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Nyman J, Hasselmann J, Monsen C, Acosta S. Staged versus non-staged elective hybrid iliofemoral revascularization - analysis of ten years of prospective data. Ann Vasc Surg 2024:S0890-5096(24)00423-0. [PMID: 39009127 DOI: 10.1016/j.avsg.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Reports of large series of hybrid iliofemoral revascularization for chronic lower limb ischemia are scarce. The aims of this study were to evaluate outcomes for staged and non-staged procedures, and to evaluate risk factors for outcomes at 90 days. MATERIALS AND METHODS Patients were consecutively included between 2013 and 2023. Surgical site infection (SSI) was defined by the ASEPSIS criteria and major adverse limb events (MALE) as onset of acute or continuing or worsening chronic limb ischemia or major amputation. Factors associated with outcomes were tested in a multivariable logistic regression analysis and expressed in Odds ratios (OR) with 95% confidence intervals (CI). RESULTS Patients undergoing non-staged procedures (n=124) had higher TASC (Trans-Atlantic Inter-Society Consensus) class representing anatomical occlusive complexity, more often through-and through femoral guidewire access, more endoprosthesis, more covered stents, longer procedure time with open groin wounds, and less contralateral femoral access, than those undergoing staged procedures (n=31). The median time interval between the staged procedures was one day, and iliac stenting was done first in 77%. The median in-hospital stay was non-significantly longer in staged procedure (8 versus 6 days, p=0.053). The overall SSI and MALE rates were 25.8% and 20.0%, respectively, without differences between groups. Diabetes mellitus (OR 3.7, 95% CI 1.2 - 7.2]) and presence of a foot ulcer (OR 3.7, 95% CI [1.5 - 9.4]) were independently associated with MALE at 90 days. Postoperative hyperglycemia was non-significantly associated with SSI (OR 2.1 [95% CI 1.0 - 4.5], p=0.066) in multivariable analysis. CONCLUSION The risks of SSI and MALE after elective hybrid iliofemoral revascularization were high. There appears to be no benefit in performing staged as opposed to non-staged procedures. The extent of iliofemoral occlusive disease according to the TASC classification had little influence on outcomes whereas diabetes mellitus and presence of a foot ulcer had greater impact on MALE.
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Affiliation(s)
- Johan Nyman
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Sweden.
| | | | - Christina Monsen
- Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Allied Health Professions, Skane University Hospital
| | - Stefan Acosta
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Sweden
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Kirkham AM, Candeliere J, Mai T, Nagpal SK, Brandys TM, Dubois L, Shorr R, Stelfox HT, McIsaac DI, Roberts DJ. Risk Factors for Surgical Site Infection after Lower Limb Revascularisation Surgery: a Systematic Review and Meta-Analysis of Prognostic Studies. Eur J Vasc Endovasc Surg 2024; 67:455-467. [PMID: 37925099 DOI: 10.1016/j.ejvs.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse adjusted risk factors for surgical site infection (SSI) after lower limb revascularisation surgery. DATA SOURCES MEDLINE, Embase, Evidence Based Medicine Reviews, and the Cochrane Central Register of Controlled Trials (inception to 28 April 2022). REVIEW METHODS Systematic review and meta-analysis conducted according to PRISMA guidelines. After protocol registration, databases were searched. Studies reporting adjusted risk factors for SSI in adults who underwent lower limb revascularisation surgery for peripheral artery disease were included. Adjusted odds ratios (ORs) were pooled using random effects models. GRADE was used to assess certainty. RESULTS Among 6 377 citations identified, 50 studies (n = 271 125 patients) were included. The cumulative incidence of SSI was 12 (95% confidence interval [CI] 10 - 13) per 100 patients. Studies reported 139 potential SSI risk factors adjusted for a median of 12 (range 1 - 69) potential confounding factors. Risk factors that increased the pooled adjusted odds of SSI included: female sex (pooled OR 1.41, 95% CI 1.20 - 1.64; high certainty); dependent functional status (pooled OR 1.18, 95% CI 1.03 - 1.35; low certainty); being overweight (pooled OR 1.82, 95% CI 1.29 - 2.56; moderate certainty), obese (pooled OR 2.20, 95% CI 1.44 - 3.36; high certainty), or morbidly obese (pooled OR 1.65, 95% CI 1.08 - 2.52; moderate certainty); chronic obstructive pulmonary disease (pooled OR 1.42, 95% CI 1.17 - 1.71; high certainty); chronic limb threatening ischaemia (pooled OR 1.67, 95% CI 1.22 - 2.29; moderate certainty); chronic kidney disease (pooled OR 2.13, 95% CI 1.18 - 3.83; moderate certainty); intra-operative (pooled OR 1.23, 95% CI 1.02 - 1.49), peri-operative (pooled OR 1.92, 95% CI 1.27 - 2.90), or post-operative (pooled OR 2.21, 95% CI 1.44 - 3.39) blood transfusion (moderate certainty for all); urgent or emergency surgery (pooled OR 2.12, 95% CI 1.22 - 3.70; moderate certainty); vein bypass and or patch instead of endarterectomy alone (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty); an operation lasting ≥ 3 hours (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty) or ≥ 5 hours (pooled OR 1.60, 95% CI 1.18 - 2.17; moderate certainty); and early or unplanned re-operation (pooled OR 4.50, 95% CI 2.18 - 9.32; low certainty). CONCLUSION This systematic review identified evidence informed SSI risk factors following lower limb revascularisation surgery. These may be used to develop improved SSI risk prediction tools and to identify patients who may benefit from evidence informed SSI prevention strategies.
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Affiliation(s)
- Aidan M Kirkham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Trinh Mai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy M Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Dubois
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henry T Stelfox
- The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Derek J Roberts
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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Ahmic E, Hitzl W, Seitelberger R, Linni K. Using Isolated Femoral Bifurcation Endarterectomy or Combined with Bypass Surgery for Patients with Chronic Limb-Threatening Ischemia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:316. [PMID: 38399603 PMCID: PMC10890108 DOI: 10.3390/medicina60020316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The aim of this study was to evaluate the clinical outcomes of patients suffering from chronic limb-threatening ischemia (CLTI) and tissue loss treated with primary isolated femoral bifurcation endarterectomy (FBE) or with FBE combined with bypass surgery. Materials and Methods: This retrospective study was performed in a tertiary university-based care centre. Between January 2008 and December 2019, a prospectively collected database of patients suffering from CLTI and tissue loss and undergoing either primary FBE (group A) or FBE in combination with bypass surgery (group B) was analysed. Study endpoints were ulcer healing, primary and secondary patency rate, limb salvage, and survival. Results: In total, FBE was performed in 73 patients and FBE with bypass in 60 patients. Between both groups, there were no significant differences regarding demographic data or the Global Limb Anatomic Staging System (GLASS) grade III and IV of femoropopliteal lesions. After 3 years, ulcer healing could be achieved in 72% of FBE and in 75% of FBE with bypass patients. The primary patency rate was 95% and 91% for FBE and 83% and 80% for FBE with bypass after one and three years, respectively. The 3-year limb-salvage rate was 78% for FBE and 84% for FBE with bypass. The secondary patency rate after one and three years was 99% and 97% for FBE and 93% and 88% for FBE with bypass. Conclusions: FBE and FBE with bypass are equally effective for ulcer healing in cases of combined CFA and superficial femoral artery lesions. There was no significant difference between both groups regarding primary and secondary patency rates, limb salvage rates and ulcer healing. Isolated FBE could be an alternative strategy in patients with higher operative risk.
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Affiliation(s)
- Edin Ahmic
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria; (R.S.); (K.L.)
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria;
| | - Rainald Seitelberger
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria; (R.S.); (K.L.)
| | - Klaus Linni
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria; (R.S.); (K.L.)
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Kirkham AM, Candeliere J, McIsaac DI, Stelfox HT, Dubois L, Gill HL, Brandys T, Nagpal SK, Roberts DJ. Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Surg 2023; 278:e447-e456. [PMID: 36994744 DOI: 10.1097/sla.0000000000005867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery. BACKGROUND SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality. METHODS We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty. RESULTS Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11-0.57; n=4 studies; I2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38-0.78; n=5 studies; I2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26-0.73; n=2 studies; I2 =0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33-1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097-1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44-1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42-1.03; n=1 study) (low certainty for all). CONCLUSIONS Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.
