Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease

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 - 2015/7/1

Y1 - 2015/7/1

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

SN - 0741-5214

VL - 62

SP - 75

EP - 82

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 1

ER -