Lower Extremity Arterial Bypass Research Articles

Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis.

Background Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods The American College of Surgeons' NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29-22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12-38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79-30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27-6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37-7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03-10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54-8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66-29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27-25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.

Variation in Transfusion Practices and the Association with Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative

Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI). Adults undergoing open abdominal aortic aneurysm repair (OAR) and lower extremity arterial bypass (Bypass) within VQI (2003-2016) were identified. All emergent cases, patients with preoperative hemoglobin <7g/dL, preoperative hospitalization >1day, or a return to operating room during the index hospitalization were excluded. Units of red blood cells transfused were the primary outcome. Secondary outcomes were postoperative myocardial infarction (MI) and death. Patient, center, and procedural factors were evaluated. Multivariable mixed effects negative binomial regression and multivariable logistic regression were performed. We identified 24,131 procedures (OAR 3885, 16.1%; Bypass 20,246, 83.9%) among 22,532 patients (10.1% had >1 procedure). Overall, 37.5% of OAR and 19.5% of Bypass were transfused. Transfusion rates varied across estimated blood loss quartiles and across various preoperative hemoglobin levels. The overall rate of postoperative MI and death was 4.0% and 1.8% for OAR, and 2.2% and 0.7% for Bypass, respectively. In univariate and multivariable analysis, transfusions were associated with an increased risk of postoperative MI and death. A mixed effects negative binomial model demonstrated variation in transfusions across centers (P<0.001). Female gender and preoperative anemia were significantly associated with transfusions. Blood transfusions are variable across centers in VQI. Transfusions are associated with a higher postoperative MI and death after OAR and Bypass. Efforts to reduce transfusion may focus on center variability, gender, and preoperative anemia.

Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques

Endoscopic vein harvest for lower extremity arterial bypass grafting has beenquestioned due to concern for endothelial damage during procurement. We sought to compare nitric oxide (NO)-mediated endothelial-dependent relaxation (EDR) in vein segments harvested using open surgical techniques (OH) versus endoscopic vein harvest (EH) techniques. Saphenous vein segments were harvested for lower extremity bypass, and a single, minimally handled section of saphenous vein, free of branches, was taken from the end of the graft. Four 4-mm venous ring segments were then cut and mounted on force transducers. Segments were mounted in 37° oxygenated Krebs-Henseleit solution and maximally contracted using KCl. Individual ring segments that did not react to KCl were excluded from the study. Norepinephrine (NE) was used to achieve submaximal contraction. EDR was determined using increasing concentrations of bradykinin (BDK). Endothelial-independent relaxation (EIR) was confirmed using sodium nitroprusside. Two-way analysis of variance (ANOVA) was used to analyze differences between harvest techniques across BDK concentration and a Student's t-test was used to analyze single comparisons. Vein segments harvested from patients (n=13) led to 28 viable rings that exhibited a positive reaction to KCl (11 rings; 5 patients EH vs. 17 rings; 8 patients OH). Both vein groups achieved moderate relaxation to maximal BDK concentration, [10-6M]; (49.5% EH vs. 40.55% OH, P=0.270). Analysis by 2-way ANOVA for mean % relaxation for BDK concentration [10-11-10-6M] showed improved EDR in EH samples compared with OH (P=0.029). Mean nitrite/nitrate (NO(x)) tissue bath concentration measurements post-BDK were 139.8nM (EH) vs. 97.2nM (OH; P=0.264). Histology and positive factor VIII immunohistochemistry staining provided evidence for the presence of intact endothelium in our sample segments. EIR was preserved and was similar in the two groups. Endothelial function is preserved when utilizing endoscopic harvesting techniques. The advantages of minimally invasive vein procurement for lower extremity bypass can be obtained without concern for damaging venous endothelium.

Variation in Transfusion Practices and Their Associations with Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative (VQI)

Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI).

Creation of spliced vein conduit using microvascular anastomotic coupler

The single-segment great saphenous vein continues to be a conduit of choice for lower extremity arterial bypass. In patients without an adequate continuous segment of great saphenous vein, a spliced vein graft may be used as an alternative. Creating a spliced vein conduit can be technically challenging and time consuming. We present a technique of creating a spliced vein conduit by using a microvascular anastomotic coupler.