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Affiliation(s)
- Aidan M Kirkham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
- Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Luc Dubois
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Division of Vascular Surgery, Department of Surgery, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, ON, Canada
| | - Heather L Gill
- Division of Vascular Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Timothy Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Derek J Roberts
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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Noronen K, Söderström M, Kouhia S, Venermo M. Bovine pericardial patch: A good alternative in femoral angioplasty. J Vasc Surg 2023; 77:225-230. [PMID: 35987464 DOI: 10.1016/j.jvs.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability. METHODS This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups. RESULTS Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024). CONCLUSIONS BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.
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Affiliation(s)
- Katariina Noronen
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
| | - Maria Söderström
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Kouhia
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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Marie Hoffmann-Wieker C, Ronellenfitsch U, Rebelo A, Görg N, Schwarzer G, Ballotta E, Gouëffic Y, Böckler D. Open Surgical Thrombendarterectomy Versus Endovascular Treatment in Occlusive Processes of the Femoral Artery Bifurcation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:803-809. [PMID: 36424715 PMCID: PMC9906024 DOI: 10.3238/arztebl.m2022.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/07/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The standard treatment of occlusive processes of the femoral artery bifurcation is thrombendarterectomy (TEA). Endovascular techniques (ENDO) have recently been put forward as a potential alternative. It is unclear so far which modality yields better outcomes with respect to long-term revascularization and periprocedural complications. Method: Multiple databases were systematically searched for pertinent publications (publication date November 1965 to February 2022). From the included studies, individual patient data (IPD) were requested. Aggregate data (AD) were used when no IPD were available. Primary and secondary patency (PP and SP), perioperative morbidity/mortality, and further endpoints were determined separately for TEA and ENDO and compared with each other. AD for each modality were summarized in meta-analyses. Time-to-event analyses and comparative meta-analyses with PP as primary endpoint were carried out using IPD. Results: 42 studies (3 IPD, 39 AD; 27 TEA, 12 ENDO, 3 comparisons of TEA versus ENDO) were included. In the combined meta-analysis of IPD and AD, PP for TEA was 97% at 6 months and 92% at 12 months, while PP for ENDO was 84% at 6 months and 85% at 12 months. The differences were not statistically significant. The comparative meta-analysis regarding PP did not reveal any significant differences either (TEA versus ENDO: HR 0.30 [0.06; 1.48]). SP at 12 months was 97% (TEA) and 93% (ENDO). The periprocedural morbidity was 16% for TEA and 9% for ENDO. Conclusion: In light of a higher PP, even without formal statistical proof of superiority, TEA can still be considered the standard treatment for occlusive processes of the femoral artery bifurcation. METHODS Multiple databases were systematically searched for pertinent publications (publication date November 1965 to February 2022). From the included studies, individual patient data (IPD) were requested. Aggregate data (AD) were used when no IPD were available. Primary and secondary patency (PP and SP), perioperative morbidity/mortality, and further endpoints were determined separately for TEA and ENDO and compared with each other. AD for each modality were summarized in meta-analyses. Time-to-event analyses and comparative meta-analyses with PP as primary endpoint were carried out using IPD. RESULTS 42 studies (3 IPD, 39 AD; 27 TEA, 12 ENDO, 3 comparisons of TEA versus ENDO) were included. In the combined meta-analysis of IPD and AD, PP for TEA was 97% at 6 months and 92% at 12 months, while PP for ENDO was 84% at 6 months and 85% at 12 months. The differences were not statistically significant. The comparative meta-analysis regarding PP did not reveal any significant differences either (TEA versus ENDO: HR 0.30 [0.06; 1.48]). SP at 12 months was 97% (TEA) and 93% (ENDO). The periprocedural morbidity was 16% for TEA and 9% for ENDO. CONCLUSION In light of a higher PP, even without formal statistical proof of superiority, TEA can still be considered the standard treatment for occlusive processes of the femoral artery bifurcation.
