Sharon Worcester

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

ORLANDO – Massively parallel sequencing of DNA from tumor samples in 50 patients with luminal-type breast cancer revealed a novel mutation in the breast cancer tumor suppressor gene MAP3K1, which normally controls programmed cell death.

Presumably, the knockout mutation – which affected about 10% of estrogen receptor–positive breast cancers in the study and which "unequivocally destroys the function of the gene" – allows cells to survive when they would normally die, Dr. Matthew J. Ellis said at the annual meeting of the American Association for Cancer Research.

This finding, along with others from the sequencing of more than 10 trillion chemical bases of DNA in this extensive genomics investigation (one of the largest to date), marks an important early step toward personalized therapy for breast cancer patients who fail to respond to estrogen-lowering therapy prior to surgery, said Dr. Ellis, professor of medicine and chief of breast oncology at the Washington University in St. Louis.

Luminal-type breast cancer is the most common form of the disease, accounting for 70%-80% of hormone receptor–positive breast cancers. Many patients have a good prognosis, but a subset has this very aggressive type of disease. Indeed, more patients die of aggressive luminal-type breast cancer than do all other breast cancer subtypes combined, he said.

"So we set out to find a molecular basis for poor outcome in receptor-positive disease," he said.

DNA from tumor samples of patients who were enrolled in ongoing neoadjuvant endocrine clinical trials – 24 of whom were resistant to estrogen receptor–targeted therapy – was used for the supercomputer-conducted analysis. The whole genomes of the tumors were compared with the matched DNA of the same patients’ healthy cells, allowing identification of mutations occurring only in the cancer cells.

In all, 1,700 mutations were identified, and most of these were unique to individuals. In addition to two previously identified, relatively common mutations (PIK3CA and TP53), Dr. Ellis and his colleagues found only three others – including MAP3K1 – that recurred at a frequency of at least 10%; the other two were ATR and MYST3.

PIK3CA and TP53 were the most frequently mutated genes in estrogen receptor–positive breast cancer in this study, occurring in about 50% and 20% of tumors, respectively. MAP3K1 was the third most commonly mutated gene.

Considering the large number of mutations found, it was "a rather shocking result" to find only three new gene mutations at the 10% recurrence level, Dr. Ellis said. "What it says is that breast cancer is highly complex, that the genetic make-up involves a large number of mutations that averages about 20 tier-1 [or coding region] mutations in each tumor, and there’s a wide range," he added.

But the findings do offer a glimpse into how therapy can be personalized.

Using a "very, very simple model" produced by this analysis, Dr. Ellis illustrated how a constellation of mutations could be used to predict response or resistance patterns: The three-gene cluster of mutated MAP3K1, mutated PIK3CA, and wild type TP53, which occurred in a small subset of patients, was shown to be significantly associated with "luminal A status [indicative of good prognosis], suppressed proliferation, and favorable small tumors at the end of neoadjuvant treatment," he said.

Although there remains "a great sea of unknown," the findings – when considered in the context of the growing list of "druggable mutations" and treatments approved for other diseases – allow for a vision of therapy that involves obtaining the genetic information in advance of treatment to allow for the design of individually appropriate therapy to address the problem of resistance.

"Very clearly, this is a big problem clinically ... and only a tailored approach will lead to a solution to the problem," he said.

Dr. Ellis disclosed that he has received grant or research support from and/or served on the speakers bureau for Novartis, AstraZeneca, and Bioclassifier LLC.

ORLANDO – Massively parallel sequencing of DNA from tumor samples in 50 patients with luminal-type breast cancer revealed a novel mutation in the breast cancer tumor suppressor gene MAP3K1, which normally controls programmed cell death.

Presumably, the knockout mutation – which affected about 10% of estrogen receptor–positive breast cancers in the study and which "unequivocally destroys the function of the gene" – allows cells to survive when they would normally die, Dr. Matthew J. Ellis said at the annual meeting of the American Association for Cancer Research.

