Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery.

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Presentation transcript:

Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery Vascular Quality Initiative Salvatore T. Scali, MD, Sara J. Runge, MD, Robert J. Feezor, MD, Kristina A. Giles, MD, Javairiah Fatima, MD, Scott A. Berceli, MD, PhD, Thomas S. Huber, MD, PhD, Adam W. Beck, MD Journal of Vascular Surgery Volume 64, Issue 2, Pages 338-347 (August 2016) DOI: 10.1016/j.jvs.2016.02.028 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 This flow chart shows the different inclusion and exclusion groups in the analysis. Of all native abdominal aortic aneurysm (AAA) repairs in the Vascular Quality Initiative (VQI), 32% were nonelective. There were 277 endovascular aneurysm repair (EVAR) conversion (EVAR-c) procedures (6% of total infrarenal aortic operations). Estimating the true incidence of EVAR-c from the VQI is not possible because patients undergoing an index EVAR at a VQI institution can undergo EVAR-c at non-VQI facilities. The mode of presentation for nonelective primary aortic repair and nonelective EVAR-c was similar (∼60% for a ruptured indication). Journal of Vascular Surgery 2016 64, 338-347DOI: (10.1016/j.jvs.2016.02.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 This bar graph highlights the expected differences that symptomatic and ruptured presentations have on 30-day postoperative mortality. Not surprisingly, a ruptured presentation for native abdominal aortic aneurysm (AAA) and endovascular aneurysm repair conversion (EVAR-c) patients had significantly worse outcome. Interestingly, EVAR-c was not associated with higher rates of postoperative complications; however, mortality was significantly different. EVAR-c patients undergoing nonelective repair had significantly greater risk of 30-day mortality compared with nonelective primary aortic repair (PAR) irrespective of presenting with a symptomatic or ruptured indication. Journal of Vascular Surgery 2016 64, 338-347DOI: (10.1016/j.jvs.2016.02.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 The additive risk that endovascular aneurysm repair conversion (EVAR-c) has to nonelective abdominal aortic aneurysm (AAA) repair is highlighted. Similar risk profiles are compared among hypothetical nonelective infrarenal aortic aneurysm repair patients, with or without endograft explantation. Various random combinations of different 30-day mortality risk factors (Table IV) are depicted. The 30-day mortality risk is twofold greater for nonelective patients undergoing EVAR-c compared with native AAA repair. Ant, Antegrade; BB, β-blockers; CRI, chronic renal insufficiency; F, female; M, male; PAR, primary aortic repair. Journal of Vascular Surgery 2016 64, 338-347DOI: (10.1016/j.jvs.2016.02.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 A, The two survival curves highlight the overall survival comparison between nonelective endovascular aneurysm repair conversion (EVAR-c) and primary aortic repair (PAR) patients in the Vascular Quality Initiative (VQI). PAR patients have a significant survival advantage that is maintained out to at least 3 years (log-rank P = .0006). All displayed intervals have <10% standard error of the mean. B, The significant differences in survival among the different modes of presentation are demonstrated. Specifically, patients undergoing symptomatic or ruptured aortic repair with or without need for EVAR-c are compared. Among all intergroup comparisons, EVAR-c confers a significantly higher risk of all-cause mortality compared with PAR patients. Notably, EVAR-c patients are frequently older and have an increased incidence of cardiovascular risk factors that affect long-term survival. All displayed intervals have <10% standard error of the mean. Journal of Vascular Surgery 2016 64, 338-347DOI: (10.1016/j.jvs.2016.02.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions