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Background: Endovascular aneurysm repair (EVAR) is associated with decreased perioperative morbidity and mortaliy in comparison with open repair, and thus octagenarians are traditionally offered EVAR given their age and medical comorbidities. The aim of this study was to investigate outcomes and predictors of complications associated with EVAR in octogenarians. Methods: We conducted a retrospective chart review of consecutive patients aged 80 years and older who received an EVAR between August 2010 and January 2017 at a single centre in Toronto, Ontario. We conducted univariate comparisons and then completed logistic regression to determine predictors of complications. We used Kaplan--Meier analysis to explore survival times. Results: A total of 154 octogenarians underwent an EVAR during the study period for an infrarenal aneurysm with a mean size of 64.8 (standard deviation [SD] 12.7) mm. The mean age of the patients was 84.1 (SD 3.7) years, and most patients (81%) were men. Eighteen patients presented with a ruptured abdominal aortic aneurysm (AAA). Ninety-five (62%) patients sustained a complication. Fifty percent of patients experienced an intraoperative complication. A majority of these (77%) resulted in an endoleak, with type II endoleaks requiring no further intervenion being the most common (58%, n = 45). The remaining complications (n = 70) occurred postoperatively, with myocardial ischemia (n = 24) and dysrhythmias (n = 10) being the most common. Past aortic surgery ([chi square] = 8.62, p = 0.014, Cramer V = 0.27) was found to be a multivariate predictor of complications. Most patients (88%) continued follow-up to an average of 20.9 months. Twenty-one patients (13%) died. Nine of these deaths (43%) occurred during the index admission and involved a ruptured AAA. Past aortic surgery was the only predictor of vascular complications. The mean survival time after EVAR was 57.63 months for patients without events. Conclusion: Endovascular aneurysm repair in octogenarians is a suitable form of therapy with acceptable short- and long-term results in the elective setting. Past aortic surgery was a predictor of complications in this population. Contexte : La réparation endovasculaire de l'anévrisme (REVA) est associée à une diminution de la morbidité et de la mortalité périopératoires comparativement à la chirurgie ouverte, c'est pourquoi on offre habituellement la REVA aux octogénaires, compte tenu de leur âge et de leurs comorbidités. Le but de cette étude était d'analyser l'issue de la REVA et les prédicteurs de complications chez les octogénaires. Méthodes : Nous avons procédé à une analyse rétrospective des dossiers de patients de 80 ans et plus consécutifs soumis à une REVA entre août 2010 et janvier 2017 dans un établissement de Toronto, en Ontario. Nous avons effectué des comparaisons univariées, puis une analyse de régression logistique pour dégager les prédicteurs de complications. C'est l'analyse de Kaplan--Meier qui a permis d'explorer la survie. Résultats : En tout, pendant la période de l'étude, 154 octogénaires ont subi une REVA pour un anévrisme infrarénal dont la dimension moyenne était de 64,8 mm (écart-type [É.-T.] 12,7 mm). L'âge moyen des patients était de 84,1 ans (É.-T. 3,7 ans) et la majorité des patients (81 %) étaient des hommes. Dix-huit patients ont présenté une rupture d'anévrisme de l'aorte abdominale (AAA). Quatre-vingt-quinze patients (62 %) ont connu une complication. Cinquante pour cent des patients ont eu une complication peropératoire. Une majorité des complications (77%) ont causé des endofuites, le plus fréquemment de type II, ne nécessitant pas d'autres interventions (58 %, n = 45). Les autres complications (n = 70) sont survenues en période postopératoire et les plus fréquentes ont été l'ischémie myocardique (n = 24) et la dysrythmie (n = 10). Des antécédents de chirurgie à l'aorte ([chi square] = 8,62, p = 0,014, test V de Cramer = 0,27) se sont révélés être un prédicteur multivarié de complications. La plupart des patients (88 %) ont maintenu le suivi pendant une durée moyenne de 20,9 mois. Vingt-et-un patients (13 %) sont décédés. Neuf de ces décès (43 %) se sont produits pendant l'admission index et impliquaient une rupture de l'AAA. Des antécédents de chirurgie à l'aorte ont été le seul prédicteur des complications vasculaires. La survie moyenne après la REVA a été de 57,63 mois pour les patients n'ayant présenté aucune complication. Conclusion : La REVA est une forme de traitement qui convient aux octogénaires et qui donne des résultats acceptables à court et à long terme dans un contexte de chirurgie non urgente. Des antécédents de chirurgie à l'aorte se sont révélés être un prédicteur de complications dans cette population., Life expectancy for Canadians has increased steadily, with the 2017 census reporting an average of 80.7 years. (1) Imaging has revealed that the prevalence of abdominal aortic aneurysms (AAAs) rises [...]

