Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

Prateek K. Gupta, Reshma Brahmbhatt, Kelly Kempe, Shaun M. Stickley, Michael J. Rohrer

Research output: Contribution to journalArticle

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Abstract

Objective Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. Methods Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed. Results There were more men (82% vs 72%; P <.0001), diabetic patients (16% vs 11%; P =.005), patients with dependent functional status (4% vs 2%; P =.002), and nonsmokers (70% vs 56%; P <.0001) in the FEVAR group vs OS. There was no difference in rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P >.05). FEVAR had fewer major postoperative pulmonary complications (3.0% vs 19.0%; P <.0001), less renal failure requiring dialysis (1.9% vs 6.4%; P <.0001), less frequent cardiac arrest or myocardial infarction (2.2% vs 5.8%; P =.001), less bleeding with major transfusion (17.4% vs 50.2%; P <.0001), and decreased incidence of return to the operating room (4.5% vs 9.6%; P <.0001) and death (2.4% vs 4.7%; P =.02). The median length of stay was also significantly shorter for FEVAR (2 days vs 7 days; P <.0001). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.0), pulmonary complications (OR, 8.8; 95% CI, 5.1-15.0), cardiac complications (OR, 3.4; 95% CI, 1.8-6.6), renal failure needing dialysis (OR, 3.8; 95% CI, 1.9-7.7), and return to the operating room (OR 2.5; 95% CI, 1.6-4.0). Conclusions FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.

Original languageEnglish (US)
Pages (from-to)1653-1658.e1
JournalJournal of Vascular Surgery
Volume66
Issue number6
DOIs
StatePublished - Dec 1 2017

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Aortic Aneurysm
Abdominal Aortic Aneurysm
Odds Ratio
Confidence Intervals
Operating Rooms
Renal Insufficiency
Dialysis
Lung
Quality Improvement
Heart Arrest
Aneurysm
Length of Stay
Logistic Models
Myocardial Infarction
Regression Analysis
Databases
Hemorrhage
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels. / Gupta, Prateek K.; Brahmbhatt, Reshma; Kempe, Kelly; Stickley, Shaun M.; Rohrer, Michael J.

In: Journal of Vascular Surgery, Vol. 66, No. 6, 01.12.2017, p. 1653-1658.e1.

Research output: Contribution to journalArticle

Gupta, Prateek K. ; Brahmbhatt, Reshma ; Kempe, Kelly ; Stickley, Shaun M. ; Rohrer, Michael J. / Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels. In: Journal of Vascular Surgery. 2017 ; Vol. 66, No. 6. pp. 1653-1658.e1.
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abstract = "Objective Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. Methods Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed. Results There were more men (82{\%} vs 72{\%}; P <.0001), diabetic patients (16{\%} vs 11{\%}; P =.005), patients with dependent functional status (4{\%} vs 2{\%}; P =.002), and nonsmokers (70{\%} vs 56{\%}; P <.0001) in the FEVAR group vs OS. There was no difference in rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P >.05). FEVAR had fewer major postoperative pulmonary complications (3.0{\%} vs 19.0{\%}; P <.0001), less renal failure requiring dialysis (1.9{\%} vs 6.4{\%}; P <.0001), less frequent cardiac arrest or myocardial infarction (2.2{\%} vs 5.8{\%}; P =.001), less bleeding with major transfusion (17.4{\%} vs 50.2{\%}; P <.0001), and decreased incidence of return to the operating room (4.5{\%} vs 9.6{\%}; P <.0001) and death (2.4{\%} vs 4.7{\%}; P =.02). The median length of stay was also significantly shorter for FEVAR (2 days vs 7 days; P <.0001). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95{\%} confidence interval [CI], 1.3-5.0), pulmonary complications (OR, 8.8; 95{\%} CI, 5.1-15.0), cardiac complications (OR, 3.4; 95{\%} CI, 1.8-6.6), renal failure needing dialysis (OR, 3.8; 95{\%} CI, 1.9-7.7), and return to the operating room (OR 2.5; 95{\%} CI, 1.6-4.0). Conclusions FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.",
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T1 - Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels

AU - Gupta, Prateek K.

AU - Brahmbhatt, Reshma

AU - Kempe, Kelly

AU - Stickley, Shaun M.

AU - Rohrer, Michael J.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objective Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. Methods Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed. Results There were more men (82% vs 72%; P <.0001), diabetic patients (16% vs 11%; P =.005), patients with dependent functional status (4% vs 2%; P =.002), and nonsmokers (70% vs 56%; P <.0001) in the FEVAR group vs OS. There was no difference in rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P >.05). FEVAR had fewer major postoperative pulmonary complications (3.0% vs 19.0%; P <.0001), less renal failure requiring dialysis (1.9% vs 6.4%; P <.0001), less frequent cardiac arrest or myocardial infarction (2.2% vs 5.8%; P =.001), less bleeding with major transfusion (17.4% vs 50.2%; P <.0001), and decreased incidence of return to the operating room (4.5% vs 9.6%; P <.0001) and death (2.4% vs 4.7%; P =.02). The median length of stay was also significantly shorter for FEVAR (2 days vs 7 days; P <.0001). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.0), pulmonary complications (OR, 8.8; 95% CI, 5.1-15.0), cardiac complications (OR, 3.4; 95% CI, 1.8-6.6), renal failure needing dialysis (OR, 3.8; 95% CI, 1.9-7.7), and return to the operating room (OR 2.5; 95% CI, 1.6-4.0). Conclusions FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.

AB - Objective Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. Methods Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed. Results There were more men (82% vs 72%; P <.0001), diabetic patients (16% vs 11%; P =.005), patients with dependent functional status (4% vs 2%; P =.002), and nonsmokers (70% vs 56%; P <.0001) in the FEVAR group vs OS. There was no difference in rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P >.05). FEVAR had fewer major postoperative pulmonary complications (3.0% vs 19.0%; P <.0001), less renal failure requiring dialysis (1.9% vs 6.4%; P <.0001), less frequent cardiac arrest or myocardial infarction (2.2% vs 5.8%; P =.001), less bleeding with major transfusion (17.4% vs 50.2%; P <.0001), and decreased incidence of return to the operating room (4.5% vs 9.6%; P <.0001) and death (2.4% vs 4.7%; P =.02). The median length of stay was also significantly shorter for FEVAR (2 days vs 7 days; P <.0001). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-5.0), pulmonary complications (OR, 8.8; 95% CI, 5.1-15.0), cardiac complications (OR, 3.4; 95% CI, 1.8-6.6), renal failure needing dialysis (OR, 3.8; 95% CI, 1.9-7.7), and return to the operating room (OR 2.5; 95% CI, 1.6-4.0). Conclusions FEVAR is associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs.

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