Natalie Marks

Effects of anesthesia versus regional nerve block on major leg amputation mortality rate.

There are greater than 120,000 above-knee amputations (AKA) and below-knee amputations (BKA) performed in the USA each year. Traditionally, general anesthesia (GA) was the preferred modality of anesthesia. The use of regional nerve blocks has recently gained popularity, however, without the supporting evidence of any mortality benefits. Our objective was to evaluate whether regional nerve blocks yield significant mortality reduction in major lower-extremity amputations. Retrospective data of both AKA and BKA procedures at the Maimonides Medical Center from 2005 to 2009 were analyzed. Patients received either general sedation, spinal or ultrasound-guided regional nerve blocks as per decision of the attending anesthesiologist. Regional nerve blocks for major lower-extremity amputations consisted of femoral, sciatic, saphenous and popliteal nerve blocks. A retrospective inquiry of 30-day mortality was performed with reference to the Social Security Death Index and hospital records. One hundred and fifty-eight patients were included in the study (82 men and 86 women with mean age of 74.5 years ± 12.9 SD, range of 33-98 years) of which 46 patients had regional nerve blocks and 112 had GA or spinal blocks. Patients who received both regional blocks and GA/spinal blocks within 30 days were excluded. The overall 30-day mortality was 17.1% (27 patients) consisting of 15.2% for regional nerve analgesia versus 17.9% for GA/spinal blocks (P = 0.867). Age did not affect mortality outcome in either groups of anesthesia modality. Our analysis did not reveal any mortality benefit of utilizing regional nerve block over GA or spinal blocks.

Lower Extremity Arterial Mapping: Duplex Ultrasound as an Alternative to Arteriography Prior to Femoral, Popliteal, and Infrapopliteal Reconstructions

In this chapter, our clinical experience with procedural duplex ultrasound used in over 3000 lower extremity open and endovascular arterial revascularization procedures is reviewed. The topics discussed include goals of preoperative duplex ultrasound arterial mapping (DUAM) for revascularization decision-making, detailed DUAM protocols, and comparison of DUAM with other imaging modalities such as contrast arteriography (XRA), computed tomographic arteriography (CTA), and magnetic resonance angiography (MRA). The learning curve for duplex arterial testing is discussed as well as the limitations and pitfalls of this diagnostic technique including necessary components to be followed during the training phase for replacing other imaging modalities with DUAM.

IP265 Underexpansion of Iliac Vein Stents in the Treatment of Venous Insufficiency

hemodynamic changes in the operative extremity. This study for the first time investigated changes in calf muscle pump function after TKA. The study hypothesis stated improvement in calf muscle pump function after TKA would improve venous health and quality of life for patients. Methods: This prospective pilot study compared preoperative and postoperative measurements and unilateral patient control in patients undergoing TKA with postoperative follow-up at 1, 2, and 3 months. Clinicians from the Divisions of Vascular Surgery and Orthopedics conducted the study. Demographics including smoking status and CEAP classification were obtained (Table I). Quality of life was assessed using the Chronic Venous Insufficiency Questionnaire. Preoperative and postoperative Venous Clinical Severity Score, body mass index, leg measurements, and assessment of calf muscle pump function (venous volume, ejection volume, and ejection fraction) using air plethysmography were measured (Table II). Mean and standard deviation were calculated, with descriptive variables compared using Wilcoxon signed rank test. Probability of P < .05 was considered statistically significant Results: A total of 19 patients (68.4% female), mean age 64.6 6 5.6, were evaluated between June 2013 and June 2015. Quality of life was shown to improve postoperatively with significant reductions in Chronic Venous Insufficiency Questionnaire scores (62.7 vs 48.3; P 1⁄4 .002). Postoperative venous volume (78.5 vs 103.3; P 1⁄4 .025), ejection volume (27 vs 102; P 1⁄4 .023), and ejection fraction (42.5 vs 74.4; P 1⁄4 .0017) were all significantly increased, indicating an improvement of calf muscle pump function. Also, body mass index decreased significantly postoperatively (32.3 vs 31.5; P 1⁄4 .02). Conclusions: Our pilot study indicates, for the first time, a significant improvement in calf muscle pump function, quality of life, and body mass index postoperatively in patients undergoing TKA. This may be attributable to increased range of motion and ambulation, although more investigation is required.

