Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era
Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era....
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| Veröffentlicht in: | Annals of vascular surgery 2020-01, Vol.62, p.21-29 |
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| creator | DeCarlo, Charles Boitano, Laura T. Schwartz, Samuel I. Lancaster, R. Todd Conrad, Mark F. Eagleton, Matthew J. Brewster, David C. Clouse, W. Darrin |
| description | Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era.
Data for patients undergoing primary ABF from 2000 to 2017 were queried. Primary endpoints included major complication (unplanned return to the operating room, life-or-limb-threatening complications, and 30-day readmission or death) and long-term survival. Logistic regression and Cox proportional hazard models determined predictors of primary endpoints. Kaplan-Meier analysis estimated patency, freedom from reintervention, and long-term survival.
During these 17 years, 256 patients underwent primary ABF. Mean age was 67.9 ± 10.6 years and 51.2% were women. Most had claudication (69.5%); 28.9% had critical ischemia. Sixty-five (25.4%) patients had prior aortoiliac endovascular intervention, 106 (41.4%) required aortic cuff endarterectomy, 111 (43.3%) femoral outflow adjunct, 9 (3.5%) simultaneous lower extremity bypass, and 230 (89.8%) had Trans-Atlantic Inter-Society Consensus D lesions. Concomitant renovisceral revascularization was needed in 42 (16.4%) patients. Thirty-day mortality was 2.7%. Major complication occurred in 92 patients (35.9%). Predictors included prior endovascular intervention (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.2–4.1; P = 0.01), malignancy (OR, 2.6; 95% CI: 1.3–5.3; P = 0.01), intraoperative complication (OR, 3.3; 95% CI: 1.3–9.2; P = 0.03), operative blood loss, (OR, 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.03), and cuff endarterectomy (OR, 1.8; 95% CI: 1.0–3.1; P = 0.04). Median follow-up was 5.3 years (interquartile range: 7.2 years). Survival at 1, 3, and 5 years was 94%, 90%, and 82% respectively. Primary patency and freedom from reintervention at 5 years were 76% and 79%, respectively. Predictors of late mortality included malignancy (hazard ratio [HR], 2.3; 95% CI: 1.3–3.9; P |
| doi_str_mv | 10.1016/j.avsg.2019.03.040 |
| format | Article |
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Data for patients undergoing primary ABF from 2000 to 2017 were queried. Primary endpoints included major complication (unplanned return to the operating room, life-or-limb-threatening complications, and 30-day readmission or death) and long-term survival. Logistic regression and Cox proportional hazard models determined predictors of primary endpoints. Kaplan-Meier analysis estimated patency, freedom from reintervention, and long-term survival.
During these 17 years, 256 patients underwent primary ABF. Mean age was 67.9 ± 10.6 years and 51.2% were women. Most had claudication (69.5%); 28.9% had critical ischemia. Sixty-five (25.4%) patients had prior aortoiliac endovascular intervention, 106 (41.4%) required aortic cuff endarterectomy, 111 (43.3%) femoral outflow adjunct, 9 (3.5%) simultaneous lower extremity bypass, and 230 (89.8%) had Trans-Atlantic Inter-Society Consensus D lesions. Concomitant renovisceral revascularization was needed in 42 (16.4%) patients. Thirty-day mortality was 2.7%. Major complication occurred in 92 patients (35.9%). Predictors included prior endovascular intervention (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.2–4.1; P = 0.01), malignancy (OR, 2.6; 95% CI: 1.3–5.3; P = 0.01), intraoperative complication (OR, 3.3; 95% CI: 1.3–9.2; P = 0.03), operative blood loss, (OR, 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.03), and cuff endarterectomy (OR, 1.8; 95% CI: 1.0–3.1; P = 0.04). Median follow-up was 5.3 years (interquartile range: 7.2 years). Survival at 1, 3, and 5 years was 94%, 90%, and 82% respectively. Primary patency and freedom from reintervention at 5 years were 76% and 79%, respectively. Predictors of late mortality included malignancy (hazard ratio [HR], 2.3; 95% CI: 1.3–3.9; P < 0.01), chronic obstructive pulmonary disease (HR, 1.8; 95% CI: 1.1–3.1; P = 0.02), congestive heart failure (HR, 2.3; 95% CI: 1.2–4.3; P = 0.01), Rutherford's class (HR, 1.5; 95% CI: 1.1–2.1; P = 0.01), operative blood loss (HR 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.04) and chronic kidney disease (HR, 2.3; 95% CI: 1.2–4.2; P = 0.01).
