Complex Endovascular Intervention Requiring Long Operative Time Loses the Benefits of Lower Mortality/Morbidities Over Open Bypass for Patients With Aortoiliac Occlusive Disease

Endovascular intervention has become the first-line therapy for aortoiliac occlusive disease because of lower operative mortality and morbidities. However, there is little data comparing outcomes prolonged complex endovascular procedures with those open bypasses. In this study, we asked whether longer time adversely affects cases at what point long negates benefits over The American College Surgeons National Surgical Quality Improvement Program targeted Aortoiliac Endo (ENDO) Open databases (OPEN) 2011 to 2021 were used. Emergent excluded. A histogram vs ENDO showed that adverse events markedly increased after 3 hours time. Based on this, stratified into three groups (ENDO <3 hours, 3-4 >4 hours) compared each group OPEN. Studied 30-day mortality, major cardiovascular (MACE), pulmonary, renal dysfunction, sepsis, wound complications, length stay. Multivariable regression analyses There 8866 OPEN 6717 cases. distribution by shown in table (Table). patients generally sicker, more likely be obese, use steroids, have hypertension, congestive heart failure, type 2 diabetes mellitus, bleeding disorders, chronic obstructive pulmonary disease, dialysis. After adjusting these preoperative differences multiple analysis, under had most OPEN: (adjusted odds ratio [aOR], 0.415; P < .0001), MACE (aOR, 0.285; events, others between 4 no superior MACE. When was than all lost except shorter Performing first still sensible when it done an but morbidities bypasses are if hours. Given known long-term operation should considered anticipated require time.TableMultivariable analysis proceduresOPEN (n = 8866)ENDO 5838)3 7 days40.1610.450.152 .0001)19.960.355 .0001)34.040.640 .0001)Discharge facility24.1615.950.580 .0001)20.480.667 (.0010)28.200.953 (.6805)MACE, Major events. a new tab