Mortality variability after endovascular versus open abdominal aortic aneurysm repair in a large tertiary vascular center using a Medicare-derived risk prediction model

Hicks, Caitlin W.; Black, James H.; Arhuidese, Isibor; Asanova, L K; Qazi, Umair; Perler, Bruce A.; Freischlag, Julie A.; Malas, Mahmoud B.

doi:10.1016/j.jvs.2014.04.078

Cited by 19 publications

(9 citation statements)

References 47 publications

(69 reference statements)

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“…Some 3061 articles were identified, of which 115 were selected and read in full. Eventually 53 studies fulfilled the inclusion criteria ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm

Bulder

Bastiaannet

Hamming

et al. 2019

British Journal of Surgery

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Background: Endovascular aneurysm repair (EVAR) has become the preferred strategy for elective repair of abdominal aortic aneurysm (AAA) for many patients. However, the superiority of the endovascular procedure has recently been challenged by reports of impaired long-term survival in patients who underwent EVAR. A systematic review of long-term survival following AAA repair was therefore undertaken.Methods: A systematic review was performed according to PRISMA guidelines. Articles reporting shortand/or long-term mortality of EVAR and open surgical repair (OSR) of AAA were identified. Pooled overall survival estimates (hazard ratios (HRs) with corresponding 95 per cent c.i. for EVAR versus OSR) were calculated using a random-effects model. Possible confounding owing to age differences between patients receiving EVAR or OSR was addressed by estimating relative survival.Results: Some 53 studies were identified. The 30-day mortality rate was lower for EVAR compared with OSR: 1⋅16 (95 per cent c.i. 0⋅92 to 1⋅39) versus 3⋅27 (2⋅71 to 3⋅83) per cent. Long-term survival rates were similar for EVAR versus OSR (HRs 1⋅01, 1⋅00 and 0⋅98 for 3, 5 and 10 years respectively; P = 0⋅721, P = 0⋅912 and P = 0⋅777). Correction of age inequality by means of relative survival analysis showed equal long-term survival: 0⋅94, 0⋅91 and 0⋅76 at 3, 5 and 10 years for EVAR, and 0⋅96, 0⋅91 and 0⋅76 respectively for OSR.Conclusion: Long-term overall survival rates were similar for EVAR and OSR. Available data do not allow extension beyond the 10-year survival window or analysis of specific subgroups. Literature search and inclusion criteriaA systematic review of the literature between 1991 and 2018 was undertaken according to PRISMA guidelines 6 . Studies were identified using PubMed, Embase, Web of Science and Cochrane databases. Eligible studies included patients with an intact AAA treated by either EVAR or OSR. Studies that did not compare Publication biasFunnel plots for 30-day and 5-year survival did not show considerable asymmetry (Fig. S2, supporting information).

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“…Some 3061 articles were identified, of which 115 were selected and read in full. Eventually 53 studies fulfilled the inclusion criteria ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm

Bulder

Bastiaannet

Hamming

et al. 2019

British Journal of Surgery

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“…However, few studies have assessed the association between postoperative AKI and mortality in patients undergoing AAA repair. 5,[9][10][11] The 30-day mortality rates after AAA repair were higher in octogenarians compared with nonoctogenarians, especially in those undergoing OAR (OAR, 5.7% vs 1.7%; EVAR, 1.5% vs 0.5%). These findings are in line with those reported in previous literature.…”

Section: Discussionmentioning

confidence: 99%

“…5 Nevertheless, postoperative renal impairment is associated with increased morbidity and mortality, in both OAR and EVAR. [8][9][10][11] Age is an established risk factor for mortality after AAA repair. 12 Elderly patients, aged 75 years and above, have been found to perform worse and have more postoperative complications than their younger counterparts after AAA repair.…”

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confidence: 99%

Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Dang

Dakour-Aridi

Rizwan

et al. 2019

Journal of Vascular Surgery

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“…Our prior studies involving infrarenal and TAA aneurysms have also reported similar results to our current study involving juxtarenal, pararenal, and suprarenal aneurysms. [17][18][19][20][21][22][23][24] These benefits with the endovascular approach are largely due to the absence of aortic cross-clamping above renal and mesenteric vessels, that is physiologically demanding and leads to increased hemodynamic cardiac stress and end-organ ischemia. Additionally, compared to endovascular repair, patients undergoing OAR also had increased length of hospital stay and were more likely to return to operation room.…”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

Locham

Dakour-Aridi

Bhela

et al. 2018

Vasc Endovascular Surg

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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.

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Mortality variability after endovascular versus open abdominal aortic aneurysm repair in a large tertiary vascular center using a Medicare-derived risk prediction model

Cited by 19 publications

References 47 publications

Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm

Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm

Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

Thirty-Day Outcomes of Fenestrated and Chimney Endovascular Repair and Open Repair of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Using National Surgical Quality Initiative Program Database (2012-2016)

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