This finding, along with others from the sequencing of more than 10 trillion chemical bases of DNA in this extensive genomics investigation (one of the largest to date), marks an important early step toward personalized therapy for breast cancer patients who fail to respond to estrogen-lowering therapy prior to surgery, said Dr. Ellis, professor of medicine and chief of breast oncology at the Washington University in St. Louis.

Luminal-type breast cancer is the most common form of the disease, accounting for 70%-80% of hormone receptor–positive breast cancers. Many patients have a good prognosis, but a subset has this very aggressive type of disease. Indeed, more patients die of aggressive luminal-type breast cancer than do all other breast cancer subtypes combined, he said.

"So we set out to find a molecular basis for poor outcome in receptor-positive disease," he said.

DNA from tumor samples of patients who were enrolled in ongoing neoadjuvant endocrine clinical trials – 24 of whom were resistant to estrogen receptor–targeted therapy – was used for the supercomputer-conducted analysis. The whole genomes of the tumors were compared with the matched DNA of the same patients’ healthy cells, allowing identification of mutations occurring only in the cancer cells.

In all, 1,700 mutations were identified, and most of these were unique to individuals. In addition to two previously identified, relatively common mutations (PIK3CA and TP53), Dr. Ellis and his colleagues found only three others – including MAP3K1 – that recurred at a frequency of at least 10%; the other two were ATR and MYST3.

PIK3CA and TP53 were the most frequently mutated genes in estrogen receptor–positive breast cancer in this study, occurring in about 50% and 20% of tumors, respectively. MAP3K1 was the third most commonly mutated gene.

Considering the large number of mutations found, it was "a rather shocking result" to find only three new gene mutations at the 10% recurrence level, Dr. Ellis said. "What it says is that breast cancer is highly complex, that the genetic make-up involves a large number of mutations that averages about 20 tier-1 [or coding region] mutations in each tumor, and there’s a wide range," he added.

But the findings do offer a glimpse into how therapy can be personalized.

Using a "very, very simple model" produced by this analysis, Dr. Ellis illustrated how a constellation of mutations could be used to predict response or resistance patterns: The three-gene cluster of mutated MAP3K1, mutated PIK3CA, and wild type TP53, which occurred in a small subset of patients, was shown to be significantly associated with "luminal A status [indicative of good prognosis], suppressed proliferation, and favorable small tumors at the end of neoadjuvant treatment," he said.

Although there remains "a great sea of unknown," the findings – when considered in the context of the growing list of "druggable mutations" and treatments approved for other diseases – allow for a vision of therapy that involves obtaining the genetic information in advance of treatment to allow for the design of individually appropriate therapy to address the problem of resistance.

"Very clearly, this is a big problem clinically ... and only a tailored approach will lead to a solution to the problem," he said.

Dr. Ellis disclosed that he has received grant or research support from and/or served on the speakers bureau for Novartis, AstraZeneca, and Bioclassifier LLC.

ORLANDO – Massively parallel sequencing of DNA from tumor samples in 50 patients with luminal-type breast cancer revealed a novel mutation in the breast cancer tumor suppressor gene MAP3K1, which normally controls programmed cell death.

Presumably, the knockout mutation – which affected about 10% of estrogen receptor–positive breast cancers in the study and which "unequivocally destroys the function of the gene" – allows cells to survive when they would normally die, Dr. Matthew J. Ellis said at the annual meeting of the American Association for Cancer Research.

This finding, along with others from the sequencing of more than 10 trillion chemical bases of DNA in this extensive genomics investigation (one of the largest to date), marks an important early step toward personalized therapy for breast cancer patients who fail to respond to estrogen-lowering therapy prior to surgery, said Dr. Ellis, professor of medicine and chief of breast oncology at the Washington University in St. Louis.

Luminal-type breast cancer is the most common form of the disease, accounting for 70%-80% of hormone receptor–positive breast cancers. Many patients have a good prognosis, but a subset has this very aggressive type of disease. Indeed, more patients die of aggressive luminal-type breast cancer than do all other breast cancer subtypes combined, he said.

"So we set out to find a molecular basis for poor outcome in receptor-positive disease," he said.

