This report examines outcomes of revascularization for acute arterial mesenteric ischemia (AAMI) using the American College of Surgeons National Surgical Quality Improvement Program database. Patients with International Classification of Diseases, 9th Revision and Current Procedural Terminology codes indicating AAMI with concomitant mesenteric revascularization were identified. Demographic, risk factor, procedural, morbidity, and mortality data were examined. Associations with morbidity and mortality were analyzed by logistic regression. One hundred forty-two cases of AAMI were identified. Seventy-one cases were thrombotic and 71 were embolic according to revascularization codes. Mean age was 66 years, 84 per cent of patients were white, and 54 per cent were female. Unadjusted major morbidity and mortality rates were 69 and 30 per cent, respectively. Patients with thrombotic AAMI were more likely to have a lower body mass index, greater than 10 per cent weight loss in the past 6 months, and a history of smoking. Patients with embolic AAMI were more likely to present emergently with sepsis. Unadjusted morbidity and mortality rates were 78 and 38 per cent for embolic and 61 and 23 per cent for thrombotic AAMI, respectively. Multi-variable predictors of morbidity included bowel resection at the time of revascularization, transfer admission, and involvement of a surgical resident. Multivariable predictors of mortality included impaired functional status, increased age, and postoperative sepsis. Cause of AAMI was not a significant predictor of morbidity or mortality. In a large sample of AAMI cases, AAMI remained a highly lethal and morbid condition. Predictors of morbidity and mortality included indicators of advanced presentation, treatment delay, and patient-related factors specific to AAMI, including debility and advanced age. Efforts directed at prevention and increasing the speed of diagnosis and definitive treatment appear to be necessary to improve outcomes.

Purpose Outcomes and predictors of acute surgical conversion during endovascular aortic aneurysm repair (EVAR) were examined using the American College of Surgeons-National Safety and Quality Improvement Project (ACS-NSQIP) Database (2005 to 2008). Methods Acute intraoperative surgical conversions occurring during elective EVAR were identified using Current Procedural Terminology codes. Nonemergent EVAR and primary open surgical repairs of infrarenal aneurysms were examined for comparison. Perioperative morbidity was categorized as wound, pulmonary, venous thromboembolic, genitourinary, cardiovascular, operative, and septic. Mortality, overall morbidity, and length of stay (LOS) were examined. Results We identified 72 acute conversions, 2414 open repairs, and 6332 EVAR without acute conversion. Demographics and comorbidities were generally similar among operative groups. Mean operative time was 274 minutes for acute conversion vs 226 minutes for primary open repair and 162 minutes for EVAR (conversion vs EVAR and open repair vs EVAR P < .0001 for each; conversion vs open repair P = .0014; analysis on rank operative time). Blood transfusion was required in 69% of acute conversions (mean volume, 6.0 units) vs 73% of open repairs (mean volume, 3.3 units) and 12% of EVARs (mean volume, 2.6 units; P < .0001 for each pair-wise comparison; analysis on rank number of units among those transfused). Major morbidity was 28% for acute conversions, 28% for open repairs, and 12% for EVARs. Mortality was 4.2% for acute conversions, 3.2% for open repairs, and 1.3% for EVARs. Median (quartile 1, quartile 3) LOS was 7 (5, 9) days for acute conversion and open repair, and 2 (1, 3) days for EVAR. Morbidity and mortality were significantly higher for acute conversion and open repair vs EVAR. The OR (95% confidence interval) for morbidity was 2.9 (1.7–4.8) after conversion and 2.8 (2.5–3.2) after open repair (P < .0001 for both) and for mortality was 3.4 (1.0–10.9; P = .0437) for conversion and 2.5 (1.9–3.5; P < .0001) for open repair. Morbidity and mortality were similar between acute conversion and open repair. A similar pattern among repair groups was demonstrated for LOS, with similar LOS for acute conversions and open repair, which were significantly longer than those observed for EVAR. No significant demographic or medical risk factor predictors of acute conversion during EVAR were identified. Conclusion Acute surgical conversion was a rare complication affecting 1.1% of EVAR cases, with no broadly identifiable at-risk population. When conversion did occur, morbidity and mortality rates paralleled those observed for elective open repair.

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transmitral flow velocity (E), the atrial transmitral flow velocity (A), and the mitral annular tissue doppler velocity (e=). Patients were divided into two groups of diastolic dysfunction as either none/mild (E/A Յ 0.75, E/e= Ͻ 10) or moderate/severe (E/A Ͼ 0.75, E/e= Ն 10). Perioperative and long-term mortality was determined from a prospective vascular database and the National Death Index. Descriptive statistics were calculated. Postoperative survival was estimated by product-limit methods. Associations between preoperative and perioperative factors and long-term survival were examined using proportional hazards regression models. A backwards variable elimination procedure was used to select a 'best' model to predict long-term survival.Results: Seventy-six patients were followed for an average of 41.9 months after renal revascularization. Within this group, 47/76 (61.8%) patients were identified as having moderate or severe diastolic dysfunction. Systolic function was preserved. The mean ejection fraction for the entire group was 58.3% Ϯ 11.1%. Diastolic dysfunction had no apparent association with abnormal systolic function. The mean ejection fraction for those with moderate/severe diastolic dysfunction was 57.7% Ϯ 11.5%. When comparing the moderate/severe and none/mild groupings of diastolic dysfunction, there was a significant difference in left ventricular mass index (151.9 Ϯ 48.9 vs 125.3 Ϯ 31.7, P ϭ .0087). There were five deaths in the perioperative period and 20 deaths on follow-up. Among survivors, hypertension was cured or improved in 82% of the none/mild group and 53% of the moderate/severe group (P ϭ .012). Renal function was improved in 32% of the none/mild group and 26% of the moderate/severe group (P ϭ .54).Multivariate analysis among 71 perioperative survivors demonstrated a significant and independent association between diastolic dysfunction and survival (HR 5.1, 95% CI 1.1-23.6, P ϭ .037) (Fig 1). Ejection fraction did not have a significant effect on long-term survival. Backward elimination resulted in a final model that included diastolic dysfunction (HR 5.8, 95% CI 1.4-25, P ϭ .018) and history of stroke/TIA (HR 2.5, 95% CI 0.9-7.1, P ϭ .092) as the only signficant predictors of long-term survival.Conclusions: Diastolic dysfunction, but not systolic function, was frequent in patients with renovascular disease. After renal revascularization, diastolic function had a significant and independent association with longterm survival. Preoperative assessment of diastolic function should be considered in patients prior to surgical repair.

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