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 PVSS16. Perioperative Use of Dextran is Associated with Cardiac Complications After Carotid Endarterectomy

​Alik Farber1, Tze-Woei Tan1, Jeffrey Kalish1, Naomi M. Hamburg1, Robert Eberhardt1, Gheorghe Doros1, Denis V. Rybin1, Philip P. Goodney2, Jack L. Cronenwett2, For the Vascular Surgery Group of New England
1Boston Medical Center/Boston University School of Medicine and Public Health, Boston, MA; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: Although dextran has been theorized to diminish the risk of stroke after carotid endarterectomy (CEA) variation exists in its use. We evaluated outcomes of dextran use in patients undergoing CEA to clarify its utility.

METHODS: We studied all primary CEA performed by 71 surgeons within the Vascular Study Group of New England database (2003-2010). Patients were stratified by perioperative dextran use. Outcomes included perioperative death, stroke, myocardial infarction (MI) and congestive heart failure (CHF). Group and propensity score matching were performed for risk adjusted comparisons, and multivariable logistic regression was used to examine associations between dextran use and outcomes.

RESULTS: There were 6,641 CEA performed, with dextran used in 334 (5%) procedures. Dextran and No Dextran patients were similar in age (70 years) and symptomatic status (25%). Other differences between the cohorts diminished after adjustment (Table). In crude, group-matched, and propensity matched analyses, stroke/death rate was similar between cohorts (1.2%),while Dextran patients were more likely to suffer perioperative MI (2.4% vs. 1.0%; p=.029) and CHF (2.1% vs. 0.6%; p=.005). In multivariate analysis, dextran was associated with a higher risk of perioperative MI (OR 5.2,CI:1.9-14.4; p=0.002) and CHF (OR 5.9,CI:1.9-18.5; p=0.002).

CONCLUSIONS: Dextran use was not associated with perioperative stroke but was associated with higher rates of MI and CHF. Taken together, our findings suggest limited clinical utility for dextran.

AUTHOR DISCLOSURES: J. L. Cronenwett, Nothing to disclose; G. Doros, Nothing to disclose; R. Eberhardt, Nothing to disclose; A. Farber, Nothing to disclose; P. P. Goodney, Nothing to disclose; N. M. Hamburg, Nothing to disclose; J. Kalish, Nothing to disclose; D. V. Rybin, Nothing to disclose; T. Tan, Nothing to disclose.

 
Crude Sample
Group Matched Sample
Propensity Matched Sample
 
Dextran, % (n=443)
No Dextran, % (n=6,397)
p-value
Dextran, % (n=333)
No Dextran, % (n=1,523)
p-value
Dextran, % (n=334)
No Dextran, % (n=1,670)
p-value
Characteristics
 
 
 
 
 
 
 
 
 
General Anesthesia
74.3
88.9
<0.001
74.5
79.3
0.06
74.3
73.5
0.84
Eversion
19.2
10.0
<0.001
19.2
24.7
0.03
19.2
19.2
0.99
Shunt
18.9
48.6
<0.001
18.9
20.1
0.65
18.9
23.2
0.10
Outcomes
 
 
 
 
 
 
 
 
 
Stroke or Death
1.2
1.0
0.58
1.2
0.6
0.27
1.2
0.7
0.32
MI
2.4
1.0
0.03
2.4
0.6
0.005
2.4
0.5
0.003
CHF
2.1
0.6
0.005
2.1
0.5
0.006
2.1
0.2
<0.001
 

 

 

 

Posted April 2012

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