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A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2018 Jan; Vol. 67 (1), pp. 199-205.e1. Date of Electronic Publication: 2017 Aug 16. - Publication Year :
- 2018
-
Abstract
- Objective: We sought to analyze the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair by endovascular revascularization and open common femoral endarterectomy (ER-CFE) with open aortoiliac reconstruction and CFE (OR-CFE).<br />Methods: Using the national Society for Vascular Surgery Vascular Quality Initiative database from 2009 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with concomitant infrainguinal procedures were excluded, as were procedures performed at centers with <50% 9-month or longer follow-up. Main outcome variables were 30-day mortality, length of stay, 1-year mortality and patency, ankle-brachial index (ABI), secondary interventions, major amputations, and ambulatory status.<br />Results: After exclusions, the cohort comprised 879 patients in the OR-CFE group and 1472 in the ER-CFE group with follow-up of at least 9 months. Patients with ER-CFE were older (68 ± 9 years vs 63 ± 9 years; P < .001) and were more likely to have diabetes (37% vs 29%; P < .001) or heart failure (13% vs 9%; P < .01). Those receiving OR-CFE were more likely to have received a previous inflow procedure (27% vs 21%; P < .001). A greater number of arterial segments were treated or bypassed for patients undergoing OR-CFE (5.2 ± 1.6 vs 2.9 ± 1.0; P < .01). ER-CFE was associated with lower 30-day mortality (1.8% vs 3.4%; P = .01), shorter length of stay (median 3 vs 7 days; P < .001), and higher 1-year mortality (8.6% vs 6.3%; P = .04). The two cohorts had equivalent major amputation rate (2.8% vs 2.9%; P = .84). Patients with OR-CFE had greater ABI improvement at long-term follow-up (0.39 ± 0.37 vs 0.26 ± 0.23; P < .001) and were more likely to achieve improved ambulatory status (82% vs 65%; P < .001).<br />Conclusions: For patients with aortoiliac-femoral occlusive disease, endovascular repair with concomitant CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, open repair with CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk.<br /> (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Amputation, Surgical statistics & numerical data
Ankle Brachial Index
Endarterectomy methods
Endovascular Procedures methods
Female
Femoral Artery physiopathology
Follow-Up Studies
Humans
Iliac Artery physiopathology
Length of Stay statistics & numerical data
Limb Salvage instrumentation
Limb Salvage methods
Male
Middle Aged
Peripheral Arterial Disease mortality
Reoperation statistics & numerical data
Retrospective Studies
Risk Factors
Stents
Treatment Outcome
Vascular Patency
Endarterectomy adverse effects
Endovascular Procedures adverse effects
Femoral Artery surgery
Iliac Artery surgery
Limb Salvage adverse effects
Peripheral Arterial Disease surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 67
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28822655
- Full Text :
- https://doi.org/10.1016/j.jvs.2017.06.098