Background: The Society for Vascular Surgery Vascular Quality Initiative (SVS-SVQI) is a database that provides insight into standards of care and highlights opportunities for quality improvement by benchmarking institutional data against local, regional and national trends. Endovascular aneurysm repair (EVAR) is a frequently performed vascular operation. Postoperative length of stay in hospital (LOS) varies among institutions. We reviewed the morbidity and mortality of patients who underwent EVAR at our institution and the financial impact of increased LOS for these patients. In addition, we sought to identify modifiable factors associated with prolonged LOS. Methods: We identified all patients who underwent elective EVAR between Jan. 1, 2011, and Dec. 31, 2014. Preoperative patient characteristics, intraoperative details, postoperative factors, long-term (1 yr) outcomes and cost data were reviewed. Univariate analysis was used to determine statistical differences between patients with LOS less than or equal to 2 days and greater than 2 days. Interventions were implemented to modify factors identified as having a negative impact on EVAR LOS. Results: Identified factors that negatively affected EVAR LOS included social, neurologic, cardiovascular, urologic and renal issues. Following targeted interventions, LOS after EVAR decreased from an average of 3.8 to 3.0 days (p < 0.05). Logistic regression (n = 124) identified cardiovascular issues as the most significant predictor of LOS greater than 2 days (p = 0.001, odds ratio 14.24, 95% confidence interval 2.8-71.4). Reduction in LOS was associated with the additional benefit of 6.6% adjusted cost savings. Conclusion: By leveraging SVS-VQI data, we were able to reduce EVAR LOS by identifying modifiable factors and instituting focused interventions. The reduction in LOS was associated with cost savings to the hospital. Contexte : L'Initiative pour la qualite de la chirurgie vasculaire de la Societe canadienne de chirurgie vasculaire (IQCV-SCCV) est une base de donnees qui donne un apercu des normes therapeutiques et souligne les possibilites d'ameliorations de la qualite en faisant la comparaison entre les tendances institutionnelles et les tendances locales, regionales et nationales. La reparation endovasculaire d'anevrisme (REVA) est une intervention frequente. La duree du sejour hospitalier postoperatoire varie d'un etablissement a l'autre. Nous avons examine la morbidite et la mortalite chez les patients ayant subi une REVA dans notre etablissement et mesure l'impact economique d'un sejour hospitalier prolonge chez ces patients. De plus, nous avons tente de degager les facteurs modifiables associes a un sejour prolonge. Methodes : Nous avons recense tous les patients ayant subi une REVA entre le 1er janvier 2011 et le 31 decembre 2014. Nous avons pris en compte les caracteristiques preoperatoires des patients, les details peroperatoires, les facteurs postoperatoires, les resultats a long terme (1 an) et les couts. Une analyse univariee a servi a determiner les differences statistiques entre les patients ayant sejourne a l'hopital 2 jours ou moins et plus de 2 jours. Des interventions ont ete appliquees pour modifer les facteurs reconnus pour leur impact negatif sur le sejour hospitalier apres une REVA. Resultats : Les facteurs identifes pour leur effet negatif sur le sejour hospitalier apres une REVA etaient entre autres problemes sociaux, neurologiques, cardiovasculaires, urologiques et renaux. Apres l'application d'interventions ciblees, la duree du sejour hospitalier post-REVA a diminue d'une moyenne de 3,8 a 3,0 jours (p < 0,05). La regression logistique (n = 124) a permis d'identifer les problemes cardiovasculaires comme principaux predicteurs d'un sejour hospitalier de plus de 2 jours (p = 0,001, rapport des cotes 14,24, intervalle de confance de 95 % 2,8-71,4). L'abregement du sejour hospitalier a ete associe a un avantage additionnel de 6,6 % en economies de couts ajustees. Conclusion : Apres analyse des donnees de l'IQCV-SCCV, nous avons reussi a abreger la duree des sejours hospitaliers pour REVA en identifant les facteurs modifiables et en appliquant des interventions ciblees. L'abregement des sejours hospitaliers a ete associe a des economies pour l'hopital., Health care is the single largest budget item for every province and territory in Canada. In 2019, total health expenditure in Canada is expected to reach $264 billion, or $7068 [...]

