Perioperative Outcomes Of Minor And Major Reinterventions For Peripheral Arterial Disease
Joshua J. Huttler, BA1, Keyuree K. Satam, BA1, Tanner I. Kim, MD1, Haoran Zhuo, MPH2, Yawei Zhang, MD, PhD, MPH2, Edouard Aboian, MD1, Raul J. Guzman, MD1, Cassius Iyad Ochoa Chaar, MD, MS1.
1Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA, 2Division of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Objective: Patients with peripheral arterial disease (PAD) commonly require reinterventions after initial lower extremity revascularization (LER) to sustain patency. The Society of Vascular Surgery (SVS) guidelines classify reinterventions into minor and major, but the associated risks have not been evaluated. The aim of this study is to compare the perioperative outcomes of minor and major reinterventions. Our hypothesis is that major reinterventions are associated with significantly higher morbidity and mortality compared to minor reinterventions.
Methods: A retrospective chart review of patients undergoing initial LERs for PAD at a tertiary care center was performed. All subsequent reinterventions were captured and classified into minor reinterventions if they consisted of an endovascular procedure without thrombolysis or a focal patch angioplasty. Major reinterventions included any open surgical LER as well as endovascular interventions with thrombolysis per SVS guidelines. The perioperative outcomes of minor and major reinterventions were compared.
Results: There were 713 patients. The reintervention rate was 40.8% and 291 patients underwent a total of 695 reinterventions (Range = 1-12 reinterventions) after mean follow up of 2.5 years. Minor reinterventions were more common (n = 498) and constituted 71.7% of all the reinterventions. The group of patients undergoing reinterventions had a mean age of 67.2 ± 11.5, were predominantly white (73.5%), males (60.1%) with history of diabetes (55.7%), hypertension (88.3%), hyperlipidemia (69.1%), and coronary artery disease (51.2%). Major reinterventions were associated with significantly increased bleeding and acute renal failure. There was a trend towards increase in major amputation and return to the operating room with major reinterventions but that did not reach statistical significance. Major reinterventions were associated with significantly increased morbidity (54.8% vs 29.5%, P=<0.001) as compared to minor reinterventions but there was no significant difference in mortality. (Table)
Conclusions: Major reinterventions are associated with significantly higher rate of perioperative morbidity compared to minor reinterventions. However, there is no difference in early mortality and limb loss.
|Perioperative Outcomes||Major Reinterventions (N=197)||Minor Reinterventions (N=498)||P|
|Hematoma||8 (4.1%)||9 (1.8%)||0.085|
|Pseudoaneurysm||4 (2.1%)||5 (1.0%)||0.282|
|Bleeding||19 (9.7%)||17 (3.5%)||0.001*|
|Wound Infection||11 (5.7%)||16 (3.3%)||0.144|
|Pneumonia||4 (2.1%)||5 (1.0%)||0.281|
|Urinary Tract Infection||2 (1.0%)||6 (1.2%)||1.000|
|Arterial Thrombosis||6 (3.1%)||5 (1.0%)||0.084|
|Deep Vein Thrombosis||1 (0.5%)||3 (0.6%)||1.000|
|Pulmonary Embolism||1 (0.5%)||0||0.283|
|Myocardial Infarction||0||1 (0.2%)||1.000|
|Acute Renal Failure||12 (6.2%)||12 (2.4%)||0.016*|
|New Hemodialysis||2 (1.0%)||3 (0.6%)||0.625|
|Return to OR||32 (16.7%)||57 (11.6%)||0.079|
|Major Amputation||6 (3.1%)||6 (1.2%)||0.068|
|Any Morbidity||108 (54.8%)||147 (29.5%)||<0.001*|
|Mortality||5 (2.6%)||5 (1.0%)||0.151|
P-value from Fisher test for small numbers
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