LAUSR

BACKGROUND While prior endovascular intervention is a risk factor for inferior outcomes after infrainguinal bypass, there are few studies evaluating the effect of prior aortoiliac endovascular intervention (AIEI) on outcomes after aortofemoral bypass (AFB). We sought to determine if prior AIEI was predictive of adverse events after AFB. METHODS The VQI was queried for all patients who underwent AFB form 2009-2019. Urgent/emergent cases and repeat procedure were excluded. Primary outcomes were major perioperative complication, major adverse-limb-event (MALE)-free survival, and long-term survival. Multivariable logistic regression identified predictors of major complication. Predictors of MALE-free survival were identified with Cox Proportional Hazards modelling. RESULTS There were 3,056 patients who underwent AFB; 618 had a prior AIEI. Mean age was 60.3±8.7 years and 58.7% of patients were male. There was no difference in major complications between the two groups (AIEI:23.8%, No AIEI:24.5%; p-value=0.70). Factors associated with major complication were COPD (Odds Ratio [OR]: 1.28, 95% Confidence Interval [CI]: 1.07-1.54; p=0.008), simultaneous lower extremity intervention (endarterectomy, bypass, or transluminal intervention, OR 1.41, 95% CI: 1.18-1.69; p<0.001), CHF (OR 1.58, 95% CI: 1.15-2.16; p=0.004), increased age (OR 1.03 per year, 95% CI: 1.02-1.04; p<0.001), increasing operative blood loss (OR 1.35 per liter, 95% CI: 1.21-1.50; p<0.001), increasing operative time (OR 1.07 per hour, 95% CI: 1.02-1.13; p=0.008), and end-to-side proximal anastomosis (OR 1.23, 95% CI: 1.03-1.46; p=0.022). One-year MALE-Free Survival was 88.2% (95% CI: 85.2-90.7%) for the prior AIEI group and 89.7% (95% CI: 88.3-90.7%) for the group without prior AIEI (Logrank p-value=0.201). Predictors of MALE/death were history of a bypass (Hazard Ratio [HR] 1.51, 95% CI: 1.16-1.96; p=0.002), increasing degree of ischemia on presentation (HR 1.28 per increasing level of ischemia, 95% CI: 1.16-1.41; p<0.001), diabetes (HR 1.29, 95% CI: 1.05-1.59; p=0.014), simultaneous PVI (HR 2.06, 95% CI: 1.02-4.15; p=0.044), CHF (HR 1.60, 95% CI: 1.18-2.18; p=0.002), ESRD on HD (HR 5.07, 95% CI: 2.45-10.48; p<0.001), and presenting hemoglobin<9 g/dl (HR 1.76, 95% CI: 1.02-3.02; p=0.041). One-year survival for the prior AIEI group was 94.5% (95% CI: 92.2-96.1%) and 94.0% (95% CI: 92.9-94.9%) for the group with no prior AIEI (logrank p=0.486). Prior AIEI did not predict any of the primary outcomes in multivariable analysis. CONCLUSION An endovascular-first approach for aortoiliac occlusive disease appears to be safe and does not portend to inferior results after AFB.