Outcomes after Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Prateek K. Gupta, Kelly Kempe, Reshma Brahmbhatt, Himani Gupta, Jorge Montes, R. Armour Forse, Shaun M. Stickley, Michael J. Rohrer

Research output: Contribution to journalArticle

Abstract

Objectives: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability. Materials and Methods: Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed. Results: No significant difference (P >.5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P =.7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P =.053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P =.004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P =.01), return to operating room (38.2% vs 20.0%; P =.003), and mortality (34.5% vs 21.4%; P =.03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P =.2). Conclusion: Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.

Original languageEnglish (US)
Pages (from-to)357-362
Number of pages6
JournalVascular and Endovascular Surgery
Volume51
Issue number6
DOIs
StatePublished - Aug 1 2017

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Aortic Rupture
Abdominal Aortic Aneurysm
Mortality
Operating Rooms
Quality Improvement
Comorbidity
Erythrocytes
Logistic Models
Odds Ratio
Regression Analysis
Databases
Confidence Intervals
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

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Outcomes after Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. / Gupta, Prateek K.; Kempe, Kelly; Brahmbhatt, Reshma; Gupta, Himani; Montes, Jorge; Forse, R. Armour; Stickley, Shaun M.; Rohrer, Michael J.

In: Vascular and Endovascular Surgery, Vol. 51, No. 6, 01.08.2017, p. 357-362.

Research output: Contribution to journalArticle

Gupta, Prateek K. ; Kempe, Kelly ; Brahmbhatt, Reshma ; Gupta, Himani ; Montes, Jorge ; Forse, R. Armour ; Stickley, Shaun M. ; Rohrer, Michael J. / Outcomes after Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. In: Vascular and Endovascular Surgery. 2017 ; Vol. 51, No. 6. pp. 357-362.
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abstract = "Objectives: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability. Materials and Methods: Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9{\%}) and MUB (n = 370; 87.1{\%}) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed. Results: No significant difference (P >.5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P =.7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9{\%} vs 4.6{\%}; P =.053) and preoperative transfusion of >4 U packed red blood cells (18.2{\%} vs 6.8{\%}; P =.004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4{\%} vs 6.2{\%}; P =.01), return to operating room (38.2{\%} vs 20.0{\%}; P =.003), and mortality (34.5{\%} vs 21.4{\%}; P =.03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95{\%} confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8{\%} vs 32.3{\%}; P =.2). Conclusion: Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.",
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T1 - Outcomes after Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

AU - Gupta, Prateek K.

AU - Kempe, Kelly

AU - Brahmbhatt, Reshma

AU - Gupta, Himani

AU - Montes, Jorge

AU - Forse, R. Armour

AU - Stickley, Shaun M.

AU - Rohrer, Michael J.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objectives: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability. Materials and Methods: Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed. Results: No significant difference (P >.5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P =.7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P =.053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P =.004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P =.01), return to operating room (38.2% vs 20.0%; P =.003), and mortality (34.5% vs 21.4%; P =.03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P =.2). Conclusion: Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.

AB - Objectives: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability. Materials and Methods: Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed. Results: No significant difference (P >.5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P =.7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P =.053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P =.004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P =.01), return to operating room (38.2% vs 20.0%; P =.003), and mortality (34.5% vs 21.4%; P =.03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P =.2). Conclusion: Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.

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