Contemporary comparison of supra-aortic trunk surgical reconstructions for occlusive disease

• Published in: Journal of vascular surgery 2014-06, Vol.59 (6), p.1577-1582.e2
• Main Authors: Daniel, Vijaya T., MPH, Madenci, Arin L., MD, MPH, Nguyen, Louis L., MD, MPH, MBA, Eslami, Mohammad H., MD, Kalish, Jeffrey A., MD, Farber, Alik, MD, McPhee, James T., MD
• Format: Article
• Language: English
• Subjects: Axillary Artery - surgery; Carotid Stenosis - surgery; Comparative Effectiveness Research - methods; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Postoperative Complications - epidemiology; Quality Improvement; Reconstructive Surgical Procedures - methods; Retrospective Studies; Stents; Subclavian Steal Syndrome - surgery; Surgery; Survival Rate - trends; Treatment Outcome; United States - epidemiology; Vascular Surgical Procedures - methods
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.12.017

Objective Open surgical reconstruction for supra-aortic trunk occlusive disease persists despite advances in endovascular therapy. Although extrathoracic reconstructions developed as a safer alternative to transthoracic reconstructions, contemporary national data evaluating relative rates of operative outcomes are lacking. Methods With use of the National Surgical Quality Improvement Program (2005-2011), patients who underwent transthoracic or extrathoracic reconstruction were evaluated. Patients with nonocclusive indications were excluded. The primary outcome was a composite end point of stroke/myocardial infarction (MI)/death. Secondary outcomes were 30-day postoperative complications. Univariate and multivariable regression analyses were performed. Results Overall, 83 patients (10.7%) underwent transthoracic reconstructions and 692 patients (89.3%) underwent extrathoracic reconstructions. Vascular surgeons performed most transthoracic (96%) and extrathoracic (97%) reconstructions. The most common extrathoracic reconstructions were carotid-subclavian bypass (68%), carotid-carotid bypass (14%), and subclavian transposition (7%). Less commonly, axillary-axillary bypass (6%), subclavian-axillary bypass (2%), subclavian-subclavian bypass (1%), and carotid transposition (1%) were performed. At the time of operation, 10% (transthoracic reconstructions) and 8% (extrathoracic reconstructions) of patients had a concurrent carotid endarterectomy ( P  < .60). Analysis of more than 20 characteristics showed that the groups did not differ significantly. The two groups had similar rates of postoperative stroke (1.2% in the transthoracic reconstruction group vs 2.2% in the extrathoracic reconstruction group; P > .99), MI (0% vs 1.3%; P  = .61), death (2.4% vs 1.3%; P  = .33), and stroke/MI/death (3.6% vs 3.8%; P > .99). Transthoracic reconstruction patients had longer hospital stays (6.3 days vs 4.0 days; P