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Affiliation(s)
- Carola Marie Hoffmann-Wieker
- *These authors share first authorship.,Department of Vascular and Endovascular Surgery, Heidelberg University Hospital,*Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie Universitätsklinikum Heidelberg Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Ulrich Ronellenfitsch
- *These authors share first authorship.,Department of Visceral, Vascular and Endocrine Surgery, University Medical Center, Martin-Luther-University Halle-Wittenberg (Saale)
| | - Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center, Martin-Luther-University Halle-Wittenberg (Saale)
| | - Nadine Görg
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, Albert-Ludwigs-University of Freiburg
| | - Enzo Ballotta
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy
| | - Yann Gouëffic
- Department of Vascular Surgery, University Hospital of Nantes, France
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital
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Kuyumdzhiev S, Kuyumdzhieva G, Tiwari A. Comparison of transverse versus longitudinal skin incisions for femoral endarterectomy and patchplasty. Vascular 2021; 30:1168-1173. [PMID: 34866514 DOI: 10.1177/17085381211051483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Access to the femoral artery for a femoral endarterectomy and patchplasty (CFE) can be undertaken either through transverse (TI) or longitudinal incision (LI). LIs have been shown in previous studies to have higher groin complications though these were undertaken in multiple types of vascular procedures. We looked at wound complications for patients undergoing elective CFE procedures only with or without angioplasty via TI or LI. METHODS All patients who had undergone CFE were retrospectively analysed from a prospective database. Length of stay, wound complications and readmission rates were recorded. Factors for wound complication were looked at using logistic regression with backward elimination. RESULTS 122 CFE procedures were performed (30 TI) over the study period. 92 (76.7%) of patients had a prosthetic patch used, whilst 57 (46.7%) patients underwent an adjunctive endovascular procedure, namely, iliac angioplasty and stenting. Median length of stay was 3 days for both groups. The wound complication rate was 6.7% in the TI group and 22.6% in the LI group. 85.6% of the wound complications were identified after discharge. 6/122 (4.9%) were readmitted for intravenous antibiotics, whilst others were managed in the outpatient setting. TI (aOR = 0.15; 95% 0.03-0.75) and combined open FE with endovascular revascularisation (aOR = 0.33; 95% 0.11-0.95) had protective effects on wound complications. Type of the patch used was not associated with any wound complications (p = 0.07). CONCLUSION Compared to traditional LI, TI for CFE and OTA have lower risk of wound complications and reduced readmission rates in our series. We advocate adopting TI as the standard for femoral artery procedures rather than LI.
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Affiliation(s)
- Smilen Kuyumdzhiev
- Department of Vascular Surgery, Queen Elizabeth Hospital Birmingham, 1732The University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Galena Kuyumdzhieva
- Immunisation, Hepatitis and Blood Safety Department, 371011Public Health England, London, UK
| | - Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital Birmingham, 1732The University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Dinoto E, Ferlito F, Urso F, Mirabella D, Bajardi G, Pecoraro F. Iliac-femoral stent-graft infection after hybrid procedure redo: Case report. Int J Surg Case Rep 2021; 84:106096. [PMID: 34119935 PMCID: PMC8209074 DOI: 10.1016/j.ijscr.2021.106096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Stent-graft infection in peripheral arteries is rare and potentially dangerous. The use of hybrid procedures, in complicated patients previously treated, involves an increase of infective risk especially in no collaborative patients. Presentation of case We report a case of rare stent-graft infection in a patient treated for a Rutherford IV Multiple Peripheral Arterial Disease (MPAD) involving the right iliac-femoral axis with stenosis on deep femoral artery due to a previously stenting procedure for Superficial Femoral artery (SFA) stenosis. The first simultaneous hybrid intervention consisted of an endovascular iliac stent-graft placement and a surgical common femoral patch angioplasty. After two months the patient was readmitted to our unit for a purulent secretion through a fistulous channel and a suspect infection of stent-graft. Subsequently, the stent-graft was completely removed without possibility to have a surgical revascularization. An amputation major amputation was needed for irreversible ischemia of right leg. Discussion The incidence of stent-graft infection after endovascular aortic aneurysm repair had been reported as 0.4–1.0% while Aortoiliac graft infection occurs in 2–6% of patients. Hybrid procedures are secure and need close follow-up for cases of redo and patient with comorbidities. Conclusions Graft infection is a rare complication after endovascular treatments. Hybrid procedures outcomes are good with less morbidity but in patient with high risk of infection is important a close follow-up. Stent-graft infection in peripheral arteries is rare and potentially dangerous. Stent-graft infection after angioplasty Aortoiliac occurs in 2–6% of patients. Hybrid procedures are useful, patients high risk for infection need a close followup.
