Venous Interventions Research Articles

Importance of Venous Inflow: Emergence of the Invisible Gorilla

Deep venous interventions and the development of new devices to improve outcome have gained popularity rapidly in recent years. In the paper by Morris et al.1 in this issue of the journal, the authors have attempted to further scrutinise this interesting field, more specifically venous stenting. They tried this by focusing on the type of venous stent, which is an understandable approach. The single most important variable in deep venous interventions since the pioneering work of Neglen and Raju2 in the early years of the twenty first century is the “dedicated” venous stent.

Impact of Postthrombotic Vein Wall Biomechanics on Luminal Flow during Venous Angioplasty and Stent Placement: Computational Modeling Results

This study characterized the impact of vein wall biomechanics on inflow diameter and luminal flow during venous angioplasty and stent placement, using postthrombotic and healthy biomechanical properties from an ovine venous stenosis and thrombosis model. Finite element analysis demonstrated more pronounced inflow channel narrowing in the postthrombotic vein compared with the healthy control vein during angioplasty and stent placement (relative inflow diameter reduction of 42% versus 13%, P < .0001). Computational fluid dynamics modeling showed increased relative areas of low wall shear rate in the postthrombotic vein compared with the normal vein (0.46 vs 0.24 for shear rate < 50 s−1; 0.13 vs 0.07 for shear rate < 15 s−1; P < .05), with flow stagnation and recirculation. Since inflow narrowing and low wall shear rate are associated with in-stent restenosis and reintervention, these computational results based on experimentally obtained biomechanical values highlight the significance of postthrombotic venous properties in optimizing venous intervention outcomes.

Iatrogenic Portal Venous Circulatory Injuries in the IR Suite.

Advanced portal venous interventions including transjugular intrahepatic portosystemic shunts, variceal sclerotherapy, and portal venous recanalization are more widely performed, as more aggressive approaches to manage portal hypertension increase patient candidacy for liver transplantation and other therapies. Initial percutaneous portal access may be achieved through transjugular, transsplenic, and transhepatic accesses. Although rare, a potentially life-threatening complication from these approaches is hemorrhage from venous perforation.[1] [2] Patients with portal hypertension often have tortuous vascular anatomy, weakened vessel walls, and high portal venous pressures, predisposing them to potentially devastating outcomes if this complication is encountered. As such, interventional radiologists must take extra precaution to avoid venous injuries during advanced portal venous interventions.[3] [4] Herein we present two patients who experienced rapid, dramatic decompensation from intraperitoneal hemorrhage after initial access was achieved. These cases provide an overview of the clinical course and management strategies for this rare complication in the hopes of improving patient outcomes.

Catheter-directed venography for evaluating internal jugular vein pseudo-occlusion

The incidence and effects of stenosis of the cerebral venous system are poorly understood. When noninvasive computed tomography venography (CTV) of the head and neck suggests complete internal jugular vein (IJV) occlusion, invasive catheter-directed venography can discordantly show venous patency. We compared CTV vs digital subtraction venography (DSV) in the evaluation of patency/occlusion in the suspected IJV and contralateral IJV. We queried the venous intervention database of our U.S. academic tertiary-care hospital to identify patients with complete or near-complete IJV occlusion per CTV from March 1, 2019 to March 1, 2020. We included patients with both noninvasive and invasive imaging of the target segment and the contralateral IJV. Four patients had suspected occlusion of the IJV at the skull base. Invasive catheter-directed venography consisted of DSV to assess direction of flow and vessel caliber, as well as manometry proximal and distal to areas of suspected stenosis. DSV showed patency in all 4 IJVs for which CTV had shown suspected occlusions. CTV findings of the contralateral IJVs were patency (n = 2), moderate stenosis (n = 1), and severe/critical stenosis (n = 1). Contralateral IJV caliber, measured by DSV, was concordant with CTV findings. Median mean-pressure gradients across the apparent occlusion and contralateral segments were 1 (range, 1–4) mmHg and 0 (range, 0–5) mmHg, respectively. Although noninvasive CTV may suggest absence of or attenuated flow within the IJV, this technique may be insufficient to establish complete occlusion. Catheter-directed venography can be used to evaluate patency, vessel caliber, and mean-pressure gradient.