Wound Disruption after Lower Extremity Bypass Surgery is a Predictor of Subsequent Development of Wound Infection

Despite advances in endovascular surgery, lower extremity arterial bypass (LEB) remains the gold standard treatment for severe, symptomatic Peripheral Arterial Disease. With recent changes in health care, there has been an increasing emphasis on reducing the hospital length of stay (LOS). The purpose of this study was to identify the postoperative complications, which occur after discharge from hospital and to find risk factors for developing such complications. The 2013 lower extremity revascularization-targeted American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing LEB were assessed. Postoperative complications were identified and their relationship to the median discharge date. Univariate and multivariable analyses were performed to identify the risk factors associated with developing these complications. A prediction model was then created to accurately predict the risk of developing such complications. A total of 2,646 patients (65% male and 35% female) were identified in the NSQIP database that underwent LEB during the year 2013. Median LOS was 6days. Most common significant complications after hospital discharge were wound infection/complication (13.7%, mean days from operation [MDAO]=15days), wound disruption/dehiscence (1.6%, MDAO=15days), and organ space surgical site infections (0.6%, MDAO=16days). Multivariable analysis showed the following factors associated with wound infection: wound disruption/dehiscence (odds ratio [OR]: 16, confidence interval [CI]: 7.09-36.07, P<0.001), organ space infection (OR: 9.63, CI: 2.71-34.25, P<0.001), unplanned reoperation (OR: 3.86, CI: 2.85-5.24, P<0.001), urinary tract infection (OR: 2.79, CI: 1.28-6.05, P=0.010), body mass index ≥40 vs. <25 (OR: 2.28, CI: 1.18-4.39, P<0.001), postoperative bleeding requiring a transfusion (OR: 2.03, CI: 1.49-2.78, P<0.001), operation time >300min vs. 0-170min (OR: 1.98, CI: 1.32-2.96, P=0.008), prior ipsilateral percutaneous intervention involving currently treated segment vs. prior ipsilateral bypass involving currently treated segment (OR: 1.98, CI: 1.30-3.01, P=0.004), history of chronic obstructive pulmonary disease (OR: 1.73, CI: 1.21-2.48, P=0.003) and total LOS ≥28 vs. <7days (OR: 1.21, CI: 0.60-2.48, P=0.014). The risk prediction model for developing wound infection was developed. Wound infection is the most common complication after LEB. Most of these complications occur after discharge from hospital. Patients with risk factors for developing wound infections should be followed and closely monitored after discharge from the hospital.

Lower Extremity Bypass Surgery on Patients Transferred from Other Hospitals is Associated with Increased Morbidity and Mortality

Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted from home. The purpose of this study is to identify factors associated with an interfacility transfer in patients with PAD and compare the postoperative outcomes of these patients to those who are directly admitted to the hospital. The 2013 lower extremity revascularization-targeted American College of Surgeons (ACS-National Surgical Quality Improvement Program [NSQIP]) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for transfer to another hospital. A total of 2,646 patients (65% male, 35% female) were identified in the NSQIP database that underwent lower extremity open revascularization during the year 2013. A total of 287 patients (11%) were transferred from other institutions: acute care hospital inpatient (4%), nursing home/chronic care/intermediate care (3%), outside emergency department (3%), and other (1%). Factors associated with increased risk of interfacility transfer included need for emergency surgery (odds ratio [OR]: 5.51, P<0.05), infected wounds (OR: 2.77, P<0.05), and age >85years (OR: 2.24, P<0.05). Postoperative outcome associated with transfer was mortality <30days postop (OR: 1.96) and length of stay >30days (OR: 2.04; P<0.05). Multiple factors affect an interfacility transfer of patients including advanced age, need for emergency procedure, contaminated wounds. Patients who are transferred from another institution for a lower extremity bypass surgery are at a substantially higher risk for postoperative morbidity and mortality.

