Division of Vascular & Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular and Endovascular Surgery, UC San Diego, San Diego, CA.
Division of Vascular & Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular and Endovascular Surgery, UC San Diego, San Diego, CA.
J Vasc Surg. 2024 Dec;80(6):1746-1754. doi: 10.1016/j.jvs.2024.08.027. Epub 2024 Aug 22.
Preoperative anemia is associated with worse postoperative morbidity and mortality after major vascular procedures. Limited research has examined the optimal method of carotid revascularization in patients with anemia. Therefore, we aim to compare the postoperative outcomes after carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR) among patients with anemia.
This is a retrospective review of patients with anemia undergoing CEA, TFCAS, and TCAR in the Vascular Quality Initiative database between 2016 and 2023. We defined anemia as a preoperative hemoglobin level of <13 g/dL in men and <12 g/dL in women. The primary outcomes were 30-day mortality and in-hospital major adverse cardiac events (MACE). Logistic regression models were used for multivariate analyses.
Our study included 40,383 CEA (59.3%), 9159 TFCAS (13.5%), and 18,555 TCAR (27.3%) cases in patients with anemia. TCAR patients were older and had more medical comorbidities than CEA and TFCAS patients. TCAR was associated with a decreased 30-day mortality (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.37-0.59; P < .001), in-hospital MACE (aOR, 0.58; 95% CI, 0.46-0.75; P < .001) compared with TFCAS. Additionally, TCAR was associated with a 20% decrease in the risk of 30-day mortality (aOR, 0.80; 95% CI, 0.65-0.98; P = .03) and a similar risk of in-hospital MACE (aOR, 0.86; 95% CI, 0.77-1.01; P = .07) compared with CEA. Furthermore, TFCAS was associated with an increased risk of 30-day mortality (aOR, 2; 95% CI, 1.5-2.68; P < .001) and in-hospital MACE (aOR, 1.7; 95% CI, 1.4-2; P < .001) compared with CEA.
In this multi-institutional national retrospective analysis of a prospectively collected database, TFCAS was associated with a high risk of 30-day mortality and in-hospital MACE compared with CEA and TCAR in patients with anemia. TCAR was associated with a lower risk of 30-day mortality compared with CEA. These findings suggest TCAR as the optimal minimally invasive procedure for carotid revascularization in patients with anemia.
术前贫血与大血管手术后的术后发病率和死亡率增加有关。有限的研究检查了贫血患者颈动脉血运重建的最佳方法。因此，我们旨在比较贫血患者行颈动脉内膜切除术（CEA）、股动脉颈动脉支架置入术（TFCAS）和经颈动脉血运重建术（TCAR）后的术后结局。
这是一项对 2016 年至 2023 年血管质量倡议数据库中接受 CEA、TFCAS 和 TCAR 的贫血患者进行的回顾性研究。我们将贫血定义为男性术前血红蛋白水平<13g/dL 和女性<12g/dL。主要结局为 30 天死亡率和院内主要不良心脏事件（MACE）。多变量分析采用 logistic 回归模型。
我们的研究包括 40383 例 CEA（59.3%）、9159 例 TFCAS（13.5%）和 18555 例 TCAR（27.3%）贫血患者。TCAR 患者比 CEA 和 TFCAS 患者年龄更大，合并症更多。与 TFCAS 相比，TCAR 术后 30 天死亡率（调整比值比[aOR]，0.45；95%置信区间[CI]，0.37-0.59；P<.001）和院内 MACE（aOR，0.58；95%CI，0.46-0.75；P<.001）降低。此外，与 CEA 相比，TCAR 可降低 30 天死亡率（aOR，0.80；95%CI，0.65-0.98；P=0.03）和院内 MACE（aOR，0.86；95%CI，0.77-1.01；P=0.07）的风险降低 20%。此外，与 CEA 相比，TFCAS 术后 30 天死亡率（aOR，2；95%CI，1.5-2.68；P<.001）和院内 MACE（aOR，1.7；95%CI，1.4-2；P<.001）的风险增加。
在这项多机构前瞻性收集数据库的回顾性分析中，与 CEA 和 TFCAS 相比，TFCAS 与贫血患者 30 天死亡率和院内 MACE 风险增加相关。与 CEA 相比，TCAR 术后 30 天死亡率降低。这些发现表明，TCAR 是贫血患者颈动脉血运重建的最佳微创方法。
