Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.11.008
Maxwell T. Tulimieri , Peter W. Callas , Daniel J. Bertges
Background
We sought to explore the utility of closed incision negative pressure wound therapy (ciNPWT) in prevention of groin wound complications after suprainguinal bypass using a national quality improvement database reflective of real-world practice.
Methods
The Vascular Quality Initiative was queried for suprainguinal bypass procedures from December 2019 to August 2023. Propensity matching was performed comparing ciNPWT versus standard dressings at (1) the index hospitalization (full cohort) and (2) 30 days (subgroup). The primary outcome was surgical site infection (SSI) at 30 days. Secondary outcomes included in-hospital SSI, return to operating room for infection, discharge disposition, length of stay and 30-day readmission rate, noninfectious wound complications, and mortality.
Results
The propensity-matched cohort consisted of 3,467 of a total of 5,082 patients undergoing suprainguinal bypass. Within the propensity-matched full cohort, 2,680 (77%) received standard dressing and 787 (23%) ciNPWT. Of those, 337 (61%) in the standard group and 150 (31%) in the ciNPWT group had 30-day follow-up data. There was a significant decrease in the rates of in-hospital SSI for those with ciNPWT at 2% compared to those with standard dressing at 4% (P = 0.02). There was no difference in 30-day SSI between groups with 3% in the ciNPWT group and 4% in the standard group (P = 0.40). After adjusting, there was no differences in 30-day readmission rates (P = 0.37), 30-day noninfectious wound complications (P = 0.28), 30-day mortality (P = 0.24), discharge disposition (P = 0.82), or length of stay (P = 0.23).
Conclusions
In this Vascular Quality Initiative analysis of suprainguinal bypass, we observed a decrease in the in-hospital SSI rate but no difference in the SSI or noninfectious wound complications at 30 days for patients treated with ciNPWT versus standard dressings. Given these findings, consideration should be given to conducting an adequately powered randomized control trial of ciNPWT targeted for suprainguinal bypass.
{"title":"Effectiveness of Closed Incision Negative Pressure Wound Therapy for Suprainguinal Bypass in the Vascular Quality Initiative","authors":"Maxwell T. Tulimieri , Peter W. Callas , Daniel J. Bertges","doi":"10.1016/j.avsg.2024.11.008","DOIUrl":"10.1016/j.avsg.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>We sought to explore the utility of closed incision negative pressure wound therapy (ciNPWT) in prevention of groin wound complications after suprainguinal bypass using a national quality improvement database reflective of real-world practice.</div></div><div><h3>Methods</h3><div>The Vascular Quality Initiative was queried for suprainguinal bypass procedures from December 2019 to August 2023. Propensity matching was performed comparing ciNPWT versus standard dressings at (1) the index hospitalization (full cohort) and (2) 30 days (subgroup). The primary outcome was surgical site infection (SSI) at 30 days. Secondary outcomes included in-hospital SSI, return to operating room for infection, discharge disposition, length of stay and 30-day readmission rate, noninfectious wound complications, and mortality.</div></div><div><h3>Results</h3><div>The propensity-matched cohort consisted of 3,467 of a total of 5,082 patients undergoing suprainguinal bypass. Within the propensity-matched full cohort, 2,680 (77%) received standard dressing and 787 (23%) ciNPWT. Of those, 337 (61%) in the standard group and 150 (31%) in the ciNPWT group had 30-day follow-up data. There was a significant decrease in the rates of in-hospital SSI for those with ciNPWT at 2% compared to those with standard dressing at 4% (<em>P</em> = 0.02). There was no difference in 30-day SSI between groups with 3% in the ciNPWT group and 4% in the standard group (<em>P</em> = 0.40). After adjusting, there was no differences in 30-day readmission rates (<em>P</em> = 0.37), 30-day noninfectious wound complications (<em>P</em> = 0.28), 30-day mortality (<em>P</em> = 0.24), discharge disposition (<em>P</em> = 0.82), or length of stay (<em>P</em> = 0.23).</div></div><div><h3>Conclusions</h3><div>In this Vascular Quality Initiative analysis of suprainguinal bypass, we observed a decrease in the in-hospital SSI rate but no difference in the SSI or noninfectious wound complications at 30 days for patients treated with ciNPWT versus standard dressings. Given these findings, consideration should be given to conducting an adequately powered randomized control trial of ciNPWT targeted for suprainguinal bypass.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 241-249"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.11.001
Alexandre Rossillon, Nicolas Massad, Robin Sagnet, Raphael Soler, Marine Gaudry, Pierre-Edouard Magnan, Michel-Alain Bartoli
Background
Fenestrated endografts have been a safe and effective solution in our institution for patients with juxtarenal abdominal aortic aneurysms (AAAs) that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions.
Methods
Between September 2005 and December 2021, this study included all the patients bearing juxtarenal aneurysm electively treated with a fenestrated endograft. We conducted a retrospective analysis of prospectively collected monocentric data. Preoperative, perioperative, and postoperative data were processed. Postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18, and 24 months then every year. Secondary procedure was defined as any additional procedure performed to treat aneurysm or endograft-related complications after index procedure. Demographic and perioperative data were analyzed descriptively. Overall survival and freedom from secondary procedures were determined using the Kaplan–Meier estimate.
