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Endovascular Repair With Fenestrated-Branched Stent Grafts Improves 30-Day Outcomes for Complex Aortic Aneurysms Compared With Open Repair
- Source :
- Annals of Vascular Surgery. 27:267-273
- Publication Year :
- 2013
- Publisher :
- Elsevier BV, 2013.
-
Abstract
- Background Endovascular repair is associated with better 30-day outcomes than open surgical repair for patients with infrarenal aortic aneurysms. In patients with complex aortic aneurysms (CAAs) requiring suprarenal or supravisceral aortic cross-clamping during open repair, few data exist directly comparing the real-world outcomes of open repair versus endovascular repair with fenestrated-branched stent grafts (FEVAR). Methods Outcomes for patients who underwent elective CAA repair using open repair and FEVAR between 2005 and 2010 were analyzed using the American College of Surgeons National Surgical Quality Improvement Program database. CAA was defined as aneurysm of the aorta involving the visceral and/or renal arteries. Results This study compared 1091 patients who underwent open repair (group A: male, 71.5%; age, 71 ± 9 years) with 264 patients treated with FEVAR (group B: male, 82.2%; age, 74 ± 9 years). The 2 groups did not significantly differ with respect to American Society of Anesthesiologists (ASA) classification (ASA III/IV: A, 93%; B, 95%, P = 0.6), severe chronic obstructive pulmonary disease (A: 21%; B: 22%; P = 0.7), prior cardiac surgery (A: 24%; B: 20%; P = 0.19), or preoperative renal function (glomerular filtration rate: A: 69 ± 2; B: 70 ± 27; P = 0.535). Group A had significantly higher risk of any complication (A: 42%; B: 19%; P < 0.001), nonsurgical complications (A: 30%; B: 8%; P < 0.001), pulmonary complications (A: 21%; B: 2%; P < 0.001), renal complications (A: 10%; B: 1.5%; P = 0.001), and any cardiovascular complication (A: 8%; B: 2%; P < 0.001). The composite end point of surgical site infections/graft failure/bleeding transfusions were also higher in group A (A: 22%; B: 15%; P = 0.014). Thirty-day mortality was significantly lower for FEVAR (A: 5.4%; B: 0.8%; P = 0.001), as was total length of hospital stay (A: 11 ± 10 days; B: 4 ± 5 days; P < 0.001). Conclusions This nationwide real-world database suggests that in similar patient populations, repair of CAAs with FEVAR is associated with reduced 30-day morbidity and mortality compared with open repair. Although long-term comparative studies are needed, FEVAR may represent a preferred treatment alternative to open repair for patients with CAAs.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Renal function
Prosthesis Design
Risk Assessment
Group B
Blood Vessel Prosthesis Implantation
Postoperative Complications
Aneurysm
Risk Factors
medicine.artery
Odds Ratio
medicine
Humans
Hospital Mortality
Registries
Aged
Aged, 80 and over
Surgical repair
Aorta
Chi-Square Distribution
business.industry
Endovascular Procedures
Stent
General Medicine
Length of Stay
Middle Aged
medicine.disease
United States
Aortic Aneurysm
Blood Vessel Prosthesis
Surgery
Cardiac surgery
Logistic Models
Treatment Outcome
Elective Surgical Procedures
Multivariate Analysis
Female
Stents
Cardiology and Cardiovascular Medicine
Complication
business
Subjects
Details
- ISSN :
- 08905096
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Annals of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....bcf63c7a4ee62369aea7ec593468dd09