title: Impact of coexisting aneurysms on open revascularization for aortoiliac occlusive disease.
abstract: OBJECTIVE
  National data evaluating outcomes for occlusive abdominal aortic reconstructions are well described. The relative effect of operative indication as well as the presence of concomitant abdominal aortic aneurysm (AAA) on in-hospital mortality is not well defined.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried to identify patients who underwent open aortic surgery (2003-2010). Indication for surgery was classified by International Classification of Diseases, Ninth Revision diagnostic codes to identify isolated occlusive indications as well as combined occlusive disease and AAA. Primary outcome was in-hospital mortality. Secondary outcomes were complications and discharge disposition.
  
  
  RESULTS
  Overall, 56,374 underwent aortic reconstruction, 48,591 for occlusive disease (86.2%) and 7783 for combined occlusive disease with AAA (13.8%). Intermittent claudication was the most common indication for intervention (60.9%), whereas 39.7% underwent intervention for critical limb ischemia (22.2% rest pain, 17.6% gangrene). Patients with intermittent claudication had more concomitant AAAs (17.3%) than did patients with critical limb ischemia (8.4%). The baseline characteristics for those with occlusive disease and combined occlusive with AAA disease were similar in terms of obesity (4.8% vs 4.2%; P = .27) and congestive heart failure (6.6% vs 6.3%; P = .65) but differed by age (62.2 years vs 68.4 years; P < .0001) and hypertension (65.4% vs 69.1%; P = .005). Patients with combined occlusive and AAA disease had higher mortality than those with occlusive disease alone (3.9% vs 2.7%; P = .01). On multivariable regression, factors associated with in-hospital mortality included gangrene with AAA compared with gangrene alone (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.6-4.7; P < .0002), age >65 years age (OR, 3.1; 95% CI, 2.4-4.1; P < .0001), renal failure (OR, 2.7; 95% CI, 1.9-3.8; P < .0001), and concurrent lower extremity revascularization (OR, 1.3; 95% CI, 1.1-1.7; P < .02).
  
  
  CONCLUSIONS
  Intermittent claudication or critical limb ischemia with concomitant AAA carries a higher mortality than intermittent claudication or critical limb ischemia alone, especially in older patients with gangrene requiring revascularization and renal insufficiency. Preoperative risk stratification strategies should focus on the indication for surgery as well as the presence of concomitant AAA.
authors: Department of Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: v.m.thomas@gmail.com.
authors: Vijaya T
authors: VT
authors: Daniel
authors: Division of Vascular Surgery, VA Boston Healthcare System, West Roxbury, Mass; Department of Surgery, Harvard Medical School, Boston, Mass; Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Naren
authors: N
authors: Gupta
authors: Division of Vascular Surgery, VA Boston Healthcare System, West Roxbury, Mass; Department of Surgery, Harvard Medical School, Boston, Mass; Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: Joseph D
authors: JD
authors: Raffetto
authors: Division of Vascular Surgery, VA Boston Healthcare System, West Roxbury, Mass; Department of Surgery, Boston University School of Medicine, Boston, Mass.
authors: James T
authors: JT
authors: McPhee
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States