Abstract Journal Vascular Surgery

Abstract

Journal Vascular Surgery VS001 ANATOMICAL FEASIBILITY OF ENDOVASCULAR INTERVENTION FOR TYPE-A AORTIC DISSECTIONS ABHISHEKH SRINIVAS, MING YII, KENNETH LAU AND JULIAN SMITH Monash Health and Monash University, VIC Purpose: Type-A aortic dissections (AD) represent a life-threatening abnormality of the aorta with the current gold-standard of treatment being open surgical repair (OSR). However, up to 20% of all patients remain unsuitable for major OSR, due to concurrent comorbidities, age or frailty. Additionally, mortality of these operations remains unacceptably high, in the range of 25%. Consequently, there is strong interest in minimallyinvasive surgery of the ascending aorta and determining the anatomical characteristics of patients suited for this. Methodology: We conducted a retrospective cohort study of all Type-A AD patients presenting to Monash Health between January 2002 and November 2019. Patients’ CT-angiograms were analysed using multiplanar reconstruction to determine dissection entry tear location, aortic length and width, and supra-aortic vessel characteristics. This data was then compared to instructions for use (IFU) for five endovascular devicesZenith A-branch, Zenith Ascend, Tag TBE, Valiant Navion and a valve-carrying conduit, to determine patient suitability for endovascular intervention. Results: 102 patients were included in our study. A cumulative total of 39% of Type-A AD patients were suited for endovascular treatment. Specifically, the Tag TBE was best suited to our population, providing a therapeutic option for 34% of all cases. Conclusion: Endovascular treatment of Type-A AD is desirable, especially when considering its preand post-operative benefits compared to OSR. However, dissection of the supra-aortic branch vessels, location of entry tear and a large aortic diameter at the level of the proximal and distal landing zones were the most common factors precluding its usage amongst patients in our study. VS002 OUTCOMES AND ESTIMATED COSTS OF OPEN AND ENDOVASCULAR REVASCULARIZATION FOR CHRONIC LIMB ISCHEMIA IN AN AUSTRALIAN COHORT STUDY SAMUEL SMITH, RICHARD NORMAN, JOSEPH MOXON, RAMESH VELU, FRANK QUIGLEY AND JONATHAN GOLLEDGE Queensland Research Centre for Peripheral Vascular, QLD Objective: The costs of open and endovascular revascularization to treat peripheral artery disease (PAD) have not been fully established. This study examined the costs of both index admissions and readmissions within 30 days for people having revascularization in Australia. Method: This was a retrospective analysis of prospectively collected data. Eligible participants presented with chronic limb ischemia requiring revascularization between 2002 and 2017. Generalized linear modelling was used to estimate mean (95% CI) hospital costs for the index and readmission hospital treatments and total hospital costs using diagnosis related group (DRG) data from Independent Hospital Pricing Authority data. Results: 302 participants presenting with intermittent claudication (n = 219; 72.5%) or critical limb ischemia (n = 83; 27.5%) treated by open (n = 116; 38.4%) or endovascular (n = 186; 61.6%) revascularization were included. 48 (15.9%) participants were readmitted within 30-days of discharge from their index admission. Around 70% of readmissions were related to ongoing PAD symptoms or post-operative complications. Mean index admission hospital cost was US$9495 (95%CI $8196–$10 862) per person. The cost was significantly greater for open as compared to endovascular revascularization (p < 0.001). The mean estimated hospital cost was US$10523 ($7515–$13 711) per person readmitted. When comparing participants treated before and after 2010, the total cost decreased, mainly due to decreased lengths of hospital stay for open procedures. Conclusion: In this study the hospital costs were less for endovascular than open revascularization of chronic limb ischemia. Costs decreased over time. Readmission is an important contributor to the overall costs of peripheral revascularization. VS003 INCIDENCE OF PERIPHERAL PSEUDOANEURYSMS POST PERCUTANEOUS VASCULAR ACCESS MADELEINE DE BOER, TIMOTHY SHIRAEV, LAUREN SMITH AND STEVEN DUBENEC Royal Prince Alfred Hospital, NSW Purpose: Iatrogenic pseudoaneurysms post endovascular procedures are uncommon, however their occurrence can predispose to significant morbidity and mortality. With increasing use of endovascular interventions, and recommendations for use of ultrasound guidance for percutaneous vascular puncture, the aim was to identify the incidence of iatrogenic pseudoaneurysms following percutaneous vascular access in an Australian hospital and assess trends over time. Methodology: A case–control study of all patients who were diagnosed with a peripheral arterial pseudoaneurysm at a tertiary hospital between December 2008 and August 2015 was conducted. The total number of patients undergoing peripheral arterial access for cardiology, interventional radiology and vascular surgery procedures was also collected. Results: Over the study period, 199 pseudoaneurysms were diagnosed after 24 229 procedures (pseudoaneurysm rate of 0.82%) and included for analysis. Mean patient age was 74.6 years, 53.6% of patients were female, and mean body mass index (BMI) was 27.7 6.5 kg/m2. 88 patients received ultrasound-guided compression, 104 patients underwent open surgical repair, 1 patient underwent covered stenting, and 2 patients underwent thrombin injection. The use of ultrasound guidance for access did not reduce the incidence of pseudoaneurysm. Conclusion: Overall pseudoaneurysm rate was low. The use of ultrasound during arterial puncture did not result in a lower pseudoaneurysm occurrence rate, despite current recommendations. Patients at higher risk of postprocedural pseudoaneurysm are those on anticoagulant or antiplatelet agents, and those with higher BMIs. As such, greater care is required when performing arterial puncture on these patients. VS004 ABOVE-ANKLE ENDOVASCULAR REVASCULARIZATION ALONE IMPROVES PEDAL ARCH PATENCY AND OUTCOMES OF ISCHAEMIC DIABETIC FOOT ULCERS LIMI LEE, MING YII AND STEPHEN THWAITES