Satinderjit Locham

VESS11. Risk Factors and Outcomes of Postoperative Bowel Ischemia After Abdominal Aortic Aneurysm Repair

type of management (surgical vs medical) received after development of postoperative bowel ischemia (BI). AAA, Abdominal aortic aneurysm; ACE, angiotensin-converting enzyme; CABG, coronary artery bypass graft; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; ROC, receiver operating characteristic. e54 Abstracts Journal of Vascular Surgery June 2018

IP085. Effects of Statin Use on Endovascular Repair of Thoracic Aortic Aneurysm and Dissection

treated with the ZFEN device with those treated with standard infrarenal EVAR. Primary outcomes were 30-day mortality, and secondary outcomes included procedural characteristics and occurrence of any postoperative complication registered within the database. To account for baseline differences, we calculated propensity scores and employed inverse probability-weighted logistic regression. Results: We identified 189 ZFEN cases and 6717 infrarenal EVARs. Baseline characteristics were similar between both groups, except for clinical presentation with acute preoperative renal failure (ZFEN, 1.1%; EVAR, 0.1%; P 1⁄4 .014). Thirty-day mortality was comparable between ZFEN and EVAR (2.1% vs 0.9%, respectively; P 1⁄4 .1). For patients treated with ZFEN, median operative time was almost twice as long (224 vs 120 minutes; P < .001), intraoperative and postoperative transfusions occurred more often (19.6% vs 5.8%; P < .001), and length of stay was longer (median, 2 vs 1 day; P < .001). There was no significant difference in the rate of any postoperative complications (11.1% vs 8.0%; P 1⁄4 .14). After propensity weighting, ZFEN was associated with higher 30-day mortality (odds ratio, 3.1; 95% confidence interval, 1.1-8.7; P 1⁄4 .035) but not complications (odds ratio, 1.5; 95% confidence interval, 0.9-2.5; P 1⁄4 .085). Conclusions: In this study, ZFEN was associated with higher adjusted 30-day mortality, longer procedure times, higher transfusion rates, and longer length of stay than standard infrarenal EVAR. Although residual confounding due to the application of ZFEN to more complex anatomy may explain many of these differences, more data are needed on the safety of ZFEN.

IP249. Anemia as an Independent Predictor of Adverse Outcomes After Carotid Revascularization

at 7% (n 1⁄4 17). Overall, there has been a significant trend toward increased vascular operative consultations during the study period (Fig). Conclusions: Vascular surgeons are essential team members at a level I trauma center. Vascular consultation in this setting is often unplanned and requires immediate intervention. When consulted, the vascular surgery service is effective in quickly gaining control of the situation to provide exposure, hemorrhage control, and revascularization if warranted. The frequency of vascular consultation is increasing, and it is paramount that hospitals provide adequate staffing to meet rising demand. Declining experience of trauma surgeons with vascular trauma may have an influence on this increase in demand.

PC006. Fenestrated and Chimney Endovascular versus Open Repair of Juxtarenal, Pararenal and Suprarenal Abdominal Aortic Aneurysms: A 5-Year National Study (2012-2016)

Objectives: A significant and sustained paradigm shift in abdominal aortic aneurysm treatment toward endovascular technology has come at a cost of open surgical procedures despite similar long-term survival. We sought to determine morbidity and mortality rate in patients undergoing open surgical repair (OSR) for abdominal aortic aneurysms at a single high-volume open regional center. Methods: All patients who underwent OSR for asymptomatic and nonruptured symptomatic abdominal aortic aneurysms were identified retrospectively from May 1, 2007, to March 31, 2017, using International Classification of Diseases, 10th edition, diagnosis codes at a single center in Gatineau, Quebec, Canada. The primary outcome was a descriptive analysis of all-cause mortality. Secondary outcomes of interest were predictors of adverse perioperative events after OSR using multivariable linear and logistic regression. Results: The cohort consisted of 316 consecutive patients with a mean age of 70.18 6 7.61 years, with 75% (n 1⁄4 237) being male. The perioperative risk of cardiovascular adverse events using the revised cardiac risk index was relatively low with a mean of 1.63 6 0.69 points. The median operative time was 95 minutes. The incidence of death at 30 days was 0.003% (n 1⁄4 1), death at 12 months was 0.02% (n 1⁄4 6), and all-cause death was 23.7% (n 1⁄4 75) over a median follow-up of 4.9 years (Fig). For the entire OSR cohort, the 1and 5-year calculated probability of survival was 97.7% and 82.0%, respectively. Operative time of 95 minutes or less was associated with decreased need for transfusions in the perioperative period (odds ratio, 0.29; 95% confidence interval, 0.17-0.48), decreased postoperative complications (odds ratio, 0.30; 95% confidence interval, 0.19-0.48), and decreased duration of stay (ß -2.7; 95% CI, -4.64 to -0.84) when adjusted for clinically relevant covariates. Conclusions: OSR of AAAs remains a safe and effective treatment option for patients who are appropriate candidates with a probability of survival at 5 years of 82%. OSR of AAAs can be done in less than 95 minutes and is associated with a reduction in transfusion requirements, reduction in postoperative complications, and reduced duration of stay.