Results
A total of 169 patients (92% male) were treated by fenestrated endograft with a mean 55 ± 37 months follow-up. The median aneurysm diameter was 59 mm. In 39 patients (23.1%), we performed a secondary procedure, by endovascular means in 57% of cases, mostly after the first year of follow-up (53.8%). The most frequent cause for secondary procedure was type 1b endoleak due to the evolution of aneurysmal disease of the iliac arteries (25.6%), followed by endograft limb thrombosis (20.5%), local complications related to index procedure (17.9%) and procedures performed to insure target vessel patency over time (18%). On the last CT scan of the follow-up, patients without secondary procedure were significantly more likely to present a shrinkage of the aneurysmal sac (P = 0.001), defined as a modification of the maximum diameter > 5 mm. Overall survival was not significantly different between patients that had secondary procedures compared to those that had not (80 months vs. 62 months, P = 0.3). Freedom from secondary procedures was 87% at 24 months and 63% at 60 months. Excluding secondary procedures within 30 days, freedom from secondary procedures was 76% at 50 months.
Conclusions
Fenestrated endografts constitute a sustainable therapeutic solution in the treatment of juxtarenal AAAs. The occurrence of late complications justifies a rigorous follow-up of treated patients.
{"title":"Long-Term Outcomes of Fenestrated Aortic Endovascular Repair in Patients Bearing JuxtaRenal Aneurysms","authors":"Alexandre Rossillon, Nicolas Massad, Robin Sagnet, Raphael Soler, Marine Gaudry, Pierre-Edouard Magnan, Michel-Alain Bartoli","doi":"10.1016/j.avsg.2024.11.001","DOIUrl":"10.1016/j.avsg.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Fenestrated endografts have been a safe and effective solution in our institution for patients with juxtarenal abdominal aortic aneurysms (AAAs) that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions.</div></div><div><h3>Methods</h3><div>Between September 2005 and December 2021, this study included all the patients bearing juxtarenal aneurysm electively treated with a fenestrated endograft. We conducted a retrospective analysis of prospectively collected monocentric data. Preoperative, perioperative, and postoperative data were processed. Postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18, and 24 months then every year. Secondary procedure was defined as any additional procedure performed to treat aneurysm or endograft-related complications after index procedure. Demographic and perioperative data were analyzed descriptively. Overall survival and freedom from secondary procedures were determined using the Kaplan–Meier estimate.</div></div><div><h3>Results</h3><div>A total of 169 patients (92% male) were treated by fenestrated endograft with a mean 55 ± 37 months follow-up. The median aneurysm diameter was 59 mm. In 39 patients (23.1%), we performed a secondary procedure, by endovascular means in 57% of cases, mostly after the first year of follow-up (53.8%). The most frequent cause for secondary procedure was type 1b endoleak due to the evolution of aneurysmal disease of the iliac arteries (25.6%), followed by endograft limb thrombosis (20.5%), local complications related to index procedure (17.9%) and procedures performed to insure target vessel patency over time (18%). On the last CT scan of the follow-up, patients without secondary procedure were significantly more likely to present a shrinkage of the aneurysmal sac (<em>P</em> = 0.001), defined as a modification of the maximum diameter > 5 mm. Overall survival was not significantly different between patients that had secondary procedures compared to those that had not (80 months vs. 62 months, <em>P</em> = 0.3). Freedom from secondary procedures was 87% at 24 months and 63% at 60 months. Excluding secondary procedures within 30 days, freedom from secondary procedures was 76% at 50 months.</div></div><div><h3>Conclusions</h3><div>Fenestrated endografts constitute a sustainable therapeutic solution in the treatment of juxtarenal AAAs. The occurrence of late complications justifies a rigorous follow-up of treated patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 250-259"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extending the distal sealing zone into the external iliac artery is sometimes necessary during endovascular abdominal aortic repair. As the use of an iliac branch device is contingent upon certain anatomical requirements, the application of this device is not universal. Herein, we present an alternative method to preserve hypogastric artery perfusion using a physician-modified fenestrated (PMF) AFX limb (Endologix, Inc., Irvine, CA, USA) with hydrogel coil reinforcement.
Methods
Patients undergoing PMF endovascular abdominal aortic repair for the preservation of hypogastric artery perfusion between October 2022 and October 2023 at a single center were prospectively enrolled. The clinical endpoint was technical success, defined as successful revisualization of the hypogastric artery through the created fenestration and the absence of type 3c endoleaks. Furthermore, hypogastric artery patency and newly developed endoleaks were investigated during the follow-up period.
Results
Overall, 16 hypogastric arteries from 15 patients were protected with this technique. The patients’ average age was 76.9 ± 10.4 years. The indications for PMF endovascular abdominal aortic repair were common iliac artery aneurysm (n = 6), hypogastric artery aneurysm (n = 3), correction of type 1b endoleak following previous endovascular abdominal aortic repair (n = 4), and abdominal aortic aneurysm with an inappropriate common iliac sealing zone (n = 3). All patients were considered unsuitable candidates for commercially available iliac branch devices. All fenestrations were reinforced with hydrogel coils. The technical success rate of PMF endovascular abdominal aortic repair was 100%. No branch occlusion or type 3c endoleak developed during the follow-up period (average: 11.6 months).
Conclusions
Our preliminary experience suggests that PMF endovascular abdominal aortic repair with hydrogel coil reinforcement for the preservation of hypogastric artery perfusion may be a safe and effective option for extending the sealing zone to the external iliac artery. Further experience and identification of possible complications are necessary to explore the potential for the expanded use of this technique.