A rare anastomosis between basilic and brachial veins

Variations in the veins of upper extremity are common. Knowing these variations is important for interventions to be carried out in this region. In this case report, a rare anastomosis between basilic vein and brachial vein is presented. During a routine cadaver dissection, a short and thick branch of the basilic vein was noticed to provide anastomosis between the basilic vein and the brachial vein in the right upper extremity of a 54-year-old male cadaver. The diameter of the basilic vein was quite narrow at the proximal part above the anastomosis. In addition, the axillary vein was noticed to be formed as a continuation of brachial vein, not basilic vein. The variation presented in this case report may cause serious complications, such as the rupture of the vessel in venous interventions related with the basilic vein.

TCT-386 Utilization of Intravascular Ultrasound During Peripheral Venous Intervention Among Medicare Beneficiaries

TCT-386 Utilization of Intravascular Ultrasound During Peripheral Venous Intervention Among Medicare Beneficiaries

TP5.2.6 Use of objective assessment criteria to assess symptom severity and clinical effectiveness following deep venous stenting

Abstract Aims This review aimed to identify measures that assess symptom severity in patients prior to deep venous intervention, and outcomes used to evaluate its clinical effectiveness. Methods MEDLINE was searched for studies of stent placement for treatment of iliofemoral venous disease using relevant key words (April 2019). Data were extracted and validated by three authors. Results 6,356 patients with venous stents were identified from 93 studies. 1,300 patients (20%) were treated for acute thrombosis and 5,056 patients for chronic venous insufficiency (CVI), due to non-thrombotic lesions (2,200 patients, 35%) or post-thrombotic disease (2,856 patients, 45%). The Clinical-Etiological-Anatomical-Physiological classification (CEAP) was reported in 3,233/5,056 CVI patients (64%) pre-intervention (C0:2%; C1:2%; C2:7%; C3:46%; C4:21%; C5:6%; C6:16%). Stent patency was reported in all studies, with variable follow-up (six months – five years). Primary patency was 81% in 3,365 patients and secondary patency 95% in 4,700 patients at one year. 655 patients had active ulceration, of which 397 (61%) healed post-intervention. Venous Clinical Severity Score (VCSS) or revised VCSS was reported in 849 patients (13%). Average VCSS/rVCSS was eight pre-intervention and three post-intervention. Villalta scores were reported in 768 patients (12%) pre-intervention vs. 1,111 patients (17%) post-intervention. Average Villalta scores were 20 pre-intervention vs. five post-intervention. Conclusions Few studies use objective measures to quantify the clinical effectiveness of deep venous stenting; consensus is lacking on which is the most appropriate tool to use. More research is needed on ideal assessment measures to identify suitable patients for these interventions and to quantify clinical effectiveness.

Risk factors related to the size and volume of femoral artery pseudoaneurysm after catheter angiography: a single-center study

Evaluate the risk factors associated with pseudoaneurysms' development after the percutaneous interventional procedures performed by cardiology, interventional radiology (IR), and the other clinics. We retrospectively analyzed the ultrasound scans in the hospital database and picture archiving system (PACS) and enrolled a total of 132 patients during the period from October 2015 and December 2019. We evaluated the maximum diameter and volume of the pseudoaneurysm with the patient and procedure-related factors with univariate analysis. We found that the patients with hypertension and without peripheric artery disease (PAD) had greater sac diameter (p = 0.010 and p = 0.016) and increased sac volume (p = 0.029 and p = 0.007). However, the sac volume increased in patients with diabetes than those without (p = 0.003). Both the increased maximum diameter and the volume of the pseudoaneurysm sac were in the patients in whom the procedure was applied in the common femoral artery (CFA) and with the venous intervention (p < 0.010 and p < 0.016; p = 0.004 and p = 0.001, respectively). We found that platelet count correlated negatively with the sac's maximum diameter and the volume (r = –0.383, p < 0.001 and r = –0.486, p < 0.001, respectively) duration of intervention correlated positively with the sac's maximum diameter and the volume (r = 0.205, p = 0.019 and r = 0.320, p < 0.001). Our study reveals that prolonged procedure duration, simultaneous arterial and venous accesses, peripheral artery disease, thrombocytopenia, and puncture site are the aggressive risk factors of pseudoaneurysms size after angiographic procedures.