Background: Patients who undergo vascular surgery are burdened by high early readmission rates. We examined the frequency and cause of early readmissions after elective and emergent admission to the vascular surgery service at our institution to identify modifiable targets for quality improvement. Methods: Over a 5-year period, all patients admitted and readmitted to the vascular surgery service were identified. Medical records were then individually reviewed to identify baseline characteristics from the index admission and the most responsible diagnosis for readmission within 28 days of discharge. Results: Of a total of 3324 patients, 421 (12.7%) were readmitted to our institution within 28 days of discharge. Forty-seven were found to have more than 1 readmission following their index admission. The readmission rate ranged from 11.8% to 14.1% over the 5-year study period, resulting in an average readmission rate of 12.7%. There were similar rates for men (12.9%) and women (12.3%). Of the readmitted cases, 236 (63.1%) were unplanned readmissions. The most common diagnoses for unplanned readmissions were worsening of peripheral arterial disease status including complications related to peripheral bypass graft (30.9%), surgical site infections (15.3%) and nonsurgical infections (14.8%). Conclusion: To reduce readmission rates effectively, institutions must identify high-risk patients. In our study cohort, the most frequent pathology resulting in readmission was peripheral arterial disease. The most frequent preventable reason for readmission was surgical site infection. Interventions focused on early assessment of clinical status and wounds in addition to avoidance of infectious complications could help reduce readmission rates. Preventive resources can be efficiently targeted by focusing on subgroups at risk for readmission. Contexte: Les patients soumis a une chirurgie vasculaire presentent malheureusement un taux eleve de readmission precoce. Nous avons analyse la frequence et les causes de readmission precoce apres une admission urgente ou non urgente au service de chirurgie vasculaire afin d'identifier les facteurs modifiables en vue d'ameliorer la qualite des soins. Methodes: Sur une periode de 5 ans, tous les patients admis, puis readmis au service de chirurgie vasculaire ont ete identifies. On a ensuite passe en revue individuellement les dossiers medicaux pour relever les caracteristiques de base a l'admission initiale et le diagnostic ayant le plus probablement justifie la readmission dans les 28 jours suivant le conge. Resultats: Sur un total de 3324 patients, 421 (12,7%) ont ete readmis a notre etablissement dans les 28 jours suivant leur conge. Quarante-sept ont ete readmis plus d'une fois apres leur hospitalisation initiale. Le taux de readmission a varie de 11,8% a 14,1% pendant la periode de 5 ans de l'etude, le taux moyen de readmission etant de 12,7%. Les taux etaient similaires chez les hommes (12,9%) et les femmes (12,3%). Parmi les cas readmis, 236 (63,1%) etaient imprevus. Les diagnostics ayant le plus souvent justifie une readmission imprevue etaient aggravation de la maladie arterielle peripherique (y compris complications au niveau de pontages arteriels peripheriques) (30,9%), infection du site operatoire (15,3%) et infections non chirurgicales (14,8%). Conclusion: Pour reduire efficacement les taux de readmission, les etablissements doivent identifier les patients a haut risque. Dans notre cohorte, la pathologie ayant le plus souvent mene a une readmission etait la maladie arterielle peripherique. La raison evitable la plus frequente etait l'infection du site operatoire. Les interventions axees sur une evaluation rapide de l'etat clinique et de l'etat des plaies, ainsi que la prevention des complications infectieuses pourraient contribuer a reduire les taux de readmission. Des mesures preventives pourraient cibler judicieusement les groupes a risque de readmission., Hospital readmission has become a focus of quality improvement initiatives because of the associated burden on patients and the health care system. Many studies have found that unplanned readmissions are [...]

