Society for Clinical Vascular Surgery (SCVS): Annual Symposium

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.