key: cord-0078328-bpslvm9f
authors: Cohnert, Tina U.; Stevanov, Marina; Siegl, Gregor; Konstantiniuk, Peter
title: Surgical Revascularization for Acute Mesenteric Ischemia in COVID-19 Patients
date: 2022-05-19
journal: J Vasc Surg
DOI: 10.1016/j.jvs.2022.03.035
sha: bba00d7afc80ae8a77678ac5f76e1965e7b4ee19
doc_id: 78328
cord_uid: bpslvm9f

nan

Open Repair of an Infrarenal Aortic Aneurysm Is Superior to Endovascular Repair Even in Case of Sac Shrinkage at Fifteen-Year Follow-up Emiliano Chisci, Tommaso Lazzarotto, Fabrizio Masciello, Filippo Turini, Azzurra Guidotti, Valentina Sanna, Clara Pigozzi, Mariagnese Mele, Patrizia Dalla Caneva, Patrizia Lo sapio, Renzo Lombardi, Stefano Michelagnoli. San Giovanni di Dio Hospital -USL CENTRO, Florence, Italy

Objective: The objective was to report very long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary hospital.

Methods: A total of 1777 consecutive AAA repairs (2003) (2004) (2005) (2006) (2007) (2008) (2009) (2010) (2011) (2012) (2013) (2014) (2015) (2016) (2017) (2018) were included. Primary outcomes were all-cause mortality, AAA-related mortality, and reintervention rate. Open repair (OSR) was offered in case the patient had a functional capacity of $4 metabolic equivalents and a predicted >10-year life expectancy. Endovascular repair (EVAR) was offered in case of hostile abdomen, presence of anatomic feasibility for standard endovascular graft, and <4 metabolic equivalents. Sac shrinkage was defined as a reduction of both anterior-posterior and laterolateral diameter of the sac of at least 5 mm at the last follow-up vs the first postoperative follow-up imaging.

Results: A total of 828 (47%) OSRs and 949 (53%) EVARs were performed. Of them, 93.5% (n ¼ 1661) were male; the mean age was 73.8 years. The mean follow-up was 79 (standard deviation: 51) months. Summary follow-up index was 0.91. Thirty-day mortality was 0.7% (n ¼ 6) and 0.6% (n ¼ 6) for OSR and EVAR, respectively. The survival rate was 97.6% and 94% at 1 year, 83.6% and 75% at 5 years, 59.6% and 45.8% at 10 years, and 33.1% and 20.7% at 15 years for OSR and EVAR, respectively (P < .001). Any statistical difference was found for the survival outcome in case of sac shrinkage (P ¼ .1). At the last follow-up, 15 (1.8%) vs 23 (2.4%) AAA-related deaths occurred in the OSR vs EVAR group, respectively (P ¼ .37). Freedom from reintervention was 97% and 96% at 1 year, 96.5% and 88.4% at 5 years, 95.8% vs 81.7% at 10 years, and 94.6% vs72.3% at 15 years for OSR and EVAR, respectively (P < .001). In the EVAR group, the reintervention rate was significantly lower for the sac shrinkage subgroup (P < .001) but still higher than the OSR group (see Fig a and b) . In 664 (70%), sac shrinkage occurred at the last follow-up.

Conclusions: Following current guidelines, OSR of an infrarenal AAA is superior to EVAR even in case of sac shrinkage at a very long-term followup. We strongly think that OSR proportion of AAA repair should not be less than 40%-45% in a vascular center.

Author Disclosures: E. Chisci: Nothing to disclose; P. Dalla Caneva: Nothing to disclose; A. Guidotti: Nothing to disclose; T. Lazzarotto: Nothing to disclose; P. Lo sapio: Nothing to disclose; R. Lombardi: Nothing to disclose; F. Masciello: Nothing to disclose; M. Mele: Nothing to disclose; S. Michelagnoli: Nothing to disclose; C. Pigozzi: Nothing to disclose; V. Sanna: Nothing to disclose; F. Turini: Nothing to disclose.

Tina U. Cohnert, Marina Stevanov, Gregor Siegl, Peter Konstantiniuk. Graz Medical University, Graz, Austria Objective: Acute mesenteric ischemia (AMI) is a life-threatening disease with high morbidity and mortality. In COVID-19 patients, the incidence of AMI is not yet fully known. The exact pathological mechanism leading to AMI in COVID-19 patients is not well understood at present. Systemic reactions and hypercoagulability play a role in this situation. The aim of this study was to examine the results of acute vascular surgical reconstruction for AMI in acute COVID-19 infection.

Methods: Data on all consecutive COVID-19 patients undergoing mesenteric revascularization for AMI at a tertiary university center between April 2020 and December 2021 were collected prospectively in a dedicated database and compared with data in non-COVID-19 patients treated for AMI.