Deep Venous Thrombosis After Lower Extremity Arterial Bypass is Associated with Higher Risk for Postoperative Complications

Deep venous thrombosis (DVT) after any surgical operation is now considered a preventable event. Effectiveness of DVT prophylaxis can be improved by identification of risk factors specific to each surgical procedure. Despite advances in endovascular surgery, lower extremity arterial bypass remains the “gold standard” treatment for severe, symptomatic peripheral arterial disease. The purpose of this study was to identify the factors associated with development of DVT after lower extremity bypass surgery and its impact on patient outcomes. The 2013 lower extremity revascularization-targeted database and generalized 2013 general and vascular surgery Participant Use Data File of the American College of Surgeons National Surgical Quality Improvement Program were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for postoperative DVT and the impact of DVT on postoperative outcomes. A total of 2646 patients (male, 65%; female, 35%) underwent lower extremity open revascularization during the year 2013. Indications for operations included tissue loss (39%), rest pain (32%), and severe claudication (25%). Preoperative ankle-brachial indices were 0.4 to 0.9 (32%) and <0.4 (16.5%). A total of 24 patients (0.9%) developed DVT. Factors associated with development of DVT included wound complications (odds ratio [OR], 4; confidence interval [CI], 1.2-13.7; P < .05), postoperative bleeding (OR, 2.9; CI, 1.3-6.7; P < .05), transfer from another institution (OR, 5.2; CI, 1.2-22.8; P < .05), and need for amputation (OR, 2.9; CI, 1.3-6.7; P < .05). Patients who developed DVT were at a higher risk of reoperations (OR, 4.5; CI, 2-10.2; P < .05), readmission (OR, 4.5; CI, 8.2-10.2; P < .05), and mortality (OR, 6.3; CI, 1.8-21.7; P < .05). Development of lower extremity DVT after lower extremity bypass is associated with high risk of reoperation, readmission, and mortality. Patients who are at high risk for development of DVT can be identified, and we should ensure adequate DVT prophylaxis for such patients.

Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review.

Purpose:The superiority of autogenous vein conduits is well known in lower extremity arterial bypass (LEAB). Among various alternative conduits for LEAB, long-term results of arm vein grafts were investigated in this study.Materials and Methods:We retrospectively reviewed clinical characteristics of 28 patients who underwent infrainguinal LEAB with autogenous arm vein grafts at a single institute between January 2003 and December 2015. All procedures were performed in the absence of adequate saphenous veins. Graft patency was determined by periodic examinations with duplex ultrasonography.Results:Autologous arm vein grafts were implanted for 28 patients (mean age, 60.4±16.8 years; range, 20–82 years; male, 92.9%; atherosclerosis, 19 [67.9%]; and non-atherosclerotic disease 9 [32.1%] including 5 patients with Buerger’s disease). Source of arm vein were basilic 13 (46.4%), cephalic 4 (14.3%) and composition graft with other veins in 11 (39.3%) cases. The level of distal anastomosis was distributed as popliteal in 5 (17.9%), tibio-peroneal in 21 (75.0%) and inframalleolar artery in 2 (7.1%) cases. Mean duration of follow-up was 41.5±46.9 months (range, 1–138 months). Cumulative primary patency rates at 1, 3, and 5 years were 66.5%, 60.9% and 60.9%, respectively. Assisted-primary patency rates at 1, 3 and 5 years were 66.5%, 66.5% and 66.5%, respectively. Secondary patency rates at 1, 3 and 5 years were 70.8%, 70.8% and 70.8%, respectively. There was one limb amputation during the follow-up period.Conclusion:Arm veins are a useful alternative conduit when great saphenous veins are not available during LEAB.

Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein

ObjectiveThis study was conducted to determine whether it was feasible to increase the diameter of smaller great saphenous veins (GSVs) in preparation for possible bypass and whether such a conditioned conduit could be used with reasonable patency. MethodsTwenty-five patients (26 cases: 24 peripheral arterial occlusive disease, 2 popliteal aneurysms) with GSV diameters between 2 and 3 mm underwent in situ GSV valvulotomy and were observed for 3 months. After GSV dilation to >3 mm for below-knee revascularization and >3.5 mm for above-knee revascularization, arterial bypass surgery was performed with the valvulotomized GSV. ResultsAdequate GSV diameter was reached in 20 cases (77%). Arterial bypass surgery using valvulotomized GSV was performed an average 131 days (range, 64-373 days) after valvulotomy in 16 patients (61.5%). No deaths, amputations, or aneurysms occurred 2 years after surgery. At 1 and 2 years, primary patency was 81% ± 9.8% and 69% ± 11.8%, respectively, and secondary patency was 87% ± 8.3% and 75% ± 11%, respectively. ConclusionsValvulotomy can be used to expand small-diameter GSV for lower extremity arterial bypass.

