diffuse disease. No significant differences in patency or reintervention-free survival were observed, though event rates were low in both outcomes and trended toward a protective effect with CFE.</div></div><div><h3>Conclusions</h3><div>Endovascular management for complex AIOD with or without CFE for IC patients is safe, effective, and durable. These results justify an active, patient-centered approach for this advanced anatomic disease pattern. The morbidity of a hybrid approach in the CFE subset is low, and treatment vessel patency is excellent. The presence of anatomically advanced AIOD is not prohibitive for the treatment of patients with IC; however, careful patient selection is essential.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"110 ","pages":"Pages 480-489"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}