A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease

Marco Zavatta, Matthew Mell

Research output: Contribution to journalArticle

7 Citations (Scopus)

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). 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. 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). 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.

Original languageEnglish (US)
Pages (from-to)199-205.e1
JournalJournal of Vascular Surgery
Volume67
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Thigh
Blood Vessels
Databases
Endarterectomy
Ankle Brachial Index
Amputation
Mortality
Length of Stay
Heart Failure

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease. / Zavatta, Marco; Mell, Matthew.

In: Journal of Vascular Surgery, Vol. 67, No. 1, 01.01.2018, p. 199-205.e1.

Research output: Contribution to journalArticle

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title = "A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease",
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). 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. 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). 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.",
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N2 - 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). 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. 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). 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.

AB - 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). 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. 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). 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.

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