R. Nicholas Nolte, MD1, Ravishankar Hasanadka, MD2

Slides:

Advertisements

Similar presentations

Does Preoperative Hemoglobin Value Predict Postoperative Cardiovascular Complications after Total Joint Arthroplasty? Kishor Gandhi MD, MPH, Eugene Viscusi.

Advertisements

For the motion: Endovascular Therapy is a better option for limb salvage in diabetic ulcer treatment Dr. Prasad Jetty Division of Vascular and Endovascular.

CVT 102.  Time  Distance  Shielding.

The Radial Approach to Percutaneous Coronary Intervention Is Associated With a Lower Risk for Complications Regardless of Radial Procedure Volume: A Report.

Factors influencing treatment decisions for coronary artery disease after cardiac catheterization American Heart Association November 18, 2013 Dallas,

Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:

Trends and Characteristics of Caucasian, Indian & Pakistani Patients Undergoing Coronary Angioplasty St. Mary’s Hospital PTCA Registry.

Disclosures The presenter has no financial involvement with the product or competing products being discussed. The presenter received travel and lodging.

A Novel Score to Estimate the Risk of Pneumonia After Cardiac Surgery

Transradial Approach [LEft vs right] aNd procedural Times during percutaneous coronary procedures: TALENT study ALESSANDRO SCIAHBASI, MD UO Cardiologia,

Vitamin D: A New Frontier in Diabetes Management Contact Information: Background Acknowledgement Methods.

Peripheral Artery Disease in Orthopaedic Patients with Asymptomatic Popliteal Artery Calcification on Plain X-ray Adam Podet, MS; Julia Volaufova, phD,;

Dr. Quan, Dr. Mirhashemi, Dr. Chiang

Long-Term Comparative Outcomes of Patients With Peripheral Artery Disease With and Without Concomitant Coronary Artery Disease Debbie C. Chen1, Gagan.

－ Higher SBP visit-to-visit variability (SBV) has been associated

Unplanned Return to OR in a Level 1 Trauma Center

What´s New in the Literature on Transradial Intervention

PCI related in-hospital mortality based on race and gender in the USA

The Association between Prehospital Time Intervals and ST-Elevation Myocardial Infarction System Performance.

Women, Bleeding, and Coronary Intervention

Successful CTO PCI Associated with Lower Mortality Risk

Are We Moving Away from Surgery for the Common Femoral Lesion?

Excimer Laser Atherectomy for the Treatment of Infra-inguinal Peripheral Arterial Disease Bryan P Yan MD, Thomas J Kiernan MD, Vishal Gupta MD,

Percutaneous Reconstruction of the Aortoiliac Bifurcation

The Hidden Cost of Underutilizing PCI for Chronic Total Occlusions

Pediatric Central Venous Catheters In Patients Less Than Two Years Of Age: Do Complication Rates Differ Between Tunneled IJ, Tunneled Femoral, and PICCs?

Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures

Advising complex patients who require complex heart operations

Patterns of procedure-specific radiation exposure in the endovascular era: Impetus for further innovation Mohsen Bannazadeh, MD, Ozcan Altinel, MD, Vikram.

REGISTRY ASSESSMENT OF PERIPHERAL INTERVENTIONAL DEVICES (RAPID): Superficial femoral and Popliteal EvidencE Development (SPEED) A NEST Coordinating.

RAPID and VISION September 10, 2018 VISION Think Tank Meeting

The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement.

Benefit of immediate revascularization in women with critical limb ischemia in an intention-to-treat analysis Jana Ortmann, MD, Eveline Nüesch, PhD,

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative Peter A. Soden, MD, Sara.

Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease Hasan H. Dosluoglu, MD, Purandath Lall,

Higher body mass index is associated with more adverse changes in calf muscle characteristics in peripheral arterial disease Zankhana Raval, MD, Kiang.

Surgical or endovascular revascularization in patients with critical limb ischemia: Influence of diabetes mellitus on clinical outcome Florian Dick,

Jason Zakko, BA, Salvatore Scali, MD, Adam W. Beck, MD, Charles T

Elevated serum cystatin C level is an independent predictor of contrast-induced nephropathy and adverse outcomes in patients with peripheral artery disease.

Nimarta Singh, BA, Kiang Liu, PhD, Lu Tian, ScD, Michael H

Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms Nicolas Attigah, MD, Kyriakos Oikonomou, MD,

Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients Christopher D.

Molly E. Waring, PhD, Jane S

The management of severe aortoiliac occlusive disease: Endovascular therapy rivals open reconstruction Vikram S. Kashyap, MD, Mircea L. Pavkov, MD, James.

