Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. / Bredahl, Kim; Jensen, Leif Panduro; Schroeder, Torben V; Sillesen, Henrik; Nielsen, Henrik; Eiberg, Jonas P.
I: Journal of Vascular Surgery, Bind 62, Nr. 1, 07.2015, s. 75-82.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease
AU - Bredahl, Kim
AU - Jensen, Leif Panduro
AU - Schroeder, Torben V
AU - Sillesen, Henrik
AU - Nielsen, Henrik
AU - Eiberg, Jonas P
N1 - Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2015/7
Y1 - 2015/7
N2 - OBJECTIVE: Open surgery has given way to endovascular grafting in patients with aortoiliac occlusive disease. The growing use of endovascular grafts means that fewer patients with aortoiliac occlusive disease have open surgery. The declining open surgery caseload challenges the surgeon's operative skills, particularly because open surgery is increasingly used in those patients who are unsuitable for endovascular repair and hence technically more demanding. We assessed the early outcome after aortic bifurcated bypass procedures during two decades of growing endovascular activity and identified preoperative risk factors.METHODS: Data on patients with chronic limb ischemia were prospectively collected during a 20-year period (1993 to 2012). The data were obtained from the Danish Vascular Registry, assessed, and merged with data from The Danish Civil Registration System.RESULTS: We identified 3623 aortobifemoral and 144 aortobiiliac bypass procedures. The annual caseload fell from 323 to 106 during the study period, but the 30-day mortality at 3.6% (95% confidence interval [CI], 3.0-4.1) and the 30-day major complication rate remained constant at 20% (95% CI, 18-21). Gangrene (odds ratio [OR], 3.3; 95% CI, 1.7-6.5; P = .005) was the most significant risk factor for 30-day mortality, followed by renal insufficiency (OR, 2.5; 95% CI, 1.1-5.8; P = .035) and cardiac disease (OR, 2.1; 95% CI, 1.4-3.1; P < .001). Multiorgan failure, mesenteric ischemia, need for dialysis, and cardiac complications were the most lethal complications, with mortality rates of 94%, 44%, 38%, and 34%, respectively.CONCLUSIONS: Aortic bifurcated bypass is a high-risk procedure. Although open surgery has increasingly given way to endovascular repair, 30-day outcomes have remained stable during the past decade. Thus, it is still acceptable to consider an aortic bifurcated bypass whenever endovascular management is not feasible.
AB - OBJECTIVE: Open surgery has given way to endovascular grafting in patients with aortoiliac occlusive disease. The growing use of endovascular grafts means that fewer patients with aortoiliac occlusive disease have open surgery. The declining open surgery caseload challenges the surgeon's operative skills, particularly because open surgery is increasingly used in those patients who are unsuitable for endovascular repair and hence technically more demanding. We assessed the early outcome after aortic bifurcated bypass procedures during two decades of growing endovascular activity and identified preoperative risk factors.METHODS: Data on patients with chronic limb ischemia were prospectively collected during a 20-year period (1993 to 2012). The data were obtained from the Danish Vascular Registry, assessed, and merged with data from The Danish Civil Registration System.RESULTS: We identified 3623 aortobifemoral and 144 aortobiiliac bypass procedures. The annual caseload fell from 323 to 106 during the study period, but the 30-day mortality at 3.6% (95% confidence interval [CI], 3.0-4.1) and the 30-day major complication rate remained constant at 20% (95% CI, 18-21). Gangrene (odds ratio [OR], 3.3; 95% CI, 1.7-6.5; P = .005) was the most significant risk factor for 30-day mortality, followed by renal insufficiency (OR, 2.5; 95% CI, 1.1-5.8; P = .035) and cardiac disease (OR, 2.1; 95% CI, 1.4-3.1; P < .001). Multiorgan failure, mesenteric ischemia, need for dialysis, and cardiac complications were the most lethal complications, with mortality rates of 94%, 44%, 38%, and 34%, respectively.CONCLUSIONS: Aortic bifurcated bypass is a high-risk procedure. Although open surgery has increasingly given way to endovascular repair, 30-day outcomes have remained stable during the past decade. Thus, it is still acceptable to consider an aortic bifurcated bypass whenever endovascular management is not feasible.
KW - Aged
KW - Aortic Diseases
KW - Arterial Occlusive Diseases
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation
KW - Chronic Disease
KW - Constriction, Pathologic
KW - Denmark
KW - Female
KW - Humans
KW - Iliac Artery
KW - Ischemia
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Odds Ratio
KW - Postoperative Complications
KW - Prospective Studies
KW - Registries
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Vascular Patency
U2 - 10.1016/j.jvs.2015.02.025
DO - 10.1016/j.jvs.2015.02.025
M3 - Journal article
C2 - 26115920
VL - 62
SP - 75
EP - 82
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 1
ER -
ID: 161420962