Although late outcomes after ABF in the contemporary era remain acceptable, major complications are frequent. Operative complexity and prior endovascular revascularization predict complications. Long-term survival is driven by degree of limb ischemia and comorbidities. These should be considered in selection for ABF, potentially modifying approach to improve outcomes.</description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2019.03.040</identifier><identifier>PMID: 31201980</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Aortic Diseases - diagnostic imaging ; Aortic Diseases - mortality ; Aortic Diseases - physiopathology ; Aortic Diseases - surgery ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - mortality ; Arterial Occlusive Diseases - physiopathology ; Arterial Occlusive Diseases - surgery ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Female ; Femoral Artery - diagnostic imaging ; Femoral Artery - physiopathology ; Femoral Artery - surgery ; Humans ; Iliac Artery - diagnostic imaging ; Iliac Artery - physiopathology ; Iliac Artery - surgery ; Male ; Middle Aged ; Postoperative Complications - etiology ; Progression-Free Survival ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Vascular Grafting - adverse effects ; Vascular Grafting - methods ; Vascular Grafting - mortality ; Vascular Patency</subject><ispartof>Annals of vascular surgery, 2020-01, Vol.62, p.21-29</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-79c1c705f2c13c766df06a0e04a4a36d7b3410e4ed44f622af6bb61ed998204c3</citedby><cites>FETCH-LOGICAL-c356t-79c1c705f2c13c766df06a0e04a4a36d7b3410e4ed44f622af6bb61ed998204c3</cites><orcidid>0000-0001-7552-2290 ; 0000-0001-9714-4251</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.avsg.2019.03.040$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31201980$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeCarlo, Charles</creatorcontrib><creatorcontrib>Boitano, Laura T.</creatorcontrib><creatorcontrib>Schwartz, Samuel I.</creatorcontrib><creatorcontrib>Lancaster, R. Todd</creatorcontrib><creatorcontrib>Conrad, Mark F.</creatorcontrib><creatorcontrib>Eagleton, Matthew J.</creatorcontrib><creatorcontrib>Brewster, David C.</creatorcontrib><creatorcontrib>Clouse, W. Darrin</creatorcontrib><title>Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description>Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era.
Data for patients undergoing primary ABF from 2000 to 2017 were queried. Primary endpoints included major complication (unplanned return to the operating room, life-or-limb-threatening complications, and 30-day readmission or death) and long-term survival. Logistic regression and Cox proportional hazard models determined predictors of primary endpoints. Kaplan-Meier analysis estimated patency, freedom from reintervention, and long-term survival.
During these 17 years, 256 patients underwent primary ABF. Mean age was 67.9 ± 10.6 years and 51.2% were women. Most had claudication (69.5%); 28.9% had critical ischemia. Sixty-five (25.4%) patients had prior aortoiliac endovascular intervention, 106 (41.4%) required aortic cuff endarterectomy, 111 (43.3%) femoral outflow adjunct, 9 (3.5%) simultaneous lower extremity bypass, and 230 (89.8%) had Trans-Atlantic Inter-Society Consensus D lesions. Concomitant renovisceral revascularization was needed in 42 (16.4%) patients. Thirty-day mortality was 2.7%. Major complication occurred in 92 patients (35.9%). Predictors included prior endovascular intervention (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.2–4.1; P = 0.01), malignancy (OR, 2.6; 95% CI: 1.3–5.3; P = 0.01), intraoperative complication (OR, 3.3; 95% CI: 1.3–9.2; P = 0.03), operative blood loss, (OR, 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.03), and cuff endarterectomy (OR, 1.8; 95% CI: 1.0–3.1; P = 0.04). Median follow-up was 5.3 years (interquartile range: 7.2 years). Survival at 1, 3, and 5 years was 94%, 90%, and 82% respectively. Primary patency and freedom from reintervention at 5 years were 76% and 79%, respectively. Predictors of late mortality included malignancy (hazard ratio [HR], 2.3; 95% CI: 1.3–3.9; P < 0.01), chronic obstructive pulmonary disease (HR, 1.8; 95% CI: 1.1–3.1; P = 0.02), congestive heart failure (HR, 2.3; 95% CI: 1.2–4.3; P = 0.01), Rutherford's class (HR, 1.5; 95% CI: 1.1–2.1; P = 0.01), operative blood loss (HR 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.04) and chronic kidney disease (HR, 2.3; 95% CI: 1.2–4.2; P = 0.01).
