Konrad Salata

PC062. Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

regional anesthesia (LA/RA), and general anesthesia (GA). The interaction between anesthesia technique and shunting approach was evaluated. Multivariate logistic regression analysis was performed adjusting for patients demographics (age, gender, race, ethnicity), symptomatic status, comorbidities (diabetes, hypertension, coronary artery disease, congestive heart failure, chronic kidney disease, prior bypass, endovascular intervention or amputation, degree of stenosis, prior contralateral CEA/carotid artery stenting), restenosis, presence of anatomic high-risk factors, emergency status, type of CEA (conventional vs eversion), patching, and contralateral occlusion. Results: A total of 60,399 CEA cases were included: no shunting (48.4%), RS (47.5%), and SS (4.1%). Shunting was more likely performed under GA compared with RA/LA (55.8% vs 13.3%; P < .001), particularly RS (51.7% vs 8.5%; P < .001). SS was associated with 67% increased odds of in-hospital stroke/death compared with RS regardless of anesthetic technique (adjusted odds ratio, 1.67; 95% confidence interval, 1.23-2.28; P < .01). However, in both RS and SS, the incidence of stroke/death was higher when performed under RA/LA compared with GA (2.4% vs 1.1% and 4.9% vs 2.0%, respectively; P < .05; Fig 1). On multivariable adjustment, the interaction between anesthetic technique and shunting approach was significant (P < .05). Compared with GA, LA/RA was associated with double the risk of in-hospital stroke/death in patients who were RS (adjusted odds ratio, 2.1495% confidence interval, 1.15-3.99; P 1⁄4 .02) or SS (adjusted odds ratio, 2.3595% confidence interval, 1.17-4.73; P 1⁄4 .02; Fig 2). In the SS group, stroke/death was higher in awake patients compared with those monitored via electroencephalography and stump pressure (5.2% vs 2.2% and 2.1%, respectively; P 1⁄4 .03). However, there was no association between the neuromonitoring technique and the incidence of stroke/ death after adjustment. Conclusions: Shunting during CEA is more frequently performed under GA. Whether routine or selective, shunting is more safely performed under GA. The exact cause of this difference is unknown; however, surgeons experience, comfort and technical ability might play an important role.

Lower Limb Amputations in Patients With Diabetes and Peripheral Artery Disease: A Time-Series Analysis of Trends (2005-2016)

have a relatively higher degree of stent recoil than metal does. Hence, we hereby intended to develop novel composite bioresorbable stents (cBRSs) made of poly(pdioxanone) (PPDO) and polycaprolactone with mechanically reinforced compression performance for pediatric patients. Methods: The cBRSs with PPDO monofilaments and PPDO-polycaprolactone composite braiding yarns were fabricated on a 32-bobbin braiding machine using different ratios (7:1 for cBRS type A and 3:1 for cBRS type B) and thermally treated in air thereafter. The properties of different prototypes compressed were evaluated by a parallel compression tester. Stent stress distribution and deformation mechanisms were also analyzed by the finite element method. Results: Partial interlacing yarns were bonded, and the peeling force was as high as 2126.67 6 133.14 mN to restrict their movement greatly compared with the friction resistance (<100 mN) in the control group. The compression force was promoted dramatically in the novel composite prototype stents by 124.06% in cBRS type A and 169.58% in cBRS type B. Besides, the recovery abilities were also improved significantly. Moreover, deformation mechanisms revealed by computational simulations showed that bonded interlacing points among yarn played an important role. Conclusions: This study demonstrated a novel technique for designing bioresorbable polymeric prototype stents with reinforced compression performance using a braiding and annealing procedure. The advantage of this design lies in the bonded strand interlacing points that restricted stent elongation and yarn gliding, which was revealed by computational simulations. In addition, the degradation behavior of novel composite braided stents will be evaluated in the future.

Risk of Intracranial Hemorrhage After Carotid Artery Stenting Versus Endarterectomy: A Population-Based Study

