Background: Fenestrated endovascular repair (FEVAR) and chimney endovascular repair (ChEVAR) endovascular repair offer a less invasive alternative to open aortic repair (OAR) in managing juxtarenal, pararenal, and suprarenal abdominal aortic aneurysms (AAAs). The aim of this study is to evaluate the 30-day postoperative outcomes following endovascular and open repair of nonruptured AAA involving the renal vessels. Study Design: All patients undergoing endovascular (FEVAR and ChEVAR) and open repair of juxtarenal, pararenal, and suprarenal AAA in National Surgical Quality Improvement Program database from 2012 to 2016 were included. Continuous and categorical covariates were analyzed using medians and w 2 /Fisher exact test, respectively. Multivariable logistic regression analyses were performed to evaluate primary (mortality) and secondary (renal and cardiopulmonary failure) outcomes between open versus endovascular approach. Results: A total of 1191 patients underwent AAA repair using open (72%) or endovascular (FEVAR: 14%, ChEVAR: 14%) approach. In univariate analysis, no significant difference in 30-day mortality was seen between the 3 groups (FEVAR: 2.47% vs ChEVAR: 7.32% vs OAR: 6.13%, P ¼ .13). However, 30-day major complications including renal failure (9.36% vs 6.10% vs 1.85%, P ¼ .003) and cardiopulmonary complications (19.77% vs 3.66% vs 4.94%, P < 001) failure were significantly higher in patients undergoing OAR versus ChEVAR versus FEVAR. After adjusting for potential confounders, OAR was associated with 2-to 5-folds increased risk of mortality (odds ratio, OR [95% confidence interval, CI]: 2.14 [1.09-4.21], P ¼ .03), renal (OR [95% CI]: 2.87 [1.48-5.57], P ¼ .002), and cardiopulmonary failure (OR [95% CI]: 4.63 [2.47-8.67], P < .001) compared to any endovascular repair. Conclusion: Using a large national surgical data set, our study found 2-to 5-folds higher mortality and morbidity in patients undergoing open versus endovascular repair of AAA involving the renal vessels. Endovascular repair seems to be a safer approach, especially when managing older patients with AAA.
A significant and sustained paradigm shift in abdominal aortic aneurysm treatment toward endovascular technology has come at a cost of open surgical procedures despite similar long-term survival. We sought to determine morbidity and mortality rate in patients undergoing open surgical repair (OSR) for abdominal aortic aneurysms at a single high-volume open regional center.Methods: All patients who underwent OSR for asymptomatic and nonruptured symptomatic abdominal aortic aneurysms were identified retrospectively from May 1, 2007, to March 31, 2017 International Classification of Diseases, 10th edition, diagnosis codes at a single center in Gatineau, Quebec, Canada. The primary outcome was a descriptive analysis of all-cause mortality. Secondary outcomes of interest were predictors of adverse perioperative events after OSR using multivariable linear and logistic regression.Results: The cohort consisted of 316 consecutive patients with a mean age of 70.18 6 7.61 years, with 75% (n ¼ 237) being male. The perioperative risk of cardiovascular adverse events using the revised cardiac risk index was relatively low with a mean of 1.63 6 0.69 points. The median operative time was 95 minutes. The incidence of death at 30 days was 0.003% (n ¼ 1), death at 12 months was 0.02% (n ¼ 6), and all-cause death was 23.7% (n ¼ 75) over a median follow-up of 4.9 years (Fig) . For the entire OSR cohort, the 1-and 5-year calculated probability of survival was 97.7% and 82.0%, respectively. Operative time of 95 minutes or less was associated with decreased need for transfusions in the perioperative period (odds ratio, 0.29; 95% confidence interval, 0.17-0.48), decreased postoperative complications (odds ratio, 0.30; 95% confidence interval, 0.19-0.48), and decreased duration of stay (ß -2.7; 95% CI, -4.64 to -0.84) when adjusted for clinically relevant covariates.Conclusions: OSR of AAAs remains a safe and effective treatment option for patients who are appropriate candidates with a probability of survival at 5 years of 82%. OSR of AAAs can be done in less than 95 minutes and is associated with a reduction in transfusion requirements, reduction in postoperative complications, and reduced duration of stay.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.