Cost Effectiveness of Endovascular Revascularization Compared To Open Surgical Treatment For Acutely Thrombosed Lower Extremity Arterial Bypass Grafts

Cost Effectiveness of Endovascular Revascularization Compared To Open Surgical Treatment For Acutely Thrombosed Lower Extremity Arterial Bypass Grafts

IP231. Predictors of Adequate Size Greater Saphenous Vein for Use in Distal Lower Extremity Arterial Bypasses

IP231. Predictors of Adequate Size Greater Saphenous Vein for Use in Distal Lower Extremity Arterial Bypasses

IP213. Weekend Effect and Outcomes After Nonelective Lower Extremity Arterial Bypass

IP213. Weekend Effect and Outcomes After Nonelective Lower Extremity Arterial Bypass

Unplanned return to operating room after lower extremity arterial bypass is an independent predictor for hospital readmission

Hospital readmissions after surgical operations are considered serious complications and have an impact on health care-associated costs. The Centers for Medicare and Medicaid Services strongly encourage identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the "gold standard" treatment for severe, symptomatic peripheral arterial disease. The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery. The 2013 lower extremity revascularization-targeted American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and generalized 2013 general and vascular surgery NSQIP Participant Use Data File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery. A total of 2646 patients (65% male, 35% female) were identified in the NSQIP database who underwent lower extremity open revascularization during the year 2013. Indications for operations included tissue loss (39%), rest pain (32%), and severe claudication (25%). Preoperative ankle-brachial indices were 0.4 to 0.9 (32%) and <0.4 (16.5%). A total of 425 patients (16%) were readmitted within 30 days of index operation. Risk factors associated with readmission included wound complication (odds ratio [OR], 8.54; 95% confidence interval [CI], 6.68-10.92; P < .001), need for reoperation (OR, 5.95; 95% CI, 4.45-7.97; P < .001), postoperative myocardial infarction (OR, 2.19; 95% CI, 1.25-3.83; P = .006), wound dehiscence (OR, 8.45; 95% CI, 4.54-15.71; P < .001), organ or space surgical site infection (OR, 7.62; 95% CI, 2.89-20.14; P < .001), postoperative pneumonia (OR, 2.66; 95% CI, 1.28-5.52; P = .009), progressive renal insufficiency (OR, 4.12; 95% CI, 1.52-11.11; P = .005), superficial surgical site infection (OR, 7.37; 95% CI, 5.31-10.23; P < .001), urinary tract infection (OR, 2.67; 95% CI, 1.42-5.01; P = .002), and deep wound infection (OR, 14.0; 95% CI, 7.62-24.80; P < .001). Readmission after lower extremity bypass surgery is a serious complication. Various factors put a patient at high risk for readmission. Return to the operating room, wound infection, amputation, deep venous thrombosis, and major reintervention on bypass are independent risk factors for hospital readmission. Return to the operating room is associated with a 5.95-fold increase in hospital readmission.

Return to Operating Room After Lower Extremity Arterial Bypass Is an Independent Predictor for Hospital Readmission

Hospital readmissions after surgical operations are considered as serious complications and affect health care associated costs. The Centers for Medicare and Medicaid services (CMS) strongly encourages identification and ramification of factors associated with hospital readmissions after operations. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). The purpose of this study was to retrospectively review the factors associated with hospital readmission after lower extremity bypass surgery. The 2013 lower extremity revascularization-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission ≤30 days after surgery. A total of 2646 patients (males, 35%; females, 65%) underwent lower extremity revascularization during 2013. Indications for operations included tissue loss (39%), rest pain (32%), and severe claudication (25%). Preoperative ankle-brachial indices were 0.4 to 0.9 in 32% and <.4 in 16.5%. A total of 425 patients (16%) were readmitted ≤30 days of the index operation. Risk factors associated with readmission included return to operation room (odds ratio [OR], 9.2), wound infection (OR, 8.5), limb amputation (OR, 5.4), postoperative deep vein thrombosis (OR, 3.8), and major reintervention on bypass (OR, 3.4; P < .05; Fig). Readmission after lower extremity bypass surgery is a serious complication. Various factors put a patient at a high risk for readmission. Return to the operating room, wound infection, amputation, deep vein thrombosis, and major reintervention on bypass are independent risk factors for hospital readmission. Return to the operating room is associated with a ninefold increase in hospital readmission.

