Perioperative transfusion in vascular surgical patients is independently associated with increased 30-day morbidity and mortality. Given indeterminate causation, these data suggest the need for a prospective transfusion threshold study in vascular surgical patients.

Background: The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown.Methods: A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL.Results: CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6.5%) required dialysis. |

ObjectiveTo determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease.Methods/ResultsBetween 2010–2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6–2.1), low creatinine clearance (1.3; 1.1–1.6), pre-procedural anemia (4.7; 3.9–5.7), family history of CAD (1.2; 1.1–1.5), CHF (1.4; 1.2–1.6), COPD (1.2; 1.1–1.4), CVD or TIA (1.2; 1.1–1.4), renal failure CRD (1.5; 1.2–1.9), pre-procedural heparin use (1.8; 1.4–2.3), warfarin use (1.2; 1.0–1.5), critical limb ischemia (1.7; 1.5–2.1), aorta-iliac procedure (1.9; 1.5–2.5), below knee procedure (1.3; 1.1–1.5), urgent procedure (1.7; 1.3–2.2), and emergent procedure (8.3; 5.6–12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5–31), MI (67; 29–150), TIA/stroke (24; 8–73) and ARF (19; 6.2–57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years.ConclusionIn a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible.

There is a significant increase in patients presenting with CLI. Renal artery intervention rates are decreasing while femoral-popliteal interventions are increasing. Additionally, balloon angioplasty and cutting/scoring balloon usage is increasing. © 2017 Wiley Periodicals, Inc.

femoropopliteal (fem-pop) artery disease with drug-coated balloons (DCB) vs. standard PTA. The overall impact of DCB use on medical care costs is unknown. Methods: We performed a prospective economic study alongside the IN.PACT SFA II trial, which randomized patients with symptomatic fem-pop disease to DCB vs. standard PTA and followed them for a minimum of 12 months. Detailed medical resource utilization data were collected and costs were assigned for all US patients using resource-based accounting (for revascularization procedures, medications and outpatient vascular care) and hospital billing data for costs associated with the index and follow-up hospitalizations for treatment of the target limb. The DCB was assigned a cost of $1350/balloon. Results: A total of 181 US patients were enrolled (121 DCB, 60 PTA). Initial hospital costs were approximately $1100/patient higher in the DCB group than the PTA group ($8258 vs. $7164, p< 0.001), driven mainly by the cost of the DCB itself (see Table). From discharge through 12 months, follow-up target-limb related medical care costs were w$750/pt lower in the DCB group, such that total 1-year costs were similar for the 2 groups ($10,034 vs. $9694, p¼0.82) with a resulting incremental cost-effectiveness ratio of $2906 per repeat revascularization avoided -similar to that for coronary drug-eluting stents.Conclusions: For patients with symptomatic fem-pop disease, use of the DCB was associated with higher initial costs compared with standard PTA, but these were largely offset by lower costs for follow-up target limb procedures through 1-year of follow-up. The cost-effectiveness of DCB for such patients appears to compare favorably with that for other cardiovascular interventions.

Objective: No significant evidence basis exists for who and when a preoperative cardiac consultation should be obtained. We sought to define the variation in preoperative cardiology for patients requiring a vascular surgical procedure and determine whether this was associated with differences in perioperative myocardial infarction (poMI) or death. Methods: A 29 hospital statewide QI collaborative were queried for open aortic aneurysm repair, EVAR, and open vascular bypass procedures. Preprocedure documented cardiac consultation as well as stress testing was determined as part of the database. The primary outcome was poMI and death. Results: Among 5191 patients, 48% had a documented preoperative cardiac cardiology consultation, with the poMI rate of 2.1% and a 1.3% death rate. Across hospitals, preoperative cardiac consultation varied from <10% to over 85%, and was not dependent on the procedural volume, academic versus community status , or hospital size. Cardiology consultation rates correlated with stress test usage (Pearson ρ = 0.6; p < .001). Stratification of patients by the Revised Cardiac Risk Index (RCRI) categories showed consultation varied significantly by classification; RCRI=1; 38% had preoperative cardiology consult rate versus an RCRI =4; 66% had a cardiology consult. After stratification by RCRI, there was no association between cardiac consultation use and lower postoperative MI rate (Table) or death rate. Moreover, use of preoperative cardioprotective medications was not more common in those hospitals with high (> 50%) cardiology consultation rates as compared to lower consultation hospitals. Discussion: Preoperative cardiology consultation for vascular surgical patients varies greatly between institutions. Cardiology consultation was not associated with better utilization of cardioprotective medications nor was it associated with a lower incidence of death or myocardial infarction. MI Frequency by Cardiac Consultation

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