The Vascular Quality Initiative (VQI) is a national cooperative quality-improvement initiative designed to evaluate processes of care and outcomes in vascular surgery. The purpose of this report is to show the utility of such a database to provide insight into the standard of care provided, to highlight areas of local quality improvement, to benchmark our data against local, regional and national trends, and to ultimately improve safety in Canadian patients undergoing vascular surgery. We present the history of the database, its spread in the Canadian health care system and examples of quality improvements achieved from analyses of data recorded and retrieved from the VQI. Using the VQI, our institution was able to decrease the length of stay after endovascular aneurysm repair, decrease the contrast volume in endovascular aneurysm repair, save on costs, and provide medium-term outcome data on peripheral vascular interventions and smoking cessation strategies. The VQI is a powerful tool to improve patient safety and quality in vascular surgery. Its ability to create local regional improvement groups fosters a quality-focused culture and is important for Canadian patients.La Vascular Quality Initiative (VQI) est une initiative de collaboration nationale axee sur l'amelioration de la qualite, concue pour evaluer les processus de soins et les resultats en chirurgie vasculaire. Le but du present rapport est de montrer l'utilite d'une telle base de donnees pour situer les normes de soins actuelles, mettre en lumiere les secteurs d'amelioration de la qualite locale, evaluer nos donnees a la lumiere des tendances locales, regionales et nationales et ultimement, ameliorer la securite des patients canadiens de chirurgie vasculaire. Nous retracons l'historique de cette base de donnees, son adoption par le systeme de sante canadien et donnons des exemples d'ameliorations de la qualite obtenues grace a l'analyse des donnees enregistrees et recuperees a partir de la base VQI. Cette base de donnees nous a permis d'abreger les sejours hospitaliers apres la reparation endovasculaire des anevrismes, d'epargner sur les couts et de compiler les resultats a moyen terme des interventions vasculaires peripheriques et des strategies d'abandon du tabagisme. La VQI est un outil puissant pour ameliorer la securite des patients et la qualite de la chirurgie vasculaire. Sa capacite de creer des groupes loco-regionaux d'amelioration de la qualite favorise une culture axee sur la qualite et est importante pour les patients canadiens., In the age of advanced surgical procedures for complex diseases, patient safety and quality improvement are at the forefront of effective patient-centred care. In the United States and Canada, 2 [...]

Objective: Profunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare but clinically significant diseases of the peripheral arterial vasculature. Our aim is to describe our institution's 15-year experience with PFAAs (TPFAAs and PFA PSAs) to provide insight into patient characteristics, diagnostic imaging modalities, and surgical interventions that contribute to clinically important outcomes in patients with PFAAs. Methods: We conducted a retrospective study at our institution using our radiology database. Results: We identified six patients with PFA PSAs and four patients with TPFAAs. The clinical presentation of PFA PSAs included a triad of thigh pain, bleeding, and unexplained anemia. There was variety in the aetiologies of PFA PSAs, arising from catheterizations, upper thigh fractures, anastomotic complications, or unknown causes. Most patients with PFA PSAs had hypertension and coronary artery disease, and half of our cohort had peripheral vascular disease. All patients were imaged with duplex ultrasonography (DUS) or computed tomography (CT), the latter being more accurate. All patients with PFA PSAs underwent endovascular treatment, including glue, thrombin, or coil embolization as well as stent-graft insertions. All TPFAAs presented to our center were small and incidentally discovered, explaining the conservative management of our TPFAAs. Two of the four TPFAAs were idiopathic in nature, while one was attributed to post-stenotic dilatation, and another was found in a patient with Ehlers Danlos Syndrome. There was an association between TPFAAs and multiple synchronous or asynchronous aneurysms. Conclusion: Pseudoaneurysms of the PFA are mostly iatrogenic in nature and can present with the triad of thigh swelling, bleeding, and unexplained anemia. If the clinical picture is suggestive of a PFA PSA but DUS does not detect a pseudoaneurysm, CT may be added as a more accurate imaging modality. Endovascular embolization is used in smaller pseudoaneurysms and in poor surgical candidates. Multiple glue, coil, or thrombin injections may be required to fully thrombose the pseudoaneurysm sac. True aneurysms of the PFA are associated with synchronous/asynchronous aneurysms and small TPFAAs should be carefully monitored, as there is a risk of enlargement and rupture. [ABSTRACT FROM AUTHOR]