Octogenarians Undergoing Open Repair Have Higher Mortality Compared with Fenestrated Endovascular Repair of Intact Abdominal Aortic Aneurysms Involving the Visceral Vessels

Locham, Satinderjit; Faateh, Muhammad; Dakour-Aridi, Hanaa; Nejim, Besma; Malas, Mahmoud B.

doi:10.1016/j.avsg.2018.02.017

Cited by 23 publications

(21 citation statements)

References 26 publications

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“…11 Additionally, recent studies comparing endovascular versus open repair of CAAs using NSQIP data set have also demonstrated higher mortality following OAR compared to endovascular repair. 12,13 However, these results are not consistent with systematic reviews in the literature. Three different systematic reviews on juxtarenal AAA found no difference in mortality between endovascular and OAR, which may be related to the strict inclusion criteria.…”

Section: Discussioncontrasting

confidence: 75%

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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Section: Discussioncontrasting

confidence: 75%

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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“…14 A recent study by Locham et al showed the 30 day mortality rate in octogenarians with complex AAA who were treated by either open repair or FEVAR. 15 The octogenarians undergoing open repair had a higher 30 day mortality rate than patients treated by FEVAR (8.5% vs. 4.1%). 15 A few other studies with small sample sizes on the outcomes of FEVAR in octogenarians have been published recently.…”

Section: Introductionmentioning

confidence: 90%

“…15 The octogenarians undergoing open repair had a higher 30 day mortality rate than patients treated by FEVAR (8.5% vs. 4.1%). 15 A few other studies with small sample sizes on the outcomes of FEVAR in octogenarians have been published recently. 7,16 Their findings suggest that octogenarians might not benefit from treatment by FEVAR, but the results are ambiguous.…”

Section: Introductionmentioning

confidence: 90%

“…Most studies focus on peri-operative mortality and short term survival. 15,16 Information about other outcomes, such as re-interventions and survival in the longer term, is limited. To the authors' knowledge only the studies by Hertault et al and Roy et al presented data on mid term results; consequently, more results will enable assessment of FEVAR in the elderly.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Fenestrated Endovascular Aneurysm Repair in Octogenarians: A Retrospective Multicentre Analysis

Henstra

Yazar

Niet

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS The fenestrated endograft for complex abdominal aortic aneurysm appears as a valuable treatment option in the experience of two tertiary referral centres. Objective: An ageing population leads to more age related diseases, such as complex abdominal aortic aneurysms (AAA). Patients with complex AAAs and multiple comorbidities benefit from fenestrated endovascular aneurysm repair (FEVAR), but for the elderly this benefit is not completely clear. Methods: Between 2001 and 2016 all patients treated for complex AAA by FEVAR at two tertiary referral centres were screened for inclusion. Group 1 consisted of patients aged 80 years and older and group 2 of patients younger than 80 years of age. The groups were compared for peri-operative outcome, as well as patient and re-intervention free survival, and target vessel patency during follow up. Results: Group 1 consisted of 42 patients (median age 82 years; interquartile range [IQR] 81e83 years) and group 2 of 230 patients (median age 72 years; IQR 67e77 years). No differences were seen in pre-operative comorbidities, except for age and renal function. Renal function was 61.4 mL/min/1.73 m 2 vs.74.5 mL/min/ 1.73 m 2 (p < .01). No differences were seen between procedures, except for a slightly longer operation time in group two. Median follow up was 26 and 32 months, respectively. No difference was seen between the groups for estimated cumulative overall survival (p ¼ .08) at one, three, and five years, being 95%, 58%, and 42% for group 1, and 88%, 75%, and 61% for group 2, respectively. There was no difference seen between groups for the estimated cumulative re-intervention free survival (p ¼ .95) at one, three, and five years, being 84%, 84%, and 84% in group 1, respectively, and 88%, 84%, and 82% in group 2, respectively. Ultimately, no difference was seen between groups for the estimated cumulative target vessel patency (p ¼ .56) at one, three, and five years, being 100%, 100%, and 90% for group 1, and 96%, 93% and 92% for group 2, respectively. Conclusion: Age itself is not a reason to withhold FEVAR in the elderly, and choice of treatment should be based on the patient's comorbidities and preferences.

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“…Several randomized clinical trials and recent national studies have demonstrated lower morbidity and mortality in favor of endovascular repair (endovascular aneurysm repair [EVAR]) of AAA. 2 –4 However, this approach may not be feasible in patients with hostile neck anatomy (HNA) defined as aortic neck length <15 mm, neck angulation >60°, and neck diameter >28 mm. Compared to males, females are also more likely to fail to meet the EVAR instruction for use (IFU) requirement and may be deemed ineligible for EVAR.…”

Section: Introductionmentioning

confidence: 99%

Impact of Gender on Outcomes Following Abdominal Aortic Aneurysm Repair

Locham

Shaaban

Wang

et al. 2019

Vasc Endovascular Surg

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Objective: The purpose of this study is to use a large, nationally representative vascular database to assess differences in patient characteristics, aortic neck anatomy, and outcomes between men and women following open (open aneurysm repair [OAR]) and endovascular (endovascular aneurysm repair [EVAR]) abdominal aortic aneurysm (AAA) repair. Methods: Patients undergoing AAA repair from 2003 to 2018 in Vascular Quality Initiative were identified and stratified by procedure (EVAR vs OAR). Thirty-day mortality and major in-hospital complications were assessed between genders within each operative cohort. An EVAR subset analysis was performed to assess differences in aortic neck anatomy; hostile neck anatomy was defined as length <15 mm (L < 15), angle >60° (A > 60), and/or diameter >28 mm (D > 28). Standard univariate and multivariable analyses were performed. Results: A total of 50 213 patients were identified: 9263 (19%) OAR and 40 950 (82%) EVAR. In both cohorts, majority of patients were men (OAR 73% and EVAR 81%). Women were more likely to have a hostile neck (31.7% vs 24.1%, P < .001), L < 15 (19.8% vs 11.9%, P < .001), and A > 60 (11.5% vs 5.4%, P < .001). Men had larger aneurysm (mean, 57 vs 55 mm, P < .001) and were more likely to have D > 28 (14.0% vs 10.6%, P < .001). Women undergoing EVAR were more likely to undergo aortic extensions (21.9% vs 16.0%) and receive higher contrast volume. After adjusting for potential confounders, female gender was associated with 86% and 50% increased risk of 30-day mortality in OAR and EVAR, respectively. Women were more likely than men to experience renal, cardiac, and pulmonary complications only in the EVAR cohort. Women had a 2-fold increased odds of developing type 1 endoleak. Conclusion: Our study demonstrates unfavorable neck anatomy occurs more frequently in women compared to men. Women were also at an increased risk of developing major complications, particularly following EVAR. Careful patient selection is indicated in all patients to reduce complications, with special attention in women with hostile neck.

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Octogenarians Undergoing Open Repair Have Higher Mortality Compared with Fenestrated Endovascular Repair of Intact Abdominal Aortic Aneurysms Involving the Visceral Vessels

Cited by 23 publications

References 26 publications

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)

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)

Outcome of Fenestrated Endovascular Aneurysm Repair in Octogenarians: A Retrospective Multicentre Analysis

Impact of Gender on Outcomes Following Abdominal Aortic Aneurysm Repair

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