RR4. Reducing Length of Stay Is Not Associated With Increased Readmission Rates Following Lower Extremity Arterial Bypass

RR4. Reducing Length of Stay Is Not Associated With Increased Readmission Rates Following Lower Extremity Arterial Bypass

Abstract 241: Endothelial Function is Preserved with Endoscopic Vein Harvest for Lower Extremity Bypass

Objective: Endoscopic vein harvest for lower extremity arterial bypass technique has been questioned due to concern for endothelial damage during procurement. We sought to compare NO mediated endothelial dependent relaxation (EDR) in vein segments harvested with open surgical (OH) versus endoscopic (EH) techniques. Methods: Saphenous vein segments were harvested for lower extremity bypass. 3-4mm vein rings were mounted on force transducers. Segments were mounted in 37° oxygenated Krebs solution and maximally contracted using KCl. NE was used to achieve submaximal contraction. EDR was determined using increasing concentrations of bradykinin (BDK). Endothelial independent relaxation was confirmed using sodium nitroprusside. Two-way ANOVA was used to analyze differences between harvest techniques across BDK concentration. Student t-test was used to examine nitrite levels in each cohort. Results: Vein segments harvested from patients (n=13) led to 28 rings (11 rings; 5 patients EH v. 17;8 OH). Both cohorts achieved moderate relaxation to maximal BDK concentration, [10 -6 M]; (49.5% EH vs. 40.55%, OH, P = .270). Analysis by two way ANOVA for mean % relaxation for BDK concentration [10 -11 - 10 -6 M] showed improved EDR in EH samples compared to OH (P =.029). Mean nitrite tissue bath concentration measurements post-BDK were 279 nM (EH) v. 194 nM (OH) (P = .264). Histology and IHC confirmed intact endothelium by morphometric analysis and CD31 staining. Conclusion: Endothelial function is preserved when utilizing endoscopic harvesting techniques. The advantages of minimally invasive vein procurement for lower extremity bypass can be obtained without concern for damaging venous endothelium.

41. Indication For Lower Extremity Arterial Bypass and Hospital Profiling

41. Indication For Lower Extremity Arterial Bypass and Hospital Profiling

Comparing Preoperative Targets to Failure-to-Rescue for Surgical Mortality Improvement

Failure-to-rescue (FTR or death after postoperative complication) is thought to explain surgical mortality excesses across hospitals, and FTR is an emerging performance measure and target for quality improvement. We compared the FTR population to preoperatively identifiable subpopulations for their potential to close the mortality gap between lowest- and highest-mortality hospitals. Patients undergoing small bowel resection, pancreatectomy, colorectal resection, open abdominal aortic aneurysm repair, lower extremity arterial bypass, and nephrectomy were identified in the 2007 to 2011 Nationwide Inpatient Sample. Lowest- and highest-mortality hospitals were defined using risk- and reliability-adjusted mortality quintiles. Five target subpopulations were established a priori: the FTR population, predicted high-mortality risk (predicted highest-risk quintile), emergency surgery, elderly (>75 years old), and diabetic patients. Across the lowest mortality quintile (n=282 hospitals, 56,893 patients) and highest-mortality quintile (282 hospitals, 45,784 patients), respectively, the size of target subpopulations varied only for the FTR population (20.2% vs 22.4%, p=0.002) but not for other subpopulations. Variation in mortality rates across lowest- and highest-mortality hospitals was greatest for the high-mortality risk (7.5% vs 20.2%, p<0.0001) and FTR subpopulations (7.8% vs 18.9%, p<0.0001). The FTR and high-risk populations had comparable sensitivity (81% and 75%) and positive predictive value (19% and 20%, respectively) for mortality. In Monte Carlo simulations, the mortality gap between the lowest- and highest-mortality hospitals was reduced by nearly 75% when targeting the FTR population or the high-risk population, 78% for the emergency surgery population, but less for elderly (51%) and diabetic (17%) populations. Preoperatively identifiable patients with high estimated mortality risk may be preferable to the FTR population as a target for surgical mortality reduction.

Endoscopic vein harvesting (EVH) in lower extremity arterial bypass (LEAB): A systematic review

Endoscopic vein harvesting (EVH) in lower extremity arterial bypass (LEAB): A systematic review