DNA from tumor samples of patients who were enrolled in ongoing neoadjuvant endocrine clinical trials – 24 of whom were resistant to estrogen receptor–targeted therapy – was used for the supercomputer-conducted analysis. The whole genomes of the tumors were compared with the matched DNA of the same patients’ healthy cells, allowing identification of mutations occurring only in the cancer cells.

In all, 1,700 mutations were identified, and most of these were unique to individuals. In addition to two previously identified, relatively common mutations (PIK3CA and TP53), Dr. Ellis and his colleagues found only three others – including MAP3K1 – that recurred at a frequency of at least 10%; the other two were ATR and MYST3.

PIK3CA and TP53 were the most frequently mutated genes in estrogen receptor–positive breast cancer in this study, occurring in about 50% and 20% of tumors, respectively. MAP3K1 was the third most commonly mutated gene.

Considering the large number of mutations found, it was "a rather shocking result" to find only three new gene mutations at the 10% recurrence level, Dr. Ellis said. "What it says is that breast cancer is highly complex, that the genetic make-up involves a large number of mutations that averages about 20 tier-1 [or coding region] mutations in each tumor, and there’s a wide range," he added.

But the findings do offer a glimpse into how therapy can be personalized.

Using a "very, very simple model" produced by this analysis, Dr. Ellis illustrated how a constellation of mutations could be used to predict response or resistance patterns: The three-gene cluster of mutated MAP3K1, mutated PIK3CA, and wild type TP53, which occurred in a small subset of patients, was shown to be significantly associated with "luminal A status [indicative of good prognosis], suppressed proliferation, and favorable small tumors at the end of neoadjuvant treatment," he said.

Although there remains "a great sea of unknown," the findings – when considered in the context of the growing list of "druggable mutations" and treatments approved for other diseases – allow for a vision of therapy that involves obtaining the genetic information in advance of treatment to allow for the design of individually appropriate therapy to address the problem of resistance.

"Very clearly, this is a big problem clinically ... and only a tailored approach will lead to a solution to the problem," he said.

Dr. Ellis disclosed that he has received grant or research support from and/or served on the speakers bureau for Novartis, AstraZeneca, and Bioclassifier LLC.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Serial computed tomography scans commonly used to monitor patients following endovascular aneurysm repair may be unnecessary after 6 years, according to the findings of a retrospective study of 2,965 scans in 608 EVAR patients.

Furthermore, such scans are more likely to detect a clinically significant incidental finding that warrants further workup than to find a problem with the endograft, Dr. Elizabeth L. Detschelt said at the annual meeting of the Society for Clinical Vascular Surgery.

The average annual rate of detection of EVAR-related findings was 4% (range 2%-5%), which remained constant over the first 6 years of follow-up, and the rate after 6 years was 0%. However, the annual detection rate for new clinically significant incidental findings on these scans was 25% (range 14%-32%), which remained constant for more than 10 years, said Dr. Detschelt of Allegheny General Hospital, Pittsburgh.

On multivariate analysis, predictors of detection of new clinically significant findings included age over 65 years, glomerular filtration rate less than 60 mL/min per 1.73 m², and tobacco use. No predictors were identified for EVAR-related findings, she noted.

The patients underwent EVAR for infrarenal aneurysm at a single institution between Dec. 1, 1999, and Nov. 30, 2009, and were followed for a mean of 32 months. These results are particularly relevant, Dr. Detschelt said, because risks from repeated scans, which are commonly used for serial imaging in EVAR patients to monitor for endoleak and other problems, are currently a topic of intense debate.

"Recently, the literature has really been inundated with concerns about the cumulative effects of such radiation exposure by these CT scan protocols, and in addition there’s a fair amount of literature to cite a very high rate of incidental findings that we detect on this follow-up with CT protocol," said Dr. Detschelt. Although such findings require follow-up, the literature suggests that this often falls through the cracks, she added.