Venous Leg Ulcers: A Review of Published Assessment and Treatment Algorithms.

Significance: Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. However, these documents are not fully aligned with each other.Recent Advances: The latest update of the internationally used classification system for CVD was recently published. Our review aims to summarize the existing information to provide an educational tool for clinicians new to this topic, and to highlight the commonalities between the published recommendations.Critical issues: VLUs need to be treated with consideration for the extent of venous disease present in the patient. This requires a good understanding of the various components involved and the possible additional concomitant conditions by the first-line clinician who encounters the patient. A multidisciplinary team is necessary for a successful overall treatment plan, and this plan should be tailored to each patient's specific needs and lifestyle.Future Directions: Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.

Shaking our foundations

In their most recent publication,1 the RANE group has taken on what was a standard threshold for deep venous intervention, >50% stenosis by intravascular ultrasound examination. As they eloquently describe, they found in a large sample that degree of stenosis does not reliably predict symptoms, ulceration, or foot pressures. Their conclusion is that it is possible to have clinically significant venous obstruction at less than 50% stenosis and that stenting of this obstruction leads to the same improvements that we can expect in patients with a high-grade stenosis (>50%).

Lymphatic complications after harvesting venous conduits in coronary artery bypass grafting surgery

Complications associated with the disorders of lymphatic outflow in the lower extremities are common in cardiovascular surgery involving the isolation of venous conduits and interventions on the femoral vessels. Despite the relatively low frequency, treatment of these complications requires significant efforts and does not always yield the expected results whereas timely diagnosis of lymphatic drainage disorders is often difficult. This becomes the reason for repeated hospitalizations, surgical interventions, long hospital stays, and disabilities. However, the problem of lymphatic complications is still not getting enough attention. This article discusses the pathogenesis, predictors of lymphatic complications, and the options and approaches to their treatment and diagnosis.

Artifact quantification of venous stents in the MRI environment: Differences between braided and laser-cut designs.

To quantify B0- and B1-induced imaging artifacts of braided venous stents and to compare the artifacts to a set of laser-cut stents used in venous interventions. Three prototypes of braided venous stents with different geometries were tested in vitro. B0 field distortion maps were measured via the frequency shift Δf using multi-echo imaging. B1 distortions were quantified using the double angle method. The relative amplitudes B1rel were calculated to compare the intraluminal alteration of B1. Measurements were repeated with the stents in three different orientations: parallel, diagonal and orthogonal to B0. At 1.5 T, the braided stents induced a maximum frequency shift of Δfx<100Hz. Signal voids were limited to a distance of 2mm to the stent walls at an echo time of 3ms. No substantial difference in the B0 field distortions was seen between laser-cut and braided venous stents. B1rel maps showed strongly varying distortion patterns in the braided stents with the mean intraluminal B1rel ranging from 63±18% in prototype 1 to 98±38% in prototype 2. Compared to laser-cut stents the braided stents showed a 5 to 9 times higher coefficient of variation of the intraluminal B1rel. Braided venous stent prototypes allow for MR imaging of the intraluminal area without substantial signal voids due to B0-induced artifacts. Whereas B1 is attenuated homogeneously in laser-cut stents, the B1 distortion in braided stents is more inhomogeneous and shows areas with enhanced amplitude. This could potentially be used in braided stent designs for intraluminal signal amplification.

Using Non-Contrast MRA to Discriminate between Obstructive and Nonobstructive Venous Diseases of the Legs.

Background: Venous interventions of the legs are less predictable owing to a lock of objective tools. Methods: One hundred and twenty patients with lower extremity venous disease were evaluated anatomically using TRANCE MRI. Then, a QFlow analysis was performed in 53 patients with only one leg affected for hemodynamic evaluation. Those patients with complete QFlow were classified into obstructive and nonobstructive. Results: The QFlow—namely, stroke volume, forward flow volume, mean flux, stroke distance (SD), and mean velocity (MV) in the external iliac vein (EIV), femoral vein (FV), popliteal vein (PV), and great saphenous vein (GSV). The obstructed group had a shorter SD and lower MV in the EIV, EIV/FV, and GSV/PV (SD: p-values of 0.025, 0.05, and 0.043, respectively; MV: p-values of 0.02, 0.05, and 0.048, respectively). A good performance in discriminating obstructive venous disease was reported for SD in the EIV (area under the curve (AUC) = 67.9%, 95% confidence interval (CI) = 53.2–82.7%), EIV/FV (AUC = 72.4%, 95% CI = 58.2–86.5%), and GSV/PV (AUC = 67.9%, 95% CI = 51.7–84.1%). The SD in the EIV, EIV/FV, and GSV/PV had the ability to discriminate between obstructive and nonobstructive diseases (p-values of 0.025, 0.005, and 0.043). The MV in the EIV, EIV/FV, and GSV/PV had ability to discriminate between obstructive and nonobstructive venous diseases (p-values of 0.02, 0.005, and 0.048). Conclusions: The SD and MV were lower for obstructive than nonobstructive disease in the EIV.