{"title":"Physician-Modified Fenestrated Endovascular Aortic Repair for the Preservation of Hypogastric Artery Perfusion and Efficacy of Hydrogel Coil Fenestration Reinforcement","authors":"Shinichi Iwakoshi , Yoshihiko Yokoi , Tatsuya Yokota , Takahiro Nakai , Sayaka Tamada , Shun Hiraga , Shigeo Ichihashi , Toshihiro Tanaka","doi":"10.1016/j.avsg.2024.11.012","DOIUrl":"10.1016/j.avsg.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Extending the distal sealing zone into the external iliac artery is sometimes necessary during endovascular abdominal aortic repair. As the use of an iliac branch device is contingent upon certain anatomical requirements, the application of this device is not universal. Herein, we present an alternative method to preserve hypogastric artery perfusion using a physician-modified fenestrated (PMF) AFX limb (Endologix, Inc., Irvine, CA, USA) with hydrogel coil reinforcement.</div></div><div><h3>Methods</h3><div>Patients undergoing PMF endovascular abdominal aortic repair for the preservation of hypogastric artery perfusion between October 2022 and October 2023 at a single center were prospectively enrolled. The clinical endpoint was technical success, defined as successful revisualization of the hypogastric artery through the created fenestration and the absence of type 3c endoleaks. Furthermore, hypogastric artery patency and newly developed endoleaks were investigated during the follow-up period.</div></div><div><h3>Results</h3><div>Overall, 16 hypogastric arteries from 15 patients were protected with this technique. The patients’ average age was 76.9 ± 10.4 years. The indications for PMF endovascular abdominal aortic repair were common iliac artery aneurysm (<em>n</em> = 6), hypogastric artery aneurysm (<em>n</em> = 3), correction of type 1b endoleak following previous endovascular abdominal aortic repair (<em>n</em> = 4), and abdominal aortic aneurysm with an inappropriate common iliac sealing zone (<em>n</em> = 3). All patients were considered unsuitable candidates for commercially available iliac branch devices. All fenestrations were reinforced with hydrogel coils. The technical success rate of PMF endovascular abdominal aortic repair was 100%. No branch occlusion or type 3c endoleak developed during the follow-up period (average: 11.6 months).</div></div><div><h3>Conclusions</h3><div>Our preliminary experience suggests that PMF endovascular abdominal aortic repair with hydrogel coil reinforcement for the preservation of hypogastric artery perfusion may be a safe and effective option for extending the sealing zone to the external iliac artery. Further experience and identification of possible complications are necessary to explore the potential for the expanded use of this technique.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 225-230"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms by offering a less invasive alternative to open surgery. Understanding the factors that influence patient outcomes, particularly for high-risk patients, is crucial. The aim of this study was to determine whether machine learning (ML)–based decision tree analysis (DTA), a subset of artificial intelligence, could predict patient outcomes by identifying complex patterns in data.
Methods
This study analyzed 169 patients who underwent EVAR to identify predictors of short-term mortality (within 3 years) using DTA. Data included 23 variables such as age, gender, nutritional status, comorbidities, and surgical details. The Python 3.7 was used as the programming language, and the scikit-learn toolkit was used to complete the derivation and verification of the decision tree classifier.
Results
DTA identified poor nutritional status as the most significant predictor, followed by chronic kidney disease, chronic obstructive pulmonary disease, and advanced age (octogenarian). The decision tree identified 6 terminal nodes with a risk of short-term mortality ranging from 0% to 79.9%. This model had 68.7% accuracy, 65.7% specificity, and 79.0% sensitivity.
Conclusions
ML–based DTA is promising in predicting short-term mortality after EVAR, highlighting the need for comprehensive preoperative assessment and individualized management strategies.
{"title":"Predicting Short-Term Mortality after Endovascular Aortic Repair Using Machine Learning–Based Decision Tree Analysis","authors":"Toshiya Nishibe , Tsuyoshi Iwasa , Masaki Kano , Shinobu Akiyama , Toru Iwahashi , Shoji Fukuda , Jun Koizumi , Masayasu Nishibe","doi":"10.1016/j.avsg.2024.10.009","DOIUrl":"10.1016/j.avsg.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms by offering a less invasive alternative to open surgery. Understanding the factors that influence patient outcomes, particularly for high-risk patients, is crucial. The aim of this study was to determine whether machine learning (ML)–based decision tree analysis (DTA), a subset of artificial intelligence, could predict patient outcomes by identifying complex patterns in data.</div></div><div><h3>Methods</h3><div>This study analyzed 169 patients who underwent EVAR to identify predictors of short-term mortality (within 3 years) using DTA. Data included 23 variables such as age, gender, nutritional status, comorbidities, and surgical details. The Python 3.7 was used as the programming language, and the scikit-learn toolkit was used to complete the derivation and verification of the decision tree classifier.</div></div><div><h3>Results</h3><div>DTA identified poor nutritional status as the most significant predictor, followed by chronic kidney disease, chronic obstructive pulmonary disease, and advanced age (octogenarian). The decision tree identified 6 terminal nodes with a risk of short-term mortality ranging from 0% to 79.9%. This model had 68.7% accuracy, 65.7% specificity, and 79.0% sensitivity.</div></div><div><h3>Conclusions</h3><div>ML–based DTA is promising in predicting short-term mortality after EVAR, highlighting the need for comprehensive preoperative assessment and individualized management strategies.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 170-175"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.10.016
J. Lacquemanne , C.C. Bamdé , F. Lareyre , E. Steinmetz , O. Creton
Background
The treatment of nonsaphenous varicose veins (NSVV), including incompetent perforating veins (IPV) and recurrent varicose veins (RVV), remains challenging for many reasons, including vein tortuosity, deep location and short vein to be treated. Data and recommendations are lacking. Steam vein sclerosis (SVS) is an endothermal therapy that has been used in the treatment of incompetent saphenous veins, achieving occlusion rates similar to other thermal ablation techniques with good patient tolerance and minimal postoperative pain. We report here the results of a cohort of SVS used to treat NSVV, including RVV and IPV.