In this study, EVAR-related findings included endoleak, limb occlusion, and endograft migration. Clinically significant incidental findings were varied, with the most common occurring in the broad categories of genitourinary findings, hepatobiliary findings, hernias, pulmonary neoplasms, and other vascular and cardiac lesions.

Not only do the findings suggest that serial imaging is not needed for EVAR-related concerns after 6 years, but they also underscore the importance of carefully evaluating post-EVAR CT scans for clinically significant incidental findings.

"As the ordering physicians of these CT scans, it is our legal responsibility to ensure that they have appropriate workup, so this is going to mean that not only do we have to look at the scans to assess the status of our aneurysm repair, but we also have to read the radiologist’s report to make sure we’re not missing something," she said.

That’s particularly true for patients who are older, who smoke, and who have a degree of renal insufficiency, she added.

The findings also raise the question of whether post-EVAR patients should undergo monitoring using other imaging techniques such as ultrasound, or whether a less frequent CT scan protocol can be used to reduce patient exposure to radiation and reduce patient costs.

These questions – along with the bigger question of whether it is more prudent to not use CT scans in order to reduce radiation exposure or to continue with CT monitoring to pick up findings that potentially could save or improve lives – require better data to inform decision making, she concluded.

During a discussion period after Dr. Detschelt’s talk, one audience member cautioned against suggesting that CT monitoring be considered for the purpose of detecting incidental nonvascular issues, saying that raises the argument of whether the general population aged 65-75 years should also undergo serial CT scans to find incidental nonvascular issues. He also noted that at his institution, the concerns about serial CT monitoring post EVAR are addressed in part by using duplex ultrasound in the immediate postoperative period, with follow-up by duplex ultrasound in those patients with no problems detected on the initial ultrasound.

He said findings from his experience and others have been published, and show that this is approach is "probably safe and effective." Dr. Detschelt responded that while duplex ultrasound is not used immediately postoperatively at her institution, there has been a move toward using it for long-term follow-up there. At many institutions, however, workforce issues come into play, because the duplex studies are more time intensive and require specially trained vascular staff, she said.

Dr. Detschelt had no disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA.  – Primary, primary-assisted, and secondary patency and limb salvage rates are similar in transplant and nontransplant populations, but renal transplant patients have slightly – though not significantly – worse outcomes than do heart transplant patients, according to findings from a study of endovascular peripheral interventions in these populations.

A total of 122 lesions in 58 renal or cardiac transplant patients were identified using information from a prospective lower-extremity database encompassing more than 1,500 interventions performed from 2004 through 2010 at a single, high-volume vascular and transplant center. The data were cross-referenced with heart failure and renal transplant registries from the same center, Dr. Katherine A. Gallagher said at the annual meeting of the Society for Clinical Vascular Surgery.

The transplant patients – 44 men and 14 women with a mean age of 63.5 years – all were on active immunosuppressive treatment and were followed clinically and with noninvasive laboratory testing for 30 months. Indications for lower-extremity interventions were claudication in 48% of cases and critical limb ischemia in 52% of cases. Mean lesion length was 108.6 mm, said Dr. Gallagher of Weill Cornell/Columbia University, New York.

Primary, primary-assisted, and secondary patency and limb salvage rates were "essentially the same" at 50 months in the transplant patients and in 1,162 nontransplant control patents, at about 40% vs. 45%, 55% vs. 60%, 60% vs. 65%, and 70% vs. 65% cumulative survival, respectively, she said.

Subgroup analyses showed that heart transplant patients showed a trend for better primary patency rates than did renal transplant patients with similar TASC classification and comorbid conditions (about 75% vs. 55%) , although the heart recipients had less critical limb ischemia.

After controlling for potential confounding factors, the researchers found in subgroup analyses that male transplant patients had significantly less severe disease and much better outcomes, Dr. Gallagher said in an interview.

Mean follow-up in these patients was 18.6 months, Dr. Gallagher noted.

Percutaneous intervention has become the first-line treatment for many patient groups, but outcomes in transplant patients prior to this study were relatively unknown, she said.

