Faculty Bibliography

Background: There is a paucity of data regarding outcomes of patients with premature cerebrovascular disease (<=55 years) who undergo carotid endarterectomy (CEA). The objective of this study was to analyze demographics, presentation, perioperative, and later outcomes of younger patients undergoing CEA.
Method(s): The Society for Vascular Surgery Vascular Quality Initiative was queried for CEA cases (2003-2020). Patients were stratified based on age 55 years or less or greater than 55 years. Primary end points were periprocedural stroke, death, myocardial infarction, and composite outcomes. Secondary end points analyzed included ipsilateral restenosis (>=80%) or occlusion, late ipsilateral neurologic events, and reintervention.
Result(s): Of 144,416 patients undergoing CEA, 8264 (5.7%) were aged 55 years or younger. The mean age was 51.3 years (range, 36 to 55 years). Younger patients were more likely to be female (44.5% vs 39.1%) and to be current smokers (58.8% vs 24.4%) (P <.001). They were less likely than older patients to have hypertension (82.2% vs 89.7%), coronary artery disease (25.6% vs 27.9%), and congestive heart failure (7.6% vs 11.2%; P <.001). Younger patients were less likely than older patients to be on aspirin, statins, or beta-blockers, but were more likely to be on P2Y12 inhibitors (P <.001). Younger patients were more likely to present with symptomatic disease (59% vs 47.2%) and were more likely to undergo nonelective CEA (19.3% vs 12.7%; P <.001). Younger patients had similar rates of perioperative stroke/death (1.8% vs 1.9%) and postoperative neurological events (1.7% vs 1.7%), but had lower rates of overall postoperative complications (3.8% vs 4.8%; P <.001). Sixty percent of patients had recorded follow-up (mean, 13 months). During follow-up, younger patients were significantly more likely than older patients to experience complete occlusion or significant (>=80%) restenosis of the operated artery (2.3% vs 1.6%), and were more likely to experience an ipsilateral neurological event (1.4% vs 0.9%) or any neurological event (3.2% vs 2.2%; P <.001).
Conclusion(s): Young patients undergoing CEA are more likely to be female, active smokers, and symptomatic. Although perioperative outcomes are similar, younger patients are more likely to experience carotid occlusion or restenosis as well as subsequent neurological events, during relatively short follow-up. These data suggest that younger CEA patients require more diligent follow-up, and a continued aggressive approach to medical management of atherosclerosis to prevent future events related to the operated artery.
Copyright

Background: Thoracic endovascular aortic repair (TEVAR) is increasingly used to treat aortic dissections and aneurysms. Access-related complications remain a common source of morbidity and mortality following TEVAR. Therefore, this study aims to determine major risk factors predicting postoperative access complications and 3-year survival in patients with access complications.
Method(s): We identified all patients undergoing TEVAR in the Vascular Quality Initiative from July 2010 to August 2021, excluding those converted to open repair. We defined access complication as postoperative occlusion, wound infection, hematoma, or unplanned conversion to open cutdown. The primary outcome was 3-year survival and the secondary outcome was postoperative mortality. Mixed effects logistic regression modelling with physician level clustering was used to identify factors associated with access complications and postoperative mortality. Kaplan-Meier estimates and Cox proportional hazards models were used for analysis of three-year survival.
Result(s): Of 18,172 patients, 1584 (8.7%) had access complications. Bilateral percutaneous access was obtained in 68% of patients, one percutaneous and one open in 14%, and bilateral open access in 13%. Patients with access complications were older (70 +/- 0.6 years vs 66 +/- 0.2 years; P <.01) and female (50% vs 34%; P <.01). Patients with access complications experienced higher postoperative mortality (12% vs 4.6%; P <.01), major adverse cardiac event (17% vs 6.6%; P <.01), reintervention (22% vs 10%; P <.01), and spinal ischemia (7.0% vs 2.1%; P <.01). After adjustment, factors associated with access complication include female sex (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.9-2.6; P <.01) and obesity (OR, 1.2; 95% CI, 1.0-1.4; P =.02). Access complication was independently associated with postoperative mortality (OR, 2.5; 95% CI, 2.0-3.0; P <.01). Bilateral cutdown was associated with lower mortality in male patients (OR, 0.55; 95% CI, 0.34-0.90; P =.02), but not in female patients (OR, 2.1; 95% CI, 1.1-4.3; P =.03). Last, access complications were associated with higher 3 -year mortality (hazard ratio, 1.6; 95% CI, 1.3-1.8; P <.01).
Conclusion(s): Access complications when unexpected are associated with adverse postoperative and three-year outcomes. Female sex is associated with higher rates of access complications, suggesting the need for devices tailored to female anatomy.
Copyright

INTRODUCTION/BACKGROUND:The proportion of open aneurysm repairs requiring at least a suprarenal clamp has increased in the past few decades, partly due to preferred endovascular approaches for most patients with infrarenal aneurysms, suggesting that the management of aortic clamp placement has become even more relevant. This study evaluated the association between proximal clamp site and intraoperative ischemia times with postoperative renal dysfunction and mortality. METHODS:We used the Vascular Quality Initiative to identify all patients undergoing open repairs of elective or symptomatic juxtarenal AAAs from 2004-2018 and compared outcomes by clamp site: above one renal artery, above both renal arteries (supra-renal), or above the celiac trunk (supra-celiac). Outcomes evaluated included acute kidney injury (AKI), new-onset renal failure requiring renal replacement therapy (RRT), 30-day mortality, and one-year mortality. We used multilevel logistic regressions and cox-proportional hazards models, clustered at the hospital level, to adjust for confounding. RESULTS:We identified 3976 patients (median age 71 years, 70% male, 8.2% non-Caucasian), with a median aneurysm diameter of 5.9cm (IQR 5.4-6.8cm). Proximal clamp sites were: above one renal artery (31%), supra-renal (52%), and supra-celiac (17%). Rates of unadjusted outcomes were 20.5% for AKI, 4.1% for new-onset RRT, 4.9% for 30-day mortality, and 8.3% for one-year mortality. On adjusted analyses, independent of ischemia time, supra-renal clamping relative to clamping above a single renal artery had higher odds of postoperative AKI (aOR 1.50 [95%-CI 1.28-1.75]) but similar odds for new-onset RRT (aOR 1.27 [0.79-2.06]) and 30-day mortality (aOR 1.12 [0.79-1.58]) and hazards for one-year mortality (aHR 1.12 [0.86-1.45]). However, every ten minutes of prolonged intraoperative ischemia time was associated with an increase in odds or hazards ratio of postoperative AKI by +7% (IQR 3-11%), new-onset RRT by +11% (IQR 4-17%), 30-day mortality by +11% (IQR 6-17%), and one-year mortality by +7% (IQR 2-13%). Patients with greater than 40 minutes of ischemia time had notably higher rates of all four outcomes. DISCUSSION/CONCLUSIONS:Supra-renal clamping relative to clamping above a single renal artery was associated with AKI but not new-onset RRT or 30-day mortality. However, intraoperative renal ischemia time was independently associated with all four postoperative outcomes. While further studies are warranted, our findings suggest that an expeditious proximal anastomosis creation is more important than trying to maintain clamp position below one renal artery, suggesting that suprarenal clamping may be the best strategy for open AAA repair when needed to efficiently perform the proximal anastomosis.

OBJECTIVES/OBJECTIVE:Endovascular aortic aneurysm repair (EVAR) has become the standard of care treatment for abdominal aortic aneurysms (AAA) in the modern era. While numerous devices exist for standard infrarenal AAA repair, fenestrated endovascular aneurysm repair (fEVAR) offers a minimally invasive alternative to traditional open repair in patients with short infrarenal necks. Over time, aortic neck dilation can occur leading to loss of proximal seal, endoleaks, and AAA sac growth. This study analyzes aortic remodeling following EVAR versus fEVAR and further evaluates whether fEVAR confers a benefit in terms of sac shrinkage. METHODS:A retrospective review of prospectively collected data on 120 patients undergoing EVAR was performed: 30 patients were treated with fEVAR (Cook Zenith© Fenestrated) and 90 patients were treated with EVAR devices (30 with each Medtronic Endurant ©, Gore Excluder ©, and Cook Zenith ©). Demographic data were recorded, and anatomic measurements were taken for each patient pre-operatively, 30 days post-operatively, and at the longest point of follow-up using three-dimensional reconstruction software. RESULTS:There were no significant differences in demographics data between the 4 groups. fEVAR was used more often in aortas with large necks and irregular morphology (p= 0.004). At the time of longest follow up, the suprarenal aorta encompassing 5, 10, and 15mm above the lowest renal artery (ALRA) dilated the most for fEVAR versus all EVAR groups. Despite this, the infrarenal segment tended to increase by the least, or even regress, for fEVAR compared to all EVAR groups, and was associated with the overall greatest proportion of sac shrinkage for the fEVAR group compared to Medtronic, Gore, and Cook devices, respectively (-13.90% vs. -5.75% vs. -2.31% vs. -4.68%, p=0.025). CONCLUSIONS:Compared to EVAR, patients treated with fEVAR had greater suprarenal dilation over time, consistent with an overall greater burden of disease in the proximal native aorta. However, the infrarenal segment dilated significantly less over time in the fEVAR group compared to all EVAR groups, suggesting that fEVAR may stabilize the infrarenal neck, promoting positive sac remodeling, as evidenced by the greatest degree of decrease in largest AAA diameter in the fEVAR group.

OBJECTIVE:Type II endoleaks (T2Es), often identified after endovascular aneurysm repair (EVAR), have been associated with late endograft failure and secondary rupture. The number and size of the patent aortic aneurysm sac outflow vessels (ie, the inferior mesenteric, lumbar, and accessory renal arteries) have been implicated as known risk factors for persistent T2Es. Given the technical challenges associated with post-EVAR embolization, prophylactic embolization of aortic aneurysm sac outflow vessels has been advocated to prevent T2Es; however, the evidence available at present is limited. We sought to examine the effects of concomitant prophylactic aortic aneurysm sac outflow vessel embolization in patients undergoing EVAR. METHODS:Patients aged ≥18 years included in the Society for Vascular Surgery Vascular Quality Initiative database who had undergone elective EVAR for intact aneurysms between January 2009 and November 2020 were included in the present study. Patients with a history of prior aortic repair and those without available follow-up data were excluded. The patient demographics, operative characteristics, and outcomes were analyzed by group: EVAR alone vs EVAR with prophylactic sac outflow vessel embolization (emboEVAR). The outcomes of interest were the in-hospital postoperative complication rates, incidence of aneurysmal sac regression (≥5 mm) and T2Es, and reintervention rates during follow-up. RESULTS:A total of 15,060 patients were included. Of these patients, 272 had undergone emboEVAR and 14,788 had undergone EVAR alone. No significant differences were found between the two groups in age, comorbidities, or anatomic characteristics, including the mean maximum preoperative aortic diameter (5.5 vs 5.6 cm; P = .48). emboEVAR was associated with significantly longer procedural times (148 vs 124 minutes; P < .0001), prolonged fluoroscopy times (32 vs 23 minutes; P < .0001), increased contrast use (105 vs 91 mL; P < .0001), without a significant reduction in T2Es at case completion (17.7% vs 16.3%; P = .54). The incidence of postoperative complications (3.7% vs 4.6%; P = .56), index hospitalization reintervention rates (0.7% vs 1.3%; P = .59), length of stay (1.8 vs 2 days; P = .75), and 30-day mortality (0% vs 0%; P = 1.00) were similar between the two groups. At mid-term follow-up (14.6 ± 6.2 months), the emboEVAR group had a significantly greater mean reduction in the maximum aortic diameter (0.69 vs 0.54 cm; P = .006), with a greater proportion experiencing sac regression of ≥5 mm (53.5% vs 48.7%). The reintervention rates were similar between the two groups. On multivariable analysis, prophylactic aortic aneurysm sac outflow vessel embolization (odds ratio, 1.34; 95% confidence interval, 1.04-1.74; P = .024) was a significant independent predictor of sac regression. CONCLUSIONS:Prophylactic sac outflow vessel embolization can be performed safely for patients with intact aortic aneurysms undergoing elective EVAR without significant associated perioperative morbidity or mortality. emboEVAR was associated with significant sac regression compared with EVAR alone at mid-term follow-up. Although no decrease was found in the incidence of T2Es, this technique shows promise, and future efforts should focus on identifying a subset of aneurysm and outflow branch characteristics that will benefit from concomitant selective vs complete prophylactic sac outflow vessel embolization.

Objectives: Although, post-carotid endarterectomy (CEA) stroke is rare, it can be devastating. The impairment degree and 1-year effects are unclear. Our goal was to assess the postoperative and 1-year outcomes for patients experiencing a stroke after CEA without preoperative disability.
Method(s): The Vascular Quality Initiative CEA registry was used to examine strokes after CEA that were asymptomatic or symptomatic with a preoperative modified Rankin scale (mRS) score of 0 or 1. The mRS score for stroke disability was classified as 0 (none), 1 (not significant), 2 to 3 (moderate), 4 to 5 (severe), and 6 (dead). Patients who had experienced a postoperative ipsilateral stroke with a recorded postoperative mRS score were included. Perioperative disability and long-term outcomes were analyzed.
Result(s): Of 149,285 patients, 1178 without a preoperative disability had had a postoperative ipsilateral stroke with a mRS score recorded. The average age was 71 years, and 59.6% were men. Preoperatively, most (98.8%) had lived at home and were independently ambulatory (90%). The preoperative symptoms were none (83.5%), transient ischemic attack (7.3%), and stroke (9.2%). All preoperative patients with stroke had had a mRS score of 0 or 1. Of these patients, 11.6% had required reexploration. The mRS score for all patients with a postoperative stroke with disability was classified as none for 11.6%, not significant for 19.5%, moderate for 29.4%, severe for 26.9%, and dead for 8%. The 1-year survival stratified by postoperative disability was 91.4% for none, 95.6% for not significant, 92.1% for moderate, and 81.5% for severe (P <.001). Multivariable analysis showed that severe postoperative disability was associated with death at 1 year (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.5-5.9; P <.001) but moderate postoperative disability was not (HR, 0.95; 95% CI, 0.45-2; P =.88). Other factors associated with death at 1 year were end-stage renal disease (HR, 8.1; 95% CI, 2.97-23; P <.001) and previous contralateral stroke (HR, 2.15; 95% CI, 1.13-4.07; P =.019), with postoperative reexploration associated less with death at 1 year (HR, 0.33; 95% CI, 0.15-0.77; P =.01). The 1-year freedom from ipsilateral neurologic events or death stratified by postoperative disability was 87.8% for none, 93.3% for not significant, 88.5% for moderate, and 77.9% for severe (P <.001). Multivariable analysis showed that severe disability was associated with subsequent ipsilateral neurologic events or death at 1 year (HR, 2.34; 95% CI, 1.25-4.4; P =.008) but moderate postoperative disability was not (HR, 0.2; 95% CI, 0.46-1.82; P =.8).
Conclusion(s): Most patients without preoperative disability who experienced a stroke after CEA had a significant disability. Severe disability was associated with higher 1-year mortality and subsequent neurologic events. These data can help aid in the informed consent process and expectations after a postoperative stroke.
Copyright

Objectives: Beta-blockers are first-line anti-impulse therapy for patients presenting with type B aortic dissection (TBAD); however, little is understood about their impact after aortic repair. The aim of this study was to evaluate the role of postoperative beta-blocker use on the outcomes of thoracic endovascular aortic repair (TEVAR) for TBAD.
Method(s): The Vascular Quality Initiative database was queried for all patients undergoing TEVAR for TBAD from 2012 to 2020. Aortic-related reintervention, all-cause mortality, and success of TEVAR measured by complete false lumen thrombosis of the treated aortic segment were assessed and compared between patients treated with and without beta-blocker use postoperatively. Cox proportional hazards models were used to estimate the effect of beta-blocker therapy on outcomes.
Result(s): A total of 1147 patients undergoing TEVAR for TBAD were identified, with a mean follow-up of 18 +/- 12 months (median, 14 months). The mean age was 61.3 +/- 11.8 years, and 791 (71%) were men. Of the 1147 patients, 935 (84%) continued beta-blocker therapy at discharge and follow-up. Patients receiving beta-blocker therapy were more likely to have an entry tear originating in zones 1 to 2 (22% vs 13%; P =.022). The prevalence of acute, elective, and symptomatic TBAD, concurrent aneurysms, number of endografts used, distribution of the proximal and distal zones of dissection, and operative time were comparable between the two groups. At 18 months, significantly more complete false lumen thrombosis (58.4% vs 47.4%; P =.018; Fig) was observed in the patients with beta-blocker use. However, the rates of aortic-related reintervention (12.8% vs 8.8%; log-rank P =.396) and mortality (0.7% vs 0.1%; log-rank P =.401) were similar in those with and without beta-blocker therapy. Even after adjusting for clinical and operative factors, continuous postoperative beta-blocker use was associated with increased complete false lumen thrombosis (hazard ratio, 1.56; 95% confidence interval, 1.10-2.21; P =.012) but did not affect all-cause mortality or aortic-related reintervention (Table). When analyzed separately, postoperative angiotensin-converting enzyme inhibitor use did not affect the rates of aortic-related reintervention, complete false lumen thrombosis, or mortality.
Conclusion(s): Beta-blocker use was associated with the promotion of complete false lumen in patients undergoing TEVAR for TBAD. In addition to its role in acute TBAD, anti-impulse control appears to confer favorable aortic remodeling after TEVAR. Beta-blocker therapy might improve the outcomes after TEVAR for TBAD. [Formula presented] [Formula presented]
Copyright

Objectives: Thoracic endovascular aortic repair (TEVAR) has been increasingly used to treat aortic dissection and aneurysms. Access-related complications remain a common source of morbidity and mortality following TEVAR. Therefore, this study aimed to determine the major risk factors predicting for access complications and the 5-year mortality for patients with access complications.
Method(s): We identified all patients undergoing TEVAR in the Vascular Quality Initiative from July 2010 to August 2021, excluding those who had required conversion to open repair. We defined access complication as postoperative occlusion, wound infection, hematoma, and unplanned conversion to open cut down. The primary outcome was 5-year mortality, and the secondary outcome was perioperative mortality. Mixed effects logistic regression modeling with physician-level clustering was used to identify the factors associated with access complications and perioperative mortality. Kaplan-Meier estimates and Cox proportional hazards models were used for the analysis of 5-year mortality.
Result(s): Overall, 16,588 cases were included, with access site complications in 1584 (9.5%). Bilateral percutaneous access was obtained in 68% of patients, one percutaneous and one open in 14%, and bilateral open access in 13%. The patients with access complications were older (age, 70 +/- 0.6 years vs 66 +/- 0.2 years; P <.01) and more likely to be women (50% vs 34%; P <.01). Patients with access complications experienced increased perioperative mortality (12% vs 4.6%; P <.01), major adverse cardiovascular events (17% vs 6.6%; P <.01), reintervention (22% vs 10%; P <.01), and spinal ischemia (7.0% vs 2.1%; P <.01). On adjusted analysis, the factors associated with access complication included female sex (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-2.9]; P <.01) and body mass index (OR, 0.84; 95% CI, 0.76-0.93; P <.01). The occurrence of an access complication was independently associated with perioperative mortality (OR, 2.1; 95% CI, 1.6-2.8; P <.01). Bilateral cut down was associated with decreased mortality for male patients (OR, 0.40; 95% CI, 0.24-0.68; P <.01) but not for female patients (OR, 2.3; 95% CI, 1.1-4.8; P =.02). Finally, access complications were associated with increased 5-year mortality (hazard ratio, 1.3; 95% CI, 1.1-1.5; P <.01; Fig).
Conclusion(s): Access complications, when unexpected, were associated with adverse perioperative and 5-year outcomes. Female sex was associated with increased rates of access complications, suggesting the need for devices tailored to the female anatomy. [Formula presented]
Copyright

Objective: There is a paucity of literature on the natural history of extracranial carotid artery occlusion (CAO). This study reviews the natural history of this patient cohort.
Method(s): This single-institution retrospective analysis studied patients with CAO diagnosed by duplex ultrasound test between 2010 and 2021. Patients were identified by searching our office-based accredited vascular laboratory database. Imaging and clinical data were obtained via our institutional electronic medical record.
Result(s): A total of 5523 patients underwent carotid artery duplex examination during the study period. The CAO cohort consisted of 140 patients, as characterized in Table I; incidence of CAO was 2.5%. A total of 61.3% (n = 86) of patients were asymptomatic at diagnosis. A total of 27.9% (n = 39) were diagnosed after a stroke or transient ischemic attack, with 16.4% ipsilaterally affected, 7.9% contralaterally affected, and 3.6% with unclear laterality. For 23 patients with prior duplex imaging demonstrating ipsilateral patency, 26.1% had <50% ipsilateral stenosis, 39.1% had 50%-69% stenosis, and 26.1% had >70% stenosis at a mean of 32.8 +/- 26.4 months before CAO diagnosis. At CAO diagnosis, 55.2% of patients had <50% contralateral stenosis, 24.8% had 50%-69% stenosis, and 9.9% had >70% stenosis. Ninety-five patients (67.9%) had duplex imaging follow-up (mean: 42.7 +/- 31.3 months). Six patients (6.3%) developed recanalization with the mean occurrence of 42.9 +/- 32.6 months after diagnosis. Four patients (2.9%) developed subsequent stroke ipsilateral to the CAO with the mean occurrence of 27.8 +/- 39.0 months after diagnosis. Thirteen patients (9.3%) developed other related symptoms, including global hypoperfusion (5.0%), cognitive changes (2.9%), and transient ischemic attack (1.4%). Ten patients (7.1%) underwent eventual ipsilateral intervention, including carotid endarterectomy (n = 6), transfemoral carotid artery stenosis (n = 2), transcarotid artery revascularization (n = 1), and carotid bypass (n = 1), with the mean occurrence of 17.7 +/- 23.7 months after diagnosis. Before intervention, seven occlusions on duplex imaging were recharacterized as severe stenosis per periprocedural CT or MR imaging. Two CAOs were intervened on subsequent to recanalization. One patient with confirmed CAO underwent bypass for symptoms of global cerebral hypoperfusion. Intervention characteristics are shown in Table II. The aggregate rate of developing recanalization, related stroke or symptoms, or undergoing ipsilateral intervention was 19.3%. A total of 16 patients (11.4%) underwent contralateral intervention, including carotid endarterectomy (8.6%), transcarotid artery revascularization (2.1%), and transfemoral carotid artery stenosis (0.7%), with the mean occurrence of 11.5 +/- 18.2 months after diagnosis.
Conclusion(s): In this large, institutional cohort of patients with CAO diagnosed by duplex ultrasound test, a clinically meaningful subset of patients experienced recanalization, stroke, or related symptoms. Most patients with CAO per duplex ultrasound test who underwent intervention were subsequently recharacterized as having severe stenosis. These data suggest that patients with CAO may benefit from aggressive medical management, close follow-up, and confirmatory imaging. [Formula presented] [Formula presented]
Copyright

Objectives: The impact of preoperative anemia in patients undergoing transcarotid artery revascularization (TCAR) is not well established. This study compared the perioperative outcomes of patients with and without preoperative anemia after TCAR.
Method(s): The Vascular Quality Initiative database (2016-2021) was queried for all patients undergoing TCAR for carotid stenosis. Anemia was defined as a hemoglobin level of <12 g/dL in women and <13 g/dL in men. The primary outcome was a composite of in-hospital major adverse cardiovascular events (MACE; defined as stroke, death, myocardial infarction [MI]). The secondary end points included prolonged postoperative length of stay (>2 days), death, stroke, and MI. Anemia was further stratified by hemoglobin level (mild, 10-11.9 g/dL for women or 12.9 g/dL for men; moderate, 8-9.9 g/dL; severe, 6.5-7.9 g/dL). Multivariable logistic regression and case-controlled matching were conducted to assess the association between anemia and the outcomes of interest.
Result(s): Of 21,468 patients, 7641 (36%) were anemic and 8932 (42%) had symptomatic stenosis. The anemic patients tended to be older and more symptomatic (44% vs 41%), with more comorbidities (Table I). They had a higher rate of in-hospital MACE (2.8% vs 1.9%; P <.001), primarily driven by more deaths (0.7% vs 0.3%; P <.001) and MIs (0.9% vs 0.4%; P <.001). The rate of stroke was not different between the two cohorts (1.5% vs 1.5%). Multivariable logistic regression and case-control matching demonstrated that preoperative anemia was not associated with increased odds of MACE, death, stroke, MI, or stroke or death (Table II). This trend persisted in the subgroup analysis of patients with symptomatic stenosis. However, preoperative anemia was independently associated with an increased postoperative length of stay on multivariable analysis in both the unmatched (odds ratio, 1.34; 95% confidence interval, 1.18-1.70; P <.001) and case-control matched (odds ratio, 1.42; 95% confidence interval, 1.18-1.71; P <.001) cohorts. Finally, the severity of anemia did not appear to affect the perioperative outcomes after TCAR on multivariable analysis.
Conclusion(s): Preoperative anemia was not associated with increased perioperative MACE in patients undergoing TCAR. However, anemic patients had had longer postoperative hospital stays following TCAR, which might potentially implicate increased resource usage. Given the recent study showing an association between preoperative anemia and MACE after carotid endarterectomy and transfemoral carotid stenting, TCAR could be considered for appropriately selected anemic patients with high-risk features. [Formula presented] [Formula presented]
Copyright