Determining patient risk factors associated with accelerated growth of popliteal artery aneurysms.

OBJECTIVE: The objective of this study was to determine the natural progression of popliteal artery aneurysms (PAAs) and clinical variables associated with their accelerated growth. METHODS: Retrospective chart review of 224 patients with encounters between January 2008 and May 2016 and with at least one PAA was conducted. From this group, 65 asymptomatic patients had either unilateral (n = 43) or bilateral (n = 22) PAAs that were observed for at least 1 year of medical management before intervention. We divided these aneurysms into two groups based on whether their overall growth rate was above or below the eventual mean. Aneurysm diameter was taken from duplex ultrasound and computed tomography angiography. RESULTS: There were 87 aneurysms evaluated among 65 patients. Mean age at diagnosis was 70.9 years (standard deviation [SD], 9.39 years), and 64 patients were male (98%); 50 (77%) were white and 7 (11%) were African American. The average body mass index was 27.69 (SD, 4.90). At or before initial diagnosis, 61 (94%) patients had a concomitant lower extremity or abdominal aortic aneurysm; 51 (78%) patients were current or former smokers; and 16 (25%) had atrial fibrillation. The average growth rate of all aneurysms was 1.22 mm/y (SD, 1.93 mm). The mean surveillance time from initial diagnosis to last follow-up or intervention was 3.12 years (SD, 1.66 years). Of 87 aneurysms, 25 (29%) were repaired; 18 (21%) were repaired because of size criteria, 2 (2%) because of symptom criteria (claudication or acute limb ischemia), and 5 (6%) because of both criteria. During our study window, 62 aneurysms (71%) remained asymptomatic or did not undergo an intervention. The mean initial diameter at diagnosis was 16.9 mm (SD, 5.32 mm). Within the study, 50 (57%) aneurysms presented with or developed mural thrombus. Univariate analysis identified larger initial diameter (19.2 vs 14.7 mm; P = .020), atrial fibrillation (35% vs 16%; P = .042), and mural thrombus (38% vs 20%; P < .001) as predictors of diameter expansion greater than the mean. Multivariable analysis of the significant univariate factors determined that only initial diameter (odds ratio, 5.53; P = .007) and the presence or development of mural thrombus (odds ratio, 4.00; P = .008) maintained significance. CONCLUSIONS: Patients presenting with a PAA at 20 mm or >20 mm in diameter, presence of luminal thrombus, or atrial fibrillation may need to be observed at more frequent scanning intervals than those without these risk factors. Further studies are required to validate these predictive growth factors.

The use of EndoAnchors to rescue complicated TEVAR procedures.

BACKGROUND: The aim of this study was to assess the applicability and outcomes of EndoAnchor use in the endovascular repair of thoracic and thoracoabdominal aortic aneurysms. METHODS: A retrospective review was performed of all thoracic endovascular aortic repairs (TEVARs) performed with the use of EndoAnchors between December 2012 and January 2016. Primary study endpoints included freedom from migration, freedom from aortic- related intervention, and freedom from post-operative type I or type III endoleak. RESULTS: During this study period, a total of 54 patients underwent TEVAR for thoracic or thoracoabdominal aneurysm with the use of EndoAnchors at our institution. Twenty-seven cases were performed as the index operation. Twenty-seven cases were considered redo operations. EndoAnchors were deployed for therapeutic and prophylactic indications. Mean follow-up was 9.6±8.8 months. EndoAnchors were used for therapeutic indications in 31.5% of patients and for prophylactic indications in 68.5%. The technical success of EndoAnchor deployment was 99.8%. The overall initial technical success of the operation was 98.1%. There were no instances of graft migration. The overall endoleak rate was 5.4% with prophylactic EndoAnchor use and 11.8% with therapeutic use. Aortic-related reintervention was required in 13.5% of patients who received prophylactic EndoAnchor placement and 23.5% of patients who received therapeutic EndoAnchor placement. Only one reintervention was performed for EndoAnchor failure. A p value of <0.05 was considered significant. CONCLUSIONS: EndoAnchors can be safely utilized in TEVAR with high rates of technical success. These results demonstrate the potential to enhance thoracic endograft efficacy and durability with the use of therapeutic and prophylactic EndoAnchors. Long-term data is needed to further define the use of this technology in the thoracic aorta.

Assessment of the implementation of a protocol to reduce ventilator-associated pneumonia in intensive care unit trauma patients.

Ventilator-associated pneumonia (VAP) is the primary hospital-acquired infection contracted by critically ill patients who receive mechanical ventilation. This retrospective study evaluated the efficacy of a multifaceted VAP prevention protocol in an adult trauma population. Ventilator-associated pneumonia was defined according to the National Healthcare Safety Network (2009) criteria. The number of days to onset of VAP in the postprotocol period was longer than the preprotocol period despite a concomitant increase in the number of mechanical ventilation days.