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Late outcomes of endovascular aortic stent graft therapy in patients with chronic kidney disease
- Source :
- Medicine
- Publication Year :
- 2020
-
Abstract
- Supplemental Digital Content is available in the text<br />Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD. Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events. There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46–2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35–1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32–1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09–2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15–1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups. Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Taiwan
Observational Study
Aorta, Thoracic
Comorbidity
Endovascular aneurysm repair
Patient Readmission
State Medicine
03 medical and health sciences
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Sex Factors
medicine
Humans
030212 general & internal medicine
Aorta, Abdominal
Hospital Mortality
Renal Insufficiency, Chronic
Dialysis
Aged
business.industry
Mortality rate
Hazard ratio
Endovascular Procedures
Age Factors
Stent
Postoperative complication
General Medicine
Odds ratio
Middle Aged
medicine.disease
Aneurysm
Surgery
Aortic Aneurysm
Cardiovascular Diseases
030220 oncology & carcinogenesis
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
endovascular
stent
Female
business
chronic kidney disease
Kidney disease
Research Article
Subjects
Details
- ISSN :
- 15365964
- Volume :
- 99
- Issue :
- 37
- Database :
- OpenAIRE
- Journal :
- Medicine
- Accession number :
- edsair.doi.dedup.....db862751bf5040c9a06c5f05205448aa