PC164 Fast-Track Thrombolysis for Acute Lower Extremity In-Stent Occlusions: A Novel Approach to Minimize Complications of Standard Thrombolytic Therapy

Results: A total of 20 participants (35% women, 30% African American; mean age, 69 6 9 years) enrolled and completed the study. Mean anklebrachial index was 0.69 6 0.14. Over a mean study period of 34 6 6 days, sleep data were recorded an average of 28 6 6 days and walking activity on 12 6 10 days. Mean nights of interrupted sleep were 1.3 6 1.8, and eight participants (40%) had sleep interruption at least one night. Sleep disturbance was associated with higher (more severe) Walking Impairment Questionnaire speed (P 1⁄4 .002), distance (P 1⁄4 .030), and overall (P 1⁄4 .009) scores. No associations between sleep disturbance and daily walking or VascuQol-6 scores were observed. Conclusions: Sleep disturbance impacts walking, disability and QOL among peoplewith symptomatic PAD. Ongoing investigations will further characterize sleep disturbance among patients with claudication as well as critical limb ischemia, evaluate associations with disease severity, and explore the utility of sleep end points as a PAD treatment outcomes.

IP155. A Completely Endovascular Technique for the Treatment of Dialysis-Associated Steal Syndrome

Objectives: Venous outflow stenosis secondary to intimal hyperplasia is a common cause of dialysis access failure. Currently, treatment with angioplasty and stenting has high rates of reintervention. We evaluated the efficacy of drug-eluting balloons (DEB) on the treatment of venous outflow stenosis of arteriovenous fistulas and grafts. Methods: We prospectively followed 13 patients on hemodialysis whose dialysis access had been treated with Bard Lutonix DEB (Paclitaxel) for venous outflow stenosis. Patients were not randomized, and treatments were at the discretion of the treating physician. Postinterventional follow-up consisted of clinic visits and routine duplex ultrasound imaging. Primary end points were time to reintervention and patency of target lesion. Results: All 13 patients had venous outflow stenosis diagnosed by duplex ultrasound imaging. Eight patients had brachiocephalic fistulas (AVFs), while the other five had grafts (AVGs). All patients underwent balloon angioplasty with DEB of the venous outflow stenosis. There was a mean follow-up of 10 months. Two patients died of unrelated events during the follow-up period. Of the 11 remaining patients, six (56%) were intervention free. Of those that require reintervention, two underwent angioplasty for central venous stenosis unrelated to the initial site of DEB angioplasty. Taking this into account eight (73%) of the AVFs/ AVGs whose venous outflow were treated with DEB were patent at 10 months. Only three patients required repeat angioplasty at the initial site of DEB angioplasty. Conclusions: Our study suggests favorable results for the treatment of venous outflow stenosis in arteriovenous fistulas and grafts with DEB however larger prospective studies are warranted prior to making a definitive recommendation.

Interposition bypass of the popliteal artery using the popliteal vein in 1943

This is a case report of an 85-year-old man who presented to our office in 2005 with increased lower extremity swelling, and a well healed ulceration with hemosiderin deposition of his right leg (Fig 1). The patient was noted to have no palpable popliteal or pedal pulses but a normal femoral pulse. Further examination revealed an old scar from posterior incision in the right popliteal fossa and a well healed left leg below the knee amputation. Upon further evaluation and examination, it was learned the patient was a former soldier in the Soviet army and was

Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion

thrombosis (no EHIT, three gastrocnemius thrombosis, one popliteal thrombosis), and there were three inflammatory response treated/resolved with Bactrim-DS. The VCSS score preoperatively was 5.97, at 2 weeks was 3.03, and at 6 months was 2.34. Cost savings of

The Clinical Efficacy of Balloon Assisted Maturation of Autogenous Arteriovenous Fistulae.

178/procedure (total

The Effect of Balloon Angioplasty Without Stenting for Iliac Vein Stenosis

70,666) was realized in 12 months. Conclusions: Similar performance outcomes are seen using the single use Covidien ClosureFAST catheter and the NES-reprocessed ClosureFAST catheters, with significant cost savings using RC.