IP045. Racial Disparities in Endovascular Repair of Thoracic Aortic Aneurysm and Dissection

Objective: Malignant aortic tumors are exceedingly rare. For that reason, no case series have been published so far in the literature, and a comprehensive review of clinical and therapeutic aspects is lacking. The aim of this study was to analyze all known cases of malignant aortic tumors and to identify predictors of patients’ survival. Methods: All patients with a diagnosis of aortic tumor treated in a single center together with all case reports and reviews available in the literature (through a specific PubMed search with keywords such as malignant and aorta or aortic tumor or sarcoma or angiosarcoma) were analyzed. Tumor primary location, clinical presentation, histologic features, and treatment choice were all examined. Survival at 1 year, 2 years, and 5 years and the possible preoperative and operative predictors of outcome were evaluated by Kaplan-Meier analysis with log-rank test. Results: In addition to the 5 cases treated in our center, 218 other cases of malignant aortic tumor have been reported in the literature from 1873 to 2017. Overall, the mean age of the patients was 60.1 6 11.9 years, and the male to female ratio was 1.59:1. The mean overall survival from diagnosis was 13.6 6 7.7 months; 1-, 3-, and 5-year survival rates were 35.2% 6 3.7%, 10.9% 6 2.6%, and 6.1% 6 2.2%, respectively (Fig). Chronic hypertension (P 1⁄4 .03), fever (P 1⁄4 .03), back pain (P 1⁄4 .01), asthenia (P 1⁄4 .04), and signs of peripheral embolization (P 1⁄4 .007) were significant predictors of patients’ poor outcome. Histologic subtypes had different impacts on

PC192. The Interplay of Age, Intravenous, and Oral Beta-Blocker Use in Patients With Type B Thoracic Aortic Dissection

Fig 2. Estimated adjusted probability of death stratified by repair type and oral 88 types. Adjusted for age, gender, history of HTN, CCI, dissection level (thoracoabdominal vs thoracic), nonelective versus elective repair, teaching versus nonteaching institution, and aspirin and statin intake. Besma Nejim, Caitlin W. Hicks, Hanaa Dakour Aridi, Satinderjit Locham, Brian Nolan, Mahmoud B. Malas. Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins Hospital, Baltimore, Md; Maine Medical Center, Portland, Me

PC072. The Impact of Stent Geometry on Outcomes of Carotid Artery Stenting

Conclusions: Patients undergoing CAS are at higher risk for postoperative embolization. The risk for postoperative embolization is related to the length of the lesion and calcification. Identifying the preoperative risk factors may help to guide patient selection and, thereby, reduce embolization-related neurocognitive impairment. Understanding these risky lesions may also help to guide the selection of technique when selecting CAS or CEA for a patient and decrease morbidity. Patients undergoing stenting for atherosclerotic disease, therefore, may be at greater risk for embolization and neurocognitive impairment than those undergoing CAS for radiation-induced stenosis or other indications.

PC002 Cost Analysis of Fenestrated vs Standard Endovascular Repair of Nonruptured Abdominal Aortic Aneurysm in the United States

FPA deformations may contribute to arterial wall injury and intimal hyperplasia. We measured limb flexion-induced deformations of human cadaveric FPAs before and after stenting with seven different commercially available peripheral artery stents. Methods: Retrievable nitinol markers were deployed into 28 in situ FPAs of 14 human cadavers. Limbs were perfused with 37 C fluid, and thin-section computed tomography images were acquired with limbs in the standing (180 ), walking (110 ), sitting (90 ) and gardening (60 ) postures. Image segmentation and analysis allowed comparison of relative spatial locations of each intra-arterial marker for determination of baseline FPA axial compression, bending, and torsion. Markers were then retrieved from the arteries, and the FPAs were stented with preand post-balloon dilatation. Zilver, Absolute Pro, Innova, Smart Control, SmartFlex, Supera stents, and Viabahn stent grafts were deployed across the adductor hiatus. Four unique limbs received each stent type with only one stent type per artery. After stenting, markers were redeployed in stented FPAs and imaged in the same postures. Comparison of the baseline and stented FPA deformations allowed determination of the influence of specific stent type (Fig). Results: Smart Control, Smart Flex, Zilver, Supera, and Absolute Pro restricted axial compression of the FPA within the stented segment by 56%, 45%, 42%, 26%, and 22%, respectively (P < .05). Smart Flex, Smart Control, and Zilver exacerbated FPA compression distal to the stent by 61% (P < .01), while no differences were observed proximally. Within the stented segment, maximum torsion was restricted by Supera 4 to 12 / cm (P < .05), and exacerbated by Smart Flex 10 to 15 /cm (P < .05). Torsion of the FPA proximal and distal to the stented region was not affected by stenting. Stents reduced bending of the FPA by an average of 42% (P < .01) within the stented segment, but no differences were observed proximally or distally. Conclusions: Different stent designs significantly affect limb flexioninduced deformations of the FPA not only within the stented segment but also distal to it. Stents that better match natural limb flexion-induced FPA deformations may mitigate arterial injury and potentially improve clinical outcomes of endovascular peripheral artery disease treatments. These data can be used to help more rationally select stent designs specific to arterial segments and patient conditions.

PC146 Drug Abuse Is Associated With Higher Complications and Increased Cost Following Lower Extremity Revascularizations

A, Athletes; ADLs, activities of daily living; NA, nonathletes; Neg, sum of negative responses (somewhat disagree, strongly disagree), No., number of responses; Pos, sum of positive responses (strongly agree, somewhat agree, neutral); Sum, total responses (numbers may be less than 184 because the respondent did not answer the question). 178S Abstracts Journal of Vascular Surgery June Supplement 2017