Although late outcomes after ABF in the contemporary era remain acceptable, major complications are frequent. Operative complexity and prior endovascular revascularization predict complications. Long-term survival is driven by degree of limb ischemia and comorbidities. These should be considered in selection for ABF, potentially modifying approach to improve outcomes.</description><subject>Aged</subject><subject>Aortic Diseases - diagnostic imaging</subject><subject>Aortic Diseases - mortality</subject><subject>Aortic Diseases - physiopathology</subject><subject>Aortic Diseases - surgery</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - mortality</subject><subject>Arterial Occlusive Diseases - physiopathology</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Femoral Artery - diagnostic imaging</subject><subject>Femoral Artery - physiopathology</subject><subject>Femoral Artery - surgery</subject><subject>Humans</subject><subject>Iliac Artery - diagnostic imaging</subject><subject>Iliac Artery - physiopathology</subject><subject>Iliac Artery - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - etiology</subject><subject>Progression-Free Survival</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Vascular Grafting - adverse effects</subject><subject>Vascular Grafting - methods</subject><subject>Vascular Grafting - mortality</subject><subject>Vascular Patency</subject><issn>0890-5096</issn><issn>1615-5947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1u1DAURi1ERYfCC7BAXrJJuHYcJ5HYlNEAI_WHBawtx74pHiVxsD1RZ9snJ9MpXXZ1N-d80j2EfGCQM2Dy8y7Xc7zLObAmhyIHAa_IiklWZmUjqtdkBXUDWQmNPCdvY9wBMF6L-g05L9hRqmFFHm4nDDq5GenaD1OP9y4dqB4t_RmcD3QzWj_raPa9DnQ7Jgwzjsn5kd7g3aPXH-h2mLRJ9NqH1tlHv1tAeulD8q3rcPBB9_TrYdIxUjfS9AcX2GIY6Sbod-Ss033E90_3gvz-tvm1_pFd3X7fri-vMlOUMmVVY5ipoOy4YYWppLQdSA0IQgtdSFu1hWCAAq0QneRcd7JtJUPbNDUHYYoL8um0OwX_d48xqcFFg32vR_T7qDgvayYrVtcLyk-oCT7GgJ2aght0OCgG6the7dSxvTpmVFCopf0ifXza37cD2mflf-wF-HICcPlydhhUNA5Hg9YFNElZ717a_weL7pfM</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>DeCarlo, Charles</creator><creator>Boitano, Laura T.</creator><creator>Schwartz, Samuel I.</creator><creator>Lancaster, R. Todd</creator><creator>Conrad, Mark F.</creator><creator>Eagleton, Matthew J.</creator><creator>Brewster, David C.</creator><creator>Clouse, W. Darrin</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7552-2290</orcidid><orcidid>https://orcid.org/0000-0001-9714-4251</orcidid></search><sort><creationdate>202001</creationdate><title>Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era</title><author>DeCarlo, Charles ; Boitano, Laura T. ; Schwartz, Samuel I. ; Lancaster, R. Todd ; Conrad, Mark F. ; Eagleton, Matthew J. ; Brewster, David C. ; Clouse, W. Darrin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-79c1c705f2c13c766df06a0e04a4a36d7b3410e4ed44f622af6bb61ed998204c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aortic Diseases - diagnostic imaging</topic><topic>Aortic Diseases - mortality</topic><topic>Aortic Diseases - physiopathology</topic><topic>Aortic Diseases - surgery</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - mortality</topic><topic>Arterial Occlusive Diseases - physiopathology</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Femoral Artery - diagnostic imaging</topic><topic>Femoral Artery - physiopathology</topic><topic>Femoral Artery - surgery</topic><topic>Humans</topic><topic>Iliac Artery - diagnostic imaging</topic><topic>Iliac Artery - physiopathology</topic><topic>Iliac Artery - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications - etiology</topic><topic>Progression-Free Survival</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Vascular Grafting - adverse effects</topic><topic>Vascular Grafting - methods</topic><topic>Vascular Grafting - mortality</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeCarlo, Charles</creatorcontrib><creatorcontrib>Boitano, Laura T.</creatorcontrib><creatorcontrib>Schwartz, Samuel I.</creatorcontrib><creatorcontrib>Lancaster, R. Todd</creatorcontrib><creatorcontrib>Conrad, Mark F.</creatorcontrib><creatorcontrib>Eagleton, Matthew J.</creatorcontrib><creatorcontrib>Brewster, David C.</creatorcontrib><creatorcontrib>Clouse, W. Darrin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DeCarlo, Charles</au><au>Boitano, Laura T.</au><au>Schwartz, Samuel I.</au><au>Lancaster, R. Todd</au><au>Conrad, Mark F.</au><au>Eagleton, Matthew J.</au><au>Brewster, David C.</au><au>Clouse, W. Darrin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2020-01</date><risdate>2020</risdate><volume>62</volume><spage>21</spage><epage>29</epage><pages>21-29</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract>Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era.