Results: In a total of 12 patients (8 men, 4 women, age 39-84 years, mean age 69.2 + 12.6 years), the diagnosis of AMI was established by computed tomography angiography. Eleven patients underwent thromboembolectomy of the superior mesenteric artery, in two cases with closure of the arteriotomy using a venous patch. In one patient, primary aortomesenteric bypass surgery was performed. Additional bowel resection at the time of primary revascularization was necessary in two patients. Second-look relaparotomy was performed in four patients with secondary bowel resection in two patients. In one patient, additional aortomesenteric bypass surgery was required at postoperative day 1. Five patients (two women, three men) were tested positive for COVID-19 by PCR perioperatively. In-hospital mortality was 14% in non-COVID and 60% in COVID-19 patients. All deaths occurred in the later postoperative period between day 21 and 38 due to multiorgan failure. After a mean followup of 8 months (range, 1-19 months), eight patients are alive (two COVID-19 patients after 1 and 14 months). The limitation of the study is the lack of information regarding patients with AMI who underwent explorative or therapeutic laparotomy without involvement of a vascular surgeon. e68 Abstracts

Conclusions: Acute mesenteric ischemia is a severe complication in COVID-19 patients with high morbidity and mortality. Literature reports on 100% mortality in COVID-19 patients undergoing conservative treatment. However, successful surgical revascularization and patient recovery is possible. In this patient group, 40% of COVID-19 patients survived and were discharged home, If the patient's condition permits, early computed tomography angiography to diagnose AMI, and open surgical treatment for acute mesenteric ischemia as well as generous indication for second-look laparotomy in COVID-19 patients, is recommended.

Author Disclosures: T. U. Cohnert: Nothing to disclose; P. Konstantiniuk: Nothing to disclose; G. Siegl: Nothing to disclose; M. Stevanov: Nothing to disclose. Methods: This post-market observational study was conducted at three European sites between 2012 and 2020 with ambispective enrollment. Patients underwent endovascular TAAA repair with the t-Branch and bridging stents for the celiac (CA), superior mesenteric (SMA), left renal (LRA), and/or right renal arteries (RRA). Follow-up was through 2 years per sites' standard of care. Procedural and 1-year results were reported previously.

Results: Eighty patients (mean age 71.0 6 7.4 years, 70.0% men) were enrolled; six patients had symptomatic TAAAs and 15 patients had contained ruptures. Technical success was achieved in 98.75% (79 of 80) of patients. The median follow-up was 22.2 months (interquartile range: 9.2-25.1 months). At 24 months, Kaplan-Meier (KM) freedom from allcause and aneurysm-related mortality were 78.5% and 98.6%, respectively. Beyond 12 months, 38 adverse events occurred in 20 patients, including two aortic ruptures (one study aneurysm and one nonstudy aneurysm) and six deaths (none aneurysm-related). Maximum aneurysm diameter decreased (>5 mm) in 84.6% (44 of 52), remained unchanged in 3.8% (2 of 52), and increased (>5 mm) in 11.5% (6 of 52) of patients with imaging follow-up after 12 months. No conversions to open repair and no t-Branch or other endograft component migration, integrity issues, or loss of patency were reported. Throughout the study duration, two patients had bridging stent compression, including covered and uncovered CA stents in one patient and a covered LRA stent in the other. KM freedom from secondary intervention was 76.3% at 24 months. Seven patients had nine endoleaks (seven type III and two type Ic) involving bridging stents. Fourteen target vessel-related secondary interventions were performed, primarily consisting of stent placement for endoleak, stenosis, or occlusion. One reintervention involved bridging stent placement as part of a staged procedure. KM freedom from loss of primary patency were 94.8%, 100%, 91.3%, and 89.3% for the CA, SMA, LRA, and RRA, respectively, at 24 months. KM freedom from loss of secondary patency in the CA, SMA, LRA, and RRA were 96.3%, 100%, 98.2%, and 98.3%, respectively (Fig) .

Conclusions: These results support the safety and effectiveness of the off-the-shelf t-Branch endograft for treatment of both stable and symptomatic TAAAs. Freedom from loss of secondary patency shows a high rate of target vessel maintenance.

Objective: The goal of the vascular surgery interest group at Carle Illinois College of Medicine is to increase medical student awareness and engagement in the field of vascular surgery. The objective of this study is to investigate the relationship between the type of event and the impact it had on retaining event attendees, increasing interest in vascular surgery, and enhancing students' knowledge and awareness of vascular surgery.

Methods: The VSIG at Carle Illinois College of Medicine held four interest group meetings throughout the fall semester. The four events included hosting the interest group's physician mentor, a vascular surgery resident, the program director of the Carle vascular surgery residency program, and demo deployments from industry representatives. Before each event, students were asked to fill out a form inquiring about their interest and knowledge of the field of vascular surgery on a scale of 1-10, with 1 being the lowest interest and knowledge. After each event, students were again asked to fill out a form that included the same questions regarding their interest and knowledge of the vascular surgery field.

Results: Post-event surveys showed that students had a high interest in vascular surgery (Fig 1) . The average level of interest stayed consistent with minor fluctuations before and after the events. Of note, the event with the program director had the largest increase from 5.91 to 7.53. Regarding interest in vascular surgery, each event had a high standard deviation; this could be due to students who are both changing their opinions and solidifying their thoughts about Vascular Surgery as a career 

Author Disclosures: M. Austermann: Nothing to disclose; M. Bosiers: Nothing to disclose

Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (eg, speakers' bureaus), Contracted Research, Other Financial or Material Support, Philips: Consulting Fees (eg, advisory boards), Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (eg, speakers' bureaus), Contracted Research, Other Financial or Material Support

COOK Medical Inc: Intellectual Property/Patents, Consulting Fees (eg, advisory boards)

Nothing to disclose; N. Tsilimparis: Cook Medical: Speaker's Bureau, Other Financial or Material Support; C. Yeh: Nothing to disclose

Access: Events with the Greatest Impact on Student Interest in Vascular Surgery