Superficial Venous Reflux Intervention Guided by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging: Different QFlow Pattern from Health Controls.

(1) Background: To assess the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in superficial venous reflux and its difference from health controls. (2) Methods: Thirty patients underwent TRANCE MRI before surgical intervention of their superficial venous reflux of the legs. Ten healthy volunteers were included as a control. (3) Results: TRANCE MRI involves the major tributaries, thus enhances the additional ablations in 20% of patients. QFlow pattern of superficial venous reflux (QFlow GSV/PV MF ratio > 1) was compared with the duplex scan (SFJ reflux) using Cohen’s kappa coefficient at 0.967. The 30 morbid legs undergoing TRANCE MRI-guide interventions and the healthy volunteers’ legs on the same side were compared. The stroke volumes (SV) are higher in EIV (p = 0.021) in the left-leg-intervention group. The mean flux (MF) is higher in the EIV (p = 0.012) and trend of increasing in GSV segment (p = 0.087) in the left-leg-intervention group. The QFlow of 10 patients with right leg intervention are higher in GSV in the right-leg-intervention group (SV p = 0.002; FFV p = 0.001; MF p = 0.001). QFlow data is shown for all legs for superficial venous intervention with GSV/PV (MF) ratio > 1. (4) Conclusions: Typical figures in QFlow (GSV/PV MF ratio > 1) could be observed in the morbid limbs but not in the controls.

The presence of a pathologic perforator may be predictive of central venous pathology and multilevel disease in severe chronic venous insufficiency

ObjectivesThe treatment of a refluxing perforator is indicated in the setting of severe chronic venous insufficiency, but there are limited data on the presence of multilevel disease in these patients. This study sought to evaluate whether the presence of a pathologic perforator is predictive of the presence of central venous pathology. MethodsThis study was a retrospective review of the institutional Vascular Quality Initiative database. Consecutive patient limbs were identified that underwent intervention of refluxing perforators. The patients who underwent imaging, including magnetic resonance imaging or computed tomography (group A), were compared with those who did not undergo imaging (group B). The treated limbs in group A were also compared with the contralateral limbs as an internal control. Anatomical findings on imaging were analyzed by two independent investigators. The primary outcome was the presence and degree of central venous stenosis as measured by an orthogonal diameter reduction of >50% by axial imaging. Secondary outcomes included demographic and clinical differences between the two groups, frequency of central venous intervention, and duration of ulcer healing. Standard statistical analysis was performed. ResultsNinety-three patient limbs underwent treatment of a pathologic perforator, with 30 in group A and 63 in group B. The following demographic and clinical variables were higher in group A compared with group B: male sex, body mass index, deep venous thrombosis history, recent or active anticoagulation use, perforator diameter, Clinical Etiology Anatomy Pathophysiology class 4, 5, or 6, and Venous Clinical Severity Score. Radiographic analysis of group A revealed concordance of a treated pathologic perforator with an ipsilateral central venous stenosis in 53.3% of patients, and a higher frequency of common iliac vein stenosis (50% vs 21.4%, P = .024) and external iliac vein stenosis (20% vs 0%, P = .012) compared with the contralateral limbs. When separated by the left or right limb, the left limbs exhibited a greater degree of common iliac vein stenosis as compared with the contralateral limbs (50.7% ± 20.9% vs 16.3% ± 16.5%, P < .001) as well as a greater frequency of >50% common iliac vein stenosis (46.7% vs 13.3%, P = .046). The right limbs exhibited a greater frequency of >50% external iliac vein stenosis as compared with the contralateral limbs (33.3% vs 0%, P = .022). ConclusionsThis study suggests that patients with severe chronic venous insufficiency who undergo treatment for a pathologic perforator may have additional ipsilateral central venous pathology, supporting the presence of multilevel disease. Additional axial imaging might unmask central venous pathology and provide another option for treatment.