Todd R. Vogel, MD, MPH, Viktor Y. Dombrovskiy, MD, PhD, MPH, Paul B

Five-Year Outcomes after Randomization to Transcatheter or Surgical Aortic Valve Replacement: Final Results of The PARTNER 1 Trial Michael J. Mack, MD.

Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful Salvatore Scali, MD, Virendra Patel,

No Financial Disclosure or Conflict of Interest

Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial.

Ruben L. Osnabrugge, MS, Alan M. Speir, MD, Stuart J

Philip P. Goodney, MD, MS, Kerianne Holman, MD, MPH, Peter K

“Better” (sometimes) in vascular disease management

Percutaneous intervention for infrainguinal occlusive disease in women: Equivalent outcomes despite increased severity of disease compared with men Brian.

Success of arterial revascularization determined by contrast ultrasound muscle perfusion imaging Daniel Duerschmied, MD, Philipp Maletzki, MD, Gabriele.

Comparison of open and endovascular treatment of patients with critical limb ischemia in the Vascular Quality Initiative Jeffrey J. Siracuse, MD, Matthew.

Nat. Rev. Cardiol. doi: /nrcardio

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease Mauri J.A. Lepäntalo, MD, Rabih Houbballah,

Philip P. Goodney, MD, MS, Adam W. Beck, MD, Jan Nagle, MS, RPh, H

Atlantic Cardiovascular Patient Outcomes Research Team

Jessica P. Simons, MD, MPH, Andres Schanzer, MD, Brian W

Cox regression of proportion mortality in the first 8 years for patients with three-vessel disease with a significant difference between the treatment.

Results of a randomized clinical trial of external beam radiation to prevent restenosis after superficial femoral artery stenting Eric Therasse, MD,

Joseph G. Magnant, MD, Jack L. Cronenwett, MD, Daniel B

Larger Sheath Size for Infrainguinal Endovascular Intervention is Associated with Minor but Not Major Morbidity or Mortality Scott R. Levin MD, Alik.

Is TCAR best under LA or GA

Influence of Hospital Volume on Outcomes of Thoracic Endovascular Repair in Vascular Quality Initiative Database: 5-year National Study. Presenting Author:

Axillary-Bi-Femoral and Axillary-Uni-Femoral Artery Grafts Have Similar Perioperative Outcomes and Patency Thomas W. Cheng1, M.S., Scott Hardouin1, M.D.,

Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass

Body Composition and All-Cause Mortality in Hemodialysis Patients

The Effect of Carotid Calcification on Outcomes of Transfemoral and Transcarotid Artery Stenting in the VQI Michael neilson, MD1 Mahmoud malas, MD, MHS2.

Presentation transcript:

R. Nicholas Nolte, MD1, Ravishankar Hasanadka, MD2 Effects of Body Mass Index on Fluoroscopy Time in Peripheral Vascular Interventions for Arterial Occlusive Disease in the Mid-America Vascular Study Group R. Nicholas Nolte, MD1, Ravishankar Hasanadka, MD2 1OSF St. Francis Medical Center, Peoria, IL; 2Southern Illinois University, Springfield, IL Background Endovascular interventions present an attractive alternative to open revascularization as a means to reduce hospital stay, morbidity, and mortality1. Current trends show a steady increase in endovascular interventions performed for lower extremity peripheral arterial disease, with a steady decline in open revascularization and amputation2. Increased complexity of interventions results in increased fluoroscopy time (FT) and radiation exposure to the interventionalist, patient, and staff3. Body mass index (BMI) has been found to correlate with physician radiation dose in coronary angiography as well as increased patient radiation exposure in lower extremity interventions4-5. Results Discussion Consider brachial, radial, or pedal access compared to femoral access if applicable in obese patients (BMI >30) to significantly lower FT Higher FT in obese patients with more complex lesions, TASC C/D FT increases with more complex procedures and is correlated with increased estimated skin dose (ESD)6 Reduce risk for tissue injury to the patient by using less cineangiography, close the collimators to limit dose area, consider rotating the angle of the image-intensifier to change the beam path 1 in 14 patients undergoing lower extremity interventions are exposed to radiation doses which could potentially lead to tissue injury4 Reduce operator exposure by using maximum shielding to reduce effects of scatter: table aprons, portable shields, rad pads Cumulative FT of 1404 minutes and DAP of 932000 mGy/cm2 was found to result in a critical eye lense radiation dose of 20 mSv/year7 Limitations: Retrospective nature of database could lead to missing data or inaccuracies DAP values were not entered consistently in the same units of measure across centers in the PVI registry. Therefore, this data could not be analyzed. Table 1. Summary of Multiple Linear Regression Model: Effects of Covariates on Fluoroscopy Times. Estimate Std. Error t-value (p-value) Confidence Interval (95%) Covariates Age 0.006 0.003 2.290(0.022)* 0.001 / 0.011 Race (White) -0.165 0.071 -2.313(0.021)* -0.306 / -0.025 BMI 0.019 0.007 2.567(0.010)* 0.005 / 0.034 Smoking (Current/Former) -0.171 0.079 -2.159(0.031)* -0.326 / -0.016 CHF (Yes) 0.407 0.128 3.178(0.002)** 0.156 / 0.658 Diabetes (None) -0.091 0.053 -1.710(0.087) -0.195 / 0.013 Diabetes (No Meds) 0.083 0.089 0.933(0.351) -0.092 / 0.258 Diabetes (Meds) 0.008 0.144(0.885) -0.096 / 0.111 Aortoiliac (vs infrainguinal) Treatment Site -0.684 -9.663(0.000)*** -0.823 / -0.545 Previously Treated (Yes) -0.150 0.058 -2.608(0.009)** -0.263 / -0.037 Calcification (Low) -0.442 0.054 -8.121(0.000)*** -0.549 / -0.335 Access Type (Femoral) 0.038 0.148 0.253(0.800) -0.253 / 0.329 TASC Classification (A/B) -0.306 0.057 -5.342(0.000)*** -0.418 / -0.194 Number Access Sites (2) 0.620 0.098 6.338(0.000)*** 0.428 / 0.812 Number Devices (2) 0.042 0.032 1.316(0.188) -0.020 / 0.104 Number Devices (3) 0.186 0.020 9.181(0.000)*** 0.146 / 0.226 Interaction Terms BMI * Access (Femoral) 0.055 0.024 2.269(0.023)* 0.007 / 0.102 BMI * TASC (A/B) -0.028 0.009 -2.976(0.003)** -0.046 / -0.009 Objective This study seeks to evaluate the effect of BMI on FT in lower extremity peripheral vascular interventions for arterial occlusive disease using regional data collected using the Society for Vascular Surgery Vascular Quality Initiative (VQI). Conclusions Methods Retrospective database review IRB exemption status obtained from the OSF Healthcare IRB Procedural data recorded in the PVI registry of the VQI Mid-America Vascular Study Group from January 2012 to December 2018 (n = 9,638) Procedures limited to treatment of one vessel (aortoiliac & infrainguinal) for occlusive disease with relevant data points were included (n = 1,436) Outcome variables tested initially included FT, dose area product (DAP), and contrast volume used during the procedure. Only FT was used for the final analysis Linear regression was used for univariate and multivariate analyses to assess the effect of patient and procedural variables on FT. Increasing BMI significantly increases FT when treating TASC C/D lesions or in procedures with femoral access. Our study highlights an opportunity to improve data entry and analysis in the PVI module in regard to DAP recording Fluoroscopy Time with BMI and TASC classification Fluoroscopy Time with BMI and access site References Sigterman TA, Bolt LJJ, Snoeijs MG, et al. Radiation Exposure during Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease. Annals of Vascular Surgery. 2016;33:167-172. Hong MS, Beck Aw Fau - Nelson PR, Nelson PR. Emerging national trends in the management and outcomes of lower extremity peripheral arterial disease. J Vasc Surg. 2017 January ; 65(1): 108–118 Walsh SR, Cousins C Fau - Tang TY, Tang Ty Fau - Gaunt ME, Gaunt Me Fau - Boyle JR, Boyle JR. Ionizing radiation in endovascular interventions. J Endovasc Ther 2008;15:680–687. Goldsweig AM, Kennedy KF, Abbott JD, et al. Patient Radiation Dosage During Lower Extremity Endovascular Intervention. JACC: Cardiovascular Interventions. 2019;12(5):473. Madder Ryan D, VanOosterhout S, Mulder A, et al. Patient Body Mass Index and Physician Radiation Dose During Coronary Angiography. Circulation: Cardiovascular Interventions. 2019;12(1):e006823. Bannazadeh M, Altinel O, Kashyap VS, Sun Z, Clair D, Sarac TP.Patterns of procedure-specific radiation exposure in the endovascular era: impetus for further innovation. J Vasc Surg. 2009 Jun;49(6):1520-4. Attigah N, Oikonomou K, Hinz U, et al. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. Journal of Vascular Surgery. 2016;63(1):198-203.