Methods
From October 2017 to March 2020, consecutive patients presenting with NSVV treated with SVS were included. Patients were followed at 3 months with both clinical and duplex scan examinations. The primary endpoint was efficacy defined as target vein occlusion at 3 months; secondary endpoints were: safety with analysis of per procedural and 3 months complications, evolution of functional stage and symptoms between inclusion and 3 months.
Results
Ninety-six patients were included in the study. Five patients were lost to follow-up. Fifty-nine percent (n = 60) were women. Lesions were recurrent (recurrent varicose vein after surgery) in 61% (n = 62). The location of the NSVV was sapheno-femoral residual stump in 8% (n = 8), inguinal neovascularization in 14% (n = 14), sapheno-popliteal residual stump in 12% (n = 12), popliteal neovascularization in 7% (n = 7), and IPV in 59% (n = 60). Complete occlusion after treatment occurred in 86% (n = 83) of patients, partial occlusion in 4% (n = 4), and complete recanalization in 10% (n = 9). The occlusion rate in the IPV group was 93%. Complications at 30 days postoperatively were 2 (2%) deep vein thrombosis, 1 (1%) hematoma, and 2 (2%) late paresthesias in the superficial peroneal nerve area.
Conclusions
The use of SVS has been shown to be effective and safe in the short-term treatment of NSVV, including IPV and RVV. Further studies are needed to evaluate its long-term effects.
{"title":"Steam Vein Sclerosis for Nonsaphenous varicose veins","authors":"J. Lacquemanne , C.C. Bamdé , F. Lareyre , E. Steinmetz , O. Creton","doi":"10.1016/j.avsg.2024.10.016","DOIUrl":"10.1016/j.avsg.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of nonsaphenous varicose veins (NSVV), including incompetent perforating veins (IPV) and recurrent varicose veins (RVV), remains challenging for many reasons, including vein tortuosity, deep location and short vein to be treated. Data and recommendations are lacking. Steam vein sclerosis (SVS) is an endothermal therapy that has been used in the treatment of incompetent saphenous veins, achieving occlusion rates similar to other thermal ablation techniques with good patient tolerance and minimal postoperative pain. We report here the results of a cohort of SVS used to treat NSVV, including RVV and IPV.</div></div><div><h3>Methods</h3><div>From October 2017 to March 2020, consecutive patients presenting with NSVV treated with SVS were included. Patients were followed at 3 months with both clinical and duplex scan examinations. The primary endpoint was efficacy defined as target vein occlusion at 3 months; secondary endpoints were: safety with analysis of per procedural and 3 months complications, evolution of functional stage and symptoms between inclusion and 3 months.</div></div><div><h3>Results</h3><div>Ninety-six patients were included in the study. Five patients were lost to follow-up. Fifty-nine percent (<em>n</em> = 60) were women. Lesions were recurrent (recurrent varicose vein after surgery) in 61% (<em>n</em> = 62). The location of the NSVV was sapheno-femoral residual stump in 8% (<em>n</em> = 8), inguinal neovascularization in 14% (<em>n</em> = 14), sapheno-popliteal residual stump in 12% (<em>n</em> = 12), popliteal neovascularization in 7% (<em>n</em> = 7), and IPV in 59% (<em>n</em> = 60). Complete occlusion after treatment occurred in 86% (<em>n</em> = 83) of patients, partial occlusion in 4% (<em>n</em> = 4), and complete recanalization in 10% (<em>n</em> = 9). The occlusion rate in the IPV group was 93%. Complications at 30 days postoperatively were 2 (2%) deep vein thrombosis, 1 (1%) hematoma, and 2 (2%) late paresthesias in the superficial peroneal nerve area.</div></div><div><h3>Conclusions</h3><div>The use of SVS has been shown to be effective and safe in the short-term treatment of NSVV, including IPV and RVV. Further studies are needed to evaluate its long-term effects.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 336-340"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.11.005
Tracey J. Cheun , Joseph P. Hart , Mark G. Davies
<div><h3>Background</h3><div>Wound, ischemia, and foot infection (WIfI) is an important staging system for diabetic patients presenting with chronic limb-threatening ischemia (CLTI) of the lower extremities (LEs). This study examines the clinical implications of restaging WIfI after initial vascular and podiatric interventions.</div></div><div><h3>Methods</h3><div>A prospective database of patients undergoing vascular intervention treatment of the LE for tissue loss between 2018 and 2022 was queried. Cases were reviewed and staged preoperatively according to WIfI and then based on the WIfI restaging after primary vascular and podiatric interventions. Three groups were identified as follows: improvement of WIfI score (improved), WIfI unchanged (no change), and deterioration of WIfI score (worsened) groups. In cases of active infection, patients underwent infection control (drainage and/or amputation) followed by revascularization (endovascular or open intervention). In contrast, patients with no active infection underwent revascularization followed by podiatric intervention. Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; above-ankle amputation of the index limb or significant reintervention [new bypass graft or jump or interposition graft revision]) were evaluated.</div></div><div><h3>Results</h3><div>One thousand four hundred and four patients (61% male, age 64 ± 12 years, mean ± SD) presented with CLTI underwent initial vascular and/or podiatric LE interventions. On initial presentation, 37% of the patients presented with WIfI stage 3, and 63% presented with WIfI stage 4. The majority of the patients had Global Limb Anatomic Staging System (GLASS) stage III anatomic disease. Fifty-six percent of the patients had a primary infection control procedure, and 78% had a vascular intervention (71% endovascular intervention and 29% open bypass). After completing the primary podiatric and vascular procedures and restaging the WIfI score, 48% of the patients were improved, 32% were unchanged, and 20% were worsened. The postoperative change in WIfI classification impacted both 30-day rate of MALE (5% vs. 9% vs. 24% for the improved, unchanged, and worsened groups, respectively; <em>P</em> = 0.01) and the 30-day rate of major amputation (2% vs. 3% vs. 14% for the improved, unchanged, and upgraded groups, respectively; <em>P</em> < 0.02). At 5 years, freedom from MALE was progressively worse in the improved, unchanged, and worsened groups (47 ± 5% vs. 38 ± 5% vs. 23 ± 9%, respectively; mean ± standard error of the mean (SEM), <em>P</em> = 0.001). The 5-year AFS also deteriorated for the improved, unchanged, and worsened groups (49 ± 5% vs. 33 ± 5% vs. 19 ± 6%, respectively; mean ± SEM, <em>P</em> = 0.001)</div></div><div><h3>Conclusions</h3><div>Restaging WIfI after primary vascular and podiatric intervention results in significant downgrading of WIfI staging, allows for better different
