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

Slides:

Advertisements

Similar presentations

Single Center Experience with Drug Eluting Stents for Infrapopliteal Occlusive Disease in Patients with Critical Limb Ischemia: Mid-term follow up Robert.

Advertisements

KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

The Influence of Radial vs. Femoral Access on Acute Blood Loss in Patients Undergoing Percutaneous Coronary Intervention Amit Nanda 1, Eric Novak MS 2,

The Vascular Quality Initiative Using Registries to Provide Clinical Evidence Jack L. Cronenwett, M.D. Medical Director Society for Vascular Surgery Patient.

What Is Peripheral Vascular Disease? Daniel B. Walsh, M.D. Professor of Surgery, Section of Vascular Surgery Vice-Chair, Department of Sugery Dartmouth-Hitchcock.

Peripheral Vascular Disease November 30, 2005 Basic Science Review St.-Luke’s Roosevelt.

Peripheral Vascular Disease

When Using DOPPS Slides. DOPPS Slide Use Guidelines.

Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Preoperative Anemia and Postoperative Mortality in Neonates Goobie SM, Faraoni D,

The Impact of Preoperative Renal Dysfunction on the Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement Andres M. Pineda MD, J. Kevin.

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

Single IMA {Single Arterial}

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

Axillary-to-carotid artery bypass grafting for symptomatic severe common carotid artery occlusive disease Joseph P. Archie, PhD, MD Journal of Vascular.

Single Stage CABG and Peripheral Arterial Bypass for Combined Coronary and Peripheral Arterial Disease Divya Arora, Ashok Chahal and Shamsher Singh Lohchab.

Post-Surgical Care for the Individual With PAD

Patients with chronic obstructive pulmonary disease have shorter survival but superior endovascular outcomes after endovascular aneurysm repair Moqueet.

Prophylactic use of the silver-acetate–coated graft in arterial occlusive disease: A retrospective, comparative study Axel Larena-Avellaneda, MD, Sonja.

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

Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease Kim Bredahl, MD, PhD, Leif Panduro Jensen,

Descending thoracic aorta to iliofemoral artery bypass grafting: A role for primary revascularization for aortoiliac occlusive disease? Marc A. Passman,

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

Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates Jeffrey Kalish, MD,

Impact of diabetes mellitus on outcomes of superficial femoral artery endoluminal interventions Andrew M. Bakken, MD, Eugene Palchik, MD, Joseph P. Hart,

Enrique Criado, MD, Steven J. Burnham, MD, Ellis A

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

Mortality variability after endovascular versus open abdominal aortic aneurysm repair in a large tertiary vascular center using a Medicare-derived risk.

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

Care of patients undergoing vascular surgery at safety net public hospitals is associated with higher cost but similar mortality to nonsafety net hospitals

Insulin use is associated with poor limb salvage and survival in diabetic patients with chronic limb ischemia Hasan H. Dosluoglu, MD, Purandath Lall,

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

Popliteal artery aneurysms: Current management and outcome

Patients with chronic obstructive pulmonary disease have shorter survival but superior endovascular outcomes after endovascular aneurysm repair Moqueet.

Late outcomes of limb loss after failed infrainguinal bypass

Durability of open popliteal artery aneurysm repair

Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease Jean-Baptiste Ricco,

Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms Matthew J. Eagleton, MD, Matthew.

Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms Muhammad A. Rana, MBBS, Manju Kalra, MBBS, Gustavo.

Thrombolysis for lower extremity bypass graft occlusion

Reshma P. Duffy, MD, Julie E. Adams, MD, Peter W

Outcomes of patients with type I endoleak at completion of endovascular abdominal aneurysm repair Tze-Woei Tan, MD, Mohammed Eslami, MD, Denis Rybin,

Perioperative outcomes and amputation-free survival after lower extremity bypass surgery in California hospitals, , with follow-up through 2004

Carla C. Moreira, MD, Alexander D

Benefits, morbidity, and mortality associated with long-term administration of oral anticoagulant therapy to patients with peripheral arterial bypass.

National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population Douglas W. Jones, MD, Philip.

Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure Vincent J. Santo, MD, Phong.

Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease Christopher J. Smolock, MD, Javier.

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

A personal experience with the influence of diabetes and other factors on the outcome of infrainguinal bypass grafts for occlusive disease Norman R.

Subclavian revascularization in the age of thoracic endovascular aortic repair and comparison of outcomes in patients with occlusive disease Salvatore.

Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss Mark G. Davies, MD, PhD, Wael E. Saad, MD, Eric.

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

Vascular Surgery Michael Ricci, MD.

Joseph R. Schneider, MD, PhD, Martha D. McDaniel, MD, Daniel B

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

One-Stage Upper Arm Brachial-Basilic Arteriovenous Fistulas Have Superior Patency to Two-Stage Procedure Tze-Woei Tan, MD, Jeffrey Siracuse, MD, Karen.

Surgical and endovascular revision of infrainguinal vein bypass grafts: Analysis of midterm outcomes from the PREVENT III trial Scott A. Berceli, MD,

Long-Term Outcomes of an Endovascular-First Approach for Diabetic Patients With Predominantly Tibial Disease Caitlin W. Hicks, MD, MS, Joseph K. Canner,

Peter G. Kalman, M. D. , Marilyn Hosang, R. N. , Claudio Cina, M. D

Defining utility and predicting outcome of cadaveric lower extremity bypass grafts in patients with critical limb ischemia Catherine K. Chang, MD, Salvatore.

