Chaykovska, L

Lachat, M.

Mayer, D

PECORARO, Felice

Pfammatter, T

Puippe, G

Rancic, Z

Schmidt, CA

Veith, FJ

Archivio istituzionale della ricerca - Università di Palermo

24 SSS abstractsResults: Of 16,043 patients undergoingCEA in 2012–13, 276 received at leastone transfusion prior to discharge (1.7%). 42% of transfusions occurred on theday of surgery. Patients receiving a transfusion had worse clinical 30-day out-comes: stroke (6% vs. 1% for control group, P< 0.001); myocardial infarction(8% vs. 1%, P< 0.001); mortality (6% vs. 0.6%, P< 0.001) (Fig.1). Preoper-ative hematocrit < 30% (Odds ration OR: 57.4; 95% confidence interval CI:29.6-111.1), dependent functional status (OR: 2.7; 95%CI: 1.5-5.1), coagulopa-thy (OR: 2.5; 95%CI: 1.7-3.6) and creatinine ≥ 1.2 mg/dl (OR: 2.3; 95%CI:1.6-3.3) among other risk factors predicted transfusion (Fig.2). A risk predictionmodel based on these data produced a C-statistic of 0.861; application of thismodel to the validation set demonstrated a C-statistic of 0.850. 97% of patientsin the validation set received a score of 4 or less corresponding to an individualpredicted transfusion risk of 5% (Fig.3). Omitting a T&S in these patients wouldgenerate a potential annual cost saving for NSQIP hospitals of over $5,400,000based on our institutional cost.Conclusion: While T&S is commonly performed for patients undergoingCEA, transfusion following CEA is rare and well predicted by a transfusionrisk score. Avoidance of T&S in this low-risk population provides a substantialcost-saving opportunity without compromise of patient care.Use of the STAT (Sutureless Telescoping Anastomosis Technique)to facilitate supraaortic revascularization: Mid-term Results:Z. Rancic1, F. Pecoraro1, G. Puippe2, T. Pfammatter2, L. Chaykovska1,C. A. Schmidt1, D. Mayer1, F. J. Veith1,3, M. Lachat11Clinic for Cardiovascular Surgery & 2Institute for Diagnostic and InterventionalRadiology, University Hospital of Zurich, Zurich, Switzerland, 3Division of VascularSurgery, Department of Surgery, University of New York, New York, USAObjective: We report the mid-term results of use of a sutureless telescopinganastomosis technique (STAT), the modification of technique initially describedas VORTEC, for revascularization of supra-aortic vessels.Methods: Between January 2009 and December 2004, 55 patients (37 males)with an aortic arch lesion underwent trans-sternal debranching with suturelesstelescoping anastomosis. The underlying aortic pathologies were: isolated aorticarch aneurysm (10 patients), aortic arch aneurysm extending to ascending ordescending aorta (26), subclavian artery aneurysm (3), traumatic aortic rupture(1), aortic dissection (10), and other arch pathologies as aortic ulcer of floatingthrombus (5). Follow-up included computed tomography angiography at 1, 3,and 6 months postoperatively, and then annually.Results: Overall, 148 supra-aortic vessels in the 55 patients were revascular-ized: 127 by STAT and 21 by sutured surgical anastomosis. Immediate technicalsuccess was 100%. There was no early graft occlusion and late graft occlusionwas detected in two patients. Perioperative mortality was 7.3% (one postoper-ative bleeding, one retrograde dissection, one MOF (multi-organ failure) andone cerebral bleeding). Mean follow-up (FU) at June 2015 was 45.12 months:45 patients with FUmore than 2 years, 36 more than 3years and 23 more than 4years. Patients’ cumulative survival at 4 years was 84%.There were no differencein patency rate between STAT and sutured anastomosis.Conclusion: Sutureless telescoping anastomosis technique (STAT) reducestechnical difficulties and invasiveness of aortic surgery (reduces ischemia time,no clamping or circumferential dissection). This technique allows performinganastomosis where sutured anastomosis is challenging (dissection, intramuralhematoma). Mid-term results confirm that sutureless anastomosis is safe andreliable alternative to sutured one.Modern fixed imaging systems reduce radiation exposure to patientsand providersL. Stangenberg1, F. Shuja2, M. van der Bom3, M. van Alfen3,R. Rosenberg1, A. Hamdan2, M.Wyers2, R. Guzman2, M. Schermerhorn21Department of Surgery, Cantonal Hospital of Baselland, Liestal, Switzerland,2Department of Vascular Surgery, Beth Isreal Deaconess Medical Center, Boston,3Healthcare, Philips, Andover, USAObjective: Endovascular therapy for aortic and peripheral interventions isincreasingly becoming the first line treatment modality for a wide array ofdisease processes. High definition fluoroscopic imaging is required to performthese procedures, which are furthermore growing in complexity resulting in highradiation