A. Thomas1, I. Leitman1 1Mount Sinai School Of Medicine,New York, NY, USA
Introduction: Endovascular approaches to aortoiliac disease are becoming increasingly frequent due to the prospect of reduced recovery times, bleeding and discomfort. This study was designed to identify important risk factors for major 30-day outcomes and mortality following repair.
Methods: Data were derived from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant user file. Patients that underwent aortic, bilateral common iliac, common iliac, external iliac, internal iliac, common and internal iliac, or common and external iliac repair (CPT codes 37220, 37221, 37222 and 37223) in one of 40 participating procedure targeted hospitals during 2015 were identified. Preoperative risk factors were analyzed using univariate and multivariate analysis for the endpoints of major 30-day postoperative outcomes and mortality.
Results:
818 patients underwent endovascular aortoiliac repair; 474 (57.9%) males and 344 (42.1%) females. Ages ranged from 33 to 89, with a mean of 64.3 years. The overall 30-day mortality rate was 1.7%. Smoking, advanced age, low serum albumin and hematocrit, insulin-dependent diabetes, and dialysis correlated with increased mortality. 33 patients (4%) required major re-intervention of the treated arterial segment. Risk factors included preoperative living dependency and transfer from a location other than home. 59 patients (6.9%) were discharged to a location other than home. Advanced age, low albumin and hematocrit, high BUN, creatinine, WBC, platelets, PTT and INR, ABI ≤0.89, dependency, open wound, 10% weight loss in 6 months prior to surgery, dialysis and diabetes were associated with discharge to a place other than home. Eight patients (1%) required amputation in the early post-operative period. Risk factors included high BUN and WBC, low hematocrit, ABI ≤0.39, living dependency, and transfer from a location other than home. 44 patients (5.4%) required transfusion for perioperative hemorrhage and this was associated with an underlying bleeding disorder, low albumin and hematocrit, high alkaline phosphatase, ABI ≤0.89, living dependency, open wound, weight loss, and transfer from a location other than home.
After logistic regression, 30-day mortality was correlated with low serum albumin, with survivors having an average albumin of 3.72, and non-survivors 2.36; major re-intervention of the treated arterial segment was correlated with preoperative living dependency.
Conclusion: We identified preoperative living dependency and low serum albumin to be the most strongly associated risk factors with adverse 30-day postoperative outcomes following endovascular aortoiliac procedures. Mortality rates remain low following percutaneous revascularization.