{"title":"The Value of Restaging WIfI (Wound, Ischemia, and Foot Infection) After Initial Vascular and Podiatric Intervention","authors":"Tracey J. Cheun , Joseph P. Hart , Mark G. Davies","doi":"10.1016/j.avsg.2024.11.005","DOIUrl":"10.1016/j.avsg.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Wound, ischemia, and foot infection (WIfI) is an important staging system for diabetic patients presenting with chronic limb-threatening ischemia (CLTI) of the lower extremities (LEs). This study examines the clinical implications of restaging WIfI after initial vascular and podiatric interventions.</div></div><div><h3>Methods</h3><div>A prospective database of patients undergoing vascular intervention treatment of the LE for tissue loss between 2018 and 2022 was queried. Cases were reviewed and staged preoperatively according to WIfI and then based on the WIfI restaging after primary vascular and podiatric interventions. Three groups were identified as follows: improvement of WIfI score (improved), WIfI unchanged (no change), and deterioration of WIfI score (worsened) groups. In cases of active infection, patients underwent infection control (drainage and/or amputation) followed by revascularization (endovascular or open intervention). In contrast, patients with no active infection underwent revascularization followed by podiatric intervention. Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; above-ankle amputation of the index limb or significant reintervention [new bypass graft or jump or interposition graft revision]) were evaluated.</div></div><div><h3>Results</h3><div>One thousand four hundred and four patients (61% male, age 64 ± 12 years, mean ± SD) presented with CLTI underwent initial vascular and/or podiatric LE interventions. On initial presentation, 37% of the patients presented with WIfI stage 3, and 63% presented with WIfI stage 4. The majority of the patients had Global Limb Anatomic Staging System (GLASS) stage III anatomic disease. Fifty-six percent of the patients had a primary infection control procedure, and 78% had a vascular intervention (71% endovascular intervention and 29% open bypass). After completing the primary podiatric and vascular procedures and restaging the WIfI score, 48% of the patients were improved, 32% were unchanged, and 20% were worsened. The postoperative change in WIfI classification impacted both 30-day rate of MALE (5% vs. 9% vs. 24% for the improved, unchanged, and worsened groups, respectively; <em>P</em> = 0.01) and the 30-day rate of major amputation (2% vs. 3% vs. 14% for the improved, unchanged, and upgraded groups, respectively; <em>P</em> < 0.02). At 5 years, freedom from MALE was progressively worse in the improved, unchanged, and worsened groups (47 ± 5% vs. 38 ± 5% vs. 23 ± 9%, respectively; mean ± standard error of the mean (SEM), <em>P</em> = 0.001). The 5-year AFS also deteriorated for the improved, unchanged, and worsened groups (49 ± 5% vs. 33 ± 5% vs. 19 ± 6%, respectively; mean ± SEM, <em>P</em> = 0.001)</div></div><div><h3>Conclusions</h3><div>Restaging WIfI after primary vascular and podiatric intervention results in significant downgrading of WIfI staging, allows for better different","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 319-330"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.10.022
Ahsan Zil-E-Ali, Aditya Safaya, Kristen Kent, Faisal Aziz
Objectives
This study explores the impact of prolonged fluoroscopy time (FT) on outcomes in endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). While total operative time includes multiple variables, FT precisely captures the technical precision of the EVAR procedure. By examining the factors that extend FT, we aim to establish FT as a critical quality metric for evaluating surgical performance and predicting postoperative outcomes.
Methods
A retrospective review of the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) was conducted (2003–2021). The FT was studied based on a median dichotomy of ≤18 mins (Group I) and >18 mins (Group II). Primary outcomes of in-hospital mortality and discharge status were studied, along with numerous secondary outcomes pertaining to systemic complications. Factors associated with more extended FT were also measured. All the variables examined in multivariate analyses were estimated in odds ratios, and a P-value of <0.05 was deemed significant for all the analyses performed.
Results
41,841 patients were studied, of which 20,339 were categorized in Group I and 21,502 in Group II. The average fluoroscopy time in the selected patients was reported to be 23.2 minutes. Patients in Group II generally had overall poorer health status with multiple comorbidities and on various medications. Aortic aneurysm parameters can influence the FT, including the greater aorta-neck angle, neck angle, neck diameter, and neck length. Patients treated by high-volume surgeons were observed to have less likelihood of prolonged FT. On trends analysis, it was observed that the FT has been consistent over the study period.
Conclusions
Various factors can influence the FT in patients undergoing EVAR, including the patient characteristics and the complexity of the aneurysm. Identifying the risk factors associated with prolonged FT can help prepare the surgeons and devise ways to ensure a high quality of care, better risk stratification, and enhanced safety, especially for more prolonged exposure to radiation and contrast volumes.
{"title":"Factors Associated with Increased Fluoroscopy Time During Elective Endovascular Abdominal Aortic Aneurysm Repair and Its Utilization as an Indicator of Intraoperative and Postoperative Outcomes","authors":"Ahsan Zil-E-Ali, Aditya Safaya, Kristen Kent, Faisal Aziz","doi":"10.1016/j.avsg.2024.10.022","DOIUrl":"10.1016/j.avsg.2024.10.022","url":null,"abstract":"<div><h3>Objectives</h3><div>This study explores the impact of prolonged fluoroscopy time (FT) on outcomes in endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). While total operative time includes multiple variables, FT precisely captures the technical precision of the EVAR procedure. By examining the factors that extend FT, we aim to establish FT as a critical quality metric for evaluating surgical performance and predicting postoperative outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) was conducted (2003–2021). The FT was studied based on a median dichotomy of ≤18 mins (Group I) and >18 mins (Group II). Primary outcomes of in-hospital mortality and discharge status were studied, along with numerous secondary outcomes pertaining to systemic complications. Factors associated with more extended FT were also measured. All the variables examined in multivariate analyses were estimated in odds ratios, and a <em>P</em>-value of <0.05 was deemed significant for all the analyses performed.</div></div><div><h3>Results</h3><div>41,841 patients were studied, of which 20,339 were categorized in Group I and 21,502 in Group II. The average fluoroscopy time in the selected patients was reported to be 23.2 minutes. Patients in Group II generally had overall poorer health status with multiple comorbidities and on various medications. Aortic aneurysm parameters can influence the FT, including the greater aorta-neck angle, neck angle, neck diameter, and neck length. Patients treated by high-volume surgeons were observed to have less likelihood of prolonged FT. On trends analysis, it was observed that the FT has been consistent over the study period.</div></div><div><h3>Conclusions</h3><div>Various factors can influence the FT in patients undergoing EVAR, including the patient characteristics and the complexity of the aneurysm. Identifying the risk factors associated with prolonged FT can help prepare the surgeons and devise ways to ensure a high quality of care, better risk stratification, and enhanced safety, especially for more prolonged exposure to radiation and contrast volumes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 151-164"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.11.013
Mehmet Ali Yeşiltaş , Serkan Ketenciler , Cihan Yücel , Ahmet Ozan Koyuncu , Ugurcan Sayili
<div><h3>Background</h3><div>Endovascular treatments are frequently applied in pelvic venous disorders (PeVDs) with guidelines recommendations. There is no clear answer as to which of the embolization methods applied with endovascular treatments is superior. In this study, we aimed to compare the outcomes and symptom relief of patients with PeVDs treated using coils alone versus those treated with both coils and ethylene vinyl alcohol copolymer, as well as to evaluate the material usage and safety and efficacy of these treatments.</div></div><div><h3>Methods</h3><div>Patients with PeVDs who underwent embolization of ovarian veins with coil and/or ethylene vinyl alcohol copolymer between January 2022 and April 2024 were included in the study. These patients were divided into 2 groups: patients who underwent coil embolization only (Group I) and patients who used ethylene vinyl alcohol copolymer together with coils (Group II). These patients were followed up at first, third 6th and 12th months postoperatively. Symptoms were evaluated with an examination and a visual analog scale (VAS).</div></div><div><h3>Results</h3><div>Between January 2022 and April 2024, 90 patients with PeVDs who underwent endovascular treatment of their ovarian and pelvic veins were included in our study. 31 patients underwent coil embolization only (Group I), while 59 received both coil embolization and a ethylene vinyl alcohol copolymer (Group II). The mean age was 37.5 ± 7.9 and 40.4 ± 7.9 for Groups I and II, respectively. In group I, When pelvic pain was evaluated with VAS, there was a significant decrease in VAS scores between the preoperative period and at the first (VAS: 5.3 ± 0.9), third (VAS:3.9 ± 1.2), sixth (VAS: 3.5 ± 1.5), and 12<sup>th</sup> (VAS: 3.6 ± 1.5) months postoperatively (<em>P</em> = 0.011, <0.001, <0.001, <0.001, respectively). In Group II, When pelvic pain was evaluated with VAS, there was a similarly significant decrease in VAS scores between the preoperative period and the first (VAS: 5.3 ± 1.4), third (VAS: 3.3 ± 1.7), sixth (VAS: 2.8 ± 1.8), and 12<sup>th</sup> (VAS: 2.5 ± 2.1) months postoperatively (<em>P</em> = 0.002, <0.001, <0.001, <0.001, respectively). Group II demonstrated significantly lower VAS scores at the third, sixth, and 12th months compared to Group I. When examining the clinical symptoms of the patients individually, no significant differences were observed between the preoperative and first-month VAS scores for any specific symptom. However, at the third, sixth, and 12th months, while there were no significant differences between Group I and Group II in terms of menstrual pain, Group II exhibited significantly lower scores for standing abdominal pain, sitting abdominal pain, and dyspareunia.</div></div><div><h3>Conlusions</h3><div>In our study, the use of ethylene vinyl alcohol copolymer and coils in the embolization of PeVDs is considered an effective and safe procedure with a higher clinical efficacy rate co