Short-term compression therapy in chronic vein disease without trophic disorders: possibilities of medical compression knitwear

Introduction.Medical compression stockings are one of the main methods in a conservative strategy for the treatment of chronic vein diseases as well as for adjuvant treatment after superficial venous interventions. however, compliance to this treatment is low.Objective.To evaluate patient satisfaction with medical compression knitwear therapy in a short-term follow-up.Materials andмethods.The study included 150 patients of both sexes aged 42 ± 8.3 years. Endovenous laser obliteration combined with mini-phlebectomy and/or sclerotherapy for varicose veins was performed. All patients after the surgery wore compression stockings of compression class 2 with a recommended wearing period of 14 days. At the control visit at the end of the follow-up period all patients were asked to complete a satisfaction survey with a specially prepared questionnaire including 7 questions.Results and discussion.No significant adverse events and complications related to either the invasive intervention or the compression therapy were observed during the follow-up period. There were no abnormalities such as compression sensations or changes in blood flow under the knitwear. The compression was totally adequate, with no areas of over- and/or under-compression. All respondents felt that the knitwear was well anchored to the leg and no slipping or twisting due to the wide elastic band with droplet silicone. In addition to all of the above, the patients noted that the knitwear offered to them in the study had good tactile properties: it was soft and pleasant to the skin. According to the survey, the average score for all questions was 9.5 (QR 8-10).Conclusion.Elastic compression is an effective and safe means of preventing adverse events, complications and pain in patients after superficial varicose veins surgery. Additional consumer properties of medical compression knitwear can significantly influence patients’ compliance and therefore the effectiveness of treatment.

Long-term outcome of dedicated venous stents in management of chronic iliofemoral obstruction

ObjectiveTo study the long-term outcomes in patients with occlusive Iliofemoral chronic venous insufficiency (CVI) of benign etiology treated by dedicated venous stents (Zilver Vena stents; Cook, Bloomington, Ind) placed at a single center. MethodsWe performed retrospective analysis of prospectively collected data from 58 patients with symptomatic benign lower limb CVI during the period from January 2013 to October 2020. Patients underwent recanalization using Zilver Vena stents at Ain Shams University hospitals. We excluded patients requiring stenting after intervention for acute deep venous thrombosis, CVI due to malignancy or vascular malformations, previous ipsilateral venous interventions, or CVI due to nonobstructive pathology (reflux). Patients were clinically classified at enrollment by the clinical, etiology, anatomy, pathology class, venous disability score, and Villalta score. Primary, assisted primary, and secondary stent patency were assessed. Patients were followed clinically and by duplex, at 1, 3, 6, 12 months and annually for 5 years. ResultsThere were 31 males and 27 females, with ages ranging between 25 and 60 years (mean, 43.84 years). All patients had post-thrombotic syndrome with a mean Villalta score of 16.8 (range, 10-31). Patients were treated with dedicated venous stents and had a median follow-up of 60 months. The median venous disability score was 3 at the start of the study with a significant decrease to 1 at 5-year follow-up (P < .001). Twelve-month primary patency, assisted primary patency, and secondary patency were 91.4%, 96.6%, and 98.3%, respectively. At the 5-year follow-up, primary patency was 60.3%, assisted primary patency 65.5%, and secondary patency 81%. There were no instances of stent fracture, migration, or structural deformities. ConclusionsTreating iliofemoral venous occlusive disease with a dedicated venous stent is an excellent choice for patients with occlusive post-thrombotic syndrome. The technique has good 1-year and 5-year patency and is associated with significant clinical improvement and few complications.

