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).
Vasc Endovascular Surg
; 53(3): 189-198, 2019 Apr.
Article
em En
| MEDLINE
| ID: mdl-30587096
ABSTRACT
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. STUDYDESIGN:
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 χ2/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 = .13). However, 30-day major complications including renal failure (9.36% vs 6.10% vs 1.85%, P = .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 = .03), renal (OR [95% CI] 2.87 [1.48-5.57], P = .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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Aneurisma da Aorta Abdominal
/
Implante de Prótese Vascular
/
Procedimentos Endovasculares
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Vasc Endovascular Surg
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos