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OBJECTIVES:
Studies have documented the effects of transfusion on morbidity and mortality for open lower extremity revascularization. However, no studies to date compare the effect of bleeding on open and endovascular approaches. In this study we aim to compare the morbidity and mortality associated with bleeding in patients undergoing open and endovascular intervention.
METHODS:
All patients who underwent a lower extremity revascularization between 2011 and 2012 in the Vascular Targeted NSQIP database were identified. Patients were divided based on the operative approach. All patients who underwent endovascular intervention in conjunction with a bypass were placed in the open group. Bleeding was defined as perioperative transfusion or return to the operating room due to bleeding. Patient demographics and perioperative risk factors were identified and a univariate analysis was completed using Chi-Square and Fisher Exact tests. A stepwise multivariate logistic regression was utilized to identify independent predictors of each outcome.
RESULTS:
5492 patients underwent revascularization including 2058 who underwent endovascular procedures and 3434 who underwent open procedures. Bleeding was seen in 12.9%(707) of all cases, 7.2%(149) of endovascular procedures, 16.2%(558) of open procedures, 16.3%(102) of suprainguinal open procedures, 7.2%(43) of suprainguinal endovascular procedures, 16.2%(456) infrainguinal open procedures, and 7.3%(106) of infrainguinal endovascular procedures. Bleeding was an independent predictor of death (OR 3.5, 95%CI 2.3-5.4) and all major NSQIP complications with the exception of pneumonia. (Table 1)
CONCLUSIONS:
Bleeding is an independent predictor of morbidity and mortality in both endovascular and open revascularizations. However, bleeding and adverse events independently associated with bleeding are more common in patients undergoing open operations . The significant association between bleeding and adverse outcomes highlights the importance of meticulous hemostasis regardless of operative approach.

Outcomes predicted by bleeding

	All Cases (5492)	Endovascular Cases (2058)	Open Cases (3434)
Death	2.0% 3.5 (2.3-5.4)*	1.7% 4.8 (2.3-10.3)*	2.2% 3.3 (2.1-5.4)*
Return to Operating Room	12.5% 3.6 (3.0-4.4)*	8.7% 8.0 (5.4-12.0)*	14.8% 2.9 (2.4-3.7)*
Amputation	2.6% 2.9 (2.0-4.2)*	2.3% 3.4 (1.7-6.7)*	2.7% 3.0 (1.9-4.6)*
MI or Stroke	3.3% 3.1 (2.2-4.3)*	1.3% 4.5 (1.9-11.0)*	4.5% 3.2 (2.2-4.4)*
Prolonged Ventilation	1.3% 6.7 (4.1-11.0)*	0.8% 16.0 (5.9-43.9)*	1.6% 4.4 (2.6-7.8)*
Pneumonia	0.9% 2.1 (1.1-4.1)	0.4% 7.0 (1.7-28.9)	1.1% 1.4 (0.7-3.2)
Wound Complication	5.8% 1.8 (1.3-2.3)*	1.3% 2.5 (1.1-5.8)*	8.6% 1.5 (1.1-2.1)
Septic Shock	0.8% 5.4 (2.8-10.3)*	0.5% 12.7 (3.6-45.0)*	1.0% 3.8 (1.8-8.0)*
Readmission	3.9% 1.7 (1.2-2.4)*	3.7% 2.3 (1.2-4.3)	4.0% 1.4 (0.9-2.1)