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

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

Axillary-to-carotid artery bypass grafting for symptomatic severe common carotid artery occlusive disease Joseph P. Archie, PhD, MD Journal of Vascular.

Infrainguinal & Suprainguinal Bypass Lower Extremity Amputation

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

Temporary axillobifemoral bypass as an adjunct to endovascular aneurysm repair using fenestrated stent grafts Brian J. Manning, MD, FRCSI, Obiekezie.

Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality Thomas W. Cheng1, M.S., Shelley.

Massachusetts General Hospital

Presentation transcript:

Axillary-Bi-Femoral and Axillary-Uni-Femoral Artery Grafts Have Similar Perioperative Outcomes and Patency Thomas W. Cheng1, M.S., Scott Hardouin1, M.D., Alik Farber1, M.D., Jeffrey A. Kalish1, M.D., Douglas W. Jones1, M.D., Mahmoud B. Malas2, M.D., Denis Rybin1, Ph.D., Brad S. Oriel1, M.D., Lenee M. Plauche1, M.D., Jeffrey J. Siracuse1, M.D. 1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA. 2Division of Vascular and Endovascular Surgery, University of California San Diego, School of Medicine, La Jolla, CA.

Disclosures None

Background Aortoiliac occlusive disease is a common cause of lower extremity ischemia Aortobifemoral bypass remains the “gold standard” Historically, axillobifemoral bypass have superior patency compared to axillounifemoral bypass More recent small single-center studies showed comparable results between the two bypass configurations

Objective To assess contemporary outcomes of axillounifemoral and axillobifemoral bypasses

Methods Vascular Quality Initiative 2010 to 2017 for all axillounifemoral and axillobifemoral bypass Indication included claudication, rest pain, and tissue loss Acute limb ischemia excluded Baseline characteristics, procedure details, and outcomes were collected Univariable and multivariable analyses were performed

Results 1,251 patients undergoing axillary to femoral bypass were identified

Indication for all axillary to femoral bypass Results Indication for all axillary to femoral bypass

Axillounifemoral (N=412) Results Characteristic Overall (N=1251) Axillounifemoral (N=412) Axillobifemoral (N=839) P-Value Age (mean±SD) 68.3±10.1 67.4±10.1 68.8±10.1 .022 Male 639 (51.1%) 232 (56.3%) 407 (48.5%) .009 Ambulatory 759 (60.8%) 224 (54.6%) 535 (63.8%) .002 Diabetes 387 (31%) 146 (35.6%) 241 (28.7%) .013 Prior bypass 388 (31%) 240 (58.3%) 148 (17.6%) <.001 Prior aneurysm repair 80 (6.4%) 38 (9.2%) 45 (5%) .004 Prior peripheral vascular intervention 365 (29.2%) 172 (41.8%) 193 (23%) Prior major amputation 92 (7.4%) 73 (17.8%) 19 (2.3%) Pre-operative anticoagulation 169 (15.6%) 93 (26.4%) 76 (10.4%)

Results P=.017 P<.001 P<.001 P<.001 P<.001

Freedom from graft occlusion P=.074 Axillobifemoral: 71.8% Axillounifemoral: 62.6%

Freedom from MALE P=.052 Axillobifemoral: 66.6% Axillounifemoral: 57.1%

Freedom from Major Amputation Axillobifemoral: 73% Axillounifemoral: 63.7%

Survival P=.897 Axillounifemoral: 86% Axillobifemoral: 86%

Multivariable analysis Risk factors for Occlusion or Mortality at 1 year HR 95% CI P-Value Axillounifemoral vs Axillobifemoral 1.06 .77 – 1.46 .722 Tissue loss vs Claudication 2.22 1.51 – 3.28 <.001 Non-ambulatory status 1.67 1.25 – 2.23 .001 Age (per year) 1.02 1 – 1.03 .044

Multivariable analysis Risk factors for MALE or Mortality at 1 year HR 95% CI P-Value Axillounifemoral vs Axillobifemoral .97 .73 – 1.3 .853 Tissue loss vs Claudication 2.13 1.51 – 3 <.001 No prior bypass 1.42 1.06 – 1.91 .021 Profunda vs Common femoral target 1.36 1.02 – 1.81 .034 Age (per year) 1.02 1 – 1.03 .017

Multivariable analysis Risk factors for Amputation or Mortality at 1 year HR 95% CI P-Value Axillounifemoral vs Axillobifemoral 1.12 .83 – 1.51 .45 Tissue loss vs Claudication 3.23 2.13 – 4.89 <.001 Rest pain vs Claudication 1.72 1.12 – 2.63 .013 Non-ambulatory status 1.5 1.13 – 2 .005 Age (per year) 1.02 1.01 – 1.03 .008

Multivariable analysis Risk factors for Mortality at 1 year HR 95% CI P-Value Axillounifemoral vs Axillobifemoral .91 .65 – 1.26 .552 Tissue loss vs Claudication 2.22 1.43 – 3.45 <.001 Non-ambulatory status 1.64 1.2 – 2.25 .002 Age (per year) 1.03 1.02 – 1.05

Limitations Retrospective study No graft size data No data for quality of outflow Longer term follow up data such as patency limited beyond survival

Conclusion Axillounifemoral and axillobifemoral grafts have similar outcomes Graft patency was not significantly different between axillounifemoral and axillobifemoral at 1 year Significant risk factors for 1-year graft occlusion/MALE/any amputation/death were tissue loss, non-ambulatory status, and older age Overall, these patients have many comorbidities and have low long-term survival

Thank you