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Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality Thomas W. Cheng1, M.S., Shelley.

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Presentation on theme: "Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality Thomas W. Cheng1, M.S., Shelley."— Presentation transcript:

1 Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality Thomas W. Cheng1, M.S., Shelley K. Maithel2, M.D., Nii-Kabu Kabutey2, M.D., Alik Farber1, M.D., Virendra I. Patel3, M.D., Douglas W. Jones1, M.D., Denis Rybin1, Ph.D., Gheorghe Doros1, Ph.D., Jeffrey J. Siracuse1, M.D. 1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA. 2Division of Vascular and Endovascular Surgery, University of California, Irvine Medical Center, Orange, CA. 3Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, New York.

2 Disclosures None

3 Background Benefits of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) has been extensively investigated Access type utilized in EVAR such as percutaneous compared to open surgical access is associated with lower morbidity Limited data on access type when treating ruptured AAA with EVAR

4 Objective To evaluate if access type utilized during EVAR for ruptured AAA affected outcomes

5 Methods Vascular Quality Initiative 2009 to 2018
Ruptured AAA treated with index EVAR Excluded iliac access, both percutaneous and open access, and concurrent bypass Procedures grouped by access type: percutaneous, open, and conversion to open from failed percutaneous Univariable and multivariable analyses performed for baseline characteristics, procedure details, and outcomes

6 Results 1,206 ruptured AAAs identified

7 Results P<.001 P=.026 P<.001 P=.022

8 Results P<.001

9 Results P<.001 188.7±75.1 152.6±74.2 133.4±85.8

10 Results Post-operative outcomes Percutaneous (N=739) Open (N=416)
Conversion to open after failed percutaneous (N=51) P-Value Any complication 243 (33.7%) 162 (40.2%) 27 (54%) .003 Cardiac complication (MI/Dysrhythmia/CHF) 132 (18.2%) 80 (19.8%) 17 (34.7%) .018 Abdominal hematoma requiring evacuation 19 (2.6%) 23 (5.7%) 2 (4%) .033 Pulmonary complication 128 (17.6%) 12 (24.5%) .38 Bowel ischemia 53 (7.3%) 1 (2%) .25 Leg ischemia/emboli 21 (2.9%) 12 (3%) 3 (6.1%) .44 Stroke 17 (2.3%) 7 (1.7%) 2 (4.1%) .53 Surgical site infection 11 (1.5%) 6 (1.5%) .37

11 Results P<.001

12 Multivariable analysis
Length of Stay Means Ratio 95% CI P-Value Open versus percutaneous 1.17 1.04 – 1.33 .012 Predictors for Conversion to Open From Failed Percutaneous Odds Ratio 95% CI P-Value Prior bypass 9.77 2.44 – 39.16 .001 Altered mental status 2.45 1.17 – 5.15 .018

13 Limitations Retrospective study Limited follow up
Selection bias for access type

14 Conclusion Access type for ruptured AAA did not significantly affect major morbidity or mortality Percutaneous access had the shortest operative time However, failed percutaneous access had the longest operative time Access utilized during these emergent procedures should be based on surgeon preference and experience

15 Thank you

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