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Affiliation(s)
- E Dinoto
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - F Ferlito
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Urso
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - D Mirabella
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - G Bajardi
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
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Bertges DJ, Smith L, Scully RE, Wyers M, Eldrup-Jorgensen J, Suckow B, Ozaki CK, Nguyen L. A multicenter, prospective randomized trial of negative pressure wound therapy for infrainguinal revascularization with a groin incision. J Vasc Surg 2021; 74:257-267.e1. [PMID: 33548422 DOI: 10.1016/j.jvs.2020.12.100] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Wound complications after open infrainguinal revascularization are a frequent cause of patient morbidity, resulting in increased healthcare costs. The purpose of the present study was to assess the effects of closed incision negative pressure therapy (ciNPT) on groin wound complications after infrainguinal bypass and femoral endarterectomy. METHODS A total of 242 patients who had undergone infrainguinal bypass (n = 124) or femoral endarterectomy (n = 118) at five academic medical centers in New England from April 2015 to August 2019 were randomized to ciNPT (PREVENA; 3M KCI, St Paul, Minn; n = 118) or standard gauze (n = 124). The primary outcome measure was a composite endpoint of groin wound complications, including surgical site infections (SSIs), major noninfectious wound complications, or graft infections within 30 days after surgery. The secondary outcome measures included 30-day SSIs, 30-day noninfectious wound complications, readmission for wound complications, significant adverse events, and health-related quality of life using the EuroQoL 5D-3L survey. RESULTS The ciNPT and control groups had similar demographics (age, 67 vs 67 years, P = .98; male gender, 71% vs 70%, P = .86; white race, 93% vs 93%, P = .97), comorbidities (previous or current smoking, 93% vs 94%, P = .46; diabetes, 41% vs 48%, P = .20; renal insufficiency, 4% vs 7%, P = .31), and operative characteristics, including procedure type, autogenous conduit, and operative time. No differences were found in the primary composite outcome at 30 days between the two groups (ciNPT vs control: 31% vs 28%; P = .55). The incidence of SSI at 30 days was similar between the two groups (ciNPT vs control: 11% vs 12%; P = .58). Infectious (13.9% vs 12.6%; P = .77) and noninfectious (20.9% vs 17.6%; P = .53) wound complications at 30 days were also similar for the ciNPT and control groups. Wound complications requiring readmission also similar between the two groups (ciNPT vs control: 9% vs 7%; P = .54). The significant adverse event rates were not different between the two groups (ciNPT vs control: 13% vs 16%; P = .53). The mean length of the initial hospitalization was the same for the ciNPT and control groups (5.2 vs 5.7 days; P = .63). The overall health-related quality of life was similar at baseline and at 14 and 30 days postoperatively for the two groups. Although not powered for stratification, we found no differences among the subgroups in gender, obesity, diabetes, smoking, claudication, chronic limb threatening ischemia, bypass, or endarterectomy. On multivariable analysis, no differences were found in wound complications at 30 days for the ciNPT vs gauze groups (odds ratio, 1.4; 95% confidence interval, 0.8-2.6; P = .234). CONCLUSIONS In contrast to other randomized studies, our multicenter trial of infrainguinal revascularization found no differences in the 30-day groin wound complications for patients treated with ciNPT vs standard gauze dressings. However, the SSI rate was lower in the control group than reported in other studies, suggesting other practice patterns and processes of care might have reduced the rate of groin infections. Further study might identify the subsets of high-risk patients that could benefit from ciNPT.
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Affiliation(s)
- Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Center, Burlington, Vt.
| | - Lisa Smith
- Office of Clinical Trials Research, University of Vermont College of Medicine, Burlington, Vt
| | - Rebecca E Scully
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Mark Wyers
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - Bjoern Suckow
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Louis Nguyen
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
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