{"title":"Comparison of Embolization Using Coil Versus Coil and Ethylene Vinyl Alcohol Copolymer in Pelvic venous Disorders","authors":"Mehmet Ali Yeşiltaş , Serkan Ketenciler , Cihan Yücel , Ahmet Ozan Koyuncu , Ugurcan Sayili","doi":"10.1016/j.avsg.2024.11.013","DOIUrl":"10.1016/j.avsg.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular treatments are frequently applied in pelvic venous disorders (PeVDs) with guidelines recommendations. There is no clear answer as to which of the embolization methods applied with endovascular treatments is superior. In this study, we aimed to compare the outcomes and symptom relief of patients with PeVDs treated using coils alone versus those treated with both coils and ethylene vinyl alcohol copolymer, as well as to evaluate the material usage and safety and efficacy of these treatments.</div></div><div><h3>Methods</h3><div>Patients with PeVDs who underwent embolization of ovarian veins with coil and/or ethylene vinyl alcohol copolymer between January 2022 and April 2024 were included in the study. These patients were divided into 2 groups: patients who underwent coil embolization only (Group I) and patients who used ethylene vinyl alcohol copolymer together with coils (Group II). These patients were followed up at first, third 6th and 12th months postoperatively. Symptoms were evaluated with an examination and a visual analog scale (VAS).</div></div><div><h3>Results</h3><div>Between January 2022 and April 2024, 90 patients with PeVDs who underwent endovascular treatment of their ovarian and pelvic veins were included in our study. 31 patients underwent coil embolization only (Group I), while 59 received both coil embolization and a ethylene vinyl alcohol copolymer (Group II). The mean age was 37.5 ± 7.9 and 40.4 ± 7.9 for Groups I and II, respectively. In group I, When pelvic pain was evaluated with VAS, there was a significant decrease in VAS scores between the preoperative period and at the first (VAS: 5.3 ± 0.9), third (VAS:3.9 ± 1.2), sixth (VAS: 3.5 ± 1.5), and 12<sup>th</sup> (VAS: 3.6 ± 1.5) months postoperatively (<em>P</em> = 0.011, <0.001, <0.001, <0.001, respectively). In Group II, When pelvic pain was evaluated with VAS, there was a similarly significant decrease in VAS scores between the preoperative period and the first (VAS: 5.3 ± 1.4), third (VAS: 3.3 ± 1.7), sixth (VAS: 2.8 ± 1.8), and 12<sup>th</sup> (VAS: 2.5 ± 2.1) months postoperatively (<em>P</em> = 0.002, <0.001, <0.001, <0.001, respectively). Group II demonstrated significantly lower VAS scores at the third, sixth, and 12th months compared to Group I. When examining the clinical symptoms of the patients individually, no significant differences were observed between the preoperative and first-month VAS scores for any specific symptom. However, at the third, sixth, and 12th months, while there were no significant differences between Group I and Group II in terms of menstrual pain, Group II exhibited significantly lower scores for standing abdominal pain, sitting abdominal pain, and dyspareunia.</div></div><div><h3>Conlusions</h3><div>In our study, the use of ethylene vinyl alcohol copolymer and coils in the embolization of PeVDs is considered an effective and safe procedure with a higher clinical efficacy rate co","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 268-278"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.avsg.2024.10.023
M.a Lourdes Del Río-Solá , Irene Martin-Morquecho , Ana Revilla-Orodea , Israel Sánchez-Lite
Background
The initial assessment of cardiovascular risk in patients undergoing lower limb revascularization surgery is crucial to minimize complications and improve outcomes. This study aims to determine if the iliac calcium score (ICS) serves as a cardiologic risk marker by examining its correlation with the coronary calcium score (CCS) in these patients.
Methods
This prospective observational single-center study included 248 patients with critical limb ischemia undergoing revascularization procedures from January 2022 to June 2023. Baseline characteristics such as age, gender, smoking status, comorbidities, and clinical status were recorded. CCS and ICS were calculated using preoperative computed tomography angiography. Multiple linear regression identified significant predictors of ICS, including CCS, iliac intima-media thickness (i-IMT), coronary artery disease, diabetes, chronic kidney disease, hypertension, dyslipidemia, and smoking.
Results
The study population had a mean age of 74.4 years, 83.86% male. Significant correlations were found between ICS and CCS (Pearson r = 0.34, P < 0.001) and between ICS and i-IMT (Pearson r = 0.35, P < 0.001). Regression analysis revealed significant predictors for ICS, including CCS (coefficient = 1.808, P < 0.0001), i-IMT (coefficient = 3.11, P < 0.0001), coronary artery disease (coefficient = 11.94, P = 0.042), diabetes (coefficient = 19.59, P = 0.002), chronic kidney disease (coefficient = 11.79, P < 0.0001), and hypertension (coefficient = 22.10, P = 0.001). Dyslipidemia and smoking did not show significant associations with ICS.
Conclusions
The ICS shows a statistically significant association with the CCS and i-IMT in patients undergoing lower limb revascularization surgery. This correlation suggests that ICS reflects vascular calcification patterns like those observed in coronary arteries. Further studies are needed to explore this relationship in diverse patient populations and under varying clinical conditions.
