Perioperative Outcomes After Use of Iliac Branch Devices Compared With Hypogastric Occlusion or Open Surgery for Elective Treatment of Aortoiliac Aneurysms in the NSQIP Database

D’Oria, Mario; Mendes, Bernardo C.; Bews, Katherine A.; Hanson, Kristine T.; Johnstone, Jill K.; Shuja, Fahad; Kalra, Manju; Bower, Thomas C.; Oderich, Gustavo S.; DeMartino, Randall R.

doi:10.1016/j.avsg.2019.04.009

Cited by 20 publications

(8 citation statements)

References 73 publications

(28 reference statements)

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“…There was no significant difference between the 2 groups in 30-day MAEs, with an overall rate of 9%, which compares well with the 8.8% rate recently reported for IBDs in a large national US database. 16 Moreover, this technique remains effective at a median follow-up of 1.5 years as measured by aneurysm sac regression. Our results are largely similar to those recently reported by Jerkku et al, 17 indicating that use of IBDs with distal landing beyond the IIA bifurcation may be a safe, feasible, and effective option for select patients with aortoiliac aneurysms, with outcomes comparable to those achieved using conventional landing into the main IIA trunk.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

et al. 2020

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Purpose: To evaluate the outcomes of the Gore Excluder Iliac Branch Endoprosthesis (IBE) using division branches of the internal iliac artery (IIA) as distal landing zones. Materials and Methods: Between January 1, 2014, and December 31, 2018, 74 patients (mean age 74±7 years; 72 men) treated for aortoiliac or common iliac artery aneurysms had an IBE deployed with distal landing of the side branch within the main trunk (n=60) of the internal iliac artery (IIA) vs within a division branch (n=25). Thirteen (17%) patients received bilateral IBE implantations for a total of 85 vessels evaluated. Early endpoints were technical success, 30-day mortality, 30-day major adverse events (MAEs), and 30-day major access complications. Late endpoints were survival, primary and secondary IIA patency, freedom from IIA branch instability, freedom from new-onset buttock claudication, and aneurysm sac diameter changes. Time-dependent outcomes were reported as Kaplan-Meier curves with differences assessed using the log-rank test. Estimates are presented with the 95% confidence interval (CI). Results: The overall technical success rate was 97%, with 1 technical failure per group (p=0.43). Two patients, one from each group, died within 30 days (p=0.43). No significant differences were seen in the rates of 30-day MAEs (7% vs 17%, p=0.35) or major access complications (9% vs 11%, p>0.99) for patients receiving distal landing in the main trunk vs a division branch, respectively. The mean follow-up for the entire cohort was 19±12 months. The overall 1-year survival rate was 94% (95% CI 74% to 99%). The primary and secondary patency rates at 1 year were 98% (95% CI 88% to 99%) vs 95% (95% CI 72% to 99%, p=0.72) and 98% (95% CI 88% to 99%) vs 100% (p=0.41) for the main trunk vs division branch groups, respectively. Freedom from IIA branch instability estimates were also similar at 1-year follow-up [93% (95% CI 82% to 97%) vs 90% (95% CI 66% to 97%), p=0.29], as were the freedom from new-onset buttock claudication estimates [98% (95% CI 86% to 99%) and 94% (95% CI 67% to 99%), respectively; p=0.62]. Mean sac diameter change was 5.4±5.3 mm, not significantly different between the groups (p=0.85). Conclusion: Use of the posterior or anterior division of the IIA as a distal landing zone for the Gore Excluder IBE was safe and efficacious in the midterm. This technique may permit extending indications for endovascular repair of aortoiliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Long-term assessment is needed to affirm the efficacy of this technique.

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Section: Discussionmentioning

confidence: 99%

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

et al. 2020

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“…However, clinical practice guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery recommend preservation of blood flow to the hypogastric artery at least on one side strongly, if it does not compromise aneurysm exclusion. 5,6 Currently, IBDs represent the first dedicated totally endovascular option to preserve antegrade flow to the hypogastric artery, and have shown excellent technical success, 7 lower periprocedural morbidity and mortality rates as compared with open surgery, 8 as well as superior outcomes to the bell-bottom technique in the midterm. 9 Main findings from this analysis of the pELVIS dataset showed bilateral implantation of IBD in 96 patients was safe and feasible, with extremely low rates of periprocedural morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, IBDs represent the first dedicated totally endovascular option to preserve antegrade flow to the hypogastric artery, and have shown excellent technical success, 7 lower periprocedural morbidity and mortality rates as compared with open surgery, 8 as well as superior outcomes to the bell-bottom technique in the midterm. 9 Main findings from this analysis of the pELVIS dataset showed bilateral implantation of IBD in 96 patients was safe and feasible, with extremely low rates of periprocedural morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

et al. 2021

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Objective To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry. Methods For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak. Results Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904). Conclusions Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.

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“…Complications were defined as major or minor using definitions reported previously in the literature. 7,8 Major complications included unplanned re-intubation, longer than 48 hours ventilated, sepsis or septic shock, pneumonia, deep or organ space surgical site infection, acute renal failure or renal insufficiency, venous thromboembolic event, myocardial infarction, cardiac arrest, stroke, and blood transfusion. Minor complications included urinary tract infection and superficial surgical site infection.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Surgical Morbidity After Hysterectomy During an Obesity Epidemic

Davidson

Weber

Monuzsko

et al. 2022

Obstetrics &Amp; Gynecology

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To assess 30-day outcomes for hysterectomy by body mass index (BMI) classification and estimate trends in 30-day outcomes by BMI over time. METHODS: This is a retrospective cohort study of patients older than age 18 years undergoing hysterectomy with data in the National Surgical Quality Improvement Program database from 2005 to 2018. Exclusions were made for ambiguous indication or route of surgery and missing values in covariates or outcomes of interest. Patient characteristics and outcomes were compared across BMI classifications. Outcomes included operative time, length of stay, and major and minor complications. Multivariable linear regression models were used for continuous outcomes, and modified Poisson regression models were used for binary outcomes. Patients with benign and malignant indications for hysterectomy were analyzed separately. Models were adjusted for age, race, hysterectomy route, hypertension, diabetes, smoking, selected preoperative laboratory values, and cancer type, if applicable. RESULTS:Obesity rate increased from 41.2% in 2005-2007 to 51.8% in 2018. Among 319,462 patients, minimally invasive surgery was the most common approach (58.8% vs 24.5% laparotomy vs 16.7% vaginal). Higher BMI classifications were associated with longer operative times (benign indication: average 25.0 minutes longer, 95% CI 22.1-27.9; malignant indication: average 25.1 minutes longer, 95% CI 20.8-29.4) and higher risk of complications compared with normal-weight BMIs, though operative time declined over time for patients with malignant surgical indications. Relative to normal-weight patients, rates of major complications did not increase until a BMI of 40 for hysterectomy for benign indications and 50 for hysterectomy for malignant indications.CONCLUSION: Operative times and complications both increase with obesity when performing hysterectomy. Knowledge of evolving risk level at various weight subclassifications can improve shared decision making preoperatively.

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Perioperative Outcomes After Use of Iliac Branch Devices Compared With Hypogastric Occlusion or Open Surgery for Elective Treatment of Aortoiliac Aneurysms in the NSQIP Database

Cited by 20 publications

References 73 publications

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Evaluation of Surgical Morbidity After Hysterectomy During an Obesity Epidemic

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