Preoperative HbA1c and Outcomes following Lower Extremity Vascular Procedures.

BACKGROUND: Limited data exist evaluating preoperative hemoglobin A1c (HbA1c) in patients undergoing vascular procedures for peripheral arterial disease (PAD). This study evaluated the relationship of preoperative HbA1c on outcomes after open and endovascular lower extremity (LE) vascular procedures for PAD. METHODS: We selected patients with PAD admitted for elective LE procedures between September 2008 and December 2015 from the Cerner Health Facts® database using International Classification of Disease, Ninth Edition, Clinical Modification diagnosis and procedure codes. Bivariable analysis and multivariable logistic models examined the association of patient characteristics, procedure type, and preoperative HbA1c (normal < 6.5%, high ≥ 6.5%) with postsurgical outcomes that included infection, renal failure, respiratory or cardiac complications, length of stay, in-hospital mortality, and readmission. RESULTS: Of 4087 patients who underwent a LE vascular procedure for PAD, 2462 (60.2%) had a preoperative HbA1c recorded. The cohort was mostly male (60%), white (73%), and underwent endovascular intervention (77%). Patients with high HbA1c levels were more likely of black race (P < 0.02) and had significantly higher comorbidities (P < 0.0001). Elevated HbA1c was associated with diabetes (P < 0.0001) and cellulitis (P = 0.05) on unadjusted analysis. Multivariable logistic regression (adjusting for patient, hospital, comorbidity and procedural characteristics) revealed that elevated HbA1c was significantly associated with 30-day readmission (OR = 1.06, 95% confidence interval = 1.00-1.12), but was not associated with the other outcomes. An independent diagnosis of diabetes was not predictive of complications or readmission. CONCLUSIONS: Historic glucose control, as evidenced by a high preoperative HbA1c level, is not associated with adverse outcome, other than readmission, in patients undergoing LE procedures for PAD. Given the known association of high perioperative glucose levels with poor outcome following vascular procedures, this is suggestive of a more important effect of perioperative, as opposed to chronic, glucose control upon outcome. Thus, we suggest focusing efforts on creating standardized goal-directed guidelines for glucose control in the perioperative period for LE vascular procedures to potentially mitigate complications.

Retroperitoneal extra-adrenal myelolipoma misdiagnosed as liposarcoma: A case report.

Myelolipomas are rare benign tumors that contain a mix of fatty and hematopoietic tissues. These tumors are frequently seen in the adrenal glands. While extra-adrenal myelolipomas are extremely rare, once identified, they are commonly found in the retroperitoneum--particularly the presacral region. Because of the fat content, these tumors can be easily mistaken for retroperitoneal liposarcomas. We are presenting a case of a 44-year-old female with a pathology proven case of retroperitoneal extra-adrenal myelolipoma that was initially diagnosed by imaging as a retroperitoneal liposarcoma. In this case report, the clinical presentation, imaging findings, operative details and histopathology features are illustrated.

Repair of a Syphilitic Aneurysm of the Noncoronary Sinus.

About one-tenth of patients with untreated chronic syphilis and tertiary syphilis develop structural complications involving the coronary ostia, ascending aorta, or aortic root. We describe a unique case of a large aortic root aneurysm of the noncoronary sinus with extrinsic compression of the right coronary artery, a complication of tertiary syphilis. Surgical intervention involved valve-sparing aortic root reconstruction with right coronary ostia reimplantation (hemi-Yacoub). The patient's postoperative course was uneventful; he is healthy approximately 2 years later.