{"title":"Elevated Iliac Calcium Score as a Marker of Coronary Calcification and Overall Atherosclerotic Risk","authors":"M.a Lourdes Del Río-Solá , Irene Martin-Morquecho , Ana Revilla-Orodea , Israel Sánchez-Lite","doi":"10.1016/j.avsg.2024.10.023","DOIUrl":"10.1016/j.avsg.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>The initial assessment of cardiovascular risk in patients undergoing lower limb revascularization surgery is crucial to minimize complications and improve outcomes. This study aims to determine if the iliac calcium score (ICS) serves as a cardiologic risk marker by examining its correlation with the coronary calcium score (CCS) in these patients.</div></div><div><h3>Methods</h3><div>This prospective observational single-center study included 248 patients with critical limb ischemia undergoing revascularization procedures from January 2022 to June 2023. Baseline characteristics such as age, gender, smoking status, comorbidities, and clinical status were recorded. CCS and ICS were calculated using preoperative computed tomography angiography. Multiple linear regression identified significant predictors of ICS, including CCS, iliac intima-media thickness (i-IMT), coronary artery disease, diabetes, chronic kidney disease, hypertension, dyslipidemia, and smoking.</div></div><div><h3>Results</h3><div>The study population had a mean age of 74.4 years, 83.86% male. Significant correlations were found between ICS and CCS (Pearson <em>r</em> = 0.34, <em>P</em> < 0.001) and between ICS and i-IMT (Pearson <em>r</em> = 0.35, <em>P</em> < 0.001). Regression analysis revealed significant predictors for ICS, including CCS (coefficient = 1.808, <em>P</em> < 0.0001), i-IMT (coefficient = 3.11, <em>P</em> < 0.0001), coronary artery disease (coefficient = 11.94, <em>P</em> = 0.042), diabetes (coefficient = 19.59, <em>P</em> = 0.002), chronic kidney disease (coefficient = 11.79, <em>P</em> < 0.0001), and hypertension (coefficient = 22.10, <em>P</em> = 0.001). Dyslipidemia and smoking did not show significant associations with ICS.</div></div><div><h3>Conclusions</h3><div>The ICS shows a statistically significant association with the CCS and i-IMT in patients undergoing lower limb revascularization surgery. This correlation suggests that ICS reflects vascular calcification patterns like those observed in coronary arteries. Further studies are needed to explore this relationship in diverse patient populations and under varying clinical conditions.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 351-359"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.avsg.2024.12.072
Xiao Wang, Jing Wang, Xiaoming Zhang, Xuemin Zhang, Qingle Li, Wei Li, Jingjun Jiang, Yang Jiao, Tao Zhang
Objectives: This study aimed to evaluate the demographic characteristics and changing trends in the incidence of hospital-acquired lower limb deep vein thrombosis (HA-LEDVT) in Chinese inpatients over the course of 15 years.
Methods: We performed a retrospective analysis of the HA-LEDVT events in a medical center between January 1, 2007 and December 31, 2021.
Results: A total of 846347 eligible patients were analyzed. The overall incidence of HA-LEDVT was 2.53 per 1,000 admissions. The incidence was 0.22 and 4.20 per 1,000 admissions respectively in 2007 and 2017(P < 0.01). Medical patients had a higher incidence of HA-LEDVT than surgical patients (3.19 vs. 2.14 per 1,000 admissions; P < 0.01). The incidence of HA-LEDVT increased from 0.28 to 11.90 per 1,000 admissions for those aged 17-29 years and 80-89 years respectively (P < 0.01). The increase in HA-LEDVT incidence mainly occurred in patients aged ≥ 60 years. The median length of stay of HA-LEDVT patients was longer than that of other eligible patients (17 vs. 7 days; P < 0.01). Most of the HA-LEDVT events (77.8%) were diagnosed between hospital day 3 and 15, and the time from admission to HA-LEDVT diagnosis decreased by year. The rate of vascular surgery consultation for diagnosed or suspected HA-LEDVT and HA-LEDVT-related discharge instructions both decreased by half gradually over the 15 years of this study. Isolated distal DVT accounted for 83.3% of all HA-LEDVT events and the proportion increased significantly from 62.5% in 2007 to 88.7% in 2021 (P < 0.01).
Conclusion: The incidence of HA-LEDVT has been high in the Chinese population. More high-quality prospective studies are needed to guide prevention of HA-LEDVTs.
{"title":"Trends of hospital-acquired lower limb deep venous thrombosis in an academic medical center in China from 2007 to 2021.","authors":"Xiao Wang, Jing Wang, Xiaoming Zhang, Xuemin Zhang, Qingle Li, Wei Li, Jingjun Jiang, Yang Jiao, Tao Zhang","doi":"10.1016/j.avsg.2024.12.072","DOIUrl":"https://doi.org/10.1016/j.avsg.2024.12.072","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the demographic characteristics and changing trends in the incidence of hospital-acquired lower limb deep vein thrombosis (HA-LEDVT) in Chinese inpatients over the course of 15 years.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the HA-LEDVT events in a medical center between January 1, 2007 and December 31, 2021.</p><p><strong>Results: </strong>A total of 846347 eligible patients were analyzed. The overall incidence of HA-LEDVT was 2.53 per 1,000 admissions. The incidence was 0.22 and 4.20 per 1,000 admissions respectively in 2007 and 2017(P < 0.01). Medical patients had a higher incidence of HA-LEDVT than surgical patients (3.19 vs. 2.14 per 1,000 admissions; P < 0.01). The incidence of HA-LEDVT increased from 0.28 to 11.90 per 1,000 admissions for those aged 17-29 years and 80-89 years respectively (P < 0.01). The increase in HA-LEDVT incidence mainly occurred in patients aged ≥ 60 years. The median length of stay of HA-LEDVT patients was longer than that of other eligible patients (17 vs. 7 days; P < 0.01). Most of the HA-LEDVT events (77.8%) were diagnosed between hospital day 3 and 15, and the time from admission to HA-LEDVT diagnosis decreased by year. The rate of vascular surgery consultation for diagnosed or suspected HA-LEDVT and HA-LEDVT-related discharge instructions both decreased by half gradually over the 15 years of this study. Isolated distal DVT accounted for 83.3% of all HA-LEDVT events and the proportion increased significantly from 62.5% in 2007 to 88.7% in 2021 (P < 0.01).</p><p><strong>Conclusion: </strong>The incidence of HA-LEDVT has been high in the Chinese population. More high-quality prospective studies are needed to guide prevention of HA-LEDVTs.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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