exposure to patient and providers. This is of particular importancefor training institutions as residents and fellows despite instruction in ALARAprinciples tend to have high radiation exposures. Recently, there was an upgradeof the fixed imaging system at our institution. We used this opportunity tocompare radiation exposure to patients and providers before and after theupgrade.Methods: We performed a retrospective analysis of consecutive EVAR andSFA interventions at our institution in the years 2013–14 and created twocohorts: pre and post upgrade. We analyzed BMI, fluoroscopy times (FT) andair kerma (AK), and thenmatched 1:1 based on fluoroscopy times as well as BMI.We also analyzed individual surgeons’ badge readings. The fixed imaging systemwas Allura Xper FD20 and was upgraded to Allura Clarity FD20 (both PhilipsHeathcare).Results: We identified a total of 76 EVARs (53 pre, 23 post) and 123 SFAinterventions (99, 24) yielding cohorts of 23 patients each for EVAR analysisand of 24 patients each for SFA analysis. Complete data are shown in table 1.There was a 52% reduction in AK for EVAR and 72% for SFA interventions,respectively (p< 0.001 for both). 5/6 surgeons experienced a reduction in theiraverage monthly badge readings after system upgrade (Figure 1), most notablythe fellow from 512 to 109 mrem (p= 0.0032).Conclusion: Aortic and peripheral endovascular interventions can be per-formed with reduced radiation exposure to patients and providers employingmodern fixed imaging systems. This is of particular importance in light of morecomplex procedures such as fenestrated and branched endografting that willrequire substantial fluoroscopy to perform.Treatment effect of preemptive embolization of the inferior mesentericartery prior to endovascular aortic repairV. Makaloski1, L. Meuli2, T. R. Wyss1, J. Schmidli1, F. Dick21Department of Cardiovascular Surgery, University Hospital of Bern, Bern,2Department of Vascular Surgery, Cantonal Hospital of St. Gallen, St. Gallen,SwitzerlandObjective: The early postoperative benefits after endovascular aneurysmrepair (EVAR) need to be balanced against late complications andre-intervention rates. The role of type II endoleaks (EL) and their treatmentunclear. The aim of this study is to report the treatment effect of preemptiveembolization of the inferior mesenteric artery (IMA) prior to EVAR.Methods: We analysed all patients treated with elective EVAR between Jan-uary 2001 and December 2012. Size and patency of the IMA were assessed fromthe latest preoperativeCT-angiography. Preemptive embolization had been per-formed if the IMA-diameter was ≥3mm. To maximize comparability betweenpatients’ measurements, we linearly interpolated diameters in time to obtaintwo-year endpoints for patients not having CT-scans at 24± 1 month. Studyendpoints included aneurysm diameter change after 24 months, type II ELand re-interventions as well as overall survival. Follow-up controls were per-formed with CT angiography at 1 month, 6 months, 12 months and annuallythereafter.Results: During this period 251 patients underwent EVAR for abdominal aor-tic aneurysm. 42 patients with preoperatively occluded IMA were excluded. Ofthose with patent IMA, 46/209 (22%) underwent preemptive IMA embolization.Mean follow-up time was 6.2 years (range 1.5-13.4 years). At baseline as wellafter 24 months, there was no significant difference regarding aneurysm diam-eter between the embolized and the non-embolized group, (56.9± 8.9mm vs.56.6± 9.8mm, p= 0.88 and 52.6± 17.2mm vs. 50.8± 17.7mm, p= 0.55 respec-tively). Type II EL due to patent IMA was higher in the non-embolized 36/163(22%) vs. 1/46 (2%) in the embolized group (p≤0.001). Three (1.8%) lateembolizations of the IMA were needed because of aneurysm sac progression inthe non-embolized group and no re-intervention was needed in the embolizedgroup. No difference in mortality rate was detected at any time between bothgroups (0.6% vs 0.0%, p= 0.594 after 30-days; 5.5% vs. 4.3%, p= 0.753 after 1year; 16.8% vs. 11.6%, p= 0.425 after 3 years and 38.3% vs. 23.3%, p= 0.116after 5 years follow-up, respectively).© 2016 The Authors www.bjs.co.uk BJS 2016; 103 (S4): 5–28BJS © 2016 BJS Society Ltd

Use of the STAT (Sutureless Telescoping Anastomosis Technique) to facilitate supraaortic revascularization: Mid-term Results

https://iris.unipa.it/retrieve/handle/10447/196009/328777/70_2016_BJS_STAT.pdf

Use of the STAT (Sutureless Telescoping Anastomosis Technique) to facilitate supraaortic revascularization: Mid-term Results

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Archivio istituzionale della ricerca - Università di Palermo