American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Vascular surgery studies identify promising procedures

OCTOBER 26, 2017
Clinical Congress Daily Highlights, Thursday Edition

Two studies presented this week explore potential improvements in vascular surgery. One shows that ischemic preconditioning in brain-dead donors improves heart graft survival, while the other demonstrates the benefits of a minimally invasive procedure in complex aortic aneurysm repair.

Fenestrated endovascular aortic aneurysm repair (FEVAR) is associated with dramatic reduction in 30-day mortality and morbidities compared to open aneurysm repair (OAR), a team led by Satinderjit S. Locham, MD, Johns Hopkins Medical Institution, Baltimore, MD, found in a review of ACS NSQIP® data. Using the general ACS NSQIP database (2006 – 2015), the researchers identified 2,663 patients who underwent repair for non-ruptured abdominal aortic aneurysm (AAA), 28 percent of whom underwent FEVAR and 72 percent OAR. The FEVAR patients had shorter hospital stays, fewer returns to OR, lower complications, and lower in-hospital mortality. After adjusting for differences between the groups, OAR patients had a mortality risk 3.5 times that of FEVAR patients. The authors conclude that long-term follow-up is needed to determine the durability of FEVAR and to evaluate the persistence of survival benefit.

The second study found that a simple procedure may improve heart graft survival in transplants. Remote ischemic preconditioning is based on the observation that the heart and other organs can be protected from reperfusion injury by inducing brief periods of skeletal muscle ischemia. The Remote Ischemic Preconditioning in Neurological Death Organ Donors (RIPNOD) trial tested the effects of inducing skeletal muscle ischemia in donors before transplantation. The RIPNOD trial compared outcomes in 60 standard transplants to an equal number in which remote ischemic preconditioning was performed on the donor using four five-minute inflations of a mid-thigh tourniquet at least six hours before and again at organ recovery. The procedure significantly improved all-graft survival in transplant recipients at two years, reports a team led by Advaith Bongu, MD, Rutgers University, Newark, NJ. RIPC also improved patient survival, reaching borderline significance (92 percent v. 80 percent, p = 0.07).

Additional Information:
These Scientific Forum studies were presented on or before October 26 at the 2017 Clinical Congress of the American College of Surgeons Clinical Congress in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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