"We do know that the incidence of peripheral artery disease [PAD] is high in patients with renal insufficiency, and we know that both open and endovascular outcomes in this patient cohort portend poor patency and limb salvage rates," she said, adding that there is evidence that renal transplant patients have a high incidence of PAD, but outcomes following endovascular intervention in these populations are unknown.

"We can theorize that they might have improved outcomes because they have improved renal function, but they might also have poorer outcomes because of the deleterious effects of immunosuppression as it relates to hyperlipidemia and hyperglycemia," she said.

Furthermore, it is known that cardiac transplant patients are at risk for PAD, but the effects of immunosuppression in this population are unknown.

"Specifically these patients are on a lot of tacrolimus and sirolimus, which have been well studied in drug-eluting stents, but we don’t know the effects of these drugs on endovascular interventions," she said.

In this study, transplant patients had higher rates of diabetes and renal insufficiency – two factors shown to be independent predictors of poor outcome – so they would be expected to have poorer outcomes than would nontransplant patients, yet outcomes between the two groups were very similar.

"We believe this is potentially due to protective effects from systemic immunosuppression, although this requires further investigation, she concluded.

Dr. Gallagher said that she had no relevant financial disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.

LAKE BUENA VISTA, FLA. – Endovascular treatment for critical limb ischemia offered no significant cost savings over open repair in a recent analysis of outcomes in 137 patients.

Of the 148 patients included in the retrospective review, 42% were treated with an endovascular procedure, 47% with an open procedure, and the remaining with a hybrid of the two. The mean costs were $49,802 for an endovascular hospitalization and $45,832 for an open repair hospitalization; these amounts were not significantly different, Dr. Nicholas Gargiulo III reported at the annual meeting of the Society for Clinical Vascular Surgery.

The mean lengths of stay were also similar, at 9.3 days and 10.4 days in the endovascular and open repair groups, respectively, said Dr. Gargiulo of Montefiore Medical Center, New York.

The percentage of patients discharged to a skilled nursing facility was 35% vs. 44% of endovascular and open repair patients, respectively. Although endovascular repair was associated with slightly increased likelihood of recovering enough function to be released to home upon hospital discharge, this difference also did not reach statistical significance.

Rates of readmission within 90 days were similar at 12% and 13% for the endovascular repair and open repair patients, respectively.

For hybrid repair patients, the hospitalization costs ($27,922) and length of stay (9.8 days) were lower, compared with the other groups. However, the readmission rate was much higher, at 50%, and the percentage discharged to home initially was lower at 28%.

The study included all of those patients who presented with critical limb ischemia at Montefiore Medical Center from Jan. 1, 2007, through December 2007, for whom complete data were available. The patients, who had a mean age of 67 years and Rutherford Class 4 or 5 disease, underwent initial diagnostic evaluation with conventional arteriography, and the treatment approach was based on the anatomic TransAtlantic InterSociety Consensus II classification and adequate runoff.

A variety of endovascular interventions and open procedures were used. The perioperative mortality rate was 2.7%, and amputation-free survival was 94.6% at 1 year.

Most of the patients had hypertension and diabetes; a large variety of other comorbidities were seen as well.

About two-thirds of the cohort presented with rest pain, and the remainder presented with gangrene or ulceration. The hospitalization costs were higher in those who presented with gangrene and ulceration, Dr. Gargiulo said. Over the past year, more patients have been presenting with gangrene than with rest pain, and this is a concern, he added.

"Interestingly, the only thing that was different is that those with rest pain cost less than the patients with gangrene and ulceration ... gangrene and ulceration increase the length of stay, increase readmission, and of course increase supplies and nursing services, resulting in an overall increase in mean cost," Dr. Gargiulo said.

Possible cost-cutting measures include educational programs, new alliances with podiatry colleagues, prevention, and new trials, he added.

"In conclusion, endovascular and open procedures were equally cost effective in this diverse ethnic population of patients with critical limb ischemia, and patients with gangrene and ulceration have increased health care costs. It appears it’s not the type of procedure which incurs cost, but the clinical presentation," he said.

Dr. Gargiulo had no disclosures.