Delayed referral of venous ulcers increases resource usage

ObjectiveVenous insufficiency is often not readily recognized as a contributing etiology to nonhealing wounds by nonvascular surgery specialists, potentially delaying appropriate treatment to achieve wound healing and increasing healthcare costs. The objective of the present study was to understand the time and resources used before the definitive treatment of venous ulcers. MethodsA single-institution retrospective medical record review of C6 patients undergoing radiofrequency saphenous and perforator vein ablation from May 2016 to January 2018 identified 56 patients with 67 diseased limbs. The numbers of inpatient, emergency department, and wound care visits and the intervals to vein ablation from the initial evaluation of the ulceration by a healthcare provider were collected. The demographics, comorbidities, previous venous interventions, wound characteristics, duplex ultrasound imaging, and available wound healing follow-up through July 2018 were assessed for all patients. ResultsFor the 67 limbs examined, 588 total healthcare visits were performed for wound assessment before a referral to a vascular surgeon, with 413 visits at a wound care center (70% of all visits). Other specialty visits included emergency medicine (17.9% of limbs) and rheumatology (22.4% of limbs). Six patients (nine limbs) were admitted to inpatient services for treatment of their ulceration. Overall, the patients were seen an average of 8.6 ± 9.7 times for their ulcer with the wound center before determination of a contributing venous etiology and subsequent treatment. These visits translated to a median of 230 days (interquartile range, 86.5-1088 days) between the first identification of the ulcer by healthcare providers and subsequent accurate diagnosis and definitive treatment of their venous disease with radiofrequency saphenous and perforator vein ablation. After intervention, 18.64% of the limbs had healed at 1 month, 33.92% had healed at 3 months, 50% had healed at 6 months, and 82.92% had healed by 12 months. ConclusionsAn earlier and accurate diagnosis of the venous contribution to ulcers and subsequent appropriate treatment of venous etiologies in wound formation by a vascular venous specialist could significantly improve healing and minimize resource usage.

A randomized trial of class II compression sleeves for full legs versus stockings after thermal ablation with phlebectomy

ObjectiveCompression stockings and bandages are widely used after invasive treatment of varicose veins. The goals of compression after venous interventions are to reduce pain, bruising, and ecchymosis. Nevertheless, patients often report discomfort with the compression. To make postprocedural compression more tolerable, foot-sparing bandages were tested in a randomized clinical trial of noninferiority. MethodsA total of 187 patients were randomized to use class II foot-sparing compression sleeves for the full leg or class II stockings after radiofrequency ablation with concomitant phlebectomy. The primary endpoint was the quality of life, measured using the Chronic Venous Disease Quality of Life Questionnaire 20-item scale 30 days after intervention. The secondary endpoints were pain in the leg and discomfort related to the compression garment, which were assessed using the visual analog scale (VAS) at 2, 7, 14, and 30 days. ResultsThe global index score of the questionnaire was 66.1 and 70.6 and 83.8 and 87.7 for the sleeve and stocking groups before and 30 days after intervention, respectively (P = .542 and P = .150, respectively). The VAS for pain score in the operated leg was slightly higher in the sleeve group the day after the intervention (score, 2.1 vs 1.6; P = .03). At 7, 14, and 30 days, the VAS for pain scores did not differ significantly (score, 0.7 vs 0.5; 0.5 vs 0.3; and 0.1 vs 0.1, respectively; P = NS for all). The VAS for discomfort score was not significantly different statistically in the study group at 2 days (sleeve, 1.9; vs stocking, 1.4; P = .08) but was higher after 7 days (sleeve, 0.9; vs stocking, 0.6; P = .008). No difference in discomfort was found between the study and control groups at 14 or 30 days (sleeve, 0.6; vs stocking, 0.4; and sleeve, 0.4; vs stocking, 0.4, respectively; P = NS for both). ConclusionsQuality of life after thermal ablation with phlebectomy improved equivalently in patients who had used class II compression sleeves for full legs and those who had used class II compression stockings. Pain and discomfort were slightly higher in the sleeve group.

Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients

We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality. We performed a retrospective cohort study including adult non-cardiac vascular surgery patients (open, endovascular and venous procedures) surviving hospitalization in Boston, Massachusetts, USA. The exposure of interest was functional status determined by a licensed physical therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90-day mortality after hospital discharge. The secondary outcome was readmission within 30days. Adjusted odds ratios were estimated by multivariable logistic regression models. This cohort included 2318 patients (male 51%; mean age 61 ± 17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 moderately high and 581 scored the highest functional status. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70-6.84) compared to patients with the highest functional status. When excluding venous intervention patients, the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04-2.20). In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting.