Gabriela Velazquez-Ramirez

Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia

Objective: Frailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery. Frailty measures based on walking‐based tests may be impractical or invalid for patients with walking impairment from symptoms or sequelae of vascular disease. We hypothesized that grip strength is associated with frailty, comorbidity, and cardiac risk among patients with vascular disease. Methods: Dominant hand grip strength was measured during ambulatory clinic visits among patients with vascular disease (abdominal aortic aneurysm [AAA], carotid stenosis, and peripheral artery disease [PAD]). Frailty prevalence was defined on the basis of the 20th percentile of community‐dwelling population estimates adjusted for age, gender, and body mass index. Associations between grip strength, Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI), and sarcopenia (based on total psoas area for patients with cross‐sectional abdominal imaging) were evaluated using linear and logistic regression. Results: Grip strength was measured in 311 participants; all had sufficient data for CCI calculation, 217 (69.8%) had sufficient data for RCRI, and 88 (28.3%) had cross‐sectional imaging permitting psoas measurement. Eighty‐six participants (27.7%) were categorized as frail on the basis of grip strength. Frailty was associated with CCI (odds ratio, 1.86; 95% confidence interval, 1.34‐2.57; P = .0002) in the multivariable model. Frail participants also had a higher average number of RCRI components vs nonfrail patients (mean ± standard deviation, 1.8 ± 0.8 for frail vs 1.5 ± 0.7 for nonfrail; P = .018); frailty was also associated with RCRI in the adjusted multivariable model (odds ratio, 1.75; 95% confidence interval, 1.16‐2.64; P = .008). Total psoas area was lower among patients categorized as frail vs nonfrail on the basis of grip strength (21.0 ± 6.6 vs 25.4 ± 7.4; P = .010). Each 10 cm2 increase in psoas area was associated with a 5.7 kg increase in grip strength in a multivariable model adjusting for age and gender (P < .0001). Adjusted least squares mean psoas diameter estimates were 25.5 ± 1.1 cm2 for participants with AAA, 26.7 ± 2.0 cm2 for participants with carotid stenosis, and 22.7 ± 0.8 cm2 for participants with PAD (P = .053 for PAD vs AAA; P = .057 for PAD vs carotid stenosis; and P = .564 for AAA vs carotid stenosis). Conclusions: Grip strength is useful for identifying frailty among patients with vascular disease. Frail status based on grip strength is associated with comorbidity, cardiac risk, and sarcopenia in this population. These findings suggest that grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking‐based measures. Lower mean psoas diameters among patients with PAD vs other diagnoses may warrant consideration of specific approaches to morphomic analysis.

PC162 Exploring Associations Between Sleep Disturbance and Walking Activity Among Patients With Symptomatic Peripheral Artery Disease: Results From the Project VOICE Pilot Study

Objectives: For over 50 years, standard endarterectomy with patch (SEP) of the common femoral artery (CFA) has been well described with durable results. Eversion endarterectomy (EE) uses a complete CFA transection above its bifurcation and subsequent end-to-end anastomosis. EE is potentially advantageous over SEP by avoiding prosthetic patch infection and easing future transfemoral access. With subjectively more focal femoral artery lesions encountered during the endovascular era, we reviewed our SEP and EE outcomes to see whether there were any differences between the two methods. Methods: We retrospectively identified all patients undergoing CFA endarterectomy by a single surgeon who adopted preferential EE at a single institution between 2007 and 2015. Patient demographics and surgical details were captured from the electronic medical record, including endarterectomy type and the performance of concurrent endovascular and/or bypass surgery. Complications and adverse events were recorded. Statistical comparison of means was performed using the t-test, and categoric variables were evaluated using the Fisher exact test. Results: Eighty-nine sequentially encountered patients underwent 97 endarterectomies of the CFA (68 SEP and 29 EE). More SEP than EE cases were performed concomitant with either bypass or stenting (62% vs 34%). Most patients were smokers (80% of SEP vs 93% of EE). Patients undergoing EE were older (67 vs 62 years; P 1⁄4 .01), with less hypertension (59% vs 79%; P 1⁄4 .04), and less chronic kidney disease (4% vs 27%; P 1⁄4 .01). The observed frequencies of diabetes, dyslipidemia, coronary artery disease, stroke, coagulopathy, and cancer were not significantly different among EE and SEP patients. The average follow-up duration was 28 months, longer among SEPs patients than EE patients (32 vs 20 months; P 1⁄4 .02). We observed favorable primary patency with EE (Table). There were no statistically significant differences observed among adverse events associated with SEP and EE patients (Fig): CFA restenoses (10% vs 3.4%), CFA thromboses (12% vs 0%), and wound infections (10% vs 7%). Conclusions: EE and SEP both offer reasonably durable outcomes for the treatment of focal femoral arterial occlusive disease. EE may offer an attractive alternative to SEP, potentially decreasing the risk of significant wound complications associated with prosthetic patch infections.