Risk Factors for Suboptimal Utilization of Statins and Antiplatelet Therapy in Patients Undergoing Revascularization for Symptomatic Peripheral Arterial Disease Meltzer AJ, Sedrakyan A, Connolly PH, Ellozy S, Schneider DB, Vascular Study Group of Greater. Ann Vasc Surg 2018;46:234-40. Study design: The Vascular Study Group of Greater New York (VSGGNY) database was used to identify all patients undergoing peripheral vascular intervention or lower extremity bypass for peripheral arterial disease (PAD; 2011-2013). Key findings: A total of 1030 patients underwent endovascular therapy (n 1⁄4 822; 80%) or surgical bypass (n 1⁄4 208; 20%) for symptomatic PAD (half for claudication, half for critical limb ischemia). Preoperative statinand anti-platelet therapy was observed in only 59% and 79% of patients, respectively. Multivariate relative risk regression confirmed higher rates of aspirin and statin use among patients with coronary artery disease and/or with prior coronary artery bypass grafting/percutaneouscoronary intervention. Aspirin use was also associated with prior peripheral revascularization (P 1⁄4 .03). Reduced statin use was observed in patients over 80 years old (P 1⁄4 .059). Conclusion: Patients with symptomatic PAD are less likely to be taking antiplatelet agents and statins if they do not have a prior cardiovascular history. Given the established role of these medications in the optimal medical management of patients with PAD, clinicians need to make more of an effort to be sure these patients are taking these agents prior to vascular intervention. Commentary: The study showed that only 79% of patients received antiplatelet therapy prior to vascular surgery or endovascular therapy, and they were more likely to be doing so because a physician prescribed these drugs for a prior coronary or vascular intervention. I doubt vascular interventionalists question the utility of administering antiplatelet agents before these procedures. So, why wasn’t there a higher usage rate of antiplatelet agents and statins for these procedures? Maybe some interventionalists are not aware of the value of statins for carotid artery and other vascular interventions, and there may not be much we can do to improve compliance with taking these medications after we instruct patients do to so. The reader would naturally assume that the main reason patients did not take these medications prior to these interventions is because the vascular interventionalist did not prescribe them or check if patients were taking them. However, there are two practical measures we should all take to improve preop use of aspirin and statins: (1) routine use of a questionnaire during the initial history asking if patients are taking these medications; and (2) providing written instructions to patients stating they should be taking aspirin and a statin prior to arterial interventions (clopidogrel prior to carotid stenting). Vascular surgeons need to pay more than lip service to these important studies documenting the benefit of antiplatelet agents and statins in the perioperative period. The next time a patient suffers a postoperative ischemic stroke or myocardial infarction after carotid, aortic, or peripheral arterial intervention, we should check and see if they were taking these medications. If not, shame on us.

IP215. Population-Based Secular Trends in Lower Extremity Amputations for Diabetes and Peripheral Artery Disease

Fig 1. Peripheral artery disease (PAD) or diabetes-related lower extremity amputations (minor or major) in Ontario, Canada. Inter-Society Consensus II D Aortoiliac Occlusive Disease Achieves Equivalent Long-Term Outcomes ComparedWith Surgical Bypass Joshua Gabel, Roger Tomihama, Ahmed Abou-Zamzam Jr, Theodore Teruya, Christian Bianchi, Sharon Kiang. Loma Linda University Medical Center, Loma Linda, Calif

Impact of Statins on Clinical Outcomes After Carotid Endarterectomy and Stenting: A Population-Based Cohort Study

30 days was attributed to ipsilateral carotid disease. There were 702 operations (68.4%) that had DUS follow-up, for a total 2123.5 patient-years. DUS detected

Validation of abdominal aortic aneurysm repair codes in Ontario administrative data

80% ipsilateral restenosis in 30 patients (3.1%; Fig 1). Among these, none experienced postoperative transient ischemic attack/stroke beyond 30 days (Fig 2). Per TOH post-CEA protocol, the estimated cost of DUS surveillance in this cohort was

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

311,786.40, or

PC142 A Population-Based Evaluation of Thirty-Day Cost and Emergency Department Visit, Readmission, or Death After Major Vascular Surgery

10,392 per restenosis. Not a single ipsilateral reintervention occurred during this period. Conclusions: Severe restenosis after CEA is rare and not associated with worse outcomes. Despite historical recommendation, TOH’s management of severe restenosis has been conservative on the basis of its benign natural history. Routine post-CEA DUS surveillance is costly and unlikely to improve outcomes or to affect management, even if

Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair

80% ipsilateral restenosis is detected. Further research should determine the utility of routine contralateral DUS in this population, who may be at higher risk for severe contralateral carotid disease.

Association between operator specialty and outcomes after carotid artery revascularization

PURPOSE To determine the positive predictive values (PPV) of Ontario administrative data codes for the identification of open (OSR) and endovascular (EVAR) repairs of elective (eAAA) and ruptured (rAAA) abdominal aortic aneurysms. METHODS We randomly identified 319 eAAA and rAAA repairs at two Toronto hospitals between April 2003 and March 2015, using administrative health data in Ontario, Canada. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes I71.3 and I71.4, were used to identify rAAA and eAAA patients, respectively. A blinded retrospective chart review was conducted and served as the gold standard comparator. Re-abstracted records were compared to Canadian Classification of Health Interventions (CCI) and Ontario Health Insurance Plan (OHIP) codes in the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) and OHIP databases. We calculated the PPV and 95% confidence intervals (95% CI) of individual and combined procedure and billing codes for elective and ruptured OSR and EVAR (eOSR, eEVAR, rOSR, and rEVAR). RESULTS Permutation of codes allowed identification of eOSR with 95% PPV (95% CI 88, 98), eEVAR with 96% PPV (95% CI 90, 99), rOSR with 87% PPV (95% CI 79, 93) and rEVAR with 91% PPV (95% CI 59, 100). CONCLUSIONS Diagnostic, procedure and billing code combinations allow identification of eOSR, eEVAR, rOSR and rEVAR patients in Ontario administrative data with a high degree of certainty.