Data for patients undergoing primary ABF from 2000 to 2017 were queried. Primary endpoints included major complication (unplanned return to the operating room, life-or-limb-threatening complications, and 30-day readmission or death) and long-term survival. Logistic regression and Cox proportional hazard models determined predictors of primary endpoints. Kaplan-Meier analysis estimated patency, freedom from reintervention, and long-term survival.
During these 17 years, 256 patients underwent primary ABF. Mean age was 67.9 ± 10.6 years and 51.2% were women. Most had claudication (69.5%); 28.9% had critical ischemia. Sixty-five (25.4%) patients had prior aortoiliac endovascular intervention, 106 (41.4%) required aortic cuff endarterectomy, 111 (43.3%) femoral outflow adjunct, 9 (3.5%) simultaneous lower extremity bypass, and 230 (89.8%) had Trans-Atlantic Inter-Society Consensus D lesions. Concomitant renovisceral revascularization was needed in 42 (16.4%) patients. Thirty-day mortality was 2.7%. Major complication occurred in 92 patients (35.9%). Predictors included prior endovascular intervention (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.2–4.1; P = 0.01), malignancy (OR, 2.6; 95% CI: 1.3–5.3; P = 0.01), intraoperative complication (OR, 3.3; 95% CI: 1.3–9.2; P = 0.03), operative blood loss, (OR, 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.03), and cuff endarterectomy (OR, 1.8; 95% CI: 1.0–3.1; P = 0.04). Median follow-up was 5.3 years (interquartile range: 7.2 years). Survival at 1, 3, and 5 years was 94%, 90%, and 82% respectively. Primary patency and freedom from reintervention at 5 years were 76% and 79%, respectively. Predictors of late mortality included malignancy (hazard ratio [HR], 2.3; 95% CI: 1.3–3.9; P < 0.01), chronic obstructive pulmonary disease (HR, 1.8; 95% CI: 1.1–3.1; P = 0.02), congestive heart failure (HR, 2.3; 95% CI: 1.2–4.3; P = 0.01), Rutherford's class (HR, 1.5; 95% CI: 1.1–2.1; P = 0.01), operative blood loss (HR 1.0 per 100 ml; 95% CI: 1.0–1.0; P = 0.04) and chronic kidney disease (HR, 2.3; 95% CI: 1.2–4.2; P = 0.01).
Although late outcomes after ABF in the contemporary era remain acceptable, major complications are frequent. Operative complexity and prior endovascular revascularization predict complications. Long-term survival is driven by degree of limb ischemia and comorbidities. These should be considered in selection for ABF, potentially modifying approach to improve outcomes.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>31201980</pmid><doi>10.1016/j.avsg.2019.03.040</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7552-2290</orcidid><orcidid>https://orcid.org/0000-0001-9714-4251</orcidid></addata></record> |
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| ispartof | Annals of vascular surgery, 2020-01, Vol.62, p.21-29 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Aortic Diseases - diagnostic imaging Aortic Diseases - mortality Aortic Diseases - physiopathology Aortic Diseases - surgery Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - mortality Arterial Occlusive Diseases - physiopathology Arterial Occlusive Diseases - surgery Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Femoral Artery - diagnostic imaging Femoral Artery - physiopathology Femoral Artery - surgery Humans Iliac Artery - diagnostic imaging Iliac Artery - physiopathology Iliac Artery - surgery Male Middle Aged Postoperative Complications - etiology Progression-Free Survival Reoperation Retrospective Studies Risk Assessment Risk Factors Time Factors Vascular Grafting - adverse effects Vascular Grafting - methods Vascular Grafting - mortality Vascular Patency |
| title | Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era |
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